Two Fundamentals For Understanding Low Back Pain

April 4, 2015

Two weeks ago, I posted my claim and rationale that Robin McKenzie’s serendipitous observation of “directional preference” more than 50 years ago was the greatest discovery in the history of low back and neck pain management.

But for some, it was my prior posting about the natural history (NH) of low back pain (LBP) that was especially enlightening. To review, conventional thinking is that a high percentage of LBP recovers on its own if left alone and especially if aided by maintaining daily activities as much as possible despite the pain. A further NH belief is that recurrent episodes, while very common, deserve no particular attention since they, like the original episode, also have a highly favorable prognosis for recovery. That line of thought likens LBP episodes to the common cold: one bout typically does not affect the next.

In contrast, my posting cited data that recoveries from LBP episodes are far less common than guidelines portray them to be. Further, there’s ample data indicating that recurrences often worsen over time and eventually simply don’t recover, providing a common, but rarely acknowledged, pathway to chronic pain. Finally, I proposed that the high prevalence of a directional preference across the LBP population serves as a very plausible explanation for why recurrent episodes and their recoveries are both so common.

One reader found this NH posting to be particularly enlightening and commented: “This is the best, simplest, most brilliant elucidation of the natural history of back pain.….Reading this post, I feel like I’ve just read Copernicus on how the solar system works.”

That’s quite a statement! He realizes the fundamental importance of an accurate understanding of LBP’s natural history plus how the majority of LBP behaves with a directional preference, whether a patient is seeking care or not.

Hopefully more spine care clinicians and other stakeholders will read, or perhaps re-read, these two postings to gain some perspective and insight that will likely challenge their views of this huge health care dilemma.

As always, I welcome your thoughts and questions. Please leave a comment or question below.


One Response to “Two Fundamentals For Understanding Low Back Pain”

  1. Karl Topp Says:

    This is a Doctor who is always in!

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