Warning–That Episode of Low Back Pain Will Likely Be Back

As a chiropractor, this issues hits near and dear to my heart.  When someone develops an episode of low back pain for the first time in their lives, one of three things happens.  The patient ignores it hoping it will go away.  Or, they see a non-chiropractor (PCP, ortho, PT, massage therapist, etc..) for that episode.  Or, they choose to see a chiropractor.
Which one you choose may well determine what happens for the rest of your life.

The prevailing wisdom states that most cases of acute low back pain will resolve spontaneously within 4-6 weeks.  And that’s it.  No more worries.

However, what do many people do in this situation?  The typical response may include rest, maybe some ice and some type of over the counter analgesic.  If it’s not better in a few days or weeks, a trip to urgent care, the ER or the primary care physician may result with a high likelihood of these getting a morphine derivative prescription inappropriately (such as Percocet, hydocodone or Vicodin).

Let me relay a personal experience that happened recently.  My 10 year old pug got pushed down an entire flight of stairs by my 55 pound muscled pit bull mix.  I watched in horror as he literally rolled end over end and crashed on the landed.  He could barely move.  I immediately picked him up and settled him down, but he was having much difficulty with walking on both back legs and his right front leg.  Not good.  Xrays were imminent if this did not resolve quickly.

No ice.  No OTC pain meds.  I did adjust him that night.  He also refused to sit still and continued to follow me through the house as he normally did.

Within 3 days you’d have no idea anything had happened to him.

How would most of us have handled a tumble down a full flight of stairs?  Quite differently, I’m sure.  But how much of our “typical” behaviors following an episode of low back pain actually promote chonicity?  This particular study sheds some light on how untrue our assumptions about what happens to those who suffer their first episode of low back pain are.

In this study of 605 patients who sought care for an episode of acute low back pain:

  1. 8% declared sick leave
  2. 13% experienced chronic pain at 6 months
  3. 19% experienced chronic pain at 2 years
  4. At 6 months, 54% had experienced at least 1 LBP recurrence
  5. Another 47% had experienced at least one flare up in the next 18 months

These are not good numbers.  This is my personal opinion based on my own experience, but I feel that these numbers are so high because there was no actual treatment designed to address the problem.  Anti-inflammatories do not address the problem (after all–did you have inflammation and THEN an injury?) and are very, very likely to make it worse because they interfere with the normal healing process.

Rest is extremely bad for acute episodes because it allows any injury to the fascia to thicken and perpetuate the dysfunction.  Although the pain goes away, the changes to the fascia are sitting there, just waiting for the next “wrong” movement.

The answer?  Get into your chiropractor ASAP.  This is not my opinion as the evidence suggests that this produces better outcomes.  Get treatment that includes soft tissue methods combined with adjusting to address all aspects of your condition and get back to activity as quickly as possible.  Make sure you’re in the OTHER 50%…

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.