What is the difference between ‘acute’ and ‘chronic’?

Simply put, in medical terms acute means short term and chronic means long-term. Either type of pain can be mild, moderate to severe. It’s important, however, to understand the difference between acute and chronic when discussing treatment for back pain for several reasons. The treatment and advice can vary considerably and the number of treatments, healing time and the expected treatment outcomes also very different. 

There is a lot of confusion around the use of these two terms. I often hear the expressions ‘I have chronic back pain’ or ‘my back pain is really acute’ when someone is just trying to describe how severe, excruciating or debilitating their pain is. In medical terms, this is not the case.

The word ‘acute’ in the dictionary has several meanings; sharp or pointed, severe, and unpleasant as in an acute angle.

Acute Back Pain (short-term)

Acute back pain is usually a recent injury, perhaps sudden in onset. Medically, it’s defined as a short-term injury, up to 6 weeks, commonly with sharp pain, muscle spasm, with inflammation and restricted movement, perhaps antalgia, but the pain usually settles more quickly. Chiropractic Treatment often works best at this stage and is excellent at achieving a faster recovery and helping prevent recurrence.

Subacute Back Pain

This is a term that has been used differently, and can describe the period of back pain between 6 and 12 weeks. It is also used for when the back pain has been strained slightly and the muscles give either warning twinges or feel weak as if they might spasm if you overdo it. This period is also when the back has been in the acute phase and is improving, but the injured muscles and ligaments have not fully healed, so they are weak and vulnerable to further strain.

Acute back pain

Acute pain can stop us in our tracks, cause pain and immobility, and prevent us from working or carrying on with our daily lives. One example is an acute ankle sprain.

Chronic Back Pain (long-term, or on-going)

Most back pain settles within 12 weeks. Hence, chronic back pain is when pain persists for over 12 weeks, or “pain that extends beyond the expected period of healing.” It comes from the Greek work ‘Chronos’ meaning time. Treatment emphasis is focused on managing the pain, and then, importantly, preventing the pain from recurring. This requires a far more in-depth understanding of the patient’s lifestyle and detailed understanding of what potential repetitive stresses and strains are the underlying causative factors. 

Disc degeneration

Degeneration of the spinal discs can cause chronic back pain over time.

Acute and Chronic do NOT indicate severity

Neither term indicates how severe the pain is. You can have varying degrees – mild, moderate or severe – of either a short term or a long-term condition.

An acute pain, although sharp, can be mild (you can still work and keep active) or severe (where you literally can’t move and are stuck in bed in excruciating pain).

Chronic pain too may be mild, with a stiff back in the morning that wears off shortly after getting up, or some dull ache when you sit too long, or can be severe where you are simply living 24/7 with severe pain that leads you to take painkillers. Fortunately, this is very rare.

Most clients I see are in the mild/moderate category, or if it’s severe it’s usually only during the short, acute phase.

Many conditions are a mix of both acute and chronic

This might be the first time you’ve had a sudden back spasm, so it’s purely acute, or it may just have been constantly painful or chronic for a long time. Often, however, you may have had a few recurring acute injuries, or on-going chronic pain with flare-ups from time to time;

Repeated acute episodes of back pain: You have repetitive acute episodes of pain that commonly last a couple of days to a week or that occur every few months/ 1-2 times a year/ every couple of years that may settle with self-care, or may require you to seek treatment.

Chronic ongoing back pain with intermittent acute episodes: You may have ongoing pain, tightness or stiffness every day, but then every so often, every few months or every year or so you have an acute episode that halts you in your tracks.

Chiropractic Treatment of Acute Back Pain

I enjoy treating both types of back pain for different reasons. It’s great when I can get an immediate improvement in the client’s symptoms, if they’ve come in with acute pain. It’s also incredibly satisfying for me when I can work out, usually with longer discussions, what are the underlying causes of the Chronic ongoing pain and work on treating this. If you have an acute or chronic back pain, contact us to find out how Chiropractic can help you.

Common Signs of Acute Back Pain

Locking whilst being ‘static’. You may sit down without pain, but when you go to get up you extremely stiff and may feel locked forward. It usually eases after a short time, and as the back pain settles it takes less and less time for the back to loosen as you move about. Standing still is quite often very painful and to be avoided. For example, you go shopping and are fine moving around the store, but as you stand in line waiting at the checkout your back muscles spasm and you simply can’t wait to get out of the store.

