What is the comparative effectiveness of chiropractic (chiropractor) care versus physical therapy for acute lumbar (low back) pain?

From the Guidelines

For immediate relief of acute low back pain, starting with a physical therapist may be more beneficial for most patients, as they offer a comprehensive approach including guided exercises, manual therapy, education on proper body mechanics, and a progressive rehabilitation program. This approach addresses both immediate pain relief and helps prevent recurrence by strengthening core muscles and improving movement patterns. Chiropractors focus primarily on spinal manipulation (adjustments) to improve alignment and function, which can provide quick pain relief for some patients but may require multiple sessions.

Key Differences Between Chiropractors and Physical Therapists

• Chiropractors: Focus on spinal manipulation for immediate pain relief, may require multiple sessions.
• Physical Therapists: Offer a comprehensive approach including exercises, manual therapy, education, and rehabilitation programs for long-term recovery.

According to the most recent and highest quality study 1, low-quality evidence showed no difference between exercise therapy and usual care for pain or function in patients with acute or subacute pain. However, moderate-quality evidence showed no clear differences between different exercise regimens in more than 20 head-to-head RCTs in patients with acute low back pain.

Treatment Recommendations

• Treatment duration: 4-8 weeks depending on severity.
• Session frequency: 2-3 weekly sessions initially, tapering as improvement occurs.
• Additional recommendations: Remain active within pain limits, apply ice for 15-20 minutes several times daily during the acute phase, and follow the home exercise program prescribed by the provider.

The most effective treatment often combines elements from both disciplines: spinal manipulation for immediate pain relief along with therapeutic exercises for long-term recovery, as suggested by 1. It's essential to consider the individual patient's needs and preferences when deciding between chiropractic care and physical therapy for acute low back pain.

From the Research

Effectiveness of Chiropractor vs Physical Therapist for Acute Low Back Pain

• The effectiveness of chiropractic care and physical therapy for acute low back pain is a topic of ongoing research and debate 2, 3, 4, 5, 6.
• A study published in 2009 found that staying active and continuing ordinary activity within the limits permitted by pain, as well as considering McKenzie exercises, can be helpful for pain radiating below the knee 2.
• Another study published in 2008 found that spinal manipulation can be effective in the short term for acute low back pain 3.
• A 2024 study recommended a uniform approach to the treatment of acute low back pain, including proper patient education and utilizing drugs with proven efficacy and minimal side effects, as well as considering spinal manipulative therapy and acupuncture as adjuncts to improve acute low back pain 4.
• A systematic review of systematic reviews published in 2020 found that exercise therapy may result in little or no important difference in pain or disability compared to other interventions, including spinal manipulative therapy, in adult patients with acute low back pain 5.
• A 2024 systematic review and expert consensus found that spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain, while core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain 6.

Comparison of Chiropractic Care and Physical Therapy

• There is limited direct comparison between chiropractic care and physical therapy for acute low back pain in the provided studies 2, 3, 4, 5, 6.
• However, spinal manipulative therapy, which is a common technique used by chiropractors, has been found to be effective in the short term for acute low back pain 3, 4, 6.
• Physical therapy, including exercise therapy and core stability exercise/motor control, has also been found to be effective for acute and sub-acute low back pain 5, 6.

Recommendations for Treatment

• Based on the provided studies, recommendations for treatment of acute low back pain include staying active, considering McKenzie exercises, and utilizing spinal manipulative therapy and acupuncture as adjuncts to improve acute low back pain 2, 3, 4.
• Exercise therapy, including core stability exercise/motor control, and massage may also be effective for acute and sub-acute low back pain 5, 6.
• It is essential to note that the effectiveness of chiropractic care and physical therapy may vary depending on individual patient needs and preferences, and a uniform approach to treatment should be tailored to each patient's specific condition 4.