Health & Fitness Bulletins

September 06, 2025

Low Back Pain: Passive Approaches Result in 280% Higher Recurrence

In a review published recently by The Lancet, Dr. Chris Maher and colleagues state, “The simple portrayal of the course of low back pain needs reconsideration.” Dr. Maher refers to the view that most cases of acute, non-specific low back pain recover completely within four to six weeks. He qualifies this view as commonly held. One of the problems with this notion of self-resolving back pain is that it leads to passive responses. People take pain meds, stay active, and take a wait-and-see approach.

Non-specific low-back pain is not a true injury in most cases. Rather it’s a deconditioning that causes episodes of pain and disability that come and go. Pain that subsides cannot be taken as a sign of “recovery.” This was demonstrated nicely by the work of Julie Hides, PhD, published in the journal Spine. They tracked low-back pain patients for a year. Some received old-fashioned passive management. Others received physical therapy. As expected, at 4-weeks, 80% of those with passive management felt better, and 100% of those with physical therapy felt better. The real difference became apparent at the one-year follow-up. The passive group was almost three times more likely to have recurring bouts of back pain compared to the physical therapy group (84% vs. 34%).

The passive group mostly returned to work. Even among those who returned to work, ultrasound showed that the passive group had asymmetrical muscle atrophy in their low backs. In the physical therapy group, the symmetry of the back muscles had been restored. We can’t just wait for back pain to go away, but the good news is that, with a little help, we can take control of it in most cases.