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Natural History of Back Pain. The Do Nothing Approach

Muscle Neurology

Historic Likely MSK Recovery

  • In 1974 it was thought that 70-80% of people experiencing back pain completely recover in a 12.5 week period [1].
  • Today about 40% of people with a first episode of back pain are thought not to completely recover in a 4-6 month period. [2] [3].

Probability of Recovery

A ‘Probability of Recovery’ (natural history) has been established from an Australian back pain cohort[4]  if the individual does nothing. Meaning the probability of recovery is an established placebo. People generally improve in 2-3 days from very minor sprains and strains. Whilst more significant muscle and joint pain experiences will take 6 months to normalise. Pain was the indicator by which recovery was measured and we know that pain can subside long before muscles have recovered. Pain is also a sensation that we can live with or get used to having.

Fascia First Chiropractic’s Track Record, was better than placebo with just 12.5% of people not normalising at 6 months. However, only 5% of people did not return and did not contact the practice again. Some people lived away and some people were only visiting for maintenance Care. Meaning the figure of no response is somewhere near 5% for all muscle and joint complaints, not just back pain. Which is much better than do nothing whereby 40% of people after 6 months hadn’t normalised and were likely to experience reoccurrences throughout their life.

Psychosocial Factors

The probability of Recovery Curve Study did not take into account the psychosocial aspects of an MSK pain experience. Factors that indicate a likely early recovery from a psychological and social aspect are

  • ‘having an idea of what to do and what not to do’
  • ‘understanding the nature of (their) pain’
  • (what is it and where is it coming from in the context of my life). Touches upon anxiety and muscle tightness.


[1] Kane R L et al Manipulating Patients The Lancet (1974) June 29 p1334

[2] Axen I and Leboeuf-Yde C Typical Chiropractic Patients- can they be described in terms of recovery patterns? Chiropractic and Manual Therapies 2017; 25:23

[3] Traeger AC et al Pain Education to Prevent Chronic Low Back Pain: a Study Protocol for a Randomised Controlled Trial BMJ Open 2014;4 p.1

[4] Henschke N et al Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study. BMJ 2008;337:a171

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