How can acute back pain become chronic? What went wrong?

Chronic back pain often starts the same way as acute back pain. However, the problem is not addressed with appropriate treatment. Far too often prolonged rest and deconditioning occur as it is assumed to be the correct approach to acute back pain. Unfortunately, there are “a considerable amount of patients” that are not pain-free after 12 weeks. (5) As you will learn below, there are many factors that may be involved in this lack of recovery.

There are numerous ways an injury could occur, maybe the same way as Paul, from working in the garden, perhaps from slipping on a wet floor, the list goes on. However, the problem then is most commonly prolonged rest. Every week of rest results in loss of muscle strength by 15-30%, reduced joint mobility resulting in more stiffness and pain. (25) (26) (27)

“Prolonged immobility is harmful with a rapid reduction in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest. “(25)(28)

Prolonged rest and deconditioning make pain worse and reduced activity can set up a chronic pain loop. 

In other words, the body is changing and adapting to misuse/ disuse and underuse. It gets weaker and weaker and learns maladaptive behavioural patterns. We start to understand that as the input into the cortex/ brain is changing from normal behaviour patterns, normal movements to misuse the structure of the brain is also changing.

Chronic pain is associated with “emotional and sensory components of the brain.”(29) Hence, pain impacts the interpretation or meaning we give to movement. Chronic pain can be linked to increased anger, feeling of powerless, anxiety and depression.

Reference:

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