Chiropractic Care for Back Pain

If you have back pain, chiropractic may be a very good treatment option. Chiropractic is used by many patients with low back pain. In fact, over 40% of patients with low back pain seek the services of a chiropractor to help relieve their pain. (1)

Why Consult a Chiropractor
Chiropractic offers gentle, effective, and time-saving approaches to treat your low back pain. Chiropractic is a drugless, non-surgical system of health care. One important principle of chiropractic involves returning motion to the spine. Restricted spinal motion—when the spine doesn't move as well as it should—can cause back pain.

Chiropractors emphasize spinal manipulation (or adjusting the spine) as a means of correcting spinal joint restrictions and relieving pain, treating disc injuries, improving alignment and posture, and promoting health and wellness.

Chiropractic has developed a number of treatment approaches in addition to traditional spinal adjustments.

Low back conditions that respond to chiropractic care include:

• back sprain injuries
• spinal joint restriction syndromes
• facet joint sprain
• sacroiliac sprain
• lumbar disc injuries that don't require surgery
• spinal stenosis
• various types of chronic low back pain

Before deciding which approach or approaches are for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your pain.

How a Chiropractor Diagnoses Back Pain
Even if you go to the chiropractor complaining of low back pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It's important to examine the entire spine because even though it's just your low back that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation of each unit of motion in the spine. These diagnostic techniques are unique to chiropractic. Motion and static palpation is an examination by means of movement and touch. The chiropractor will feel for tenderness and tightness, and then he or she will examine the spine to see how well each spinal joint moves. (You can read a more in-depth article on motion and static palpation here.)

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

The chiropractic examination includes standard physical and neurological exams. You'll also go through your past medical history with the chiropractor. The chiropractor may have you get imaging tests (such as x-rays or MRIs) and laboratory tests in order to help him or her diagnose the cause of your back pain.

After the examination, the chiropractor will be better able to create an effective treatment plan for your back pain.

Some possible spinal manipulation treatment approaches are:

• specific spinal manipulation: Sometimes called spinal adjusting, spinal manipulation is an active, hands-on care that returns motion to the spine. With a return of normal spinal mechanics, muscles relax and pain is resolved.
  
  In specific spinal manipulation, the chiropractor identifies the joints that are restricted or show abnormal motion (also called subluxations). He or she then returns motion to the joint with a gentle thrusting technique.
• flexion-distraction technique: This is a gentle, non-thrusting type of spinal manipulation. This treatment is still hands-on, utilizing a specialized table to assist the chiropractor. It's especially useful in treating bulging discs and ruptured (herniated) discs.
• instrument-assisted manipulation: This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

To treat your back pain, the chiropractor may also use various manual therapies. These are used to treat soft tissue (ligaments and muscles, for example) injuries. Some possible manual therapies are:

• trigger point therapy: The chiropractor identifies specific hypertonic (tight), painful points on a muscle. Then he or she puts direct pressure (using the fingers) on these points to relieve the tension.
• manual joint stretching and resistance techniques
• therapeutic massage
• instrument-assisted soft tissue therapy: The chiropractor uses instruments that were developed by David Graston in 1987 to diagnose and treat areas of dysfunction (also called restrictions) in the muscles. He or she will perform repeated strokes of the instrument over the area(s) of restriction. Research has shown that instrument-assisted soft tissue therapy increases the number of fibroblasts in the area. Fibroblasts are special cells that help heal injuries, including muscle injuries. If there are more fibroblasts, then the strained muscle, for example, can heal faster.

In addition to spinal manipulation and manual techniques, the chiropractor may use various instruments to treat muscle inflammation. These modalities are used to relax the muscles. Some examples are:

• ultrasound: By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.
• inferential electrical stimulation: This uses a low frequency electrical current to stimulate your muscles.

To reinforce the improved joint mechanics (return of normal spinal motion), your chiropractor will prescribe therapeutic exercises.

How Chiropractic Helps Patients with Back Pain
A chiropractor may help you return to your normal activities quickly so that you can enjoy your daily life without pain. He or she will work to address the underlying mechanical (how the spine moves) or neurological (nerve-related) causes of your back pain.

Prevention and Whole Person Care
Chiropractors are "whole person" doctors who view back pain as unique to each patient. Therefore, they don't focus on just your back pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to back pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Preventing low back pain is vital to the chiropractic approach to care.

Reference

1. Waddell G. Low back pain: A twentieth century health care enigma. Spine 1996;21(24):2820-2825.