The prevalence of lower back pain is staggering. Low-back pain is rated the number one burden in terms of years lived with disability in developed countries; as measured by The Global Burden of Disease (GBD). 1

IN THE WESTERN WORLD, 80% OF THE POPULATION WILL EXPERIENCE DISABLING LOW BACK PAIN DURING THEIR LIVES. An estimated 3 million Australians (13.6% of the total population) have back problems including 2.8 million with back and disc disorders and an additional 0.2 million with sciatica according to the Australian Institute of Health and Welfare (AIHW) figures.1,2

The main purpose of pain is to warn us that a region of your body has reached its threshold, or limitation. For example. Try bending your little finger backwards. I bet that if you keep going, your body will alert you when you approach the limit of its range of motion. Life without pain may sound good, but pain is essential for our wellbeing.

The same thing applied to any pain or symptom just like low back pain. It is merely a method of communication your body uses to let you know that you have reached your threshold. Pain, spasm or inflammation usually comes on at the end of normal musculoskeletal function. Most of the time people miss the subtle signs and symptoms before it becomes more serious or mask them hoping they go away and thinking it’s just “muscular”.

Without significant trauma, the underlying cause of back pain is usually an accumulation of stressors (chemical, physical, emotional) on the body over a period of time.

Research on the Chiropractic care for lower back pain is already extensive. Chiropractic care of the spine has been shown to reduce pain, decrease medication, and is extremely cost effective.

Let’s look at the research

Few (if any) other health care interventions have been assessed as extensively as chiropractic spinal manipulation, both in terms of safety and effectiveness. Furthermore, few other health care professions have been as thoroughly researched as chiropractic.

There have been at least six formal government inquiries into chiropractic worldwide over the last 25 years (including Canada, Australia, New Zealand and Sweden). These six studies state that contemporary chiropractic care is safe, effective, and cost-effective and have recommended public funding for chiropractic services.

A Government Research agency in America reviewed thousands of studies on lower back pain. After selecting the best scientifically-based studies they concluded that spinal manipulation (94% of which is done by chiropractors) was clearly superior to any other treatment for low back pain. This was stated by a panel of 23 independent multidisciplinary clinicians and supported by a staff of 200 leading back experts.3

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One of the most significant reports was produced by the Clinical Standards Advisory Group (CSAG) in the UK in 1994. The CSAG guidelines for the management of back pain recommend spinal manipulation along with active exercise and physical activity to modify pain mechanisms and speed recovery.5

The 1997 New Zealand Acute Low Back Pain Guide is a government sponsored, evidence-based guideline based on an extensive review of the international literature and wide consultation with professional groups in New Zealand. The New Zealand guideline reinforced the CSAG recommendations by including adjustment as an appropriate treatment for pain relief and improvement in mobility and function for acute low back pain.6

The Danish Institute for Higher Technology Assessment (DIHTA) produced a report in 1999 on frequency, management and prevention of low back pain. DIHTA states that spinal manipulation is indicated for management of acute pain and to improve function, and should be considered for use in patients who have been experiencing pain for longer than two to three days. DIHTA also recommends that manipulation be considered for recurrent, chronic low back pain and for nerve root/disc conditions.7

Similarly, the U.K. Royal College of General Practitioners (RCGP) 2001 Clinical Guidelines for the Management of Acute Low Back Pain state that there is strong evidence that spinal manipulation can provide short-term improvement in pain and activity levels and demonstrates higher patient satisfaction than alternate treatments. The guidelines recommend that adjustment be considered for pain relief and for patients who are failing to return to normal activities.8

Studies in other countries have reached similar conclusions and the international medical literature contains a broad range of published studies attesting to the effectiveness and safety of chiropractic care for musculoskeletal complaints including back pain, neck pain and headaches.9As research advances, evidence continues to accumulate to support the benefits of chiropractic care for a variety of conditions.

In addition to government inquiries, there have been many scientific clinical studies (randomized controlled trials included) assessing the appropriateness, effectiveness and/or cost-effectiveness of spinal manipulation or chiropractic manipulation (most notably for back pain).


A study in ‘Spine’ on low back pain has shown that compared to those who sought care from medical

Doctors, chiropractic patients were more likely to be satisfied with their care, and less likely to seek care from another provider for that same episode of pain.9

A patient information article published recently in the Journal of the American Medical Association 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.10.

“…for the management of low-back pain, chiropractic care is the most effective treatment, and it should be fully integrated into the government’s health care system.11

 “[Chiropractic Manipulative Therapy] in conjunction with [standard medical care] offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute low back pain.12

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.13

 “Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”14

For Long-Term Low-Back Problems: 

Researchers in the Netherlands funded by the Dutch Health Insurance Board, retrieved and evaluated evidence from 48 randomized controlled trials conducted worldwide that addressed the treatment of acute and chronic low-back pain. Researchers found “strong evidence” for the effectiveness of spinal manipulation in the treatment of chronic low-back pain. 15

 “…improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear.”16

“Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.16
For Pain:
“…patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.”17

In Comparison to Other Treatment Alternatives

“Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.”18

“Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”19

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”20


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Laurelle Caristo

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