Back pain: course and prognosis

Keep in mind that acute back pain is a symptom of an underlying problem. Most of the time, the pain results from injury to bones, ligaments and muscles in and around the spine.

Chronic back pain, in turn, is often the result of multiple factors – including social, psychological and physical factors – that interact and cause the pain.  

Basic facts about how long back pain lasts:

  • 90% of people with acute lower back pain recover over a period of six weeks. After this period, recovery tends to slow down.
  • 50% of episodes of acute lower back pain nearly completely resolve within two weeks.
  • Up to 70–80% of affected individuals will have another back pain episode within a year.
  • Excruciating initial pain often resolves within a few days, while mild or moderate pain may persist for a number of weeks.
  • All cases of back pain that last longer than six weeks need to be checked out by a doctor.
  • Back pain caused by an accident, and which results in substantial injuries, could become chronic. In other words, the pain may last more than three months.
  • How soon you seek treatment, as well as the quality of care, will affect your recovery rate.

Bed rest vs. activity

You may feel like lying in bed until the pain goes away. However, staying in bed for more than a day could only make matters worse and reduce muscle strength in your back. Muscle strength can decrease by as much as 20–30% after only a week of complete bed rest. It generally takes much longer to regain the strength and function than it takes to lose it.

Certain exercises are best avoided while your back hurts. This includes exercises that round the spine and which reverse the natural lumbar curve, or which put stress on the lower spine, including toe touching, sit-ups, twisting the spine, double leg raises, spinning or cycling with a rounded back, and running.

However, studies overwhelmingly show that movement and exercise reduce all kinds of pain, including back pain. It strengthens the muscles and lubricates the joints, making it less likely that you’ll get re-injured or suffer joint pain.

Exercise also releases natural pain-relieving endorphins, which can boost your mood. It also fights the inflammation associated with a number of painful conditions. By staying active, you keep the blood and nutrients flowing to the affected area, thereby controlling inflammation and reducing tension in the muscles.

Getting quality sleep, using cold and heat therapies, using anti-inflammatory medication and plasters, stretching your hamstrings, and developing mechanisms for your brain to reduce or ignore pain signals can also help to relieve back pain.

How long will it take to recover from back pain?

Researchers at NeuRA (Neuroscience Research Australia) have developed what’s known as the PICKUP (Preventing the Inception of Chronic Pain) model. This estimates how long people who have experienced lower back pain (LBP) for less than six weeks will take to recover by asking five simple questions.

The questions were developed after studying 1 230 people with acute back pain, and was tested on a separate group of 1 530 individuals. The researchers found that, when doctors use this tool, it could reduce unnecessary interventions by 40% in primary care compared with a treat-all approach.

The image below shows what the calculator looks like:

Individuals who score 20% or lower can be confident that they have a good prognosis. Those with a score above 20% should consider more intensive management.

When can I resume normal activity?

This depends on the care you take and receive, as well as the type of injury and the cause. Research shows that it’s best to return to work as soon as possible. If needed, your work environment should be adjusted to prevent repeated injury.

Reviewed by general practitioners Dr Lienka Botha and Dr Suzette Oelofse, FX Health. April 2018

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