Although doctors of chiropractic (DCs) treat more than just back pain, many patients initially visit chiropractors looking for relief from this pervasive condition. In fact, 31 million Americans experience low-back pain at any given time.1
A few interesting facts about back pain:• Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.• Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.• One-half of all working Americans admit to having back pain symptoms each year.2• Experts estimate that as much as 80% of the population will experience a back problem at some time in their lives.3• Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.• Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.4
What Causes Back Pain?The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Spinal Manipulation as a Treatment for Back ProblemsWith today's growing emphasis on quality care, clinical outcomes and cost effectiveness, spinal manipulation is receiving increased attention.
Spinal manipulation is a safe and effective spine pain treatment. It reduces pain (decreasing the need for medication in some cases), rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5
In fact, after an extensive study of all available care for low back problems, the federal Agency for Health Care Policy and Research (now the Agency for Health Care Research and Quality) recommended that low back pain sufferers choose the most conservative care first. And it recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.6
A well respected review of the evidence in the Annals of Internal Medicine pointed to chiropractic care as one of the major nonpharmacologic therapies considered effective for acute and chronic low back pain.7
More recently, research has shown that there is strong evidence that spinal manipulation for back pain is just as effective as a combination of medical care and exercise, and moderate evidence that it is just as effective as prescription NSAIDS combined with exercise.8
An article published in the Journal of the American Medical Association in 2013 also suggested chiropractic care as an option for people suffering from low back pain--and noted that surgery is usually not needed and should only be tried if other therapies fail.9
The Opioid EpidemicThe epidemic of prescription opioid overuse and abuse has also led many health groups to reconsider the value of a conservative approach to common conditions such as low-back pain. The American College of Physicians (ACP), the largest medical-specialty society in the world, updated its low-back pain treatment guidelines in 2017 to support a conservative approach to care. Published in the Annals of Internal Medicine and based on a review of randomized controlled trials and observational studies, the ACP guidelines cite heat therapy, massage, acupuncture and spinal manipulation (a centerpiece of chiropractic care) as possible options for non-invasive, non-drug therapies for low-back pain. The guidelines state that only when such treatments provide little or no relief should patients move on to medicines such as ibuprofen or muscle relaxants, which research indicates have limited pain-relief effects. According to ACP, prescription opioids should be a last resort for those suffering from low back pain, as the risk of addiction and overdose may outweigh the benefits.
The American Chiropractic Association (ACA) urges you to make an informed choice about your back care.
Tips to Prevent Back Pain•Maintain a healthy diet and weight.•Remain active—under the supervision of your doctor of chiropractic.•Avoid prolonged inactivity or bed rest.•Warm up or stretch before exercising or physical activities, such as gardening.•Maintain proper posture.•Wear comfortable, low-heeled shoes.•Sleep on a mattress of medium firmness to minimize any curve in your spine.• Lift with your knees, keep the object close to your body, and do not twist when lifting.•Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.•Work with your doctor of chiropractic to ensure that your computer workstation is ergonomically correct.
References:1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.3. Rubin Dl. Epidemiology and Risk Factors for Spine Pain. Neurol Clin. 2007; May;25(2):353-71.3.1. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.3.2. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-184.108.40.206. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.3. Chou R, Hoyt Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Ann of Internal Med 2 Oct. 2007;147(7):492-504.4. Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine. 2008;8(1)213-225.5. Goodman D, Burke A, Livingston E. Low Back Pain. JAMA. 2013; 309(16):1738.