Auteurs: By George Ellis, Chiropractor at Chiropractie Centraal, and Rico van der Kooij, Coach at 3rd Level Sports For many people with longstanding back pain, the biggest problem isn’t the pain itself. It’s what the pain slowly takes away. At first, it may be one movement in the gym. Then another. Before long, exercises disappear […]
Auteurs: By George Ellis, Chiropractor at Chiropractie Centraal, and Rico van der Kooij, Coach at 3rd Level Sports
For many people with longstanding back pain, the biggest problem isn’t the pain itself. It’s what the pain slowly takes away.
At first, it may be one movement in the gym. Then another. Before long, exercises disappear from your training programme entirely. Squats become “too risky.” Deadlifts are avoided. Long walks become less enjoyable. Even everyday activities such as getting out of a car, lifting groceries, or playing with your children start to feel like potential threats.
Rarely does this happen overnight. For most people with chronic back pain, the loss is gradual. Over months or years they slowly become less active, less confident, and less trusting of their body.
One of the biggest misconceptions about chronic back pain is that pain is only a physical problem. Pain is processed by multiple areas of the brain involved in emotion, motivation, memory, and threat detection. This is one reason chronic pain is commonly associated with fatigue, anxiety, reduced confidence, and low mood.
Anyone who has lived with persistent back pain understands this. When movement hurts, exercise becomes harder. When exercise becomes harder, motivation drops. And when activity levels fall, physical capacity often follows.
This can create a cycle that is difficult to escape: Pain → Fear → Less Movement → Deconditioning → More Pain
We know exercise is one of the most powerful tools available for improving long-term health. We also know that telling someone with chronic back pain to simply “join a gym” is often unrealistic.
The reality is more complicated. Exercise can make pain temporarily worse. If every training session leaves you in pain for the next two weeks, you’re unlikely to continue training long enough to experience the benefits.
The goal is not to avoid all discomfort. The goal is to find the amount and type of exercise your body can currently tolerate and gradually build from there.
Too little exercise can delay progress.
Too much exercise can create setbacks.
Finding the middle ground is where professional guidance becomes invaluable.
One of the most important concepts in chronic pain rehabilitation is fear avoidance. Before you make a movement, your brain constantly assesses whether it believes that movement is safe. If your brain predicts danger, it can alter muscle activity before the movement even occurs. Muscles may tighten, movements become stiff, and range of motion becomes restricted.
Immediately after an injury this can be protective. If you sprain your ankle or injure your back, your body naturally wants to protect the affected area. The problem occurs when this protective pattern continues long after the initial tissue injury has healed.
In chronic cases the inflammatory phase and tissue healing phase are often long over, yet the brain may continue acting as though the body is still under threat. This can lead to excessive muscle tension, altered movement patterns, reduced confidence, and avoidance of activity.
Ironically, these protective behaviours can contribute to the continuation of pain. A joint that is constantly guarded and not moving normally may become stiffer and more sensitive. Over time this creates a vicious cycle where fear of movement helps maintain the very problem people are trying to avoid.
At Chiropractie Centraal, exercise is almost always part of a personalised care plan. For many patients this starts with a small number of home exercises that can easily be incorporated into daily life. These exercises help improve mobility, stability, movement confidence, and overall function.
For some patients this is enough. For others it is only the beginning. Many patients want more than simply reducing pain. They want to return to the gym, play sport, improve strength, lose weight, or build a body that is resilient enough to enjoy life for decades to come.
In those situations, strength training can be one of the most effective interventions available.
The challenge is rarely deciding that exercise is beneficial. The challenge is implementing it correctly.
Questions we regularly face include:
Which exercises are appropriate?
Which movements should be modified?
How much weight should be used?
How much discomfort is acceptable?
Is this normal muscle soreness?
Is this a flare-up?
Should we progress or regress the programme?
Take the McGill Big Three as an example. We commonly prescribe these exercises as part of a core strengthening programme. But what happens if they increase symptoms? Is that acceptable? Should the exercise continue? Should it be modified?
There is rarely a simple answer. Some discomfort during rehabilitation is often normal and should not automatically be feared. The key is staying within the patient’s current capacity and progressively expanding that capacity over time.
This process is highly individual. Without ongoing assessment and modification, setbacks frequently occur. When setbacks happen repeatedly, many people simply give up.
This is exactly why we regularly collaborate with Rico van der Kooij at 3rd Level Sports.
At Chiropractie Centraal, we assess spinal function, movement patterns, neurological signs, and factors contributing to pain. Rico brings something equally important to the table: the ability to transform that information into a practical, personalised exercise programme that can be adjusted session by session.
When we share a patient, communication is ongoing. We discuss progress, setbacks, which exercises appear beneficial, and which movements need modification. When necessary, multiple chiropractors within our network may provide input, particularly if a clinician has additional expertise relevant to that individual’s condition.
