Acute Vs Chronic Back Pain

 

Written by Anna Gould

As physiotherapists we see people with back pain almost every day, in my experience it would probably account for about 60% of my caseload. As a result we see lots of people going through their own journey to reaching full function again. Back pain is such a common problem, the healthcare industry and therefore the media has been very invested in this problem and as a result there are many ideas, beliefs and attitudes towards back pain. These beliefs have a large impact on peoples disability and recovery. 

One common misconception is the difference between acute and chronic back pain. The word chronic relates to the time frame of the pain, not the severity of the pain. If pain has been experienced for longer than 12 weeks  it is referred to as chronic. We refer to acute back pain when the injury or pain is new, in the first 4 weeks and sub-acute pain lasts between 4 and 12 weeks. Chronicity does not relate to the severity of pain as many are lead to believe. 

Why is this important? This changes our management and treatment of the pain vastly. 

If you ever have experienced that sudden, extreme back pain where you're on the phone to the reception staff literally begging for an appointment we’ll treat it quite differently to your ongoing year long back pain. 

In the acute stage we usually try to calm the situation down a bit, at this stage your muscles are usually kicking in to protect you from what your body may perceive as a threat. Usually this threat was a sudden increase in load, this tensing of the muscles is usually helpful for a few minutes however they tend to stay sensitised for longer than needed, which actually fuels the pain further. Therefore we usually massage or dry needle those muscles and we want to limit your movement slightly to prevent this happening again. This will not be for long as this acute inflammatory phase will not last long. The most important things to remember in this stage is that it won't last for long, it is very unlikely you have done any serious damage and that if we do tell you to limit a particular movement, this will not usually be for more than a day or two. After this period we will begin to integrate movement into the back and your daily life again. 

In chronic pain situations we aim to normalise movement and decrease the fear of pain. Chronic pain is a rather complex situation as it is beyond just a physiological response of the body. The brain can continue to submit pain signals long after any damage or inflammation has ceased therefore we look at chronic pain very differently. We have to look at things like your daily habits, movement patterns, stress, anxiety and your understanding of the pain. We will encourage you to move more, try the things that you are fearful of in a graded and educated manner. Chronic pain can most certainly be resolved however one must remember that it takes active participation and willingness to learn. 

One thing to remember is that the back loves to move! A common misconception is that the back must be protected as it is easily damaged, the truth is, is that it needs to move to be happy and healthy so don’t be fearful of movement. Your back is not as precious as you might think! I have held cadavers and I can tell you that they are very very strong structures, it is difficult and borderline impossible to physically push out a disc or misalign a vertebra as it designed to be very durable and last a lifetime. 

If you are experiencing back pain there is so much that can be done to manage it. The most important advice I can give you would to keep calm, keep moving and call us if you need to. We are well equipped to help you deal with your back pain. Personally I love to treat them as they respond quickly to the right treatment and eliminating the pain can have a profound effect on ones’ life. 

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