The National Institutes of Health (NIH) defines chronic low back pain as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.
About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.
(Learn the critical differences between acute and chronic low back pain in this article.)
Pain, on the other hand, does not always indicate a medically significant underlying cause or one that can be readily identified and treated.
Fortunately, there are many things you can do to prevent the development of chronic low back pain. This article will outline 6 effective strategies you can implement at home to prevent chronic low back pain and maintain a healthy spine.
How to prevent low back pain from turning into a chronic condition
In most cases, acute low back pain will not become chronic.
However, pain that lasts for more than 12 weeks (3 months) is a sign of chronic pain. In this case, the brain becomes hypersensitive and sends pain signals because it is on high alert trying to protect you. This is called chronic hyperalgesic state.
Your brain remembers pain from past injuries and continues to trigger pain sensations, even though the original injury has already healed.
When you live with low back pain, it is hard not to think about it, and it’s perfectly natural to worry that your pain might get worse if you move your back or if you go back to doing your usual activities of daily living.
For some, they imagine the worst probable outcome when they move their back or when they participate in any physical activity. They would significantly limit their activity participation for fear of aggravating their back pain.
We call these beliefs and behavior “fear-avoidance beliefs“ and “catastrophizing”.
In my experience though, patients refrain from moving their bodies not because they do not want to, but because they do not know how to.
They are mostly afraid that moving a painful part of their body, particularly their back, will only cause more pain. Understandably, it is often hard to stay active if you are in pain.
Our natural inclination will be to stay still, or to stay in bed, not moving a limb, for fear that movement will aggravate the pain.
As counterintuitive as it may sound, not moving your back or resting your back for prolonged periods of time, for fear of hurting your back, is actually what will cause your back to hurt longer or result in chronic low back pain.
We now know from research that persistent negative thoughts and feelings about your experience of pain will only make your pain worse.
The latest clinical practice guidelines also conclude that early intervention or movement can help reduce the risk of conversion of patients with acute low back pain to patients with persistent or chronic symptoms.
So, how will you counter this fear of movement?
By learning how to move your body, specifically your back, the correct way. This is called proper body and back mechanics. This is also part of the Maintenance Phase of the Back Pain Unlocked System.
Let me share with you the strategies on how to properly move your back to prevent chronic low back pain and maintain a healthy spine:
How to prevent chronic low back pain and maintain a healthy spine
- Stand with your feet shoulder-width apart.
- Hold a dowel (or a broomstick, a golf club, or a cane) vertically behind your back with one hand on the top end and the other end by the bottom end.
- The dowel should be in contact with the back of your head (A), the center of your back (B), and the bottom of your back (C) throughout the movement.
- Start to learn forward by bending your hips and knees, bringing your shoulders and trunk forward.
- Ensure the dowel has a 3-point contact with your body at all times.
- Then, slowly bring the hips back to the starting position, ensuring the dowel has a 3-point contact with your body at all times.
- Repeat 10-15 times.
Knowing how to correctly perform this maneuver will build the foundation for doing most of the physically challenging and demanding tasks your low back is subjected to on a daily basis, i.e. getting up from a low chair, picking up light objects from the floor, or lifting heavy objects from the floor.
- Sit in a comfortable position with your feet flat on the floor and your buttocks near the front of the seat.
- Gently roll your shoulders forward. Feel the weight move backward on your “sit” bones and you tilt your pelvis backward toward the back of the chair.
- Now straighten up slowly and pause at the mid-point (this is the neighborhood of your pain-free, neutral spine position).
- Now roll your shoulders back and extend your back and you tilt your pelvis forward toward the front of the chair.
- Repeat 10 times every 30-45 minutes of prolonged sitting.
Performing a pelvic clock every time you notice your low back getting tired from prolonged sitting is a great way to reintroduce movement to your spine and increase circulation around the periphery of your vertebral disc, decreasing the stress and strain to your low back.
Sit to Stand
- Scoot your hips forward to the edge of the chair.
- Bring your toes underneath your knees.
- Lean your body forward, using the hip hinge technique, while keeping your chest out and your gaze forward. (Note: looking down will round your upper back and counter the direction of your hip hinge.)
- Extend your hips while pushing down on your feet to get into a standing position.
- Optional: Use your arms to push off the chair or off of your knees.
The ability to stand up from a chair without aggravating your back pain makes a huge difference in your activities of daily living. Essential functional activities, including getting up from a low toilet, out of bed, and out of a chair can be a distressing event if you are experiencing back pain.
It doesn’t have to be if you follow the movement pattern I outlined above.
Picking Up Light Objects from the Floor
- For this technique, the knees are only slightly bent.
