Part 2: Chronic Low Back Pain in Active Adults: What’s Really Driving the Pain

Back pain doesn’t always come from what you think it comes from, and the “stretch that feels amazing” can sometimes keep the real problem going. Julie Schwenzer and I, Dr. Alexander Telfair, break down the most common drivers behind chronic low back pain in active adults, especially arthritis changes, spinal stenosis, and disc herniations, so you can stop guessing and start making smarter choices with movement and training.

We get practical about symptoms and patterns: what stenosis actually means, why it can cause numbness, tingling, radiating leg pain, or weakness, and how flexion-based positions can often provide relief by opening space in the spine. Then we contrast that with many herniated disc presentations, where careful extension-oriented movement can be a better strategy even if flexion feels good in the moment. If you’ve ever thought, “Why does the thing that helps today make me worse tomorrow?” you’ll recognize yourself here.

From there, we lay out the conservative care mindset: restore mobility, address soft tissue limits, and build a stronger foundation with core strength, glute strength, and low back endurance. We also talk about simple at-home exercise frequency that actually fits real life, plus prevention tools like Pilates, yoga, and intentional resistance training. We close with the non-negotiables: red flags like bowel or bladder dysfunction, saddle numbness, or significant leg weakness that should trigger prompt evaluation and likely imaging, and how factors like alcohol, nicotine, and obesity can reduce healing potential and affect outcomes. 

If you found this helpful, subscribe, share it with a friend who keeps “tweaking” their back, and leave a review with your biggest low back pain question so we can tackle it next.

To learn more about Telfair Chiropractic visit:
https://www.TelfairChiropractic.com
Telfair Chiropractic  
630 S Orange Ave, Ste 300B, Sarasota, FL 34236  
941-685-2415 

Transcript

Welcome And Who This Helps

SPEAKER_00 0:00

Welcome to the Sarasota Pain Podcast with Telfair Chiropractic, hosted by Dr. Alexander Telfair. This is the show for active adults who want to move better, feel better, and stay in the game. Without jumping straight to extreme solutions, because let's face it, your body might have a few miles on it, but it's far from retired. Here we help you optimize your potential. One podcast at a time.

Why Low Back Pain Lingers

SPEAKER_02 0:27

Chronic low back pain can sneak up on even the most active adults, and often the real causes aren't what people expect. Today we're breaking down the underlying issues that keep pain lingering and what active adults should know about staying strong, mobile, and injury resistant. Welcome. I'm Julie Schwenzer, co-host and producer, here with the awesome Dr. Telefair, the chiropractic physician at Telefair Chiropractic. And we're really happy to talk to you because this is a topic so many active adults struggle

Arthritis Wear And Tear Basics

SPEAKER_02 0:55

with. Why is arthritis so common? It's so common.

SPEAKER_01 1:01

Well, people think of it like a disease. It is, I guess, technically a disease process. We use our bodies, you know? It's like you use a car for 100,000 miles, it's gonna get worn. You know, that's kind of like it's arthritis. And you know, with a car, you can replace parts. And we do that with humans sometimes, but it's different because we're biological entities and they're you know metal. So generally speaking, with anything, um, you know, gravity, uh, that sort of stuff is gonna be is you know, it's gonna cause wear and tear. And it's gonna happen with anything. I mean, it's just that with us, we can't really just replace stuff, you know.

Spinal Stenosis Symptoms Explained

SPEAKER_01 1:36

Um but yeah, so a stenosis, it's simply gonna be compression of the spinal cord, right? So you have the vertebrae, and then behind the vertebrae, there's like this hole, right, where you have like uh, you know, other elements of that segment, right? And uh and that's you know, your spinal canal. And that goes from the brain all the way down to your to your low back, essentially, right? So essentially that's where spinal cord gets compressed, and that can cause symptoms such as weakness in the legs, uh, you know, ridicular pain down the legs, so numbness, tingling, stabbing pain down the legs, and that sort of thing. And so that's kind of the gist of stenosis. Um, again, it could be due to many things. It's generally gonna be uh, you know, wear and tear arthritis that results in it, whether it's ligamentous in nature or bony, um, or due to vertebral shifting, right? Could be trauma-oriented. There's many causes of it for sure. And that it's important for the practitioner to determine what the cause is because that's how you maximize treatment outcomes.

