What happens to back pain when you leave it alone?

Todd Lloyd
August 9, 2022

What happens to low back pain and neck pain if you just leave it alone without treatment? To answer this, we have to look at the old way of thinking versus the new way of thinking.

The older thinking about the natural history of low back pain was that 80% of workers out of work for low back pain returned to work within one month. This old way of thinking was used as a way for the insurance companies to deny care past the first four weeks of care. They used to say, "90% of people in low back pain are back to work within two months." They used to say that low back pain has a great natural history. The old way of thinking said that treatment beyond six weeks is not reasonable or necessary.

This old way of thinking came from early research that only looked at healthy young men with her very first episode of back pain. They only looked at return to work as a single quantifiable outcome. They did not evaluate pain, disability, or recurrences. The researchers did not look at older people yet, or people with a previous history of low back pain. Back then, they didn't study people who were deconditioning, had comorbidities, or fear avoidance beliefs and behaviors.

This old way of thinking about low back pain is fortunately behind us.

We now know that 2/3 of people who have had back in the past can be expected to have some kind of symptoms every year. Our understanding of back pain has evolved. Low back pain is not easily classified as either an acute self-limiting condition, or a chronic unremitting element. It is more typically a recurrent or intermittent syndrome that irrupt periodically over the course of a lifetime. The concept of back pain has undergone a dramatic shift in the dominant paradigm. Until 20 years ago, low back pain was considered purely by mechanical and involves looking for anatomic damage and finding ways of fixing it. This approach hasn't worked. The inadequacy of this model has led to a radical shift from thinking about low back pain as a biomedical injury to viewing it as a multi factorial biopsychosocial pain syndrome.

There is a myth of short term acute low back pain. The chance of having a recurrence of back pain after the first episode is more than 50%. Many recurrences are coming throughout your lifetime. More than 1/3 of the back pain population have a long-term problem. A person's experience of back pain may well encompass their life story. The high rate of recurrences, episodes, and persistence of symptoms seriously questions the myth of an acute-chronic dichotomy.

Back pain should be seen from the perspective of the sufferers lifetime. We should give such a perspective that the logic of self management is overwhelming. Single episode of acute low back pain has a favorable natural history. But, the course of low back pain for most people is recurrent rather than acute or chronic. Recurrence rates are high ranging from 60 to 86 percent in the first year.

These recurrent findings underscore the significance of early intervention that aims to prevent chronic problems. There's growing evidence that changes in motor control and function of trunk muscles may result in disorders as is a result of abnormal tissue for those living in pain. Stress, fear, anxiety, and depression are known to disrupt motor behavior. Controlling the neutral zone in lumbar motion and avoiding full lumbar flexion appear to provide protection from ligament injury and discriminations. Cocontraction of torso muscles is necessary for maintaining stability around the neutral zone.

What is the prognosis of back pain?

The interesting thing is that in a population, most people who have some sort of low back pain episode choose not to receive care. Those to receive care for low back pain is only a small proportion compared to those who suffer from back pain. 65% of American adults have back pain in one year, and 50% of American adults have neck pain in one year. Only 6% of American adults seek professional care from medical doctors, chiropractors, physical therapist, or osteopaths, in one year.

For those people who presents to the clinic for care, about 62% will continue to have pain in one year and about 16% it were initially off of work will still be off at six months. For people who have a new episode of acute low back pain, rapid improvements are common during the first month after consultation. Instead of looking at the most acute patients 75 to 90% recovered from pain and disability within weeks of seeking care and many off work or rapidly return to work. However, from a longer-term perspective, many patients have recurrence after an acute initial low back pain episode.

1/4 to 1/3 of acute low back pain patients the report symptoms 6 to 12 months after consultation. Chronic low back pain symptoms have a more persistent course with 2/3 not fully recovered one to two years after onset. 80% are still having pain at bay when your follow up. Studies of mixed primary care low back pain patients persistent rates are similar to chronic populations, reflecting the high proportion of primary care symptoms with long-term problems.

The one-year prevalence of low back pain is between 22% to 65%. In most cases of acute low back pain, and objective causes can't be found and are described as "nonspecific". Low back pain is commonly classified as a cute or chronic. Acute low back pain tends to improve with time and generally has a good prognosis, but improvement in pain and disability doesn't correlate well with return to work.

What you should do if you have back pain.

If you have a new episode of acute low back pain, then it's important to start getting back to regular activity as fast as you can. Get yourself checked out by a chiropractor, and get the proper x-ray or MRI imaging as needed. Make sure you have a thorough physical examination done, and this might include some sort of functional evaluation. Chiropractic care will help you restore motion to areas that have muscle splinting or other restrictions of normal range of motion. Your chiropractor will also work with you to provide spinal stabilization exercises exercising the muscles that provide stabilization and movement in your back and neck.

If you have chronic recurrent low back pain then you need to be proactive to take steps to avoid re-injuring your back with certain postures that you have adopted. And more importantly, it's important to return to normal physical activity to help strengthen and stabilize the muscles in your whole body. You need to realize that some of the pain that you experience is hypervigilant. You might be experiencing pain that does not cause soft tissue injury. If this is the case, you need to recognize where these locations are, and work towards improving your active range of motion that matches what you were able to do before the pain started.

A good chiropractor will work with you through his full scope of practice to strengthen and stabilize your spine as well as mobilize and improve nutrient delivery. And even with the best type of care available, it is still, they have recurring episodes of low back pain. If this is the case then you should know that being proactive about taking care of yourself is the best way to mitigate the possibility of the recurrence of pain, and to reduce the severity of symptoms.

Low back pain sufferer
This person suffers from recurring low back pain because it was mismanaged early on.
Todd Lloyd
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