Short answer: recurrence is part of the usual course of low back pain rather than a sign the problem is getting worse. Research has had limited success predicting who will have a recurrence — the one factor that predicts it consistently is having had previous episodes. Prolonged sitting and frequent awkward postures have also been associated with it. Most people go looking for a structural explanation on a scan, and that is usually the least useful place to look.
How often does it actually come back?
More often than most people are told, and less predictably than most people assume.
The honest answer starts with a problem in the research itself: studies have defined “a recurrence” so differently that published twelve-month rates range from about 15% to over 80%. A 2009 systematic review found only a third of studies even stated what they meant by the word. A consensus definition was not proposed until 2011.
Using the better-designed studies: in a group of 250 people followed monthly for a year after recovering from an episode, 69% had some return of low back pain within twelve months, and about 40% had a recurrence significant enough to limit their activities or send them back for care. A separate primary-care study found a one-in-three recurrence rate. The median time from recovery to the next episode was around 139 days.
So: somewhere between one-third and two-thirds, depending on how strictly you count — and typically several months apart, which is long enough that the return feels unconnected to whatever came before it.
A recurrence does not mean it is getting worse
This is worth stating plainly, because it is the assumption that sends people looking for something alarming on an X-ray. The 2018 Lancet low back pain series describes recurrence as part of the natural course of the condition — not as evidence of deterioration.
That distinction matters for more than peace of mind. Negative recovery expectations, high distress and fear of movement are among the factors most consistently associated with back pain becoming persistent and disabling. What you believe is happening influences what happens next.
Why the scan usually is not the answer
Most people with recurring back pain want an image, and want the image to show the reason. The difficulty is that the findings people expect to be meaningful are extremely common in people with no pain at all.
A 2015 systematic review in AJNR pooled imaging studies of asymptomatic people — people with no back pain whatsoever — and found:
- Disc degeneration in 37% of 20-year-olds and 96% of 80-year-olds
- Disc bulges in 30% of 20-year-olds, rising to 84% by 80
- Disc height loss in 24% of 20-year-olds and 56% by 50
- Facet degeneration in 4% of 20-year-olds and 50% by 60
The authors concluded that many of these findings are likely part of normal ageing, and must be interpreted alongside the clinical picture rather than on their own.
This does not mean imaging is useless, or that degenerative changes are meaningless — other research has found disc degeneration is more prevalent in people with back pain than in those without. It means a finding on a scan is common enough in pain-free people that, by itself, it rarely explains why a particular person’s back keeps going out. It is one input, not a verdict. Current clinical guidelines reflect this: they advise against routine imaging for low back pain unless the result would change management.
What the research does associate with recurrence
Less than you would hope. When researchers tested a wide panel of candidate predictors in a primary care cohort, the only one that consistently predicted recurrence was having had previous episodes — people reporting more than two prior episodes had roughly three times the odds of another within a year. A separate cohort added two factors: frequently working in awkward postures, and sitting more than five hours a day.
Nobody can currently look at an individual and say why theirs in particular keeps returning. Anyone telling you otherwise is going beyond what the evidence supports.
That sitting finding is worth pausing on if you live in Chestermere and work in Calgary. More people live here than work here — around 4,500 more — which means a large share of the city spends twenty to forty minutes each way on Highway 1 or 17 Ave SE, and a working day at a desk in between.
What appears to help
The clearest finding in the prevention literature: a 2016 meta-analysis in JAMA Internal Medicine found that exercise combined with education reduced the risk of a future episode of low back pain by roughly 45%. Exercise alone accounted for most of it.
With an important caveat the researchers were explicit about: the protective effect diminished beyond about a year. Which suggests that continuing to do it matters more than any particular programme you complete once.
Clinical guidelines converge on the same core — stay active, exercise, understand what is going on, and manage it yourself where you can. Manual therapy including spinal manipulation appears in guidelines from the American College of Physicians, NICE, the World Health Organization and the Canadian Chiropractic Guideline Initiative, consistently as one component of a package that includes exercise and advice, rather than as a treatment on its own.
Where chiropractic fits
Honestly: as part of that package, with modest and real effects.
For acute low back pain, a 2017 meta-analysis in JAMA found spinal manipulative therapy was associated with short-term improvements in pain and function that the authors themselves described as “real, but small.” For chronic low back pain, a 2019 review in the BMJ of 47 trials involving over 9,000 people concluded it produces effects broadly similar to other treatments recommended by clinical guidelines.
Mild, temporary soreness or stiffness afterwards is common. Serious complications have been reported and are rare, though the available literature cannot establish a reliable rate.
What a chiropractor can offer is a careful assessment of what is happening mechanically, treatment where it is indicated, and an exercise and self-management plan — because that last part is where the prevention evidence is strongest.
When to get it looked at sooner
Some symptoms warrant prompt medical assessment rather than waiting to see whether an episode settles: numbness in the groin or inner thighs, loss of bladder or bowel control, progressive weakness in a leg, unexplained weight loss alongside back pain, fever, or back pain following significant trauma. If you have any of these, contact a physician or attend an emergency department.
If this is the pattern you are in
Divine Spine is opening a chiropractic clinic in Chestermere. If you would like to talk through what has been happening with your back before booking anything, a ten-minute call costs nothing and commits you to nothing.
References
- da Silva T, et al. Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy, 2019;65(3):159–165.
- Machado GC, et al. Can recurrence after an acute episode of low back pain be predicted? Physical Therapy, 2017;97(9):889–895.
- Stanton TR, et al. Definitions of recurrence of an episode of low back pain: a systematic review. Spine, 2009;34(9):E316–E322.
- Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR, 2015;36(4):811–816.
- Hartvigsen J, et al. What low back pain is and why we need to pay attention. The Lancet, 2018;391(10137):2356–2367.
- Steffens D, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Internal Medicine, 2016;176(2):199–208.
- Paige NM, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. JAMA, 2017;317(14):1451–1460.
- Rubinstein SM, et al. Benefits and harms of spinal manipulative therapy for chronic low back pain. BMJ, 2019;364:l689.
- Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain. Annals of Internal Medicine, 2017;166(7):514–530.
- NICE guideline NG59. Low back pain and sciatica in over 16s: assessment and management.
- Bussières AE, et al. Spinal manipulative therapy and other conservative treatments for low back pain. JMPT, 2018;41(4):265–293.