Prolonged bed rest. You wake in the night in pain as you go to turn, when the muscles have been static lying on one side. It’s painful to get up in the morning and can take some time before you can move easily, sometimes the first few steps are excruciating.

Acute Back Pain Treatment

You probably have three main objectives:

  1. Get out of pain
  2. Get moving again
  3. Return to work and being active

Possibly, and especially if this has happened before, you may also be thinking about how you can prevent having another acute episode.

Treating acute back pain is about getting you back on your feet, back to work and generally feeling normal again. Once the pain has settled and movement in the back has returned, the focus can shift towards prevention and avoiding the stresses that caused the pain in the first instance. This is where my passion lies.

Understanding the cause of the acute pain

The first step is to figure out, if possible, how the pain came on, and to rule out anything more serious called ‘Red Flags’. If it’s a fall, accident or trauma then we at least understand why it’s happened and it is important to gauge whether X-rays or MRI scans are required, or whether it was only a mild trauma where scans are not indicated. Most acute back pain (around 85%) is mechanical or musculoskeletal (MSK) in nature but Chiropractors are trained at spotting any indication of any medical causes of back pain which, whilst rare, may require referral for medical investigation.

Since most back pain settles within 12 weeks, GPs and consultants are unlikely to consider referring for X-rays, MRI scans, or to a spinal specialist or further investigation during this time, unless there are ‘red-flags’ present that indicated more urgent attention is required. This can often leave you in an unhappy state of feeling simply brushed-off or neglected by your doctor and frustrated that the painkillers aren’t helping greatly, or you may be in a waiting list to see the physiotherapist. Perhaps this leaves you not only in considerable pain, but also frustrated and worried, especially if you are unable to work. Provided the condition is musculoskeletal in origin, it can be treated with Chiropractic.

When an injury occurs the body’s reaction is to protect the injured area by tightening the surrounding muscles to prevent further strain. As with many auto-immune conditions, the body does not help itself by over-doing this muscle guarding. In acute back pain, it is the muscle spasm that causes much of the pain and immobility, which actually slows down the healing process and puts us out of action for longer.

Chiropractic Treatment in the early stages of acute back pain

Chiropractic Research has shown early treatment to be excellent at achieving a faster recovery and helping prevent recurrence.

Main Goals of initial treatment:

  • Reduce muscle spasm and tightness that causes much of the pain
  • Reduce inflammation and swelling
  • Restore joint mobility and flexibility
  • Achieve an early return to work and normal life
  • Breaking the pain cycle and restoring muscle-joint movement and balance
  • Help prevent the muscles and joints from becoming chronically locked or fixed long-term

As with many medical conditions, treatment is best done early. This can help to prevent long-term withdrawal from normal activities, or long-term absence from work.

Action Plan if you’re in Acute Pain

  • Help the muscles to relax!
  • Stop if you’re playing sport or in the middle of cleaning, or DIY.
  • Perhaps lying down to rest the spine may be helpful – but not for too long.
  • If you can walk or move gently this is often very helpful.
  • You can take some painkillers, provided you are not allergic.
  • Ice treatment (usually not heat) immediately may be helpful to reduce inflammation. When there is swelling or inflammation, it is usually correct to use ice. The sooner you can apply the ice (wrapped in damp towel) the better. Heat can often aggravate or worsen the swelling so usually should be avoided. I encourage clients to ring or ask prior to Chiropractic treatment to clarify whether to apply ice or heat. For more information, please read the full Ice Treatment article.
  • Don’t just sit, or stay static in one position too long
  • Rest your back which means varying your activity, some lying, some gentle movement
  • Seek treatment if you can.

The RCGP guidelines for management of acute lower back pain are, in summary:

  • Manipulation provides better short-term improvement in pain and activity
  • Avoid bed rest – it can lead to debilitation, disability and difficult rehabilitation
  • Stay as active as possible and continue normal daily activities
  • Stay at work or return to work as soon as possible

Back exercises don’t help acute back pain, so avoid trying to ‘strengthen’ the spine at this stage.

Stay active gently to help acute back pain!

Muscles can be helped to relaxed by moving gently, but don’t overdo it. Do what is comfortable, listen to your body and try to relax. There is a fine line between exercise and strain, and this fine line becomes extra fine when we have an injury. Just listen to your body and do whichever movement you can comfortably.

