#31 – Lower Back Pain, Pt. 3: Fight Pain with Education and Exposure Therapy

Coach D and Trent are back on the topic of back pain, this time tackling the treatment* of back pain. As discussed in previous episodes, many people experiencing back pain lack both strength in their back musculature and proper control over the motor patterns the back was designed to move through. Back pain can lead to nervous system changes in which the patient becomes hypersensitive to new sensations of pain, and it can lead to maladaptive behaviors, which in turn can lead to comorbidities. So, how do we pull someone out of this spiral?


Darin reaches for education first. Similar to how these back pain episodes are laid out, Darin first educates his patients about the anatomy and function of the spine, pain science, and the literature supporting the use of strength training for building muscle and regaining function. Next, he uses “exposure without danger” therapy to slowly and incrementally expose the person to greater range of motion and heavier loads. These steps help the person reframe their ideas about pain, and rewire their brain to reduce the fear response and perceived level of threat from movement. Now the person is ready to train in earnest, and begin the process of strengthening her back, regaining function, and reducing her pain.


In the following episode, they will discuss specific exercise recommendations and programming for back rehab. Stay tuned for the next installment!


In the meantime, here are some excellent resources for further reading on pain and pain science:


*N.B. if a person has specific neuropathic pain of an acute or sub-acute nature associated with dermatonal changes like numbness or tingling, or myotomal changes such as drop foot, incontinence, or loss of reflexes, these are red flags that indicate consulting with a physician. If you are experiencing symptoms like these, discuss them with your doctor!


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