Low back pain is generally called chronic once it has persisted beyond three months. By that point it is usually driven by more than the original injury: a mechanical component that was never fully resolved, a nervous system that has become more sensitive, loss of strength and conditioning from months of guarded movement, and often disrupted sleep. Effective care has to address all of those, not just the sore spot.
I am Dr Alex Freeman (chiropractor) and I practise in Victoria Park, Perth. Chronic low back pain is the single most common presentation in my practice, and it is also the one where people arrive most discouraged, usually having been told at some point that they will just have to live with it.
Chronic pain is a different problem to acute pain
This is the idea that reframes everything, so it is worth spending a moment on.
When you injure your back, pain is a protective alarm. Tissue is damaged, the alarm sounds, you move carefully, it heals. Most tissue healing is substantially complete within six to twelve weeks.
So when pain is still present at six months, the obvious question is what is still producing it. Sometimes there is a genuine ongoing mechanical driver. Often there are two or three things happening at once, and treating only one of them is why people plateau.
What is actually keeping it going
An unresolved mechanical driver
Restricted segments in the lumbar spine or pelvis, a facet joint that has never settled, a sacroiliac joint that is not sharing load, or altered hip mechanics loading the lower back every single step. These are real, and they are findable on examination. I mention this first deliberately, because the current fashion is to skip past mechanics entirely, and I think that is a mistake.
A more sensitive nervous system
When an alarm system runs for long enough, it turns its own volume up. The threshold at which movement registers as threatening drops. This is a real, measurable physiological process, and it explains why pain can seem out of proportion to what you were doing. It does not mean the pain is imagined. It means the system reporting it has changed.
Deconditioning
Six months of moving carefully costs you real strength through the trunk, hips and legs. A weaker system tolerates less, so more ordinary activities now provoke symptoms, so you do less. That loop is often the main thing standing between someone and getting better.
Fear of movement
Entirely understandable, particularly if you have been told you have a disc problem or a degenerating spine. But avoiding movement maintains the problem, and the words used by clinicians matter enormously here. A scan report read without explanation has put more people into this loop than almost anything else I see.
Sleep, stress and load
Poor sleep measurably lowers pain thresholds. Sustained stress increases muscle tone and reduces tolerance. And the honest truth for a lot of the workers I see, particularly on FIFO rosters, is that the load has not changed at all since the injury. It is very hard to recover from something you are still doing twelve hours a day.
The trap in both directions
There are two unhelpful positions, and both are common.
The first is purely structural: your spine is degenerating, here is the damage, this explains everything. That framing tends to frighten people into inactivity and does not match what we know about how often those findings appear in people with no pain at all.
The second, which is currently more fashionable, is that structure barely matters and it is essentially all sensitisation and behaviour. I think that overcorrects. When I see disc height loss and facet change at a level, that tells me something real about how that segment has been loaded for years. Mild degenerative change is not a meaningless incidental finding. It is a marker of chronic loading, and it points me at where to look.
The useful position holds both. Mechanics matter. The nervous system matters. Strength matters. You address all three.
What needs medical attention rather than chiropractic care
Screened at every new patient examination. Seek medical assessment if you have:
Loss of bladder or bowel control, or numbness through the saddle region
Progressive weakness in one or both legs
Unexplained weight loss, fever, or a history of cancer with new back pain
Pain that is constant, unrelated to position, and consistently worse at night
Back pain following significant trauma, or in the context of osteoporosis
Back pain beginning before age 20 or after age 55 without clear cause
What a proper assessment looks for
A first appointment here is a consultation and examination, not treatment. For chronic low back pain I want the full history: the original injury if there was one, what has happened since, what you have already tried and what each of those things did, how it behaves through a day and through a week, what your work actually involves, and how you are sleeping.
The examination covers lumbar and pelvic movement segment by segment, hip range and strength, neurological screening through the relevant myotomes and reflexes, neural tension tests, functional movements such as sit to stand and single leg loading, and how leg length and tone change between prone and supine. I want to know what is restricted, what is weak, what is irritable and what is simply avoided.
Imaging is not automatic but I use it more readily than some, particularly where there is a long history of loading or where the presentation does not fit cleanly. When we do image, we go through it together at a report of findings appointment before care starts, so that you understand what we are working with rather than reading a report alone.
What actually changes it
Chiropractic care may help manage the musculoskeletal component of chronic low back pain. In practice, what I find changes things is a combination rather than any single element.
Adjusting restricted segments to restore movement and reduce local irritation. Soft tissue work or dry needling through the lumbar paraspinals and gluteal group. Graded movement that starts at a level you can actually tolerate. Then, and this is the part that decides whether the result holds, progressive strengthening once symptoms have reduced enough that you can train properly. Manual therapy without loading tends to produce relief that does not last.
Alongside that, some unglamorous things: protecting sleep, breaking up sustained postures during the working day, and being realistic about which parts of your work load can be modified.
How to tell whether it is working
This matters, because chronic pain does not improve in a straight line and it is easy to misread the signal.
We take objective measures at the start: range of motion, specific strength testing, functional tests, and how far and how long you can do things. Our standard is a formal progress examination at the twelfth visit, roughly six weeks in, where we repeat those same measures and compare. That is the difference between care that is going somewhere and care that is drifting.
What I look for is not a straight drop in pain score. It is more good days between the bad ones, flare-ups that settle faster, more capacity before symptoms start, and measurable improvements in strength and range. Those changes usually arrive before the pain fully settles, and they are the more reliable indicator.
A flare-up after a good period is not a relapse and it does not undo your progress. It is a normal feature of chronic pain recovery.
Common questions about chronic low back pain
When is back pain considered chronic?
Generally once it has persisted beyond three months. At that point the original tissue injury has usually healed, and persistence is more often driven by a combination of unresolved mechanical factors, increased nervous system sensitivity, loss of conditioning and ongoing load.
Can chronic low back pain be fixed?
Many people achieve substantial and lasting improvement in pain and function, though outcomes vary and some people manage an ongoing tendency rather than eliminating it entirely. The more useful goal is usually capacity: doing what you want to do without it costing you the next two days.
Does my scan explain my pain?
Sometimes, but not automatically. Disc degeneration, bulges and facet changes are common in people with no pain at all. A finding becomes relevant when it corresponds with your symptoms and examination. Degenerative change still tells your clinician something useful about how that segment has been loaded.
Should I rest or keep moving with chronic back pain?
Keep moving, within tolerance. Extended rest tends to reduce strength and tolerance and prolongs the problem. Movement should be graded rather than pushed through severe pain, and a clinician can help set that level.
How often would I need to be seen?
That depends on the presentation. Our standard initial schedule is twice weekly for six weeks, with a progress examination at the twelfth visit to compare objective measures before deciding what happens next. Visit frequency should reduce as you improve.
If it has been going on for months
Long-standing back pain is not something you have to accept. It usually just has not had all of its drivers addressed at once. We are at 249B Albany Highway, Victoria Park, and we see patients from East Victoria Park, Kensington, South Perth, Como, Lathlain, Carlisle, Burswood, Rivervale and Belmont, including a good number of FIFO workers whose schedules need care planned around their swing.
Book online or call 0493 290 505. You may also want to read about back pain care in Perth, what your MRI report actually means, and sciatica.
Freeman Chiropractic · Victoria Park
Back pain that has lasted for months?
Book a consultation and examination with Dr Alex Freeman at 249B Albany Highway, Victoria Park. No GP referral needed.
This article is general information and is not a substitute for individual assessment. Dr Alex Freeman is a registered chiropractor practising in Victoria Park, Western Australia.