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By: Chad E Cook PT, PhD, FAPTA

Definition: The natural history of a disease refers to the progression of a disease in an individual over time, from its onset (pathological or exposure to causal agents) to its resolution. It is generally considered “natural” when no interventions are used that could affect the resolution process [1,2]. Natural history should encompass both the subclinical phase (when the disease is asymptomatic) and the clinical phase (when symptoms are apparent), thus how the “episode” of the disease is defined is of considerable importance. Other terms used to represent natural history include disease progression, course over time, epidemiological trajectory, or disease lifecycle.

Favorable Outcomes: Historically, most musculoskeletal conditions, specifically, low back pain (LBP) are thought to have a favorable natural history. For example, in an older, very well cited paper, it was stated that LBP episodes are self-limiting, suggesting that 90% of patients recover in 6 weeks without loss of function [3]. As such, natural history is commonly factored in to the management process for individuals with LBP in clinical practice guidelines and dedicated treatment strategies. Most clinical practice guidelines have nominal suggestions for acute LBP (pain less than six weeks) when compared to chronic LBP, as it is thought to resolve on its own [4,5]. Stepped care strategies for managing LBP often align with the concept of natural history, and emphasize non-invasive, self-management approaches as the first step, allowing the natural recovery process to take its course [6].

Unfortunately, our understanding the natural history of conditions such as LBP is less clear than what we might think. This is because the process of measuring natural history has varied markedly across studies and is highly dependent on a number of factors [7].