Cycle of Wellness Remedy PT

Key factors in back pain resilience

“A paradigm shift from a tissue- and disease-based approach towards individually tailored multimodal lifestyle interventions should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain.”

Joe Nijs


Lifestyle factors play a vital role in back pain recovery. Too often education surrounding back pain is about the negative factors affecting pain and disability. This has the potential to create a fear of movement and avoidance of activity which predicts worse outcomes in people with back pain.

But what about the positive factors that can improve pain resilience? Pain resilience is described in The Journal of Pain as “positive coping/adjustment in the face of adversity”.  Certain lifestyle factors act as protective agents to support pain reduction, decrease functional impairment, and enhance quality of life. 

Let’s dive in.


We can’t remove all stressors from our lives but we can improve our self awareness, learn better stress responses, and have tools to calm our nervous system.

  • Self awareness
    Self awareness is huge. It’s greater than self help in my opinion because it opens your eyes to the why behind your actions. Understanding why you act under stress can help you navigate better ways to respond and as opposed to react. A healthy stress response means you are connected with yourself enough to know how you normally react and give yourself better options to respond appropriately. A healthy stress response also means having safeguards and boundaries in place.
  • Calm your nervous system
    This is where the vagus nerve become more important than your sciatic nerve.
    Your vagus nerve activates the rest and digest system. In this high tech and high stress day and age, most people are living in fight or flight mode (sympathetic) and have a hard time winding down. The resilience piece is being able to ramp up and ramp down seamlessly. In a physical example, recovery after a hard workout. A mental example would be having the ability to wind down after a stressful interaction at work.

    • How to calm your nervous system:
      1. Singing
      2. Breathwork
      3. Exercise
      4. Slee
      5. Laughter
      6. Prayer/meditation
      7. Healthy sun exposure
    • 8. Social connection



Disturbed sleep significantly affects pain catastrophizing and one’s inability to function.  Sleep disturbance is a stronger predictor of pain than pain is of sleep.  In fact pain is not even a strong indicator of someone developing insomnia. As a side note, insomnia requires further medical help beyond the scope of this article.

Understanding the role of sleep in mitigating pain and having helpful strategies is an empowering piece of building pain resilience.  When you suffer from back pain, it can be easy to think that good sleep is unattainable and that pain is to blame. How much more valuable to be empowered toward knowing you can change the pain response by focusing on sleep hygiene. Sleep is a buffer for your body’s resilience through its impact on inflammation and the immune system.  

5 factors to optimize sleep

  1. Body Temperature
  2. Social Support/Connection
  3. Food
  4. Exercise
  5. Light

and don’t forget these other common sleep disruptors...

  • Worrying about getting a specific amount of sleep
  • Feeling anxiety around sleep loss
  • Obsessing over apps and trackers
  • Clock watching in the middle of the night
  • Decreasing social support and meaningful activity
  • Worrying about a perfect sleep position


Movement directly affects your energy, flexibility, strength, mindset, physical health, emotional health, and even your sugar cravings.

What keeps you from moving well?

Besides illness or injury, other factors that reduce the capacity to move are pain and fear.

  • Pain
    • Choosing movement when you’re in pain can be a daunting task. No one wants to further injure or re-injure themselves. Once you have had red flags ruled out, engaging in exercise and meaningful activity is highly valuable for improving back pain.
  • Fear
    • Fear of movement worsens the pain cycle. Fear avoidance leads to more pain which leads to even less movement- a cycle that perpetuates disuse, disability and depression. Seek out help from a qualified physical therapist to learn how to move beyond fear. Engaging in movement you enjoy and feel safe with can calm your fears and decrease pain.

To begin feeling resilient with movement:

  1. Choose a meaningful activity
  2. What do you really enjoy to do?
  3. What activity goals do you have?
  4. What feels safe to you ?
  5. Why is this important to you?
  6. How much help, accountability, and support do you need?



Back pain is multi factorial. Gut health may be one piece to the puzzle.

Eating healthy is so much more than just changing which foods you consume. A healthy diet gives you energy, nourishes the immune system, regulates the GI system, and positively affects the gut microbiome. Studies suggest an association with altered gut microbiota and back pain. “It is possible that back pain in obesity is driven by a persistent state of chronic low-grade inflammation partially driven by dysbiosis of the gut microbiome.

70% of your immune system resides in the gut. The importance of a resilient immune system goes without saying. What is becoming more widely studied is the immune system’s role since the neuroinflammatory process causes more sensitization to pain.

Important dietary reminders if you are experiencing back pain:

  1. Eat a variety of colored fruits and veggies
  2. Eat foods rich in Vitamin C and Vitamin D
  3. Eat an adequate daily protein intake
  4. Increase your daily fiber
  5. Eat foods rich in Omega 3’s
  6. Reduce industrial seed oils
  7. Decrease sugar and alcohol



Positive and effective health behaviors may reduce back pain and pain’s emotional distress.

It has been shown that people with chronic low back pain have ineffective coping strategies,  poor back pain beliefs and increased fear avoidance behaviors relating to physical activity.

It’s not your fault. Most likely the explanation you have been given regarding your back pain  is heavily biomedical. This type of view leads people to feel damaged, in need of protection, an in search of a fix.

Instead a key mindset shift toward resilience is seeing your potential for change.

Start by asking yourself these 5 questions.




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