It’s estimated that about one-in-seven 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. As such, it’s important to identify which factors may be associated with an increased risk for progressing from acute low back pain to chronic low back pain.

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, and 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 and 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; and a high score on the STarT Back screening tool, which looks at nine specific items (pain referred to the leg; shoulder/neck pain; difficulty walking long distances; difficulty getting dressed; fear of physical activity; worrisome thoughts; despair about condition improving; reduced ability to enjoy hobbies and other pleasurable activities; and bothersome pain). Additionally, the researchers concluded that exposure to care outside of current guidelines in the first 21 days can raise the risk for low back pain chronicity by up to 2.16 times!

So, what are the current recommendations for acute low back pain? Clinical guidelines recommend that all provider types (including chiropractors) offer reassurance to reduce fear of movement and encourage 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, like spinal manipulation, to reduce pain and improve function in the low back, doctors of chiropractic will also look for dysfunction in associated areas of the body that commonly co-occur (or even contribute) to low back pain. For example, individuals with tight hamstrings may be more likely to develop back pain, and issues in the hip are often present in low back pain patients. Patients will also be encouraged to stay or become active and to engage in home-based exercises to strengthen the muscles in the low back.