Patient Review: Lower Back Pain and How Feeling Better ≠ Fixed

Pain gone = problem solved? I hear this often. People think that since they are out of pain, they are good to go.

It makes sense why. Pain is the thing you can feel, so it becomes the thing you use to judge progress. But pain and the actual problem are not always the same thing, and confusing the two is one of the most common reasons people end up back where they started. 

Pain can settle for many reasons that have nothing to do with the root cause:

1. Avoiding movements that bother you.

2. Pain becomes less noticeable.

3. Pain naturally goes away.

To back this up, one study showed changes in low back musculature strength despite decreased pain and return to functional activities. The authors hypothesize this is a reason for recurring LBP. ¹

In engineering school, I learned that the true cause of failure might not be the part of the system that is broken. You have to look at the whole system. Same with your body. Addressing the symptom does not mean it's fixed. Symptoms show up at the weakest link, but the actual issue may be somewhere else. 

Finishing rehab includes rebuilding strength in the areas that were compensating, not just the area that hurt. It means addressing movement patterns that developed while you were guarding or avoiding certain motions. And it means testing capacity, not just comfort, making sure you can actually tolerate the demands of your sport, your training, or your daily life, not just tolerate sitting or standing without pain. This distinction matters because pain and physical capacity do not always improve together. 

I saw a version of this recently with a patient of my own. With this person, I probably could have gotten them out of pain through massage, stretching, manipulation, dry needling, or some combination of hands on techniques. That approach works for a lot of people, however, they now rely on their providers for pain relief. But this patient was ready to do more than that. They wanted to work and actually address where the pain was coming from. Now they can manage this issue on their own if it ever comes back, instead of needing to see a physical therapist again just to get out of pain. 

Tired of going to your provider and getting out of pain just for it to come back? Now is the time to try out physical therapy.

- Dr. Isaac

Resources: 

1.  https://pubmed.ncbi.nlm.nih.gov/23369927/ 

AI Disclaimer: All original thoughts. AI used in edit and cleaning up ideas. See handwritten proof below: