Long-standing Lower Back Pain (Longer Than 3 Months)

Is it the same as chronic back pain?

In short, yes. If you’ve had your back issue for some time, you will probably have noticed it being called different things by different people. The names ‘chronic’, ‘persistent’ and ‘lumbago’ are often used and they generally mean the same thing i.e. pain that has been with you for a long time (typically more than 3 months).

Given that some of these words mean different things to different people (for example, the word ‘chronic’ might mean worse pain or symptoms to some people, but to others it might mean that it has been a problem for ages), we will be using the phrase ‘long-standing’ back pain for the rest of this information page.

Who can get lower back pain?

Lower back pain is very common. Most research (experiments and clinical studies) suggests that approximately 80-90% of people will have back pain at some point in their lives. As mentioned above, anyone can find themselves with lower back pain regardless of age, gender or work role.

What causes lower back pain?

In a lot of cases, lower back pain can follow something easily identifiable like a twist or picking something up, however sometimes it just seems to come out of the blue for no obvious reason. In the vast majority of cases, lower back pain is not something to be worried about, even though it can be quite sore and interfere with your activities.

As mentioned before, your lower back is unbelievably strong and robust, therefore it is very difficult to damage. This doesn’t mean that it can’t be sore from time to time, but most lower back complaints have nothing to do with any damage, even the really sore ones.

Why is it different to a recent (less than 3 months) episode of back pain? 

This is a really important question because understanding the answers will help you realise why there are some differences in terms of assessment, treatment and management of long-standing back pain compared to back pain that has only been with you for a few weeks.

Over recent years, our understanding of pain and the science behind it has grown so much that we now recognise that pain itself (not just back pain) is very complicated, and managing it requires a flexible and sometimes creative way of approaching it.

Current research (clinical studies, experiments etc.) tell us that pain is influenced by many factors that we all experience every day. We know now that worry or stress, your expectations of treatment, your sleep levels, your job satisfaction, your level of fitness or simply how you feel on that particular day will all have an influence on how much pain you feel. Although not exclusive to long-standing pain, some of these factors do seem to have more of an influence on pain if you’ve had it longer, hence the approach to dealing with it might need to be different.

Treating the person rather than the pain itself is strongly encouraged (NICE 2021) for all healthcare professionals working with people in pain. This is one of the main reasons why the ‘treatment’ for long-standing pain might ‘look’ different to the treatment offered for pain that has only been with you for a short while.

Where can I go to learn a bit more about pain then? 

As we’ve mentioned, we think that knowing more about pain, why things might be sore, why it hasn’t simply gone away or why it might be worse when you’re under pressure at home or at work is important. That's why we’ve dedicated a whole group of information pages to it.

You can view our pages on ‘persistent pain’ (otherwise known as 'long-standing pain’ here: Understanding Pain

Don’t forget to come back to this page afterwards to see what you can do to help get your rehabilitation and recovery started.

OK, but how can you tell mine isn’t serious?

That is a very good question. If you are concerned about your back issues, we would encourage you to refer yourself to our Physiotherapy service. You can do so here: Refer Yourself

As we mentioned above, the vast majority of lower back issues might be sore, frustrating and really annoying, but they are not from anything nasty. If you choose to refer yourself to physiotherapy, it is important to know that it is our first job to make sure that you are safe and that your back complaint is not something serious. Whether your assessment is over the internet, phone, video call or face-to-face, you will be thoroughly reviewed to make sure that everything is checked as comprehensively as possible and that you are able to start your rehabilitation in confidence.

Interestingly, the National Institute for Health and Care Excellence (NICE) recently updated their guidelines for the management of low back pain and sciatica in over 16s to state that imaging (MRI/CT and X-rays) should not be routinely offered to people suffering with back pain (NICE, 2016).

Interestingly, there is a growing body of evidence (research/clinical studies) that suggest that some things found in MRIs/X-rays and labelled as ‘abnormal’ are just as common in people with pain as they are in people without pain. To help demonstrate this, Brinjikji et al. (2015) completed a study of over 3000 people who had no back pain and found that 50% of 40-year-olds had disc bulges; 50% of 60-year-olds had age-related changes (otherwise known as osteoarthritis), and nearly 100% of people in their 80s had disc changes. In other words, some of these ‘abnormalities’ can be considered as normal signs of ageing, as they are there whether you are in pain or not. This doesn’t mean that X-ray or MRI findings don’t matter, but it means that they might only form part of an assessment and shouldn’t be relied upon alone.