Perfect gentle exercises that can be done whilst the back pain is acute:

  • Walking is the simplest. If walking is too painful, standing bending forward arms on a table or supported, just walking on the spot gently.
  • Cycling gently, even on a static bike if you are in too much pain or do not feel safe to ride
  • I’m a huge fan of swimming and this is one of my own favourite activities when my back has spasmed. It can be a hassle to get into a swimming pool, but once you are there it can help tremendously.
  • Aqua-aerobics or simply walking and relaxing in water. If you can’t swim, then just perhaps walk up and down, or use a spaghetti float and lie and relax gently, moving the legs. This can be amazing to help the muscles relax.
  • Lying on your back gently rocking your knees from side to side, pulling one knee up to the opposite shoulder, then swapping and then pulling both knees to your chest.
  • Roll over into crawling position and rocking ‘cat-arch’ exercises.

Don’t stay static too long

The danger of sitting too long cannot be stressed strongly enough. Sitting is the activity that puts most pressure on the spine and surrounding muscles, so only sit for short periods of time when it is absolutely necessary. Injured muscles can tend to cramp and lock in ANY position, so gentle variety of comfortable movements is the best solution.

Walking to help Back Pain is one of the best exercises.

  • Walk at your OWN comfortable pace.
  • Relax the arms and shoulders.
  • Please, no handbags!
  • Try to go out and walk in a straight line.
  • Walk on an even surface if possible.
  • If pain comes on, stop, but go for regular short walks.
  • If you feel comfortable, then go further, but build it up as it’s important you don’t overdo it to find yourself in more pain later.

It is very common for people with back pain to find slow or stop-start walking or standing worsens the pain, i.e. when shopping for too long, but that walking more quickly at a relaxed comfortable pace helps much more to loosen the muscles. At other times, waking too quickly can be a struggle. Once again this is very personal, so listen to your body.

Lying down can be very helpful in the day for short periods, to break up the sitting and standing. You can either lie on your back with the hips and knees flexed (See Resting your back Lying down) or simply lie on your sides in the recovery position. Avoid prolonged bed rest. You may feel that you need to protect yourself and avoid movement, but this can make matters worse and slow the recovery.

Pain relief

Pain-killers and anti-inflammatory treatments for the back

Whilst frequently prescribed by the medical profession, there is also clear indication that drug treatments are controversial and may not have much effect of helping the back pain; please Read GP Guidelines for Back Pain. There are clear side effects on the stomach with NSAIDs (Non-steroidal anti-inflammatory drugs), so please, short-term use only, NOT long term.

Herbal treatments to reduce inflammation

There are several herbal remedies for inflammation that can be used, and more natural treatments such as homeopathy. These can help although it is difficult to guarantee their success. Provided you take them sensibly, and not excessively, they are generally safer with less harmful effects than some of the stronger prescription drugs.

Seek treatment soon!

Finally, seek treatment soon. Don’t leave it too long if you are in acute pain. Sometimes there is no substitute for treatment that can so often dramatically speed up the recovery process.

Chiropractic Treatment of Chronic Back Pain

Most long-term back injuries often require a different approach to treatment, with different expectations. Also, the emphasis is often focused not just on alleviating the pain and restoring movement in the spine, but on preventing the pain from recurring.

Chronic back pain is one that has been present for some time, may be months, years, or decades, so it is important to adjust expectations about its resolution. There may be wear and tear (osteoarthritis) in the spine and this cannot be changed; it may flare up from time to time, and more on-going treatment may be necessary. It also needs to be accepted that we are not going to be as active and flexible as when we were younger. This is a fact of life. However, that doesn’t mean that we can’t live life actively and healthily and, in large part, pain free!

Common signs of chronic back pain

Many of my clients come in with complaints such as these:

“I just don’t know what keeps causing my back to ache”
“No matter what I try it, just doesn’t seem to go away”
“I get some good spells then it comes back for no reason”
“I’ve just learned to live with it but it keeps getting me down”
“I’ve seen my GP but nothing they suggest or try helps”
“I don’t want to keep living on painkillers”

This sums up chronic back pain. Some clients that attend have been in pain for a long time and have learnt to live with it, perhaps with the aid of medication. My aim here is about stopping the pain but also reducing the severity long-term, thereby keeping the pain to a more manageable level.

