Chronic Low Back Pain in Calgary: What’s Actually Going On (and How Physiotherapy Helps)

Colin Bouma, PT, FCAMPT
Jul 6
8 min read

Most mornings start with stiffness. Putting on socks is a negotiation. Long drives, long meetings, long anything-sitting — you pay for it later. You’ve tried rest. You’ve tried stretching. Maybe you’ve had a scan or two, an injection, advice from a chiropractor or a friend or a family doctor. And here you are, still searching.

If that sounds familiar, you’re in the largest patient group in modern medicine. Low back pain is the single largest cause of disability worldwide, and most of what people have been told about it has aged badly.

At our south Calgary physiotherapy clinic on MacLeod Trail, chronic low back pain is the single condition we see most. The post you’re reading replaces our previous version. The structure of care is similar — assessment, education, exercise, manual therapy where it adds value — but the evidence underneath has shifted considerably in the last five years, and your treatment should reflect that.

What does “chronic” actually mean — and why your scan probably won’t explain it

Pain lasting more than 12 weeks is considered chronic. The reflex is to ask, "What’s structurally wrong?" and chase an MRI. Here’s the awkward truth: scans are usually not the answer.

A widely cited systematic review by Brinjikji et al. (2015) looked at spinal MRIs in people with no back pain at all. By age 30, more than half had disc degeneration. By age 50, that number was over 80%. Disc bulges, protrusions, and "degenerative changes" are normal aging findings — the spinal equivalent of grey hair. The presence of these findings on your scan does not mean they are the cause of your pain.

That’s why the NICE guideline for low back pain (NG59) explicitly recommends against routine imaging for non-specific low back pain. Scanning a chronic back without red flags usually finds something incidental, raises anxiety, and leads to interventions that don’t change outcomes.

Pain isn’t just a structural problem

The current evidence base — anchored by the 2018 Lancet low back pain series — describes chronic back pain as biopsychosocial. That isn’t a euphemism for "it’s in your head." It means pain is shaped by:

· Biological factors: tissue health, deconditioning, strength, mobility, sleep, general health.

· Psychological factors: stress, mood, fear of movement, beliefs about what your back is doing.

· Social factors: job demands, financial pressure, support systems, what other clinicians have told you.

When pain persists, the nervous system gets better at producing pain — a process called central sensitization. Small movements that used to feel like nothing start to hurt. This is real and physiological, not imaginary, and it responds to the right interventions.

Misconceptions worth letting go of

· "I need to know exactly what’s wrong before I can get better." For most non-specific chronic LBP, a precise structural diagnosis isn’t available and isn’t required to recover.

· "My back is fragile." The lumbar spine is one of the most robust structures in the body. Treating it like glass tends to make pain worse, not better.

· "Rest will fix it." Prolonged rest reliably makes chronic low back pain worse. Movement — even when it’s uncomfortable at first — is the intervention.

· "My posture is the problem." The research on posture as a cause of back pain is weak. There is no single "correct" posture; the best posture is your next one.

· "I need an MRI." Unless red flags are present, imaging usually finds incidental changes and makes things worse, not better.

What evidence-based chronic low back pain physiotherapy actually looks like

Here’s the model we use, anchored in Foster et al. (2018) and the RESTORE trial of Cognitive Functional Therapy (Kent et al., Lancet 2023) — a landmark, rigorously designed trial that showed clinically meaningful, durable improvements in disabling chronic LBP at 13 weeks and at one year.

1. A thorough, biopsychosocial assessment

We screen for red flags (cancer, fracture, cauda equina, infection, inflammatory disease) first. Then we look at your movement, your strength, your provocations and easers, and — just as importantly — your beliefs, sleep, stress, and goals. This isn’t soft. It’s what current best-practice guidelines require.

2. Pain education that actually changes things

Understanding why your nervous system has become protective is one of the most reliable interventions in the literature. It’s not a lecture; it’s a working framework for why a flare-up doesn’t mean damage, and why graded loading is safe.

3. Cognitive functional principles: graded exposure and reframing fear

The RESTORE trial demonstrated that a treatment approach combining education, graded exposure to feared movements, and addressing the beliefs and behaviours that keep pain running — Cognitive Functional Therapy (CFT) — produced significantly better outcomes than usual care, with effects that persisted at 12 months. We apply these core principles in our care: identifying the movements you’ve started to avoid, rebuilding the confidence and capacity to do them, and addressing the protective patterns that keep the pain loop running.

4. Exercise — the kind matters less than the doing

The 2021 Cochrane review on exercise for chronic LBP (Hayden et al.) pooled 249 trials and ~24,000 patients. Exercise consistently outperforms doing nothing. The 2023 network meta-analysis from the same team found Pilates, McKenzie, and functional restoration to be among the most effective types — but the more important point is that you doing exercise consistently matters far more than which type you pick.