SPEAKER_02 2:37

Do you find um people that are then long-term athletes are more susceptible to that or not really?

SPEAKER_01 2:44

Not necessarily. Honestly, it's it's people that um because they're you know, the body loves habit and they've generally been in a habit of being very fit and working out. And yes, they can be more prone to arthritis, but that's a hard question to answer because there's also your people that they sit at work nine to five, sit in a chair, they go hit the gym hard, lift heavy weights. I'd say they're probably more prone to because their bodies go from like a sedentary lifestyle to to heavy weight bearing, and uh the body's not a huge fan of that. And and I'm not saying not to lift weights by any means, it's just uh it's it's just hard to be honest with you. Um, and you just have to have weights at our desk.

SPEAKER_02 3:19

We should have weights at our desk and standing desks and all that type of stuff.

SPEAKER_01 3:23

Yeah, take breaks about the day.

SPEAKER_02 3:24

That's why I'm fans of dogs at work, you know. You gotta go out and walk the dog, take your breaks.

SPEAKER_01 3:28

Yeah, you force breaks 100%. Yes, yes, 100%. So, but yeah, so that's uh that's stenosis in a nutshell.

Flexion Relief For Stenosis

SPEAKER_01 3:35

And then sprains and strains are kind of self-explanatory. That's just, you know, again, ligaments or muscles, and uh, we work on increasing range of motion with those, and really increasing strength is most important. With um stenosis, I would say the key takeaway is if you have that diagnosis, generally speaking, flexion, so just bending over and touching your toes, laying in bed on your back and bringing your knees to chest, uh, doing the cat portion of cat cow, stuff of that nature, baby pose, right? Uh getting into some yoga stuff, that's all gonna be kind of your relief position because flexion is widens the spinal canal and takes pressure off the cord, right?

Extension Strategy For Disc Herniation

SPEAKER_01 4:12

And then in terms of herniations, generally speaking, your uh preferred motion pattern is gonna be extension oriented, so kind of leaning back, right? And the reason being is that most herniations occur backwards, and that's why they cause nerve pain because the nerve root from the spine, if you're keeping up, comes out of like that back, uh, you know, if it's 12 o'clock, six o'clock, right? In the back is six o'clock, it's gonna be coming out at like seven to eight o'clock on that thing, right? Okay, and so that's where the herniation generally occurs. And there's also inherent kind of weaknesses in the ligamentous structures and whatnot in the spine that result in that. And so what we want to do is lean back and kind of push into that disc material so that we force it forward instead of having it back into the nerve, if that makes sense, right? Um, a lot of people feel like flexion relieves their symptoms when they have a disc injury that's resulting in nerve root irritation, and it's complicated because what happens is the nerve gets irritated and then the muscles tighten up a lot to help with the integrity loss from that disc injury, right? But what they're doing is they are relieving the symptom, but they're provoking the cause, right? And so it's definitely confusing, especially for the patient when I say don't do that, and they're like, Oh, but it feels good. And I'm like, Yeah, but it feels good, but you're actually causing this to become probably worse than it already is, you know, and sometimes extension doesn't feel the greatest, but the more they do it, generally the easier it gets. And eventually we do get back to flexion, we do get back to loaded flexion. The spine is strong, it's durable, it's adaptable, um, 100%, but it takes diligence, it takes intention, it takes drive to like really get that thing better to the point where you can go do what you want again in life, especially as we age, we're less efficient at healing and stuff of that nature.

Core Glutes And Low Back Rehab

SPEAKER_01 5:56

So that's kind of my spiel on those things. And generally speaking, the uh general rehab that's gonna be required is again gonna be soft tissue. There's gonna be some, you know, we want to increase mobility in that region, and we want to strengthen it. So strengthening for pretty much all those injuries is gonna be surrounding the core, the glutes, and the low back muscles, and then obviously, you know, some other muscles depending on uh patient specific details, you know, their presentation. But generally speaking, those are the three core areas we want to kind of hit on hard.

