Why does my lower back pain / sciatica keep coming back

This episode is entitled “Why does my lower back pain or Sciatica keep coming back”, in which I will be introducing you to the Cliff of Pain. Now, before we dive into that, it’s worth mentioning that this is the first episode of the Active X Backs podcast on lower back pain and sciatica. There will be many episodes following, and the next one will be announced at the end of this episode. So keep your ears peeled at the end. However, let’s dive into the content here. So revisiting the topic, why does my lower back pain and sciatica keep coming back? And this is the case for so many people.

Lower back pain is very common

Lower back pain is exceptionally common, but I don’t need to tell you that. Do I? So assuming, and this is a big assumption by me, that your lower back pain is not a complete calamity.  By which I mean you do not have serious damage that’s been demonstrated on an X-Ray or MRI scan.  And assuming that an experienced clinician has not told you “This is a disaster”. But if your MRI or X-ray shows significant damage and an experienced clinician is convinced that the changes seen on the MRI are related, then that does pose a challenge.

Damage doesn’t equal pain

However, it is worth noting, and I’ll come back to this many times in the podcast, that the extent of damage seen on an X-Ray or MRI is very poorly correlated with the amount of pain people have. So just because it looks like a disaster does not mean it is the cause of your pain. There is hope. So casting that assumption aside and now assuming that your lower back pain is indeed salvageable. Why do you continue to experience episodes of lower back pain and or sciatica? Well, simply, it is for one of two reasons.

1. You have a bad plan for rehabilitating your lower back.


2. You’re simply not sticking to the plan.

There we are. That’s the end of this episode. No, I jest. But seriously, either you’re following the wrong plan, or you’re not following a good plan. Unless I’m missing something, that is my take on why your problem keeps recurring.

Why does my lower back pain / sciatica keep coming back – reason 1

Now to put this into context, I have been using the Cliff of Pain metaphor for over 20 years. So if you can, imagine we’re in the same room. And I am passing my hand horizontally across your field of vision. This is what life is experienced as. So I’m fine, I’m fine, I’m fine, everything’s nice and flat, horizontal. And then I’m not, I fall off the cliff of pain. So most people’s experience of health is fine, fine, fine, fine, fine… not fine. That is the Cliff of Pain.  And by the time you find yourself down in the sea of pain at the bottom of that cliff, you are now experiencing lower back pain and or sciatica.

Why you fell off the cliff

But the reality is that you were headed for the edge of that cliff for a long time before you fell off.  The last thing that happened before you fell off the cliff is simply the last puff of wind.  That is not the cause of your problem. It’s just the trigger. The thing that happened just before you fell off.  You could call it the last straw on the camel’s back. It is not the cause of your lower back.  It’s just the thing that happened just before. So often in clinical practice, I hear people say “All I was doing was”. As soon as I hear that phrase, “all I was doing was” – I know that the next thing you’re going to say is not the cause of your lower back problem.  Because it’s something you’ve done hundreds – if not thousands of times – before without your lower back going wrong.

What keeps you in the Sea of Pain

So “All I was doing was” is just the phrase that you use to tell me what the trigger was. The last thing that knocked you off the edge of the cliff; it isn’t the cause of your lower back problem. OK? So coming back to this metaphor of the Cliff of Pain… Once you find yourself in the sea of pain, bent double and arched over to one side – whatever it may be – you have lower back pain and or Sciatica.

There are 2 things that will cause you to keep having lower back pain and Sciatica. One is that you’re constantly aggravating it. So you continue to do the things that aggravate your pain. And the second is that you never get back from the edge. So you’re always either in pain or on the edge of pain. So you’re hovering around on that cliff top, still on the edge. And then all it takes is another little puff of wind and you fall off again Many people yo-yo in and out of pain.  Some people for decades yo-yoing up and down that cliff face. And in essence, those are the causes. Either you’re constantly aggravating it or you’re only recovering sufficiently, but you’re still on the edge of the next episode.

Why does my lower back pain / sciatica keep coming back – reason 2

Which ties back into having a bad pla,n or not following a good plan all the way through. So the bad plan is that you’re aggravating it. So if you had a sore head and you came to me and said, “Gavin, I would like you to fix my headaches. But the thing is I’m really busy banging my head against this wall.” I would have to tell you that’s a bad plan. You’re not going to resolve your headaches if you keep banging your head against the wall.

So if your lower back pain is worse when you’re sitting or when you get up from sitting, but you have a sitting down job, and you spend your evenings slumped on the sofa… Your lower back is not going to recover. Or if it does, it’s simply going to go wrong again very soon because you’re only ever achieving the cliff top. You’re never getting back from the edge. OK, so you have a bad plan.

Is this getting through? So either you have a bad plan or you’re not following the plan through fully, which means you’re still on the edge. So what about a good plan?  I’ll talk about that in the next episode. The good plan needs to be seen all the way through. You can’t just do it until you feel okay again, because then the chances are you’re still on the edge of the cliff and you’re just gonna fall off again. Remember, 60% of lower back pains recur within 12 months. So you have to stick to the plan for long enough, possibly a lifetime. But certainly for long enough that you don’t then fall back off again.

Summary of “Why does my lower back pain / sciatica keep coming back?”

So there we have it. There are only two real causes for your lower back pain or sciatica recurring. One is that you have a bad plan.  And the other is that you may have a good plan, but you’re not following it all the way through. Simple as that. Perhaps you thought you were going to get something more profound, but my good friend that will come in future and the next episode is entitled, “How can I relieve my lower back pain / sciatica“? Have I whetted your appetite for that one.  I thought it might.  So in the next episode we’ll dig into the detail of how can I fix my lower back pain or sciatica.

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