Chiropractic Care for Low Back Pain

There could be misconceptions out there about chiropractic care, as to how it works or how safe it actually is. Below is an overview of the principles behind chiropractic and how it may help relieve low back pain, whether acute or chronic.

Seeing a doctor of chiropractic, otherwise known as a chiropractor, chiropractic physician or DC, can be a beneficial step towards effectively treating low back pain. Below is a brief description of what chiropractors do and how they help patients resolve their low back pain.
Elderly man having a chiropractic examWhat Chiropractors Do
Chiropractors utilize a series of treatments designed to manipulate the spine, joints, and tissues of the body to relieve pain and improve functional ability. Generally, this would be referred to as spinal manipulative therapy (SMT), but there are many other chiropractic treatment methods.

A chiropractor tailors his or her treatment approach based on the individual needs of a patient, using a traditional philosophy of starting off with the more natural, less-invasive therapies before moving on to some more aggressive methods.

Informed Consent
At every stage during the process, chiropractors maintain a strict emphasis on proactively communicating with the patient exactly what is going to happen. The chiropractor makes sure the patient understands everything that occurs during a diagnosis, examination, and the proposed procedures, in order to educate the patient and receive direct approval to start the treatment process.

This emphasis on informed consent is essential because some chiropractic techniques may carry material risk*, which means there could a danger, however, insignificant, that a particular procedure possibly could cause an injury.

*The legal definition of material risk may vary state by state.

However, a chiropractor also informs a patient of the possible risks attached to abstaining from the procedure, altogether. However, none of this is meant to scare a patient. It is simply intended to eliminate misunderstandings and always make sure the patient, who has full control over his or her body can make an informed decision.

Examination Procedures
A chiropractor will examine a patient thoroughly before making any sort of diagnosis or treatment plan. The assessment can include various aspects, including:

  • Health history

Look at the characteristics of the pain, keeping an eye out for "red flags," which suggest that further diagnostic testing should be conducted in order to exclude any potentially serious medical problems that can be associated with neck or low back pain-like neurological disorders, fractures, infections, and tumors.

There are many reasons why low back pain occurs. A chiropractor will find out those reasons to configure the most appropriate treatment.

  • Physical examination, including orthopedic and neurological tests

Test the reflexes, sensory nerves, joints, muscles, and other areas of the body.

  • Advanced Diagnostic Testing

Imaging and laboratory tests are not recommended for nonspecific LBP, but they may be necessary if there are signs of a serious underlying condition.

Severity and Duration of Conditions
A chiropractor looks at the symptoms and conditions of an injury or illness and logically classifies them based on how severe they are, and how long they last.

Symptoms are subdivided into degrees of severity: mild, moderate, or severe. In terms of duration, pain (and other symptoms) can be referred to as:

  • Acute - persists for less than 6 weeks
  • Subacute - persists between 6 and 12 weeks
  • Chronic - persists for at least 12 weeks
  • Recurrent/flare-up - the same symptom(s) reoccurs sporadically or because of exacerbating the original injury

Typical Therapeutic Trial
If a patient is suffering from acute or subacute low back pain, a typical chiropractic therapeutic trial is 2 to 3 weekly sessions over the course of 2 to 4 weeks, going up to 12 total sessions per trial. Often, this can be sufficient to completely resolve the pain. Other times, additional treatments may be necessary, especially if a patient is suffering from other issues.

Outcome Measurements
Outcome measurements are a valuable tool for a chiropractor because they can help determine if the treatments are showing significant improvements.

Some ways a chiropractor can measure the outcomes of the treatments include:

  • Having a patient rate the pain on a Numeric Pain Scale
  • Using a pain diagram so a patient can describe the location and character of the pain   
  • Looking for increases (or decreases) in daily living practices, as in the ability to work (employment), exercise and sleep.
  • Testing functional capacity, such as lifting ability, strength, flexibility, and endurance

Some patients' low back pain could have lasted into and beyond the 12-week mark, making it chronic pain. During examination, chiropractors will look for signs to see if a patient is at risk of developing chronic pain- the "yellow flags" of chronicity so to speak.

To learn more about how chiropractors treat chronic low back pain, read more here.

This series of articles about chiropractic care for low back pain contains information cited from a recent update in recommended treatment guidelines published by the Council on Chiropractic Guidelines and Practice Parameters (CCGPP). All authors and panelists involved in the publishing of the new updated guidelines stated receiving no compensation from any organization. There were no conflicts of interest reported.

Updated on: 03/22/16
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