Is Low Back Pain Forever?

I was recently having a conversation with a friend of mine about a client that I was working with was having hip pain, but I had recently determined that the pain was coming from her back. He looked at me wide eyed and said,

“Oh man, that’s bad right?”

And when I asked, “Why do you say that?”

He said something that I’ll never forget:

“Well, back pain is sort of forever right?”

Sound familiar? This perception about low back pain certainly exists out there, but I was surprised that my friend believed this idea, but maybe this is because I have helped many people significantly improve or completely resolve their low back pain. There are certainly cases of chronic low back pain that can be persistent, but that is actually a relatively small percentage of the total amount of people who experience low back pain at some point in their life. In fact, more than 80% of people will experience low back pain at some point in their life.(1) The good news is that the likelihood of those people achieving “pain free status” is quite high.

According to Downie et al, almost 40% people experiencing acute low back pain were completely pain free after 6 weeks and by the end of 1 year that probability rose to 72.5%.(2)

And even those who do not get better right away who develop chronic low back pain have decent odds of improving. Costa et al followed a group of 406 patients with chronic low back pain (without nerve pain) and found that 41% of them reported complete recovery within 1 year.(3)

So how to people who develop low back pain get better? The evidence tells us that these are the top treatments for acute low back pain:

1. Education about low back pain and reassurance that it will likely get better

2. Avoiding bed rest and resuming normal activities

3. General exercise and specific exercises targeting the core muscles

4. Manual Therapy

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Some notes on imaging:

There is a growing body of evidence highlighting the limitations of imaging in helping to treat low back pain more effectively. Here are some conclusions from recent research that might surprise you:

1. Learning about the “damaged structures” found on your MRI might worsen your overall treatment outcome!(4)

2. The findings on your MRI might not be the source of your pain.(5)

3. Degenerative spinal changes are commonly found in patients with and without LBP.(5)

X-rays and MRIs can be helpful for the <1% of people who have low back pain with severe or progressive neurological deficits, but most people with low back pain don’t need it.

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All of the top 4 treatments of low back pain can be provided by a physical therapist. It’s important to note that the outcomes for treatment of acute low back pain are much better than those of chronic low back pain. This means that getting EARLY treatment can be very helpful at improving your likelihood of recovery. Chances are, if you develop low back pain, you will end up seeing a physical therapist at some point. In the insurance based model, that process can sometimes look like this:

In the out-of-network model for physical therapy, the process looks like this:

So to the question “is low back pain forever?” I say, for most people, no it is not!

Working with Alterra enables you to get treatment faster than the traditional PT model, and getting early treatment decreases your likelihood of developing chronic low back pain. Interested in working with us? Get Started

Disclaimer: The information provided in this blog post is for general informational purposes only and is not intended as medical advice.

Sources

1. Freburger JK, Holmes GM, Agans RP, et al. The Rising Prevalence of Chronic Low Back Pain. Arch Intern Med. 2009;169(3):251–258. doi:10.1001/archinternmed.2008.543

2. Downie, A. S., Hancock, M. J., Rzewuska, M., Williams, C. M., Lin, C. W. C., & Maher, C. G. (2016). Trajectories of acute low back pain: A latent class growth analysis. Pain, 157(1), 225–234. https://doi.org/10.1097/j.pain.0000000000000351

3. da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012 Aug 7;184(11):E613-24. doi: 10.1503/cmaj.111271. Epub 2012 May 14. PMID: 22586331; PMCID: PMC3414626.

4. Jordan, M. (2021). The Lumbar Spine : Evidence-Informed Physical Therapy Patient Management The Lumbar Spine : (5th ed.; G. Simoneau, ed.). Ortho Division, APTA

5. Wáng, Y. X. J., Wu, A. M., Santiago, F. R., & Nogueira-Barbosa, M. H. (2018). Informed appropriate imaging for low back pain management: A narrative review. Journal of orthopaedic translation.