In about 90% of cases, the pain subsides within two months. In some patients with chronic low back with worsening symptoms, no changes in objective indicators of disease are seen. Moreover, in many patients with worsening objective indicators of disease, symptoms remain the same or even improve (White 142).
The mechanism for soft tissue injury repair is to increase nutrition to the injured tissue. Blood supply to the injured tissue has the effect of both removing waste products from the metabolic repair process as well as infusing fresh nutrition into the area (Dreisinger 315).
The key to successful management of lower back pain in the athlete is to care for the injury in an appropriate manner both maximising the effects of the natural healing process and intervening when appropriate (Dreisinger 315).
In the lumbar spine, as with the extremities, motion is critical for repair to proceed optimally. It is well known that early movement of an injured limb reduces adhesion development, prevents disuse atrophy, and encourages proper post-injury alignment of connective tissue (Dreisinger 315).
In 90% of low back pain cases, however, there is an underlying mechanical cause to the low back pain that will resolve itself within two to eight weeks with minimal treatment (Jenkins 91).
Data on the natural history of acute low back pain are conflicting, but patients are likely to recover from their presenting episode of back pain. Rates of recovery within 2 – 3 weeks vary from 30 – 70%, and 90% are back at work within 2 months (Indahl 206).
…Biomechanical loading due to physical exertion traumatizes the tissues in and around the spine and has been shown to elicit an inflammatory response. This inflammation causes pain and recruits neutrophils and macrophages to the site of tissue trauma. If loading ceases, inflammation resolves, the tissue heals and normal structure and function is restored (Splittstoesser 6017).
Conversely, the same subject lying in a semi prone position on the right side, induces an axial torque that rotates the joint counterclockwise, thereby relieving the overstretched ligamentous fibers and the damaged facet. This posture may facilitate the healing process and markedly reduce low back pain after sleeping (Gracovetsky 552).
Too often the treatment of back pain is aimed at alleviating the symptom without regard to underlying causes. A disregard for overall function increases the likelihood of reinjury. It is imperative that the clinician have a solid understanding of the function of the fibroblast as it heals and remodels injured tissue. It is known that sprain and/or strain to the connective tissue, tendons, ligaments and fascia, set into action a process of healing that is designed to stabilize, or heal together, the torn tissue (Porterfield 273).
As with other body tissues, scar tissue is laid down proportionately to forces acting upon it. If injured areas of the low back or low back tissues subjected to excessive postural forces are not properly managed, remodeling of these tissues result in a shortened, non functional position which makes them exceptionally vulnerable to further tearing when activities of daily living are resumed (Porterfield 274).
