Common Mistakes in Chronic Back Pain Treatment

Dr. Jeremy James: DC, CSCS

As I have written before, it can be very difficult for the average person to know when to consider surgery for chronic back or neck pain. One of the most challenging questions for a patient to answer is whether they have had good conservative care before considering surgery. I hope this blog helps answer that question. This entry will build upon my previous blog entitled “When and when not to consider surgery for back or neck pain.”

I see the same patterns over and over when patients come to our clinic after being treated unsuccessfully elsewhere. Here are a few of the most common mistakes I see:

  • Their previous care was completely (or mostly) passive in nature. Chronic back pain patients go to chiropractors over and over and get adjusted without ever being transitioned to exercise. While manual therapy (including adjustments when indicated) is useful and necessary at times, a transition to exercise should almost always be made at some point.
  • Their exercise protocol did not progress as the patient improved. An exercise protocol is a dynamic thing. It should be constantly monitored and updated as the patient improves and changes. In most cases, you shouldn’t be doing the same exercises, resistance, repetitions, etc. in the second month of treatment that you did in the first week. The caveat here is that there are a few basic exercises which are good to do permanently for many back patients (plank, bridge, side plank, etc.). Generally, those exercises are prescribed as a daily “warmup” with progressions built on top of them.
  • Patients push through pain during their exercises. Proper exercises for spinal rehab should not generally aggravate a patient’s back or neck pain. The adage “no pain, no gain” does not belong in a spinal rehab program. While some exercises might cause some mild discomfort in other areas, they should not cause an increase in the patient’s chief complaint pain. If a person’s prescribed exercises are causing an increase in back or neck pain one of the following is happening: it is the wrong exercise for that person’s condition, it is too much resistance, there are too many repetitions, or the person is doing it wrong.
  • Details matter! It is incredibly easy to do an exercise the wrong way. In fact, it is usually easier to do it the wrong way than to do it the right way. The old movement patterns that contributed to your problem in the first place are going to take over as soon as you let your guard down. Zoning out in front of the TV and going through your routine is not the way to get better. Make sure you understand exactly what muscles you are supposed to be using and the goal of each exercise. Your therapist should pay close attention in the beginning stages of treatment to make sure you understand each exercise and know how to do each of them properly.


As always, feel free to send us a message with all your questions about spine health and fitness at

Out of Pain. Into Possibility. Jeremy James.