SPEAKER_02 6:26

So and with the rehab, are there also like specific activities that people can do at home if they don't have the equipment? Like you teach them how to, you know, do certain movements and everything and continue on and do and with your recommendations, do you also recommend that they do that for like the duration of their life? Like, is that is that it?

SPEAKER_01 6:47

That's a good question. Yeah, I get that a lot. My thing is is yes, I do give them exercises always. Again, my goal is to get people better in my office and teach them how to stay better outside of my office, and that way it's not the greatest business model I've learned because you know you you lose patience, but uh the retention's there and they come in when they need me. My goal is not to hold on to people. Um, if I put myself in their shoes, I want my doctor to get me better, teach me how to stay better, educate me in how to prevent reoccurrence. So I do teach them the exercises, and I usually say hit it hard for about a month, you know, be five times a week, be on it, incorporate it to your lifestyle. And from there you can go to like three times a week. And then, you know, from there, maybe a couple times a week or even as needed. I would say probably to stay safe. I would say you want to stay with like three times a week, you know, just like maintenance, uh, keep up with the strength. And that's in a perfect scenario. I mean, if you do that sort of thing, you'll be in very good shape. Obviously, it depends on if they're high-level athletes versus somebody that's just going for a bike ride every now and then. There's going to be different implications for long-term uh rehab requirements for those.

SPEAKER_02 7:52

Sure.

When Pain Becomes Chronic

SPEAKER_02 7:53

And if you could expand on this, you did already touch on this, but if patients can um help identify if their back pain is becoming chronic rather than it's just a temporary issue. What are those signs again?

SPEAKER_01 8:06

So the definition of chronic pain with any region is gonna be pain that lasts greater than 12 weeks or three months without subsiding, essentially. Right? There's been no change in that. And that's essentially what that means is the body's gotten into a state where it's tried to heal it and it's been resistant, and now it just says, you know what, we quit. We're just gonna throw us some scar tissue here, we're gonna move on. And uh sometimes it's good, other times it's not, in the sense of, you know, some people are able to move on and live their life the way they want to. The body heals enough, so to speak, and sometimes the body leaves it like uh half done building and the funding gets pulled from construction.

SPEAKER_02 8:42

Well, I appreciate everything you're doing because you know, people being able to avoid surgery and being able to, you know, address the issue like you know, in this manner is wonderful. Um, what any recommendations too for um helping if somebody does not have an issue in prevention is like uh Pilates. Is that something you recommend? Are there any other things that you you love as a chiropractic physician?

SPEAKER_01 9:07

Yeah, I would definitely I like Pilates, I like yoga. Um, just movement is medicine and resistance training is fantastic. And again, form and intention with movements is huge. We're not at the gym just going, you know, that kind of thing. Like we're really, we're really trying to be intentional with our with our movements and stuff of that nature. I would say that, and then in terms of prevention, I would say just you know, pay attention to yourself, like you're your own best doctor at the end of the day. Um pay attention to little signs and symptoms and just focus on form and be intentional with your health. Treat your body like it's the only one you get because uh that is just the truth,

