Why isn't my exercise program based on pain levels?

Q: I'm seeing a physiotherapist for back pain that's lasted six months. My exercise program isn't based on my pain levels. I'm supposed to keep increasing how long I exercise. This just doesn't make sense to me. Won't I be able to do more if my pain is taken care of first?

A: Doctors and therapists know that back pain lasting more than six to eight weeks involves more than just pathology or tissue disease. Something has gone wrong with the pain signals. Studies show the nervous system has a memory and may be keeping the memory of
the pain alive longer than needed.

Pain that lasts more than three months is called chronic pain. Patients with chronic back pain are advised to regain as much movement, strength, and function as possible despite the pain. The symptom intensity should not be what limits your exercise progression.

For patients with chronic pain reducing pain isn't the goal of treatment. Being more active and increasing function is the primary goal.

S. Z. George, PT, PhD, et al. Physiotherapist Management of a Patient with Acute Low Back Pain and Elevated Fear-Avoidance Beliefs. In Physiotherapy. June 2004. Vol. 84. No. 6. Pp. 538-549.