Why does my back pain keep coming back?

One of the most frustrating presentations of lower back pain is the acute onset of pain and spasm after seemingly trivial movements. Bending over to tie a shoe or toweling off after a shower shouldn’t cause back pain; but chiropractors see this all too often.

The severe nature of pain and the difficulty of performing activities of daily living during an episode are challenging. What can make things even more vexing is the recurrence of such pain. While the clinical features of this condition are not overly concerning, the periodic nature of lumbar pain requires some thought.

Research has shown that these cases involve an underlying stability deficit. It appears that patients in these situations have deficiencies in muscle proprioception. This means there is a neurological issue, rather than a muscle strength issue. This failure to sense abnormal joint movements before the point of injury renders the patient more likely to repeat strain episodes. Simple movements that we once had good control over now can cause a great deal of pain. We can think about this in a similar way to those that have chronic ankle sprains, and therefore the combination of gentle joint manipulation and simple balance and core exercises can help build better sensory feedback.

These are clearly complex and difficult cases to treat, but conservative management of these patients is valid, and clinical outcomes can be very positive if patients can adhere to treatment and exercise plans.