How long before my lower back gets better???

Its not always black and white…

A common question typically asked by a client after their first consult is “how long until you think my back will get better”? This being a very common and logical question asked in every day practice, it is not good enough to respond with a black white answer.

Although most clients prefer a simplistic ideology of their low back symptoms, there are multiple variables and factors involved which may influence the time needed to resolve their pain.

For those of you who have consulted with me, you may have realized that I tend to question, look and examine not just the area of pain but many other contributing factors. What are these contributing factors? A brilliant paper out of the prestigious spine journal gives validation to some of the methods I utilize with my clients on a day to day basis.

This paper outlines five clinical prediction rules that determine the probability of a high successful outcome followed by manipulation. These prediction rules include:

1. Hip internal rotation (at least one hip) greater than 35 degrees
2. Duration of symptoms less than 16 days
3. No symptoms distal to the knee
4. Low back hypomobility
5. Fear-Avoidance belief questionnaire (FABQ) less than 19

This is why I also check your hip range of motion during the first consultation. If you sit down and have your hip, knee and ankle in a straight line with your knee maximally bent, turn your foot outwards. If you cannot turn your foot outwards more than 35 degrees, then guess what? You need to work on this.

Secondly, if you have experienced pain well over 16 days, this also lowers your prognosis for immediate relief after one treatment. Pain that lasts longer than 16 days require multiple treatments and other interventions, such as cognitive behavioural therapy and brain based treatments.

Furthermore, symptoms such as weakness, tingling or numbness below the knee also prolong the time to getting better and require far more than pure manipulations to the back. These things include nerve mobilisations, pain science education and corrective exercise management, all of which we provide.

From clinical experience those who present with a reduced range of motion in bending backwards, forwards and to the side tend not to respond favourably to manipulation as those who present with limited range in one direction only.

Lastly, with regards to the Fear-Avoidance belief questionnaire (FABQ) if you score well over 19, your chances for responding well after the first treatment are suboptimal. If you're interested in doing the FABQ click here:

So there you go - five clinical prediction rules that will enable me to give you a realistic time frame as to how well you will respond to lower back manipulations and whether you require further treatment interventions combined with hands on manipulation.