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Will My Low Back Pain Get Better?

Written by Chris Heywood
Cons Physiotherapist

For a vast majority of you, yes, in fact most ‘simple’ LBP and neck pain (not related to a whiplash injury) is thought to be self-limiting, normally settling within 4-12 weeks under its own steam. So why do we all know people who seem to suffer indefinitely with some type of back pain if most of it gets better? Well, that is down to the sheer numbers involved, let me explain.

The simple reality is that most of you will experience spinal pain at some point during your life time. In fact research estimates that up to 90% of you will get low back pain (LBP), and 70% will get neck pain. To put that into context, the last census showed that in mid 2020, the UK had a population of just under 67.1 million people. This means  means that just over 60 million of you will get back pain and around 47 million will get neck pain. That’s a lot of people!

In fact low back is the most common reason that you will visit your GP if we remove both headaches and tiredness from the equation. Unfortunately it is not a very exclusive club to belong to although I often say to patients that its better to be boring and common in medicine, rather than rare and interesting!​

The lower back is commonly defined as the area between the bottom of the rib cage and the buttock creases.

The lower back is commonly defined as the area between the bottom of the rib cage and the buttock creases.

In an overwhelming majority of cases, of low back pain, in the absence of Red Flags, the advice is to simply keep moving around within your pain limitations and where needed, to enable this, speak to your pharmacist about short term over the counter medications. You may also find simple back exercises such as those recommended by the NHS -, helpful, as well as icing and heating beneficial.

In situations where pain is still not controlled, or perhaps you are worried about your symptoms, it may be advisable to speak to your local GP, or, Allied Health Professional. Many surgeries now have First Contact Practitioners, some of which may be Musculoskeletal specialists, and they will be able to advise you on a multitude of topics such as further self help, exercises and even triage you to see if further investigations are needed.

Some of you may also have access to private Health Insurance, or be in a position to see a private practitioner such as a physio, osteopath or chiropractor. We will all work differently but with the same aim of getting you better. We are not a company that advocates 'profession bashing' as we have some great non-physio professional links but in fee paying situations, we always advise you to watch carefully how much treatment you get as we do hear some horror stories.

Unfortunately, we also need to address the elephant in the room that you will no doubt have noticed. Our explanation so far means that this does leave somewhere between 3-10% of you, or up to 6.7 million, who will go on to develop chronic low back pain, (same pain lasting for more than 3 months consecutively). Although this group is proportionally small, it accounts for nearly 50% of all resources allocated to the treatment of LBP. The bottom line is, it is impossible to stop everyone from developing chronic LBP even in today’s age of medicine, and we need to accept this fact. What we can do however is strive to limit this occurrence where possible, and help those of you where it is not preventable, to still reach your full potential and continue to lead normal rewarding lives.

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.....despite what you may be told! 

There is NO RELIABLE evidence to support monthly top up's once you
are better......

Without doubt there are many situations where by on going self-management strategies, such as prescribed physio exercises, pilates, yoga etc, may help with the long term effects of back pain. Such is the underlying nature of the condition however, we are still unable to tell you exactly what exercise is best in general, just that doing exercise is better than not doing it!

It is also worth mentioning our adoption of the ‘bio psychosocial‘ model nowadays. This is supported and encouraged by most of the health organisations in the developed world and recognises the importance of addressing any psychological and environmental aspects of your presentation as well as the physical. This DOES NOT mean that we think it is in your head, but simply that most of us will adapt behaviours and thoughts towards everyday tasks in response to our pain.

This may range from something as simple as not sitting for too long in the evening to making a lengthy plan on how you will be able to get dressed in the morning. In recognition of this, nearly all spinal pain should aim to be treated with a rounded approach and should involve you, the patient, in the leading role. Whether it is simple self management, professional rehabilitation or even surgery, you will need to be prepared to adopt a temporary or permanent change in your lifestyle to reach your full potential.  

Assessing and treating low back pain in across Northamptonshire and South Leicestershire is a challenge that we have significant experience in at Team Rehab uk Ltd. There are very few clinics in either area that have had the same exposure to spinal research, surgical rehabilitation and preventive care, as our own, so if you need some first time help or advice, or a second opinion, be confident tha
t we can provide both the expertise and honesty that you deserve.

Reference List
​[i] Waddell W. A new clinical model for the treatment of low back pain.  Spine  1987; 12(7): 632-44
[ii] Kelsey JJ. Epidemiology of musculoskeletal disorders. New York: Oxford University Press, 1982 
[iii] Biering-Sorensen F. A prospective study of low back pain in a general population: 1. Occurrence, recurrence, and etiology.  Scand J Rehab Med  1983; 15: 71-9
[iv] Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain  Cur Opin Rheum  2001; 13: 128-34 
[v] Clinical Standards Advisory Group. Back pain: Report of a CSAG committee on back pain  HMSO, 1994 
[vi] Maniadakis N, Gray A. The economic burden of back pain in the UK.  Pain  2000; 84: 95-103 
[vii] Nachemson AL. The natural course of low back pain. In: White AA, Gordon SL. Eds. Symptoms of idiopathic low back pain. St Louis: Mo, Mosley, 1982; 46-52 
[viii] Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ. Predicting who develops chronic low back pain in primary care: A prospective study. Brit Med J  1999; 19: 1662-7 
[ix] Watson PJ. Psychosocial Assessment; The emergence of a new fashion, or a new tool in physiotherapy for muscular pain.  Physiotherapy  1999; 85(10): 530-5 
[x] A systematic review of conservative treatments for acute neck pain not due to Whiplash. Howard T. Vernon, DC, PhD,a B. Kim Humphreys, DC, PhD,b and Carol A. Hagino, MBA Journal of Manipulative and Physiological Therapeutics Treatment of Acute Neck Pain July/August 2005 
[xi] Pengel LHM, Herbert RD, Maher CG, et al. Acute low back pain: Systematic review of its prognosis. BMJ  2003; 327: 323-5 
[xii] Reid S, Haugh LD, Hazard RG, et al. Occupational low back pain: Recovery curves and factors associated with disability. J Occ Rehab  1997; 7: -14 
[xiii] Nachemson A, Jonsson E. Neck and back pain: The scientific evidence of causes, diagnosis and treatment. Philadelphia: PA, Lippincott Williams & Wilkins, 2000; 495

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