5. Manual therapy, where it adds value

Hands-on work — joint mobilization, soft tissue techniques — can reduce short-term pain and improve mobility, which often opens the door for the active work that actually changes outcomes. It’s a tool, not the plan. If a clinician is doing only this, you should ask why.

How long does it take to feel better?

Honest answer: most people notice meaningful change within 4–8 weeks of consistent work, but "recovery" from chronic LBP isn’t a single endpoint. It’s a gradual rebuild of capacity and confidence. Flare-ups still happen — and the goal is not to eliminate them but to make them shorter, less scary, and less limiting.

The biggest predictors of a good outcome aren’t age, scan findings, or pain severity. They’re engagement, consistency, and a clear plan.

When you actually do need imaging or a doctor

Get medical assessment immediately if you have any of these:

· Loss of bladder or bowel control, or saddle numbness

· Progressive weakness or numbness in the legs

· Fever, unexplained weight loss, or a history of cancer

· Significant trauma (fall from height, motor vehicle accident)

· Pain that wakes you consistently at night with no positional relief

Without those red flags, the data is clear: routine imaging makes things worse, not better, in most cases of chronic back pain.

Frequently asked questions

Should I see a chiropractor or a physiotherapist for chronic back pain?

Both can help in the short term. For long-term recovery from chronic low back pain, the evidence favours active rehabilitation — exercise, education, graded loading — which is core physiotherapy practice. If you’ve been seeing any clinician for months without lasting change, the issue likely isn’t that you need more of the same passive treatment; it’s that passive treatment alone doesn’t change chronic pain. The active components matter more than the discipline.

Can chronic low back pain be cured?

“Cured” is the wrong frame. Many people experience substantial, durable reductions in pain and disability — to the point where back pain stops limiting their life. Some have flare-ups indefinitely but learn to manage them in days instead of weeks. The realistic goal is not zero pain forever; it’s confident function and the tools to handle setbacks when they happen.

Is walking good for chronic back pain?

Yes — and it’s one of the most underrated treatments. Walking improves blood flow, reduces stiffness, gently loads the spine, and is one of the few activities that consistently helps without aggravating. Start with what you can tolerate and build gradually. Twenty to thirty minutes most days is a reasonable target for most people. If walking specifically flares your symptoms, that pattern is worth assessing.

Will an MRI tell me what’s wrong with my back?

Usually not. MRIs of chronic low back pain almost always show something — disc bulges, degeneration, “wear and tear” — and these findings are present in large percentages of people with no pain at all. Imaging is useful when red flags are present (loss of bowel or bladder control, progressive weakness, suspected fracture or cancer). Without red flags, it tends to raise anxiety and lead to interventions that don’t improve outcomes.

How long does chronic low back pain last?

By definition, “chronic” means longer than 12 weeks. Many people have symptoms for months or years before getting effective care. With the right approach — exercise, education, graded exposure, and addressing fear — most patients see meaningful change in 4–8 weeks of consistent work, with continued gains over months. Pain trajectory is rarely linear; setbacks are part of recovery, not evidence it isn’t working.

Is it safe to exercise if my back hurts?

For non-specific chronic low back pain, yes — and the evidence shows it’s one of the most effective interventions available. The key is graded loading: start with what you can do, progress steadily, and don’t let pain dictate whether you exercise at all. Pain during exercise doesn’t mean damage. A clinician can help you calibrate intensity and select exercises that match your starting point.

Book a chronic back pain assessment in south Calgary

We’re located at 8989 MacLeod Trail SW, serving Haysboro, Kingsland, Acadia, Fairview, and the broader south Calgary community.

Your first visit is 45–60 minutes. We screen for red flags, assess your movement and function, ask the questions that often get skipped, and build an initial plan you walk out with. No mystery, no upsells.

If you’ve been told your back is fragile, that you need to avoid bending, or that an MRI will solve it — let’s have a more accurate conversation. The plan you actually need is straightforward; it just isn’t the plan most people are given.

About the author

Colin Bouma, PT, FCAMPT holds Fellow status with the Canadian Academy of Manipulative and Μusculoskeletal Physiotherapy — an advanced post-graduate qualification in orthopaedic manual physiotherapy held by only a small fraction of Canadian physiotherapists. He focuses on chronic and complex musculoskeletal pain at our south Calgary clinic on MacLeod Trail.

*This article is for general educational purposes only. It is not medical advice, does not replace individualized assessment by a qualified healthcare professional, and does not create a physiotherapist–patient relationship. Always consult a regulated healthcare provider before starting a new exercise program or making changes to your care.