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The Best Option for Low Back Pain

Chiropractic’s effectiveness for low back and other spinal pain is well understood in the peer-reviewed literature, and has been for some time now.  As the evidence continues to build, the question has evolved from “is it effective?” to “should it be the first choice for low back pain and other spinal pain?”  When a comprehensive and honest look at the literature is undertaken, the answer becomes fairly clear.

“The prevalence and impact of back pain have led to an expanding array of tests and treatments, including injections, surgical procedures, implantable devices, and medications. Each is valuable for some patients, but use may be expanding beyond scientifically validated indications, driven by professional concern, patient advocacy, marketing, and the media.”


-Deyo, RA et al. “Overtreating Chronic Back Pain: Time to Back Off?” The Journal of the American Board of Family Medicine

Volume 22 Number 1, January 2009, pp. 62-68.


“This is the first reported randomized controlled trial comparing full CPG (clinical practice guidelines)-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC (usual care) in the treatment of patients with AM-LBP (acute mechanical low back pain). Compared to family physician-directed UC, full CPG-based treatment including CSMT (chiropractic spinal manipulative therapy) is associated with significantly greater improvement in condition-specific functioning.”


-Bishop, PB et al. “The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial...” Spine J. 2010 Dec;10(12):1055-64.



“For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.”

As a side note, the authors of these guidelines consider acute pain less than 4 weeks duration, and subacute/chronic over 4 weeks duration.  Also, note that for acute LBP not resolved with self-care options the ONLY recommendation is spinal manipulation!


-Chou R, et al. “Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline...” Ann Intern Med 2007 Oct 2;147(7):478-91.


“For acute and subacute low back pain (LBP), strong evidence supports the use of spinal manipulation to reduce symptoms and improve function...For chronic LBP, strong evidence supports the use of spinal manipulation/mobilization to reduce symptoms and improve function.”


-Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C, Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther 2008 Nov-Dec;31(9):651-8.