Not All Lower Back Pain Treatments Are Equal

Recent evidence muddies instead of clarifies the best course to take if you are suffering from lower back pain.

Lower back pain is incredibly prevalent across the globe, with some estimates in the scientific literature showing 80% or more of the human population experiencing lower back pain at some point in our lives.

The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

  1. Nonpharmacologic treatments
  2. Superficial heat
  3. Massage
  4. Spinal manipulation
  5. Exercise
  6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

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General HealthNot All Lower Back Pain Treatments Are Equal
Dr Erik Reichhttps://drerikreich.com/
Dr. Reich lives in Cheshire, CT with his wife and son, and their Boston terrier Jarvis. When not taking care of his patients he enjoys exercising, cooking and baking for his friends and family, listening to music and keeping current with his favorite podcasts. He attended the University of Bridgeport College of Chiropractic and graduated in 2012 with his Doctor of Chiropractic degree.
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