Prevention Plus Red Flags To Image

SPEAKER_01 9:41

you know. Um, and then lastly, something I wanted to hit on chronic low back pain is not always conservatively manageable, right? We always want to trial it for about three to six weeks, but sometimes, you know, there's cases or God forbid there's red flags, such as bowel or bladder dysfunction, issues using the restroom. Uh if you have something called saddle paresthesia, so that's kind of like numbness tingling, kind of going from uh both hamstrings into the buttock region, right? Or if you have like bilateral leg weakness or significant leg weakness, those are all indications for further evaluation and management, right? Certainly imaging to figure out what exactly is going on because those can be life-altering symptoms, right? Something like cautochinus syndrome or something of that nature, right? So it's essential that the doctors consider that sort of thing, or there's other conditions where you might have arthritis, right, causing uh a bony growth, right? Because essentially that wear and tear in the human body, there's a law called Wolf's Law. The more that you demand from a bone, it's gonna adapt to those habits, essentially, is what it is, right? So kind of like you know, working out. When you work out a muscle, it's gonna get stronger. When you wear on a bone, there's gonna be more mineral deposition onto that bone, right, to try to make it stronger. And so when we wear on a bone here, right, it's gonna start to grow like kind of like an icicle or what they call an osteophyte or spondylophyte, there's a bunch of terms for it, but generally an osteophyte is what they call it, and the spine is a spondylophyte, but nonetheless, that can impinge on a nerve, and there's not a whole lot I can do conservatively to take a structure from impinging on a nerve. You know what I mean? Like a bony structure, because there's no moving a bone like that, right? Sometimes there's techniques you can use to like maybe reposition that area somewhat or help the patient kind of prevent movement patterns that are associated with symptoms, but generally that might require some like uh it's usually a minimally invasive surgery, but that could definitely be surgical and can be some very intense pain for sure. So it just depends on the presentation. It's important that the doctor does their due diligence in determining what the cause of their pain is.

SPEAKER_02 11:44

This is great because you've been really helpful in breaking down the causes of lower back pains.

Alcohol Nicotine Obesity And Healing

SPEAKER_02 11:49

But I had a question that some people won't like, and my question is about alcohol, nicotine, other diet. Like, so how much I mean, obviously that that affects the whole body and our mind and everything, but what about when it comes to back pain?

SPEAKER_01 12:04

Hmm. That is a tough answer. They could be factors that decrease healing potential. I mean, there's so much mixed literature on nicotine and stuff of that nature in terms of like there could be cognitive benefits, but also there can be other deleterious risks with it. And then alcohol is just bad in general. Like, obviously, everybody does it, but there's no good amount of alcohol you can ever intake. It's literally you get that feeling because it's toxic to your body, you know. Like that's you know, why you start to get mildly poisoned, essentially, is why we get this feeling.

SPEAKER_02 12:38

It slows the healing, like if your body is trying to heal itself, it slows it makes everything uh just less efficient.

SPEAKER_01 12:45

You're just like you get a little foggy, your cells get a little foggy and are kind of like, what are we doing? You know, so essentially, yeah, that that's kind of I don't I can't really give a direct answer on that.

SPEAKER_02 12:55

Um you did talk about obesity. Obesity is uh, yeah, that's well, that's different.

SPEAKER_01 13:01

That's not like it inhibits a healing process, it certainly can result in increased inflammation. That's more so like there's more weight on that joint, and therefore it wears and tears, and therefore arthritis, you know, uh progresses. And generally the people with that are gonna be more sedentary, which again, you know, bones respond to demands, and if they're not being worked, they're gonna get kind of weaker and you're gonna be more prone to that weight causing arthritis. Those are complicated subjects because they're variables, and I would say it depends on severity of usage, chronicity of usage, even the type of uh alcohol or whatever. And there's no direct correlation between the two, I would say. But they're definitely factors that can result in decreased prognosis or outcomes for somebody, right? Especially if they're heavy users.

SPEAKER_02 13:45

Sure. Well, thank you for breaking this down and like the different types of common causes of back pain, because that's very helpful, and you've probably given people hope, you know, that they can feel better if they've been dealing with this for a while, and that's what we need.

SPEAKER_01 14:00

Yeah, absolutely. I hope so. Yeah.

SPEAKER_02 14:02

Well, yeah, thanks again for breaking that down so clearly. Chronic low back pain is something so many people deal with. So this has been very helpful. Thank you, Doctor.

SPEAKER_01 14:10

Of course, thank you, Julie.

Closing And How To Book

SPEAKER_00 14:11

Thanks for listening to the Sarasota Pain Podcast with Telfair Chiropractic. If pain is slowing you down, Dr. Alexander Telfair at Telfair Chiropractic specializes in conservative, comprehensive care designed to keep you active, mobile, and doing what you love without unnecessary procedures or downtime. Because the goal isn't just to feel better, it's to move better, live stronger, and truly optimize your quality of life. For more information or to schedule your visit, go to Telfairchiropractic.com or call 941 685 2415. Until next time, keep moving, keep improving, and remember a well maintained body performs better than a brand new excuse.