Back Pain: Can a Chiropractor Help?


Back pain is one of the most common-and debilitating-ailments people face. And finding the right pain relief is no easy feat: A paper in The Spine Journal likened choosing a treatment to relieve back pain to supermarket shopping, comparing the wide array of treatment choices to the vast inventory on grocery store shelves.

Many people choose to see a chiropractor about their back pain. In fact, an estimated 27 million Americans are evaluated and treated by a chiropractor each year, mostly for back pain relief, according to a 2015 National Institutes of Health report. The hallmark therapy of chiropractic care is spinal manipulation.

Getting your back on track

Modern chiropractic treatment is based on the assumption that back pain is caused by misalignment of the spine. Spinal manipulation involves physical pushing, pulling, and methodical repositioning of the head, shoulders, neck, back, or hips to help alleviate back pain.

Once considered a fringe medical treatment for back pain, the practice of spinal manipulation for low back problems is being adopted by more medical doctors. The American College of Physicians and the American Pain Society, in their patientcare guidelines, included spinal manipulation as one of several treatment options for trained practitioners to consider using. The groups’ guidelines specify that spinal manipulation be considered when ordinary, uncomplicated back pain (pain not caused by a more serious underlying problem such as compression fractures or a herniated disc) doesn’t improve with self-care. Adjustments may help with acute back pain of six weeks or less or with flare-ups of chronic back pain.

Caveats to consider

Other treatments can also relieve back pain, from over-the-counter pain relievers such as ibuprofen (Advil, Motrin), to physical therapy, massage, or a combination of therapies. Research has found that spinal manipulation works about as well as anti-inflammatory and pain relief medications and other traditional interventions.

A 2011 Cochrane review examining various interventions found that spinal manipulation slightly improved chronic low back pain and disability in the short term. But the researchers reported that there was no evidence as to whether or not manipulation is better than other therapies, such as physical therapy, pain-relief drugs, and exercise. A 2013 Cochrane review reported similar results for acute low back pain. Other evidence suggests spinal manipulation might help with conditions such as neck pain, headaches (including migraines), and shoulder pain.

Often, patients don’t need any treatment, and back pain will go away on its own. For chronic pain, chiropractic treatment may offer temporary relief.

Some chiropractors treat anything and everything, from asthma to premenstrual syndrome to headaches-whatever might be bothering you. Many sell herbal and other types of supplements, promote health fads such as iridology (“reading” the body by looking at the iris of the eye), and use hair analysis and similar tests to diagnose bogus nutritional deficiencies, illnesses, and allergies.

Some chiropractors are dismissive of mainstream medicine, including immunizations. Others work with medical doctors, giving and accepting referrals. Still others treat only back problems, and use conventional methods such as ice, heat, and massage. Given the broad range of approaches, it is hard to know what you might encounter when you visit a chiropractor.

The value of chiropractic treatment of back pain and other musculoskeletal problems has been studied more than any other aspect, and in 1994 the Agency for Health Care Policy and Research concluded that chiropractic spinal adjustment could be useful for relieving acute low back pain if started early. But chiropractic treatment has never been proven effective for chronic back pain or radiating back pain (such as sciatica). And many studies have found that spinal manipulation is no more effective than a placebo for back pain. Nevertheless, use of chiropractors is growing.

Why consider chiropractic treatment?

According to the American Chiropractic Association (ACA), chiropractors treat not only back pain, but several other health conditions, including neck pain, headaches, and muscle, ligament, and joint injuries and disorders. Doctors of chiropractic (DCs) undergo extensive training to diagnose and treat musculoskeletal problems.

Chiropractors take a holistic, or whole-body, approach to patients, counseling them on diet, nutrition, and healthy lifestyle habits. Treatments generally consist of six to 12 visits over two to four weeks. Conservative pain management is emphasized over drugs and surgery, but a good chiropractor will refer patients to other medical professionals if the diagnosis is beyond the scope of his or her practice.

Chiropractors perform spinal manipulation by using their hands or a device to apply a small amount of force-or a more forceful thrust-to readjust the bones in the spine and neck. Spinal manipulation is typically most effective when combined with more traditional therapies to treat back pain, such as:

  • Heat and cold therapies
  • Massage
  • Relaxation techniques
  • Electrical stimulation or ultrasound
  • Exercise and stretching
  • Patient education

Chiropractic risks

The risk of injury from chiropractic treatment is generally low when performed by a trained and licensed practitioner. Spinal manipulation has fewer risks than nonsteroidal anti-inflammatory drugs (NSAIDs). Most of the technique’s side effects are mild: sore, stiff, or achy muscles, lasting a day or two after treatment. Some people may experience temporary dizziness, headache, or numbness after a visit.

Though rare, there have been reports of more serious side effects after chiropractic manipulation, including spinal cord injury, spinal fluid leakage, herniated disc or progression of an existing herniated disc, and compression of nerves in the lower spine, called cauda equina syndrome. Your primary care doctor should discuss with you any possible risks before you undergo treatment.

Neck manipulation carries a rare risk of stroke, according to a 2014 American Heart Association (AHA) scientific statement. High-velocity rotation of the head has been linked to a tear in an artery in the neck, referred to as vertebral artery dissection (VAD). If left untreated, VAD may block blood flow in the brain and lead to a stroke.

It’s not certain whether manipulation directly causes VAD and stroke, or if people who have undiagnosed VAD are simply more likely to visit a chiropractor for care. For example, whiplash, certain sports movements, and violent coughing or vomiting can result in dissection, says the AHA.

Spinal manipulation isn’t for everyone. If you have seen a chiropractor and your condition isn’t improving-or it’s getting worse-you might need to visit your primary care doctor or see a specialist.

If you decide to visit a chiropractor …

First, see your primary care doctor for a diagnosis and possible treatment. Ask your doctor to refer you to a chiropractor.

Find out ahead of time if your health insurance will cover treatment; Medicare covers medically necessary chiropractic services.

When choosing a chiropractor, look for someone who:

  • Provides advice on home treatment and exercises
  • Arrives at a diagnosis through a thorough physical examination and interview, ordering X-rays only in specific cases
  • Is willing to refer you to a specialist when warranted

Avoid a chiropractor who:

  • Uses X-rays as a standard diagnostic test
  • Uses manipulation to treat such ailments as respiratory infections, skin conditions, and eye problems
  • Promotes regular manipulation as a means to prevent an unrealistic list of health problems
  • Advises against flu or pneumonia vaccines
  • Wants to run a hair or fingernail analysis or use other unproven methods to detect allergies, deficiencies, or “unhealthy body chemistry.”