Why Back Pain Comes and Goes: An Evidence-Based Perspective

Back pain is one of the most common ailments affecting people of all ages and lifestyles. As a rehab-focused chiropractor, I've encountered many patients who are frustrated by the seemingly unpredictable nature of their back pain. One day they feel fine, and the next, the pain is back with a vengeance. Understanding why back pain comes and goes is crucial to managing it effectively. In this blog, we'll explore the nature of back pain, the reasons behind its recurrence, treatment options, and why conservative methods like chiropractic care and physical therapy are often the best approach for long-term relief.

1. The Nature of Back Pain

Back pain is a complex condition with various causes, ranging from muscular strain to degenerative disc disease. It can be classified as acute (lasting less than six weeks), subacute (six weeks to three months), or chronic (lasting more than three months). The pain can be localized to a specific area or radiate down the legs, often reffered to as sciatica (although other factors can cause pain down the leg).

The spine is a highly intricate structure composed of vertebrae, intervertebral discs, muscles, ligaments, and nerves. Any disruption in this delicate balance can lead to pain. Common causes of back pain include:

• Muscle or Ligament Strain: Overuse, heavy lifting, or a sudden awkward movement can strain the muscles and ligaments in the back, leading to pain.
• Herniated or Bulging Discs: The intervertebral discs act as cushions between the vertebrae. When a disc herniates or bulges, it can press on nearby nerves, causing pain.
• Arthritis: Osteoarthritis can affect the lower back, leading to pain and stiffness. In some cases, arthritis in the spine can lead to spinal stenosis, a narrowing of the space around the spinal cord.
• Osteoporosis: Weak and brittle bones can lead to fractures in the vertebrae, causing back pain.

While most of these "causes" are blamed for back pain, the most common root cause underneath all of these is poor movement patterns. This is why it is essential that you seek a professional who will assess your mobility, range-of-motion, and basic movement patterns like the squat, hip hinge, and overhead reach.

Understanding the underlying cause of back pain is essential for determining the most appropriate treatment and prevention strategies, and without a movement-based approach, you are missing a huge piece of the picture.

2. Why Back Pain Comes and Goes

Back pain is notorious for its episodic nature. Many patients experience periods of relief followed by sudden flare-ups. This cyclical pattern can be frustrating and challenging to manage. But why does back pain come and go?

1. Variable Stress on the Spine:

   • Daily Activities: The spine is constantly subjected to varying levels of stress depending on our daily activities. Prolonged sitting, improper lifting techniques, or even sleeping in an awkward position can lead to microtraumas in the spinal structures, resulting in pain.
   • Physical Activity: While regular exercise is beneficial for overall health (please exercise consistently), certain activities can exacerbate back pain if we have movement deficiencies. High-impact exercises, poor form during workouts, or sudden increases in physical activity can stress the back, leading to flare-ups. The best way to make sure your physical activity doesn't have to be limited is to figure out where your movement limitations are and then fix them. 

2. Inflammatory Cycles:

   • Inflammation: Inflammatory processes play a significant role in back pain. Inflammation can result from tissue injury, and while the body’s healing response is to reduce inflammation, repetitive stress or injury can reignite the inflammatory process, causing pain to return. This is another reason why nutrition is such a huge key for reducing and keeping back pain at bay. 
   • Autoimmune Responses: Some individuals may experience back pain due to autoimmune conditions like ankylosing spondylitis, where the body’s immune system mistakenly attacks the spine, leading to periodic inflammation and pain.

3. Psychological Factors:

   • Stress and Anxiety: Psychological factors such as stress, anxiety, and depression can exacerbate back pain. Stress leads to muscle tension, particularly in the back, which can trigger or worsen pain. Additionally, chronic pain can contribute to a cycle of pain, stress, and depression. This is why we incorporate habit tracking and weekly check-ins in our treatment plans, so that the patient is not left to their own worries/fears when not in the office, and can lead on the guidance of a professional who understands the ups and downs of back pain. 
   • Pain Perception: Pain perception is influenced by several factors, including emotional and psychological states. A person's mental state can amplify the sensation of pain, making it seem more intense or prolonged than it actually is. 

4. Lifestyle and Habits:

   • Posture: Poor posture, whether at work or during leisure activities, can place undue stress on the spine, leading to recurring back pain. Posture is often over-blamed for back pain, but it's effect can be real. Typically, improving posture is just a small piece of the puzzle, and overall movement deficiencies are a bigger concern. 
   • Diet and Nutrition: Inadequate nutrition can affect muscle and bone health, contributing to back pain. For instance, deficiencies in vitamin D and calcium can weaken bones, making them more susceptible to fractures and pain. This is especially true if you have an acute injury. Your body needs ample nutrition and water intake to ensure adequate recovery. 
   • Sedentary Lifestyle: A lack of regular physical activity can weaken the muscles that support the spine, making the back more vulnerable to pain. People often think that avoiding physical activity will help with their back pain, but this couldn't be further from the truth. Our backs crave movement, we just need to find a safe way to move while we are recovering. 

