Natural History of Back Pain. The Do Nothing Approach

Historic Comparison of likely MSK Recovery

  • In 1974 it was thought that 70-80% of patients recover over a 12.5 week period when receiving Medical Care or Chiropractic Care [1].
  • More recent work has shown that 41% of people do not respond to typical Chiropractic Care[2].
  • Whereas 40% of people do not recover with Best (current) Medical Care within 3 months[3].

Natural History of MSK pain

A ‘Probability of Recovery’ (natural history) has been devised for back pain from an Australian cohort showing an expected rate of recovery[4] if the individual does not seek and receive Medical care or Chiropractic Care. People generally improve in 2-3 days from very minor sprains and strains. Whilst more significant muscle and joint pain will take up to 3 months to improve. There is a 40% prevalence of back pain in those that do not seek care meaning pain can subside but the underlying muscle and joint problem may not have resolved. A weakness of this study is that pain was the indicator by which recovery was measured. Pain is a sensation and we can get used to it / live with it. The technical term is accommodation. A common example of accommodation that we have all experienced is one where we can substitute the sensation of pain with the sensation of a bad smell. If you stay in the bad smell, it seems to fade away (get better) because you can no longer sense the smell. Nonetheless the smell is just as pungent as when you first smelt it. Differentiating between resolving and get used is needed to give us information about muscle imbalance and off centre joints.

Fascia First Chiropractic’s Track Record, at 6 weeks was better than the ‘probability of recovery’ at 6 and 12 months respectively. As well as better than expected typical Chiropractic Care effects and Best Medical Care. Fascia First Chiropractic Clinical Results were sustained at 6 months (follow up).

Psychosocial Prognostic Factors in MSK Pain

Important (statistically significant) prognostic factors for msk pain include ‘having an idea of what to do and what not to do’ and ‘understanding the nature of (their) pain’ (what is it and where is it coming from in the context of my life) are strong prognostic indicators to early recovery. This second prognostic factor touches on the overlap between anxiety and muscle and joint problems, that can co-exist.

[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