Chiropractic Care for Lower Back Pain
Yes, chiropractors can effectively help with lower back pain—the American College of Physicians recommends chiropractic spinal manipulation as a moderately effective treatment option for both acute and chronic low back pain, with benefits comparable to other evidence-based therapies like physical therapy and exercise. 1
Evidence for Acute Lower Back Pain
- Spinal manipulation provides small to moderate short-term pain relief, reducing pain by approximately 10 points on a 100-point visual analogue scale compared to sham manipulation. 2, 1
- Functional improvement averages 2.8 points on the Roland-Morris Disability Questionnaire, though this benefit is moderate and should be considered when patients don't improve with initial self-care approaches. 2, 1
- The treatment performs comparably to other effective interventions—there are no significant differences between spinal manipulation and physical therapy, exercises, or analgesics for acute pain. 2, 1
Evidence for Chronic Lower Back Pain
- For chronic pain, spinal manipulation demonstrates moderate effectiveness with pain reduction averaging 10 points short-term and 19 points long-term on a 100-point scale. 1
- Functional improvement averages 3.3 points on the RDQ in the short term, and large trials show spinal manipulation slightly superior to usual care for both pain and disability. 2, 1
- A military trial of 750 active-duty service members found that adding chiropractic care to usual medical care resulted in statistically significant improvements: mean difference of -1.1 points for pain intensity and -2.2 points for disability at 6 weeks, with higher patient satisfaction. 3
Safety Profile
- Serious adverse events from spinal manipulation are extremely rare, with risk estimated at less than 1 per 1 million patient visits. 1
- More than 70 controlled clinical trials reported no serious complications, and five systematic reviews consistently confirmed this excellent safety profile. 1
Important Caveats
One critical exception exists: chiropractic spinal adjustment is conditionally recommended against for rheumatoid arthritis management due to potential cervical spine complications in this specific population. 2 This guideline specifically addresses RA, not mechanical low back pain, so it doesn't contradict the use of chiropractic care for typical musculoskeletal lower back pain.
Clinical Application
- Chiropractic care should be administered by appropriately trained providers (DCs) who can diagnose, treat, and co-manage low back pain disorders. 4
- Treatment typically includes spinal manipulative therapy in the low back and adjacent regions, plus additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies. 5, 6
- Patients typically receive an average of 12 treatments over a 4-week period, achieving approximately 52-53% reduction in both pain and disability scores. 5
- Chiropractic care works best as part of a comprehensive treatment plan, not as a replacement for other evidence-based interventions, and can be combined with NSAIDs, activity modification, and other nonpharmacologic therapies. 7, 6