About 1-in-7 adults in the United States have chronic low back pain lasting longer than three months. Which can have a major effect on one’s ability to carry out their daily activities. It’s important to identify which factors are associated with an increased risk of progressing from acute low back pain to chronic low back pain.

Chronic Back Pain Study

A systematic review published in 2020 reported that 26% of patients who seek treatment for new-onset low back pain will still have back pain three months later. A third of these patients will continue to have low back pain at the six-month mark.

A February 2021 study reviewed data concerning 5,233 acute low back pain. They found that 32% transitioned into chronic low back pain. Further analysis identified the following risk factors for chronic low back pain: smoking; obesity; severe initial disability; depression/anxiety. A high score on the STarT Back screening tool, which looks at nine specific items. These include pain referred in the leg, shoulder/neck pain, difficulty walking long distances, and difficulty getting dressed. This also includes fear of physical activity, worrisome thoughts, despair about the condition improving, reduced ability to enjoy hobbies, and bothersome pain. Additionally, researchers concluded that care in the first 21 days can raise the risk for LBP chronicity up to 2.16 times!

Conclusion

So, what are the current recommendations for acute low back pain? Clinical guidelines recommend that all providers, including chiropractors, offer reassurance to reduce fear. They should encourage movement and for patients to maintain normal activity as tolerated. The guidelines also recommend non-pharmacological treatments including ice/heat, spinal manipulation (a chiropractic specialty), massage, or acupuncture as FIRST-LINE treatment options. Patients should avoid diagnostic imaging, specialty consults, and prescription opioids in the absence of “red flags” (cancer, fracture, or infection).

In addition to manual therapies, spinal manipulation reduces pain and improves function in the low back. Chiropractors will also look for dysfunction in areas of the body that commonly contribute to low back pain. For example, individuals with tight hamstrings may be more likely to develop back pain. Issues in the hip are often present in low back pain patients. Patients will also be encouraged to stay or become active. They should engage in home-based exercises to strengthen the muscles in the low back.