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Chronic Back Pain Physiotherapy

Low back pain (LBP) is the fifth most common reason for physician visits (this means that 20%, or 1 in 5 visits to doctors are because of low back pain). To make matters worse, low back pain affects nearly 60-80% of people throughout their lifetime.

Low back pain that has been present for longer than three months is considered chronic (long term), although there is still no consensus about the definition of chronic low back pain (CLBP).

Right now, specific causes of LBP are uncommon, and in approximately 90% of patients a specific generator cannot be identified with certainty.

More than 80% of all health care costs can be attributed to chronic LBP. Nearly a third of people seeking treatment for low back pain will have persistent moderate pain for one year after an acute episode. It is estimated that seven million adults in the United States have activity limitations as a result of chronic low back pain.

Clinically Relevant Anatomy

The lumbar region is situated under the thoracic region of the spine.

The lower back consists of five vertebrae (L1- L5) and has a slight inward curve known as lordosis. The fifth lumbar vertebrae is connected with the top of the sacrum. The vertebrae of the lumbar spine are connected in the back by facet joints, which allow for forward and backward extension, as well as twisting movements.

The two lowest segments in the lumbar spine, L5-S1 and L4-L5, carry the most weight and have the most movement, and this is what that makes the area prone to injury.

In between vertebrae are spinal discs, and they provide shock-absorbing functions to support. Discs in the lumbar region of the spine are most likely to herniate (slipped disc) or degenerate (degenerative disc disease), which can cause pain in the lower back, or radiating pain to the legs and feet.

The spinal cord travels from the base of the skull to the joint at T12-L1, where the thoracic spine meets the lumbar spine. At this segment, nerve roots branch out from the spinal cord, forming the cauda equina.

Some lower back conditions may compress these nerve roots, resulting in pain that radiates to the lower extremities, known as lumbar radiculopathy.

The lower back region also contains large muscles that support the back and allow for movement in the trunk of the body. These muscles can spasm or become strained, which is a common cause of lower back pain.

Epidemiology /Aetiology

5-10% of all low back pain patients will develop into chronic low back pain (ie long term).

From research, CLBP prevalence rates are lower in individuals aged 20-30 years, increasing from the third decade of life, and reaching the highest prevalence between 50-60 years.

That being said, the prevalence rates stabilizes in the seventh decade of life. There’s no difference in CLBP prevalence at different periods of the year or in different places.

There is higher CLBP prevalence in

  • females
  • people of lower economic status
  • people with less schooling
  • smokers

There’s indication that prevalence has doubled over time too, which may be due to important changes in lifestyle (obesity) and in the work industry.

Factors as a

  • family history of disabling back pain
  • radiating pain
  • advice to rest upon back pain consultation
  • occupational LBP or
  • LBP caused by traffic injury

are all associated with chronic disabling back pain over lifetime. Job satisfaction and psychosocial factors also play a role in the development of CLBP.

In patients with low back pain (LBP), alterations in fiber typing in multifidus muscle and erector spinae are assumed to be possible factors in the etiology and/or recurrence of pain symptoms as it negatively affects muscle strength and endurance.

Characteristics/Clinical Presentation

Most patients who suffer from chronic low back pain experience pain in the lower area of the back (lumbar and sacroiliac regions) and mobility impairment.

Pain can also radiate (travel) in the lower extremities, or generalized pain can be present. Patients with CLBP may also experience movement and coordination impairments. This could affect the control of voluntary movements of the patient.

It can be challenging for the patient to maintain the neutral position, malalignment of the body can occur. It can also be found difficult to maintain a standing, sitting or a lying position, especially in case of radiating pain to the lower extremities.

Carrying things in the arms, or bending can also provoke complaints. Daily activities, such as cleaning, sports and other recreational occupations can become a big task for people with CLBP.

The complaints are recurring and occur longer than three months. It is possible that CLBP passes in episodes. Some episodes are more severe than others, but overall the patient is affected by the impairments. Eventually, social contact and work environment will suffer from this great impact on the patient's health and wellbeing.


Research has shown that the patient history and biopsychosocial evaluation are crucial to establish chronic LBP. Patient history and self-report forms help rule out serious pathologies such as

There are also clinical tests that could be used to sort patients with a higher risk for CLBP from patients with (sub)acute low back pain. The best predictor is the lumbar spine flexion test.

Other differences might be seen in

  • functional tests
  • sensation in the feet and
  • in the different pain provocation tests

what our senior physiotherapists can do for your chronic low back pain

Patients with chronic low back pain generally don't need corrective spinal surgery and tends to respond well to spinal physiotherapy.

Some of the spinal physiotherapy treatments our senior physios may provide includes:

We may also recommend:

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book an appointment today
(or check your pains / injuries)

Phoenix Rehab Physio Services

Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.


Patients who sustained injuries to their elbows, forearms, hands, wrists (sprains and fractures) and fingers, usually will benefit / require Hand Therapy to

  1. manage and decrease hand pains
  2. improve range of motion, strength and dexterity
  3. increase the function of their hand following injuries or post-operations

Commonly treated hand pain injuries includes


Clinical Pilates is a form of physical exercise that focuses on posture, core stability, balance, control, strength, flexibility and breathing.

It is a system of safe and effective exercises, which meet specific individual needs, to treat a wide range of injuries and conditions.

You may do Pilates as matwork or with the reformer or both, and every session will be customized 100% to your fitness, injury and tolerance.


  • Cupping TCM
  • Auricular Therapy TCM
  • Herbal TCM Medicine & Supplementation


Sports and deep tissue release massage helps to increase nutrient-rich blood flow to tired, tight and tense muscles to accelerate recovery and  shorten downtime / recovery period required.

It also prevents muscles from scar tissue micro-tears (and potential ruptures), and increases muscle performance. Having regular deep tissue and sports massage will keep your muscles healthy and fit with body/movement-confidence.

Read the benefits of regular deep tissue release therapy here.


All our allied health therapists and TCM physicians are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCMB).

See our entire team here with introductions and their specializations.

At the first session, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover as well as provide treatment in the same session.

Follow up sessions are inline to provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

do Tell Your Family, Friends And Colleagues About Us =)

We appreciate you as our valued clients and want you to know that the # 1 way we grow as a clinic / brand is through word of mouth referrals from valued patients like yourself.

We prefer not to rely on advertising - instead, we prefer and appreciate the goodwill and positive reinforcement from patients. When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics.

book an appointment today
(or check your pains / injuries)

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