Low back pain is an extremely common malady. It is the most frequently encountered condition in chiropractic offices. Chiropractors have gained a reputation among their patients for success in working with low back pain. That reputation is increasingly supported by research and evidence-based practice guidelines utilized by informed clinicians.
Low Back Pain Statistics
It is sobering to consider that, according to the American Chiropractic Association, 7.6% of American adults are likely to report at least one episode of severe low back pain in a given year. Low back pain is the fifth most common reason for all physician visits in the U.S. It is the most frequent cause of activity limitation in young adults. Yearly costs for treatment and for work time-loss related to low back pain are thought to exceed $50 billion. At least there is some reassurance knowing that the majority of those afflicted recover reasonably well from these episodes.
Causes of Low Back Pain
Fortunately, only a small fraction of low back pain is caused by a serious underlying condition like a fracture, cancer, infection or inflammatory arthritis. Even disc bulges or herniations are the exception rather than the rule when it comes to causes of low back pain. This leaves the majority of cases in a large and nebulous category known as "mechanical low back pain."
This category of back pain usually has certain characteristic mechanical aspects to it such as increased pain during certain postures or movements. Specific positions may reduce the pain. Certain movements may provoke physical sensation of a catch. An examining clinician will often note regional or localized muscle spasms or guarding and reduced mobility.
The Chiropractic Approach
The most significant difference between chiropractic and most other forms of treatment for this condition is the emphasis on the mechanical nature of the problem. A big part of chiropractic evaluation involves identifying the location, severity and specific qualities of altered or impaired movements in the spine and pelvis. Chiropractic treatment usually involves some sort of manipulation or adjustment with the goal of overcoming restrictive barriers and restoring normal motion to the involved segments.
The chiropractor may use ice, heat, massage or other modalities to help facilitate the process. Activity modification, posture, exercise and other lifestyle issues may also be addressed to assist in the recovery and to prevent a recurrence.
Literature Support
While many of the perceived benefits of chiropractic treatment have yet to be validated through research, chiropractic treatment of low back pain has been extensively studied. There is currently sufficient research supporting spinal manipulation for low back pain that it is no longer considered an alternative approach, but is part of the mainstream in evidence-based care.
Spinal manipulation is one of very few recommended treatments contained in practice guidelines developed by the U.S. Department of Health and Human Services for treatment of low back pain. A 2009 Cochrane Review of the literature noted superior outcomes for spinal manipulation compared to other treatments for chronic low back pain sufferers.
Expert Insight
After an evaluation to rule out a serious underlying disorder, chiropractic treatment can be an appropriate and effective tool in the management of the most common types of low back pain. Additional diagnostic testing may be necessary in cases that do not improve after several weeks.
References
- American Chiropractic Association: Low Back Pain Statistics
- "Acute Low Back Problems in Adults: Assessment and Treatment"; U.S. Dept. of Health and Human Services; Agency for Public Health Policy and Research; December 1994
- Cochrane Database of Systemic Reviews; "Spinal Manipulative Therapy for Chronic Low-Back Pain"; 2009
