Chronic low back pain is the leading cause of disability worldwide. Low back pain is the second leading cause of missed work days, second only to respiratory infections. With low back pain affecting up to 80% of the adult population, understanding the most effective treatments is critical as not all treatments achieve the same results and some treatments achieve better long-term relief.
Spinal Manipulation / Adjustments
Spinal manipulation is one of the most effective treatment options for back pain relief. All spinal joints and the surrounding connective tissues are loaded with receptors known as mechanoreceptors and nociceptors. Sensory information from these receptors is constantly being sent to the central nervous system. These receptors send information to the central nervous system and brain such as pain, touch, temperature and proprioception (position sense). When joints and tissues get injured and/or locked up they send as stress signal called nociception.
When nociception reaches a certain part of the brain called the pre-frontal cortex, one detects the sensation of pain. Mechanoreceptors work to counter nociception and when joints move properly they send proprioception. It has been demonstrated that the transmission of pain can be blocked by increasing proprioception. As proprioception goes up it shuts down nociception and pain signals. This simple concept explains why rubbing acute injury relieves pain. Spinal adjustments or manipulation increase joint mobility and fires off proprioception and decrease pain signals.
Spinal Manipulation vs Acupuncture vs Medication
In 2003 a randomized control trial was conducted with two-year follow-ups to compare the effectiveness of spinal manipulation, acupuncture and medication for the treatment of non-complicated back pain. In the study patients were randomly assigned to receive chiropractic adjustments, acupuncture or pain medication (Celebrex, Vioxx or paracetamol). The average duration of back pain symptoms before treatment was 8.3 years in the spinal manipulation group, 6.4 years in the medication group and 4.5 years in the acupuncture group. Spinal manipulation received the best outcomes for all the back pain related outcome measures, even though the patients who received manipulation had the most chronic symptoms. The results of this study suggest that spinal manipulation, if not contraindicated, may be superior to needle acupuncture or medication for short-term back pain relief. Acupuncture had the second-best results for back pain relief but performed the best for acute neck pain relief. Pain medication had worst results and also have some cases with adverse side-effects.
Chiropractic BioPhysics (CBP®) vs Traditional Chiropractic vs Physiotherapy
There is a strong relationship with loss of lumbar lordosis (loss of lumbar curve) and back pain. Normal lumbar lordosis is about 40°, a loss of lumbar lordosis below 36° has been shown to be a cut point where below 36° there is an increased likelihood of having chronic low back pain. Additionally, low back pain caused by disc degeneration and disc herniation is also strongly associated with loss of lumbar lordosis. A randomized control trial comparing individuals with low back pain compared patients receive spinal manipulation to patients receiving spinal manipulation and spinal manipulation and CBP® mirror-image traction. Individuals receiving manipulation and other physical therapy modalities without CBP® mirror-image traction did not show a change in the lumbar curve. Another study compared giving patients physical therapy including stretching and infrared radiation compared to stretching, infrared radiation and 3-point-bending traction (mirror image traction). Both groups showed decreased back pain levels, however, the traction group showed greater improvements. At long-term follow-up post-treatment exercise, the only group returned to original pain levels and the exercise with the traction group maintained decreased back pain levels. The exercise-only group did not show changes in lumbar curves, the traction group showed significant improvements in lumbar. A similar study was done comparing individuals who received spinal manipulation and no traction to those who received traction and no spinal manipulation. The traction group showed improvement in lumbar curves compared to no change in lumbar curves in the spinal manipulation only group. The traction group with improved lumbar curves had better long-term back pain relief.
With 33% of the American population now classified as obese, there is a growing interest in understanding the role of increased body mass index (BMI) and low back pain. Numerous studies have reported an association between back pain and increased BMI. Health-care professions frequently refer to obese patients with low back pain to lose weight. In morbidly obese patients’ bariatric surgery has been shown effective in weight loss and the reduction of back pain. A recent pilot study demonstrated the effectiveness of medically supervised, non-surgical weight loss program for the reduction of low back pain. This study demonstrated the non-surgical medically supervised weight loss program was effective in reducing BMI and with a reduction in BMI low back pain and disability were decreased.
Spinal manipulation has been shown more effective than acupuncture and medication for short-term back pain relief. Spine rehabilitative methods such as CBP® that aim to restore normal lumbar lordosis have better short-term and long-term results for back pain relief than methods that have not been shown effective in correcting lumbar curves such as spinal manipulation and/or exercises alone. In obese individuals, participating in a medically supervised weight loss program is a critical component for weight loss and back pain relief. Obese patients with loss of lumbar lordosis may benefit from participating in both a weight loss program and spine rehabilitation program aim at restoring lumbar lordosis.
- Giles, L.G. and R. Muller, Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine (Phila Pa 1976), 2003. 28(14): p. 1490-502; discussion 1502-3.
- Chun, S.W., et al., The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J, 2017. 17(8): p. 1180-1191.
- Diab, A.A. and I.M. Moustafa, The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial. J Back Musculoskelet Rehabil, 2013. 26(2): p. 213-20.
- Roffey, D.M., et al., Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults. Spine J, 2011. 11(3): p. 197-204.