I hurt my back in a bicycle accident over a year ago. Despite medical and chiropractic treatment, I still have back pain. My doctors think I’m actually dealing with two separate injuries, but I’m not convinced. It seems like I’ve had constant back pain ever since the accident. Is there some way to sort this all out? Can I figure out what’s from the first accident and what’s from something else?

You might be able to do this in hindsight (looking back) but it can be difficult. You would have to remember dates; precipitating events; and the frequency, intensity, and duration of all your symptoms. If you have this written down or your doctors have documented what you’ve told them, then you may be able to sort this out carefully.

Sometimes patients feel as if they have had one continuous episode of back pain. In fact, it’s possible there was enough of a break in symptoms that any new pain could really be constituted as a new episode.

The definition of an episode of back pain isn’t always the same from one doctor to the next. This may be changing as authors of some of the more recent studies have become aware of the problem and are making efforts to use a more standardized definition.

The current definition proposed for future studies is as follows. An episode of low back pain is a period of pain in the lower back lasting for more than 24 hours. It is preceded by and followed by a period of at least one month without low back pain.

So, in other words, if you have experienced 30-days without back pain at any time in the past year, then your two episodes of back pain are really separate. They may or may not have the same precipitating risk factors. That would be something to explore with your health care providers. A previous history of back pain does increase your risk of recurrence — but it doesn’t guarantee it.