Over 85% of us will suffer from lower back pain at some point in our working lives. When that pain strikes, patients will try anything to find relief: bed rest, painkillers, injections and more. When you consider just how frustrating chronic back pain can be to deal with it's no surprise that it's the leading cause of disability worldwide and second only to the common cold as a cause of lost work time.
30 years of clinical practice as a chiropractor has taught me that one size does not fit all when it comes to back pain. There is no silver bullet. While some treatments may help some people, they don't work well for others, so it's very important to offer a targeted combination of approaches based on a thorough assessment and diagnosis.
Chiropractors are specifically trained to diagnose the underlying cause of back pain and recommend treatment options to help keep you doing the things you love to do. Here is how a chiropractor would approach your back pain:
Assessment
The first step is always a thorough assessment that includes both the specific complaint and your general state of health. Your chiropractor will ask you to share the history of your condition to help determine your pain's location, duration, constancy/intermittency, intensity and character, and whether there is an associated referral of pain into the arms or legs. A physical examination includes specific testing such as checking the ranges of motion, function and mobility of the spinal joints, and orthopedic tests to determine exactly what is happening to your body.
As you go through your assessment, your chiropractor will be looking for yellow and red flags. Yellow flags are psycho-social barriers to recovery that include a belief that bed rest, time off work and passive interventions are the key to recovery (the opposite is true), alongside social withdrawal and low job satisfaction.
Red flags are potentially serious problems that mean a referral to another practitioner is required because the condition is not one a chiropractor can treat. Fortunately, red flags are very rare, and most patients with back pain can be treated by a chiropractor.
Diagnosis
From the assessment stems a diagnosis of the condition. The spine is complex and there are many potential sources of pain. Research clearly shows what chiropractors and other spine clinicians have learned: most back pain (as much as 90%) is "non-specific". While clinicians used to identify a specific disc, joint, ligament or muscle as the source of the pain, we now know that this level of specificity is not really possible. What "non-specific" really means is that the back pain is related to how your spine and associated tissues function and move and not the result of tissue or structural damage.
Nerves carry messages to the brain, for example to transmit the sensation of pain. They also carry messages from the brain, including how to make muscles contract and coordinate movement. That's why it's important for a chiropractor to understand and assess how the nervous system is functioning and how this could be related to the complaint.
This is particularly useful in deciding whether a patient is likely to respond to the care a chiropractor provides, or whether a referral to another practitioner is warranted. Loss of muscle function related to the bladder or bowel are very rare, but can be dangerous and indicate conditions for which urgent surgery may be required. The presence of pain, numbness and other sensations, even if severe, usually do not mean you need surgery.
Prognosis
Non-specific back pain can be categorized as Acute - symptoms lasting less than 6 weeks, Subacute - symptoms lasting 6-12 weeks, Chronic - symptoms lasting 12 weeks or more or Recurrent/flare up - symptoms are similar to original symptoms, and return sporadically or as result of exacerbating circumstances. Episodes of acute low back pain are very common; the key is to prevent these from becoming chronic or recurrent. There is a growing body of evidence on how to identify those patients who are at most risk of experiencing chronic pain, and this informs how a chiropractor or other healthcare provider would tailor their approach.
Treatment
A chiropractor has a large number of tools available to help care for people with low back pain and other musculoskeletal conditions. The evidence, including a number of high-quality interprofessional guidelines shows that the chiropractic approach is in fact the most appropriate approach for most back pain patients. This includes engaging you to keep moving and going about life, a focus on exercise, education about your condition, and spinal manipulation and/or mobilization (which can include neck and back adjustments). The goals are to help people return to full function, and to train and motivate them to care for themselves so they can manage and prevent future debilitating episodes.
Based on the assessment, and keeping in mind the patient's unique history and context a chiropractor can recommend a combination of massage, acupuncture and manual therapies, alongside exercises to strengthen the back. As a patient's condition improves, the exercises can be modified to maximize their benefit.
Throughout your care, a chiropractor will provide you with clear, detailed information about the treatment you are receiving, and manage your expectations around what a treatment can and can't do. The key is constant, clear communication and continuous reassessment to see if you are responding to treatment, and amending the approach as necessary.
Once you experience low back pain you can appreciate how much of an impact it can have on everyday life, and how routine activities can all of a sudden become huge obstacles. That's why it is so important to make sure you tackle back pain with the right tools, the right evidence and the right approach for your needs, whether it's from your chiropractor, physician, physiotherapist or other practitioner.
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