Chronic Back Pain Treatment

Treatment of chronic back pain commonly involves two parts: On one hand, some treatment from the Chiropractor or practitioner with realignment of the spine and release of the muscle spasm. On the other hand, an effort from clients to take a more active role in learning how to help themselves; changing lifestyle, changing ways of working, exercises and activities of daily living. Altogether, this helps keep the back healthier and avoid further strain to effect longer-lasting change and improvement. I’m passionate about this part of the treatment, and I’m never happier than when, with some treatment and lifestyle changes, the client can keep active and healthy.

Understanding the cause of the chronic pain

Most of the time (85%+) patients don’t know what caused their back pain (known as idiopathic – ‘of unknown origin’ in medical terms). This doesn’t mean, however, that there aren’t reasons for the back pain developing; it simply that clients are unaware of them. Some common causes could be

  • Old injuries (even if these did not cause pain at the time)

  • Pain caused by repetitive movements, known as Repetitive strain injuries.

  • Bad posture and working habits. With more people working from home, it is increasingly important to evaluate our workstation and home ergonomics. I have particular experience with this and my Alexander Technique training means I am able to help you become more aware of your posture and movement.

Usually, the source of chronic back pain is multi-factorial. It’s about fitting the pieces of the jigsaw together to get to the root. This requires a far more in-depth understanding of the patient’s lifestyle and detailed questioning about their work and habit patterns; the potential repetitive strains and stresses that may be causing the pain. Usually, these are the activities we spend most of our time doing in our lives.

Chiropractic Treatment of Chronic Back Pain

This is commonly a combination of approaches:

  1. Treatment for the back pain to improve the function of the tight joints and muscles
  2. Advising clients to make lifestyle changes: improving home ergonomicsreducing the amount of driving, and being wary of sports injuries from overtraining.
  3. Perhaps some on-going maintenance treatment is required.
  4. Introducing exercise and activity to help keep the spine as mobile and relaxed as possible.
  5. Learning to be more relaxed, balanced, and less tense in our movement patterns (Alexander Technique, Yoga, Pilates). Sometimes with the best intentions, we can ensure we’re sitting well, keeping active, and avoiding repetitive strains. However, despite all of this, we can tense and find ourselves tightening, causing a build-up of pain. This is where Alexander Technique can be so helpful to work with our inner tensions and stresses, becoming more aware of the underlying tension patterns.

Sometimes treatment can help improve function, reduce pain and aid you to live a more active life, but with the underlying tensions, the scar tissue and tightness the joints will tend to stiffen again over time. Therefore, some ongoing treatments may be required.

There is no one perfect solution for treatment, prevention and management of chronic back pain. It’s a combination of approaches and sometimes this requires trial and error and learning to find what works for each of us as individuals. Please don’t give up if you feel defeated or resigned to living in pain. There are so many treatment options and if you are determined, you may be just able to find an approach that can work for you.

Healing Times for Acute vs Chronic Back Pain

In simple terms, the longer a condition has been there, the longer it can take to heal. Yes, the same could be said of severity, the more severe it is, the longer it takes to settle, but this does depend on each individual case, and the cause. For example, a slight muscle strain will heal perhaps in a few days, vs a full rupture, for an Achilles heel injury. But again, for back pain with no specific onset or trauma, as I have explained in Your first Chiropractic Visit, it’s likely that a short-term acute injury will usually take fewer treatments than a Chronic or long-term condition.

  • Acute injuries are more likely to fully resolve quickly
  • Chronic conditions may heal fully but may require ongoing maintenance or preventative treatment.

Acute low back pain and sciatica usually recovers very favourably and is self-limiting.

  • 60% recover in 1 to 3 weeks;
  • 90% recover in 6 to 8 weeks; and
  • 95% recover in 12 weeks.

Health Insurance for Back Pain

Health insurance payments are usually for Chiropractic treatment of acute pain, not chronic. It’s very helpful to understand that most health insurance companies are usually happy to pay for a short set of treatments for an acute injury, but don’t cover Chiropractic fees for chronic or long-term conditions. If you are considering asking your insurance company to cover your chiropractic treatment, we recommend speaking to the Chiropractor beforehand.

Do you suffer from back pain?

Jeremy English

Jeremy English Chiropractor

If any of this article resonates with you, you probably have acute or chronic back pain. I have extensive experience as a Chiropractor having treated over 17,000 happy clients. Why not give us a call or pop into the clinic to see how we can help you?