- One leg is allowed to come off the floor behind the lifter and acts as a counterbalance.
- The opposite hip bends and the body becomes almost parallel to the floor, except for the leg bearing your weight.
- One arm reaches down to pick up the object while the other is often holding on to a stationary object for support, i.e. countertop, chair, or a golf club or cane.
- Although the chest points down toward the floor, lifting the back leg allows the spine to stay straight and the counterbalance offsets the strain on the back.
This technique is also called “golfer’s pick”. This technique builds on the hip hinge technique (the first strategy) in that you are bending your hip joint while keeping your spine straight, decreasing the strain on your lumbar spine.
Lifting Heavy Objects from the Floor
- Keep a wide base of support. Your feet should be shoulder-width apart, with one foot slightly ahead of the other (karate stance).
- Squat down, bending at the hips and knees only. If needed, put one knee to the floor and your other knee in front of you, bent at a right angle (half kneeling).
- Look straight ahead, and keep your back straight, your chest out, and your shoulders back. This helps keep your upper back straight while having a slight arch in your lower back.
- Slowly lift by straightening your hips and knees (not your back). Keep your back straight and don’t twist as you lift.
- Hold the load as close to your body as possible
- Use your feet to change direction or to turn; do not twist your back.
- Set down your load carefully, squatting with the knees and hips only.
How many times have you heard people hurting their back after lifting a heavy object from the floor?
Follow the movement pattern I outlined above to avoid compressing your spinal discs or straining your lower back when you are lifting heavy objects.
Getting Up from the Bed
- The first step before transitioning from lying to sitting up in bed is to gently draw in your abdomen by pulling your belly button towards the bed. Maintain the abdominal drawing-in maneuver while sliding one heel up at a time to bend both knees.
- Keep your shoulders and hips in line with each other while turning onto your side. (This technique, referred to as log rolling, helps to reduce twisting and bending stress on the spine.)
- Once you are on your side, bend your knees so that your feet and lower legs are almost over the edge of the bed.
- Now push into the bed with your top hand and bottom elbow while simultaneously allowing your feet to drop to the floor.
The body mechanics of getting out of bed require transitional movements that often combine bending and twisting forces on your low back.
Use the movement pattern I outlined above to counter the effects of early morning low back stiffness and discomfort.
If you want to see a step-by-step framework to free yourself from chronic low back pain using the biopsychosocial model of treatment, check out this article.
Frequently Asked Questions
How do I get over my fear of pain?
Educate yourself. Learning more about what is causing your pain or discomfort may help you realize that your chronic pain condition will not harm your body, allowing you to be more active and ease any anxiety.
In my book, Back Pain Unlocked, I shared four specific improvements I see my patients achieve after learning and implementing the Back Pain Unlocked System™️:
- One, by recognizing their belief systems about pain, they are better equipped to anticipate their reactions to the stresses that would otherwise aggravate their back pain.
- Two, by understanding the inherent structural strength of their back, they start to trust themselves and their body’s capacity to heal.
- Three, by baking-in accountability prompts, they are more likely to stay the course and see themselves through their goals.
- Four, by following the framework I outlined in the book, they found a long-term solution to their chronic low back pain problems.
What is a fear-avoidance belief?
Fear-avoidance ideas are strongly linked to the sensation of pain, especially when the pain becomes chronic in nature.
The fear of experiencing pain will frequently cause you to be on constant guard for painful sensations and constantly monitor them, which can make even minimal discomfort feel excruciating.
The anticipation of greater suffering or reinjury can, in itself, serve as a source of motivation to avoid situations. Therefore, fear of pain and/or injury may contribute to your avoidance of certain activities, resulting in inactivity and, eventually, greater disability.
Why do fear-avoidance beliefs make the pain worse?
If you view pain and discomfort as catastrophic, a cycle can begin. The pain can become worse and progress to a chronic condition as a result of inactivity and disability. This can make your threshold for feeling pain even lower.
One of the most powerful things you can do today is to be purposeful in evaluating your beliefs about your own pain experience. Drill down to what makes you scared to do what you used to be able to do with ease. Are you afraid your back will not hold up?
By avoiding movement of your core and back or by limiting your physical activities, your back and core muscles grow weaker and your joints become stiffer. Your recovery will take longer.
The more you stay still, or sit around, or stay in bed, the worse your back pain gets.
The latest clinical practice guidelines conclude that early intervention can help reduce the risk of conversion of patients with acute low back pain to patients with chronic symptoms.
Dr. Lex Gonzales, PT, DPT is an author and speaker who has been working as a licensed healthcare professional for over 24 years. On drlexgonzales.com he provides quality information and practical solutions you can use to achieve the best version of your healthy self.