4 Keys to Treat Your Chronic Low Back Pain

So You Can Get Back to the Things You Want to Do

Girl with chronic low back pain

Your low back pain isn’t improving after all this time and you’re wondering why? Shouldn’t the normal healing process have run its course by now? The short answer is – yes. And likely, it did take place. But the longer you experience pain, the more sensitive your nerves become, essentially turning up the “pain volume knob” in your brain.

The good news: there are steps you can take to turn this volume down by:

  1. Understanding pain
  2. Exercising
  3. Sleeping well
  4. Setting positive goals

Let’s get started…

Pain Is In the Brain

Shouldn’t the normal healing process have taken place by now?

The short answer is – yes. And likely, it did take place.

“But I’m still having pain,” you say…

The longer you experience pain, and depending on several other factors, your pain can essentially become you’re new normal. Your nerves are on high-alert, so even everyday harmless activities – bending, lifting, turning, walking – can be experienced as extremely painful1,2,3.

The first step you need to take to turn this pain volume down is to understand that pain does not equal harm. Remember, any initial injury you may have had to precipitate your pain – a strain, or fall, or whatever it was – is likely healed at this point. Therefore, all of the movements and functions you’re performing that lead to you experiencing pain, likely aren’t causing any actual harm.

This truth is crucial for you to understand as you begin your journey to better function.

The Importance of Exercise

Movement is key for your recovery. I’m not suggesting you go run 10 miles tomorrow morning, but I am suggesting you take an active role on the path to a better you.

Studies show endurance exercise has a positive effect on well-being, physical functioning, and pain4.

What does this look like?

Well, it won’t look the same for everyone – we all have different capabilities. Therefore, you need to start where you’re at.

Where are you at right now?

What exercise can you start doing today that will be enjoyable?

It doesn’t have to be an hour. It doesn’t even have to be 10 minutes. Don’t worry, those milestones come later. But, for now: start slow, take it easy, and enjoy moving your body.

Here’s a few ideas:

  • Go for a walk
  • Swim
  • Try water aerobics
  • Go for a bike ride

If these activities sound intimidating to you, remember to start where you’re at. A walk might look like taking a stroll to the end of your street and back. Swimming might mean moving your arms and legs around in the shallow end of a pool. A bike ride might be a few minutes on a stationary recumbent bike on low resistance.

As long as you’re moving, that’s all that matters right now5,6.

Sleep Like You Mean It

You’ve heard that getting adequate sleep is super important for a number of reasons. But did you know it can actually help aid your recovery?

Cortisol – a stress hormone – normally decreases just before bed and increases when you wake up.

Melatonin – a hormone responsible for regulating sleep cycles – increases just before bed and begins to suppress as you wake up.

Getting adequate sleep is crucial to help regulate these hormones, which can greatly impact how you feel.

Here’s a few tips for getting a good night’s sleep:

1. Your bed is for sleeping

  • No phone, no tablet, no TV, no pets (sorry pet people) – these things are distractions and can hinder sleep

2. Turn Down the Lights

  • I mean way down. Use black out blinds, get rid of night lights. The amount of light your body is exposed to can effect cortisol and melatonin levels, which are crucial for sleep quality

3. Get on a regular sleep cycle

  • Go to bed at the same time every night
  • Get up at the same time every morning
  • Your body works in cycles – train it to be regular

4. Calm Down at night

  • Start unwinding a couple of hours before you go to sleep
  • Minimize use of electronics
  • Dim the lights

5. Get enough sleep

  • How much is enough? Everyone requires different amounts of sleep. In general, though, try to get somewhere between 7–9 hours per night

6. Minimize noise

  • Try a soothing white noise machine or a fan to drown out any noises that may hinder your sleep

7. Minimize liquid consumption before bed

  • Having to get up to use the restroom at night disrupts your sleep cycle.

8. Take short naps during the day

  • The first 20 minutes of sleep, your brain’s activity stays similar to that of its waking activity. The longer you sleep, the brain’s activity changes. This is why, after a long 2-hour nap, you feel less rested than before you napped
  • Long naps can also hinder the amount of rest you get at night
  • Shoot to nap 20 minutes or less to feel refreshed

Set Positive, Realistic, Achievable Goals

Getting where you want to go is all about the steps it takes to get there. Very few people get where they want to go if they don’t believe it’s possible. This is where hope comes into play.

Hope isn’t a wish. Its isn’t a dream. Hope doesn’t say “if only”.

No – “Hope is an optimistic attitude of mind based on an expectation of positive outcomes.”

Did you get all that?

Optimistic.

Expectation.

Positive outcomes.

Adriaan Louw, a prominent pain neuroscience educator, asks his patients “If I could flip a switch in your lower back and suddenly all of your pain went away, what would you do?”

What’s your answer? What would you do?

Play with your grandkids?

Run a 5K?

Go back to work?

Whatever it is you want to do, be optimistic that you can get there, expect that you will get there and when you do, expect that you’ll be successful at achieving your goal.”

Of course, there’s always a “but…”

…remember, Rome wasn’t built in a day. It was built brick by brick.

Likewise, your goal must be broken down into planned steps – steps that will gradually lead you in a positive direction. Will there be bumps along the way? Undoubtedly. Expect that. But don’t give up.

A Few Practical Tips

I had a patient – let’s call him John – come and see me recently with complaints of low back pain. In fact, he had a long history of low back pain and had been through a lot. He assured me, though, that he really wants to get better and he’s willing to do whatever it takes.

I believed him. I could see it in his eyes – he was determined.

When I asked John to tell me what he was currently doing to get better, he demonstrated a few stretches. I was impressed that he knew some really good stretches – ones that I would have given him myself… with one problem: he was stretching to the point of unbearable pain, yelling out in anguish with each repetition.

John informed me that he was doing these stretches 3 times per day, every day, and had been doing so for the last year.

He also had been going for long walks, even jogs, pushing himself to go further and harder than the day before.

I admire John’s grit, I really do. In a lot of ways, I’m the same way – I want to push myself and do whatever it takes.

Many of us have been groomed to think this way in all that we do – work hard, push through the pain.

And the truth of it is: in sports, in business, in many aspects of life, this kind of grit proves to be incredibly fruitful.

Not here.

John was utterly perplexed as to why he wasn’t getting better. He later disclosed to me that, after each stretching session, he had to crawl his way to a piece of furniture to help himself get up – he was in that much pain.

Essentially, John was turning up his “pain volume knob” with each stretch, with each long walk, and with each jog.

Friends, you don’t have to be the Rocky Balboa of low back pain. This training doesn’t involve chants of “no pain, no pain, no pain” as you take a beating.

This journey starts with doing activities you can tolerate. As your body and your brain learn to tolerate them, the volume is turned down, allowing you to do a little more the next week, and so on.

This is a process – a marathon – not a sprint.

Take the first steps today.

Question: What first step can you take on your journey to better function today? You can leave a comment by clicking here.


  1. Cavanaugh JM. Neural mechanisms of lumbar pain. Spine (Phila Pa 1976). 1995;20:1804–1809.  ↩
  2. Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Man Ther. 2010;15:135141. http://dx.doi.org/10.1016/j.math.2009.12.001  ↩
  3. Winkelstein BA. Mechanisms of central sensitization, neuroimmunology & injury biomechanics in persistent pain: implications for musculoskeletal disorders. J Electromyogr Kinesiol. 2004;14:87–93. http:// dx.doi.org/10.1016/j.jelekin.2003.09.017  ↩
  4. Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007;CD003786. http://dx.doi.org/10.1002/14651858.CD003786.pub2  ↩
  5. Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Man Ther. 2010;15:135141. http://dx.doi.org/10.1016/j.math.2009.12.001  ↩
  6. Nijs J, Van Houdenhove B. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice. Man Ther. 2009;14:3–12. http://dx.doi. org/10.1016/j.math.2008.03.001  ↩
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