From the Guidelines
Physical therapy is likely a better option for most patients with chronic low back pain due to its focus on long-term self-management skills and active rehabilitation. When considering the effectiveness of chiropractors versus physical therapists for chronic low back pain, it's essential to examine the approaches and outcomes of each. Chiropractors primarily use spinal manipulation, which may provide immediate pain relief for some patients 1. In contrast, physical therapists focus on active rehabilitation through targeted exercises, movement retraining, and functional improvement, teaching patients self-management strategies they can continue independently 1.
Key Differences in Approach
- Chiropractors: spinal manipulation (adjustments) for immediate pain relief
- Physical Therapists: active rehabilitation, targeted exercises, movement retraining, and functional improvement for long-term self-management
The most effective approach often combines elements from both: manual therapy techniques with progressive exercise programs 1. Treatment typically requires multiple sessions over 6-12 weeks, with frequency decreasing as improvement occurs.
Factors Influencing Choice
- Specific cause of pain
- Patient preferences
- Insurance coverage
Many patients benefit from starting with physical therapy for its emphasis on long-term self-management skills, potentially supplemented with chiropractic care for pain relief 1. The underlying science suggests that both approaches work through different mechanisms - physical therapy by improving muscle function and movement patterns, and chiropractic by affecting joint mobility and neurological signaling pathways that modulate pain perception.
Evidence Summary
- Moderate-quality evidence supports the use of massage, exercise therapy, and spinal manipulation for chronic low back pain 1
- Low-quality evidence shows no clear differences in pain or function between spinal manipulation and other active interventions 1
- Recent systematic reviews support the effectiveness of exercise therapy, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain 1
From the Research
Effectiveness of Chiropractor vs Physical Therapist for Chronic Low Back Pain
- The effectiveness of chiropractic care and physical therapy for chronic low back pain has been studied in various research papers 2, 3, 4, 5, 6.
- A case report published in 2025 found that a multimodal chiropractic approach, including spinal manipulation and exercise, improved chronic low back pain and disability in a patient who had not responded to previous chiropractic care 2.
- A review of conservative management of low back pain published in 2021 highlighted the importance of recognizing prognostic factors, initial evaluation, and conservative management, including patient education, therapeutic exercises, and bracing 3.
- A clinical practice guideline published in 2018 recommended spinal manipulative therapy (SMT) as a treatment option for acute and chronic low back pain, either alone or as part of a multimodal approach, including exercise and education 4.
- A systematic review published in 2025 found that the addition of manual therapy to exercise therapy improved pain and disability outcomes in chronic low back pain patients, with eight out of ten studies reporting benefits 5.
- A narrative review published in 2021 highlighted the effectiveness and efficacy of SMT for the management of spine pain, including low back pain, and recommended its use in combination with exercise as part of a multimodal approach 6.
Comparison of Chiropractic and Physical Therapy
- While there is evidence to support the use of both chiropractic care and physical therapy for chronic low back pain, a direct comparison of the two is limited 2, 5, 6.
- A study published in 2021 suggested that SMT may be as effective as other recommended therapies, including physical therapy, for the management of non-specific and chronic primary spine pain 6.
- However, more research is needed to determine the specific effects of SMT and to identify factors that predict positive outcomes from this intervention 6.
Treatment Approaches
- Multimodal approaches, including spinal manipulation, exercise, and education, may be effective for the management of chronic low back pain 2, 4, 5, 6.
- The use of SMT, either alone or as part of a multimodal approach, is recommended for the management of acute and chronic low back pain 4, 6.
- Exercise therapy, including strengthening, stretching, and stabilization exercises, is also an important component of conservative management for chronic low back pain 3, 5.