Can chiropractic help you with short- and long term low back pain?
Can chiropractic help you with low back pain?
The short answer is yes; in the majority of cases, but a conclusion like this is worthless without having a look at the evidence which supports it.
Short term (acute) low back pain (LBP) continues to be a very prevalent, disabling and costly problem in modern society. This problem is most commonly treated with these interventions, including; spinal manipulation therapy (SMT - as utilized by chiropractors), physical modalities, medication, education, or exercise, or in a more multimodal approach combining several of the interventions (which is the most common approach).
In a recent systematic review (which is the study design which thrones highest in the research hierarchy) published in Spine (Dagenais et al 2010), 14 randomized controlled trial studies looking into the different treatment interventions with a total of 2027 participants were evaluated. After evaluating the results, both in terms of pain reduction and function improvement; the study concluded that:
… “Several RCTs have been conducted to assess the efficacy of SMT for acute LBP using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.” …
As shown by this study, spinal manipulative therapy shows benefit for patients suffering from short term low back pain, normally within 5 to 10 treatment sessions over two to four weeks. However, it is important to combine treatment with educational exercise to prevent reoccurrence and to address the faulty motor control pattern which triggered the low back pain in the first place. Therefore, addressing physical exercise either through a home exercise program or with a qualified training center is essential to reduce the chance of reoccurring back pain.
Later the same year, an award-winning study was published in Spine (Bishop et al 2010) entitled “Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: A Randomized Controlled Trial on the Effectiveness of Clinical Practice Guidelines in the Medical and Chiropractic Management of Acute Mechanical Lower Back Pain". The CHIRO studies are a unique series of studies being conducted in a hospital-based, tertiary-care Orthopaedic and Neurosurgical Spine Program at Canada's National Spine Institute (ICORD) in the Faculty of Medicine at the University of British Columbia in Vancouver. The chiropractors have full hospital privileges, which are a first according to Dr. Bishop, and work in a continuum-of-care model that involves related medical and surgical disciplines.
The results have been very positive, and concluded that:
… “Patients randomized to CPG (evidence-based clinical practice guidelines - reassurance, avoidance of passive treatments, acetaminophen, four weeks of lumbar chiropractic spinal manipulative therapy, and return to work within eight weeks) care improved to a significantly greater degree (Roland-Morris Disability Questionnaire - RDQ scores) than patients receiving UC (family-physician usual care); bodily pain and physical functioning scores also significantly improved in the CPG group compared to the UC group.” …
*(Italics text added for explanatory purposes)
The study further criticizes an earlier study from 2007 which denied the efficacy of spinal manipulation, by pointing out that this study based its results/conclusions on the outcomes of therapies performed by non-chiropractors, and that:
… “the levels of training and clinical acumen vary widely.” …
It is essential to remember that authorized chiropractors have an extensive 5 year university education / training (masters’ degree) and are primary health care physicians.
In concluding, it can be seen that chiropractic treatment has shown significant positive results in terms of pain reduction and physical functioning improvement scores in highly ranked studies, and thus it can be said that chiropractic care can help you with your low back pain. However, as mentioned earlier, I would like to emphasize the need to address the causative factors with a multi-modal approach to prevent reoccurrence of the problem.
If you have any questions, please submit your comment below.
Alexander (DC, Doctor of Chiropractic, 2011)
Bishop PB, Quon JA, Fisher CG, Dvorak MF. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J. 2010 Dec;10(12):1055-64. http://www.ncbi.nlm.nih.gov/pubmed/20889389
Simon Dagenais, Ralph E. Gay, Andrea C. Tricco, Michael D. Freeman, John M. Mayer. NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain. The Spine Journal, Vol. 10, No. 10. (October 2010), pp. 918-940. doi:10.1016/j.spinee.2010.07.389 Key: citeulike:7921321.
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