3. Treatment Options for Low Back Pain

Given the complex nature of back pain, treatment approaches must be individualized and multifaceted. Here are some common evidence-based treatment options:

1. Conservative Care:

   • Chiropractic Care: Chiropractic adjustments aim to restore proper joint motion of the spine, reducing pain and improving temporary mobility. Research supports the effectiveness of chiropractic care in managing both acute and chronic low back pain, particularly when paired with corrective exercises and rehabilitation.
   • Rehab and Corrective Exercise: Rehabilitation specialists design individualized exercise programs to strengthen the muscles supporting the spine, improve flexibility, and promote proper posture. They also use techniques like manual therapy, dry needling, and cupping to reduce pain. At Bergner Chiropractic, we mix chiropractic care, manual therapy, and corrective exercise to ensure a holistic treatment approach. 
   • Massage Therapy: Therapeutic massage can help to temporarily relieve muscle tension, reduce stress, and improve circulation, all of which can contribute to pain relief.
   • Acupuncture: Acupuncture is an ancient practice that involves inserting thin needles into specific points on the body to alleviate pain. Several studies have shown that acupuncture can be effective in reducing chronic back pain.

2. Medical Interventions:

   • Medications: Over-the-counter pain relievers like NSAIDs (non-steroidal anti-inflammatory drugs) can help manage pain and reduce inflammation. While these provide short-term relief, they should never be relied upon as a true solution.
   • Injections: Corticosteroid injections can be used to reduce inflammation and provide temporary relief from pain, particularly in cases where nerve irritation is involved. These can be a great adjunct to chiropractic care and corrective exercise when a patient is in intense pain. 
   • Surgery: Surgery shoudl be considered a last resort for back pain, reserved for cases where conservative treatments have failed, and where there is a clear anatomical cause that can be corrected surgically (e.g. spinal stenosis).

4. Why Conservative Methods Are the Best Option for Treating Recurring Back Pain

When it comes to managing recurring back pain, conservative methods like chiropractic care and corrective exercise are often the best options. Here’s why:

1. Addressing the Root Cause:

   • Holistic Approach: Conservative care focuses on addressing the root cause of back pain rather than just masking the symptoms. By improving asymmetries, strengthening muscles, and promoting proper movement patterns, these methods aim to prevent future episodes of pain.
   • Patient Education: Chiropractors and corrective exercise specialists emphasize patient education, teaching individuals how to maintain good posture, perform exercises correctly, and make lifestyle modifications to prevent recurrence.

2. Lower Risk of Side Effects:

   • Non-Invasive: Unlike surgery or long-term medication use, conservative treatments are non-invasive and carry a much lower risk of side effects. This makes them a safer option for most patients, particularly those with chronic pain.
   • Natural Pain Relief: Techniques like chiropractic adjustments, corrective exercise, and soft-tissue treatments provide natural pain relief without the need for potentially addictive pain medications.

3. Evidence-Based Results:

   • Proven Effectiveness: Numerous studies have demonstrated the effectiveness of chiropractic care, corrective exercise, and soft-tissue treatments in managing back pain. 
   • Long-Term Benefits: Conservative care not only provides relief from current symptoms but also helps prevent future episodes of back pain. By strengthening the spine and improving overall function, patients are less likely to experience recurring pain.

4. Cost-Effective:

   • Affordability: Conservative treatments are more affordable than surgery or long-term medication use. They also reduce the need for ongoing medical expenses related to chronic pain management.

5. Conclusion: Take Control of Your Back Pain

Back pain can be a frustrating and debilitating condition, but it doesn't have to control your life. Understanding why back pain comes and goes is the first step toward effective management. Conservative treatments like chiropractic care and corrective exercise offer evidence-based, holistic solutions that address the root cause of pain and provide long-term relief.

If you’re struggling with recurring back pain, don’t wait for the next flare-up. Take action today by booking an appointment with our clinic. I, Dr. Bergner, am an experienced chiropractor and rehabilitation specialist and you will receive 1-on-1 care with me to help you get back to doing the things you love, pain-free. Let’s work together to develop a personalized treatment plan that meets your needs and keeps your back healthy for the long haul. Contact us now to schedule your consultation.