Chronic Lower Back Pain and Manipulation: Does It Really Work?

Chronic lower back pain is a serious problem today, both in terms of cost of treatment and lost productivity. Plus, it just plain sucks if you’re the patient.

Let’s just get this out of the way right up front: My opinion on this article is going to be biased.  Not just because of the articles I read, but based on almost 15 years in practice.

Just today I had a new, 22 year old patient come into my office that has been having significant low back pain for over a year.  Prior to her flare up at that time, she had already been dealing with aching in her low back for years prior.  And yet, despite this, she had never been to a chiropractor.  Luckily, she did not wait until she was 35 and had 15 years of chronicity behind her.  Even after the first visit she noticed improvement and it is likely that, within a few visits, she’ll be back to 100%.

So why is this story so common?  I contend that chiropractic remains the red-headed stepchild of healthcare.  Quite frankly, when it comes to cost-effectveness and patient satisfaction, chiropractic care for both acute and chronic lower back pain rocks.  Just in case you don’t want to take my word for it, you can download my ebook on the research backing up natural approaches to chronic lower back pain here.

Let’s just play devil’s advocate for a second and say that there is no research to support chiropractors as the go-to physician for a back pain specialist.  And I do believe that this is much of the perception for the limited referrals to chiropractors from mainstream medicine.  Why should we, as chiropractors, be held to a higher standard?

By a higher standard, I mean that we don’t have billions of dollars of research supporting what we do.  Research that states, unequivocally, that chiropractic manipulation for musculoskeletal disorders is effective.  Of course, we do have research that supports what we do, although this is limited because of the lack of financial support our profession has for research.  No drug companies sponsoring our research.

So, the chiropractic profession (and alternative medicine in general) is expected to be backed up by hundreds of randomized placebo controlled studies documenting effectiveness.  Without these studies, other physicians are slow to make a referral to chiropractic care a first option.

Here’s the double standard.  I can say, with a relatively high degree of authority, that very little of what mainstream medicine does is supported by the same type of medical research that is expected of alternative medicine.  And this lack of strong research is despite literally billions and billions of dollars spent on research.  Did I say billions of dollars?

In almost all case, the second a physician adds a second prescription to a patient’s regimine, they are out of the realm of research and into guesswork.  And this is assuming that the original prescription was not for an off label use or actually has research suggesting that that particular drug was useless or even harmful.  I could go into lots of examples such as beta blockers, hormone replacement therapy and statin drugs, but lets just leave it as it is.

This particular study is yet another study supporting the use of manipulative therapy for chronic lower back pain relief.  While the study was small, the findings were very consistent with what most chiropractors see every single day in practice:

The was a definite and immediate reduction in pain intensity directly associated with spinal manipulation for chronic lower back pain (in this case, the diagnosis with chronic non-specific lower back pain) (Tweet this).

Of course, rarely does chiropractic care include just manipulation as the single and only treatment given.  Many of us use soft tissue manipulation (my personal favorite in my toolbox) and rehab to improve outcomes in patients.  Adding additional tools to chiropractic adjusting for the treatment of your pain should be the first thing you think of anytime something hurts.

I’d apologize for the bias inherent in the blog article, but I did fully disclose this bias in the beginning…


James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.