Sports Medicine Approach to Low Back Pain

Mathew W. Lively, DO

South Med J. 2002;95(6) 

In This Article

Natural History

Low back pain is often considered to be a self-limiting condition that resolves after an acute episode without any long-term disability. Frequently cited data show that 80% to 90% of patients with acute LBP recover within 12 weeks, regardless of the type of treatment administered.[1,2] Although encouraging for LBP recovery, this information can also be misleading because it largely reflects only those patients who return to work and stop seeking medical treatment. When pain is used as the outcome measure to define LBP recovery, a different situation is presented. Less than 50% of patients with acute LBP are pain-free after 1 month,[3,4,5] and after 3 months more than 40% are still having discomfort.[5,6] Within 1 year after injury, more than 60% of patients will have had a relapse of pain,[7,8] 15% to 20% will have at least 1 episode of moderate to severe activity limitation due to pain,[5] and 29% will report a poor recovery outcome.[4] When followed up for 10 years after initial injury, more than 80% of patients will report recurrent LBP,[9] and a lifetime recurrence rate of 85% has also been reported.[1] Viewed together, the data on recovery would indicate that the majority of patients with acute LBP return to work within 3 months but that a substantial number of these individuals continue to have persistent or intermittent pain. Thus, in clinical practice, the traditional definitions of acute and chronic often fail to adequately describe LBP. It is becoming evident that LBP is not simply an acute disease that is cured with time but is more often a recurrent problem, similar to asthma, that has symptom-free periods interspersed with frequent exacerbations.[1,6,10] Health care providers treating LBP should be aware of its episodic nature and seek treatment methods that also help to prevent future occurrences.

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