» Acute Versus Chronic Back Pain - What’s the difference?
Acute Versus Chronic Back Pain - What’s the difference?

Back pain is one of the most common causes of missed days from work and job-related disabilities. The occurrence of back pain is fairly equal for both men and women, and can have a wide ranges of causes. Back pain is generally reported as originating in the lower back, with an intensity that may range from a dull ache to a sharp, intense sensation, and it may be acute (short-term) or chronic (long-lasting). In the majority of cases, back pain is acute, but certain spinal conditions or injuries may cause chronic back pain.

Early Physical Therapy intervention in acute back pain that includes education, manual therapy, and exercise is well supported by research to decrease pain, reduce time away from work or activities, and prevent chronic symptoms.

Acute back pain is formally classified as discomfort that lasts for a few days or weeks, but no longer than three months.  Acute back pain is usually the result of a minor or moderate injury or an abnormal bodily movement that does not result in serious damage to any of the structures in the back.  If structures are damaged in an acute back pain injury, the pain from the injury subsides within 4-12 weeks.

Chronic back pain is formally classified as discomfort that persists for more than three months. It may be a constant, dull ache or an ongoing strong, sharp pain that may be accompanied by burning or tingling sensations. There are some common culprits that can (but don’t always) lead to chronic back pain like a moderate or severe traumatic injury, which may occur due to playing high impact sports, falling, or a car accident. Some jobs or sports that require someone to engage in repetitive movements like lifting items or twisting regularly may also lead to chronic back pain due to the cumulative wear and tear on the structures of the spine, such as the vertebrae, discs, muscles, ligaments, tendons, or nerves in the back.

Why do some injuries lead to chronic back pain and some don’t?

As mentioned above, severity of injury can play a part in whether one experiences chronic back pain. If structures are more severely damaged, or certain structures (such as the nerves) are involved in the injury, you may be more prone to experiencing chronic pain. In traditional medical models it was thought that damaged structures were the sole cause of chronic pain, yet interestingly enough, not everyone with permanent structural damage, even severe, experiences chronic pain. Most tissues heal within a few months, so theoretically pain from the healing of the tissues should subside also in this time. So why does chronic pain occur?

In more recent research, it has become evident that chronic pain develops because the brain, spinal cord and associated nerves become more sensitive to the stimulus of pain. Pain is regulated by the brain, not by the damaged tissue! Long after normal healing of damaged structures has occurred, the pain continues. In other words, the pain outlives its original cause. In addition, in many cases, over time more pain can occur with less provocation or with movements or stimuli that would normally not cause pain at all. The chronic pain may also be out of proportion to what the original injury was. The pain response in the body becomes ‘hyper’ or more sensitive. This hypersensitive pain response one deals with in chronic pain can make other sensations in the body also hypersensitive, like one’s response to noise, visual stimulus, touch, stress, or emotional events. The cycle of chronic pain can perpetuate due to this ongoing sensitivity. Unfortunately, we don’t know yet exactly why some injuries become hypersensitive and chronically painful, and some don’t. We do know, however, that chronic pain can be extremely debilitating, and that it isn’t ‘just all in your head’ as some patients are advised.

Chronic back pain can disrupt an individual’s daily routine or even cause a person to lose their independence at home and at work. Furthermore, persistent discomfort may lead to psychological problems like depression, painkiller addiction, sleep disturbances, social isolation, relationship problems and even job loss. Fortunately, something can be done about chronic back pain.

The Role of Physical Therapy in Improving Back Pain

If you are experiencing back pain, either acute or chronic, Physical Therapy at Purposed Physical Therapy can help!

Physical Therapy for back pain involves the use of pain and hypersensitivity education as well as mobility restoring techniques that help you recover your normal range of motion, regain strength, reduce pain and prevent back pain from recurring or managing the pain if it does reoccur.

During the initial assessment at Purposed Physical Therapy, your Physical Therapist will discuss your medical history including how and why your back pain started. They will carry out a physical examination in order to explore your back symptoms, as well as to exclude the possibility of serious underlying conditions that may be contributing to your pain. Functional deficits, which may include decreased mobility or range of motion, will also be evaluated by your Physical Therapist. Your Physical Therapist will also assess your posture and will help you understand the role habitual movement or poor posture may be playing in your back pain. They will teach you how to improve your posture during activities such as your work, or when playing sports or lifting items.

After the initial assessment has been conducted, an individualized Physical Therapy management program will be designed that specifically targets the source of your problem from multiple perspectives. Your Physical Therapist will teach you how to stretch and strengthen your body in a way that will enhance your recovery. They will teach you about when it is appropriate to get your back moving and show you how to move safely. Understanding what is “sore and safe” versus “painful and harmful” will help you to trust your body’s resilience and reduce any tissue hypersensitivity. If you are experiencing chronic back pain, one of the most important pieces of back pain rehabilitation is to assist you in understanding the concept of pain hypersensitivity and how and why we experience pain.

Although back pain can become a long-term or debilitating condition, it doesn’t have to be. Physical Therapy can really help. Give Purposed Physical Therapy a call today to get started on your road to recovery.

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