If you have had a scan and are finding yourself worrying about the results, it’s very important to discuss these with your physio, as they may be able to explain the results in a way that makes them easier to understand. It is important to know that an MRI does not predict your future either. In other words, if you’ve had an MRI scan, the results don’t mean that you will be worse as you get older. Saakksjarvi et al. (2020) followed up 26 patients who had had an MRI of their lower back in 1987 and found that although the changes found on MRI were more obvious on the repeat scan in 2017 (30 years later), the changes were not associated with worsening of pain or disability. In simple terms, although some changes were found on MRI when these patients were younger, it didn’t mean that they were in more pain or had more difficulties as they got older.

What can I do?

Managing long-standing pain of any kind can be tough and requires a different way of approaching the issue, however there are a number of steps that are often useful for people.

If you haven’t read it already, we’ve dedicated a whole series of information pages to understanding pain and what to do about it. You can find these pages here and start to explore some of the steps you can take towards helping you manage your back pain better.

Go to our 'Understanding Pain' page

What can physiotherapy do to help me?

Physiotherapists are important members of any team when it comes to helping people manage their pain and disability more effectively. If you choose to refer yourself to us, you will speak with your physiotherapist (by phone, video or face-to-face) and they will work with you to explore your back pain and the other things that might be involved in your ‘pain experience’.

Your physiotherapist will explore a number of things with you, ranging from your understanding of the issues, your goals, your expectations for treatment and whether it is the right time to start your rehabilitation. Exercise, looking at lifestyle choices and pacing are all things that will likely form a part of your rehabilitation. To get the best out of any rehabilitation programme, you will be encouraged to take part in deciding the direction that it goes in and will be expected to take an active role in helping get yourself better.

All of our physiotherapists are trained in Health Coaching, which is a type of conversation style that can help you get the best out of your appointment and rehabilitation programme when you are at home. You can find more information about Health Coaching here: Health Coaching page

Once I get myself moving again, is there anything else I can do to help my back?

Once you feel that your movement is easing and your confidence to use your back is returning, a very useful addition to your rehabilitation is strength training. Some people find themselves feeling a bit nervous about strength training for their back and it is understandable when you’re surrounded by messages that ‘the back should be protected’ or ‘your back is fragile and you should look after it’, however these statements simply are not true.

Even though it might have been (or still is) sore, your back is strong, robust and designed to be used for lifting things. To help improve your back issue and reduce the likelihood of it coming back again, adding strength training into your rehabilitation programme is important, just like it would be if you were trying to get your knee or shoulder better. An interesting review of the evidence regarding back issues and the effect of strength training by Tataryn et al. (2021), found that using resistance exercises (pulling/pushing/lifting things) led to a significantly positive effect on people’s pain levels, level of disability and strength. In other words, getting your back strong can help reduce pain levels, improve your ability and help your recovery.

We’ve added a series of strengthening exercises for you to explore below.

Is there any way I can do exercises in a class or group?              

We’re proud that we can offer a range of classes/group sessions for people trying to manage their back pain better. You can find out more information here: Classes

Feel free to explore what options we offer with your physiotherapist, or if you are not currently under our care but are interested in one of our classes, you can refer yourself and just mention that you are keen to explore a class. A decision will be made with you by one of our specialist physiotherapists if a class is going to be a suitable option for your rehabilitation. Refer Yourself

Exercise tip:

Try to explore these exercises little and often throughout the day. Do as much or as little of the exercise as you feel comfortable. It is ok to feel a little sore whilst doing (or after doing) the exercise/s.

Exercises to help you get yourself stronger:

Once your back starts to feel easier and more settled, you can start to explore some of the following exercises to help gain some strength around your back.

We recommend that you start with exercises that feel slightly easier/that you feel more confident with to begin with, but feel free to explore any of the options below.

Aim to complete the exercises (perhaps 2 or 3) between 3-4 times per week. Try to complete between 8-12 repetitions per exercise, have a brief rest (1 minute) and repeat a further 3-4 times.