About one and seven adults in the US have chronic low back pain. Chronic low back pain is categorized as pain lasting longer than three months. This can have a huge effect on a person’s ability to carry out daily tasks and activities. It is very important to identify the factors that are associated with a heightened risk for developing chronic low back pain from acute low back pain.
A review done in 2020 found that 26% of patients who receive treatment for new onset low back pain will still have the back pain three months later. A third of these patients will continue having low back pain even at the six month mark.
A study done in February 2021 looked at data from 5233 acute low back pain patients. They found that 32% transitioned into chronic low back pain. Further research found that there are some risk factors for developing chronic low back pain. These include: smoking, obesity, severe initial disability, depression/anxiety, and a high score on the start back screening tool. This tool looks at nine specific items.
These are as follows:
- pain in the leg, shoulder and neck pain,
- difficulty walking on distances,
- difficulty getting dressed,
- fear of physical activity,
- worrisome thoughts,
- despair about condition improvement,
- reduced ability to enjoy hobbies and activities,
- and bothersome pain.
Researchers also found that exposure to care outside of current guidelines in the first 21 days of the pain can raise the risk by up to 2.16 times.
So let’s go over the current recommendations for acute low back pain. Current guidelines recommend that all provider types offer reassurance in order to lessen fear of movement in patients. It is also encouraged that patients maintain normal activity as tolerated. Non-pharmacological treatments including ice, heat, spinal manipulation, massage, and acupuncture are recommended first line treatment options. Patients should avoid diagnostic imaging, specialty consult, and prescription opioids.
Doctors of chiropractic will perform manual therapy such as spinal manipulation to reduce pain and improve low back function. Chiropractors will also look for dysfunction in other associated areas of the body that commonly co occur with low back pain. Those who have tight hamstrings could be more likely to develop low back pain, and hip issues are also often present in low back pain patients. Chiropractors will encourage patients to become or stay active and engage in at home exercises to strengthen the low back.