Work Related Low Back Pain and the Risk of Recurrent Injury

In two separate studies the risk of recurrence of low back pain was evaluated. It was established that back pain varied between 8% and 14% 3 to 6 months after the initial injury, and 20% to 35% between 6 to 22 months. 1 This means that before two years had lapsed, 1/5 to 1/3 of those with low back injuries had been re-injured.

In another study that compared chiropractic and physical therapy treatment, nearly 60% of the patients reported two or more recurrences within a year of their original low back episode. 2 According to this study, chiropractic was more favorable for patients with a current pain episode of less than 1 week.

In April of 2011 the Journal of Occupational and Environmental Medicine published that with work related low back pain, the risk of disability recurrence was lower for patients treated primarily (by a doctor of chiropractic than for patients treated primarily by a medical physician or a physical therapist. Recurrence was defined in terms of disability following the patients return to work. Patients receiving health maintenance or supportive care from chiropractors were significantly less likely to have a recurrence of pain that removed them from the work place within the first 14 days of returning to work.

11420 cases of nonspecific low back pain were evaluated in this study, and the researchers established that the physical therapy group had the highest level of recurrence, with almost 17% of those seeing physical therapists being reinjured upon
return to work, those who saw an MD for care had a 12.5% recurrence rate while those receiving chiropractic care had a 6.5% recurrence. 3 Year’s ago the Manga study out of Canada suggested millions a year in health care could be saved by making chiropractors the mandatory portal of entry health care provider for musculoskeletal complaints. A few years later, Kaiser found that patients receiving chiropractic averaged less dollars a year spent on overall health care. This
study is suggesting that employers, employees and each states worker's compensation system would benefit from using chiropractors as portal of entry for musculoskeletal low back pain incurred at work. Ironically, in Missouri, getting employers to authorize chiropractic for these patients is like getting milk from a stone. . .Patients with recurrence saw the same practitioner type they had seen for the index episode 88% of the time. Satisfaction was slightly greater for patients who saw chiropractors when compared with patients seeing allopathic physicians

1 Med Care. 1999 Feb;37(2):157-64.
Recurrence and care seeking after acute back pain: results of a long-term follow-up study. North Carolina Back Pain Project.
Carey TS, Garrett JM, Jackman A, Hadler N.
2 Spine (Phila Pa 1976). 1998 Sep 1;23(17):1875-83; discussion 1884.
One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.
Skargren EI, Carlsson PG, Oberg BE.
3 J Occup Environ Med. 2011 Apr;53(4):396-404. doi: 10.1097/JOM.0b013e31820f3863.
Health maintenance care in work-related low back pain and its association with disability recurrence.
Cifuentes M, Willetts J, Wasiak R.