The patient doesn’t simply receive chiropractic care or fitness coaching. They receive a collaborative team approach.
One patient, a man in his early forties, had experienced chronic lower back pain for years following a lumbar disc herniation. Although his most severe leg symptoms had improved, he remained terrified that they would return.
His back felt unstable. Most days he experienced moderate lower back pain which worsened towards the end of the workday. Every few weeks something seemingly insignificant would trigger a major episode: getting out of his car, bending awkwardly, or rotating while lifting something light.
He would then spend several days severely restricted. This pattern had repeated itself for years.
At Chiropractie Centraal we began working on spinal movement and reducing pain sensitivity through an individualised plan of care. His daily pain improved by approximately 30%. More importantly, flare-ups became less frequent.
However, he still lacked the confidence and resilience he needed. That was when we referred him to Rico.
The challenge was not exercise itself. The challenge was determining which pain was acceptable and which pain was not. Because he had never trained seriously before, almost everything produced some level of soreness or discomfort.
There were frequent discussions between ourselves, Rico, and the patient:
Was this muscle soreness?
Was this referred pain?
Was the disc being irritated?
Should training progress or be reduced?
Several findings pointed us towards adaptation rather than reinjury. For example:
Coughing and sneezing did not increase symptoms.
Pain did not travel below the knee.
There was no numbness or tingling.
Symptom increases often followed increased training loads.
One severe flare-up improved dramatically after a lumbar adjustment, suggesting muscle guarding and movement dysfunction were major contributors.
Together, these findings gave us confidence to continue progressing the programme.
Over time, his resilience improved dramatically. At the beginning of treatment, getting out of a car could trigger several days of pain. After consistent chiropractic care and progressive strength training, that same movement became completely uneventful.
His daily pain levels dropped significantly. Flare-ups became less frequent, and when they did occur, they required substantially more loading than before. Most importantly, he trusted his body again.
One aspect of Rico’s coaching that consistently stands out is the attention he gives to every client. His small class sizes allow detailed observation of movement quality, technique, progress, and symptom responses. For complex rehabilitation cases, this personalised attention is invaluable.
Every exercise can be modified.
Every concern can be addressed immediately.
Every success can be built upon.
The result is a fitness programme that is tailored, personalised, and surprisingly approachable.
Another significant advantage is access to multiple training sessions each week. Not everyone with chronic pain can tolerate three heavy workouts. Sometimes shorter, lighter, more frequent sessions are far more effective. This flexibility helps patients remain active while still managing symptoms appropriately.
Many patients who could benefit enormously from strength training never start because gyms feel intimidating. They’re worried they won’t know what to do, that they’ll look foolish, or that they’ll make their pain worse.
Rico creates an environment that removes those barriers. The one-to-one introduction, small group setting, relaxed atmosphere, and supportive coaching make exercise feel accessible rather than intimidating. For someone recovering from a complex pain condition, that can make all the difference.
If you’re struggling with chronic back pain in Den Haag, Scheveningen, Zeeheldenkwartier, Statenkwartier, Voorburg, or Rijswijk, it is important to understand that persistent back pain rarely has a single cause or a single solution.
Many people benefit from a combination of chiropractic care and personalised exercise. At Chiropractie Centraal, we frequently help people who have tried rest, medication, or simply waiting for the pain to disappear.
Unfortunately, long periods of inactivity often make chronic back pain more difficult to overcome. Our goal is to help patients move better, move more confidently, and develop long-term physical resilience. For many people, the combination of chiropractic care and professional fitness coaching provides exactly that.
One of the saddest consequences of chronic back pain is that it robs people of activities they value. Exercise is not just about reducing pain. It’s about maintaining freedom.
As we continue living longer, an important question becomes: What do you want your life to look like at 70?
Do you want to travel?
Walk long distances?
Play with your grandchildren?
Remain independent?
Enjoy retirement rather than simply endure it?
Strength, mobility, fitness, and confidence are some of the best investments you can make in that future.
Chiropractic care and strength training are not competing solutions. They are complementary tools.
When pain is limiting movement, chiropractic care may help reduce symptoms and improve function. When movement becomes possible, progressive strength training can build resilience, confidence, and capacity.
Together, they form a powerful strategy for overcoming persistent back pain. The goal isn’t simply having less pain. The goal is getting your life back.
George Ellis is a chiropractor and owner of Chiropractie Centraal, a network of chiropractic clinics in the Netherlands focused on evidence-informed care, movement rehabilitation, patient education, and long-term spinal health.
Rico van der Kooij is a fitness coach and founder of 3rd Level Sports, helping clients improve strength, fitness, health, and quality of life through personalised coaching and small-group training.
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