Chronic low back pain: a movement plan for Veterans

Before your appointment

You do not need to train like an athlete to make a plan worth following. Getting through a grocery trip or standing long enough to make breakfast can be a meaningful goal.

How long does back pain last before it is chronic?

The VA/DoD patient guide describes low back pain lasting more than 12 weeks as chronic. That label describes duration; it does not identify the cause. Contact your clinician when pain is not resolving, and sooner if symptoms are worsening. VA/DoD low back pain guide.

Start with the task you want to do

Before your appointment, finish this sentence: “I want to be able to ___, but right now ___ gets in the way.”

For example: “I want to attend my granddaughter’s game, but sitting on the bleachers becomes difficult.” That gives your therapist a specific problem to discuss. Bring notes about how long you can sit, whether changing position helps, and how you feel afterward.

Also mention equipment, transportation, or scheduling problems. An exercise plan that requires a pool you cannot reach needs a different starting point.

Ask for a plan you can explain back

Ask your therapist to write down:

• The activity: Which movement or everyday task should I practice?
• The starting amount: How many repetitions or minutes, and how often?
• The adjustment: What should I change if symptoms increase during or after it?
• The limits: Which symptoms mean I should stop and contact you?
• The review: When will we check whether this is helping?

VA/DoD guidance supports activity and exercise, with advice from a health professional before starting a new program. A physical therapist can help select exercises appropriate for you. VA/DoD exercise guidance.

Should I copy core exercises from a video?

Bring the video to your appointment and ask whether the exercise fits your situation. A demonstration cannot assess your back or set your starting dose.

In the source interview, Stuart McGill discusses matching training to a person’s goals and capacity. Much of the conversation concerns athletes and heavy lifting. The practical takeaway for a patient is to ask for an individualized plan, not to copy an athlete’s routine. Interview, around 15:15.

How can my VA team help?

Ask your primary care team whether physical therapy or another pain service would help. Describe what you have already tried and what happened. The Valor guide to chronic pain care through VA explains where to start; the Community Care guide covers questions about care outside VA.

If you already see a community therapist, ask who will send progress notes to VA and who should adjust the plan. Keep the same goal visible to both teams.

When should I seek urgent help?

New weakness, fever, or new trouble urinating or controlling your bladder or bowel needs urgent medical assessment. Do not treat these as an ordinary exercise flare. NIH pain guidance.

Your next step

Next step: Write down one daily task you want help with and ask your VA team for an assessment and a practical movement plan.

Source and scope

Adapted from Strength Chat Podcast #2: Dr. Stuart McGill, uploaded by Chris Duffin in 2016. Caption sections 02:11–03:50 and 15:15–17:32 informed the questions about evaluating advice and matching activity to the person. The source was reviewed through automatic captions, not audiovisual playback. This guide provides education, not an exercise prescription or a diagnosis.