Chiropractic treatment for back pain

3 Ways Chiropractors Treat Back Pain
April 3, 2017

Back pain can be debilitating and make the simplest tasks difficult. One way to relieve back pain is by visiting a chiropractor; for people who have never made an appointment, it might be unclear how chiropractors treat back pain. The team at American Health Chiropractic in the Cincinnati, OH, area wants you to understand the quality techniques chiropractors use to help patients suffering from back pain.

Here, they share three ways chiropractors treat back pain:

  • Diagnostic Exams: Visually checking for back issues isn’t sufficient. To properly treat back pain, chiropractors will find the root of the problem by performing several diagnostic exams. In most cases, these include X-rays and ultrasounds. These painless procedures allow medical professionals to see internal images of the spine and connective tissues so they can develop a comprehensive plan to treat the pain.
  • Massage Therapy: Chiropractic massage is another strategy used to treat back pain. Different types of massages, including deep tissue and Swedish, promote blood flow, increase flexibility, and help repair damaged tissue, resulting in a faster recovery process.
  • Adjustments & Manipulation: Chiropractors also treat back pain through an adjustment and manipulation process that realigns the spine. This process readjusts the patient’s vertebrae, which is one of the key steps to treating back pain and proactively preventing it from reoccurring in the future.

If you suffer from back or neck pain, consider visiting a chiropractor to get moving again. American Health Chiropractic offers the Greater Cincinnati area comprehensive chiropractic care. Whether you experience chronic back pain after an auto accident, sciatica, or other issues, American Health Chiropractic is here to help. Call their office at (513) 576-6699 to make an appointment or visit their website to see a full list of services.

How Can a Chiropractor Treat My Back?

Low back pain affects the posture, which in turn, can impact quality of life. Chiropractic care helps alleviate chronic pain as a result of misalignment of the spine. Certain chiropractic procedures help to correct the spine and treat related problems such as headaches and neck pain. In cases of pregnancy, the treatments balance the pelvis and ligaments to provide relief from pressure.

Chiropractic patients with both acute and chronic pain typically feel better following chiropractic care, which reduces dependence on medication or need for further treatment. Due to the holistic approach of the treatment, the methods pose no adverse effects on the patient.

The following are three methods that a chiropractor may use to treat a patient’s back pain:

1. Spinal Manipulation

Spinal manipulation is the most common technique used to realign the spine. Also known as spinal adjustment, this method involves applying a controlled force to the joints where there is restriction of mobility due to tissue injury.

Spinal manipulation targets any abnormal movement or improper functioning in the vertebrae, and helps to reduce nerve irritability, without surgical intervention.

How it works

When carrying out this technique, the chiropractor applies pressure to the spine by hand or by using an instrument, evaluating the backbone to make the necessary adjustments. During the procedure, the patient can hear popping noises similar to the sound of knuckles cracking, which causes relief.

By realigning the vertebrae that not in the proper place, the doctor helps to reduce pressure on the pinched nerves. Thus, the spine can more easily bend and flex with minimal pain.


Spinal manipulation, when performed by a licensed chiropractor, is a safe method to treating low back pain. Spinal manipulation increases the range of motion and reduces tension in the muscles. In addition, due to the secretion of melatonin, which regulates other hormones, this treatment may improve sleep. The increase in endorphins also assists in managing pain.

The objective of the treatment is to improve physical functioning and stimulate pain relief. The amount of force that needs to be applied depends on the form of manipulation used. The side effects are similar, with the most common side effect being mild discomfort in the area where the chiropractor has applied the therapy; significant complications from this treatment are rare.

2. Massage

Chiropractic is one of the most preferred methods of massage to relieve back pain. However, this method also works for people who experience pain in the other parts of the body as well, particularly when the pain occurs due to an issue with the nervous or musculoskeletal system.

Chiropractic massage aids in lowering spinal pressure and relaxing the muscles. A chiropractor can offer a massage which helps in easing the muscle tension.

The doctor may implement therapeutic massage techniques combined with spinal manipulation in the form of trigger point therapy and active release technique. ART (Active Release Technique) is a technique that entails breaking any scar tissue that develops in muscles from overuse or soft tissue.

After forty-five minutes to an hour, the patient can undergo adjustment or manipulation. There are various types of massage including the Swedish massage, deep tissue massage, and hot stone massage. Further, the patient can visit the massage therapist to enhance any condition of the soft tissues. The results vary and even though the process aids in managing pain, it does not treat the disease.

Trigger point therapy works under the premise that muscle knots that develop due to overwork cause pain. Eliminating the knots reduces the back pain. Massage therapy manipulates the soft tissues, such as tendons and ligaments, to improve the flow of blood that warms and eventually loosens them. Massage also decreases muscle tension and stiffness to enhance relaxation.

Both massage and chiropractic care decrease the need for surgery and other types of treatments. Massage also helps in easing tension in the muscles that might have cramped because of the pain. Further, this technique helps to expel toxins from the body, thus improving the immune system functioning. Chiropractic massage relaxes the muscles and reduces the pressure in the spine to manage pain.

3. Physical Therapy

A doctor may prescribe physical therapy to treat muscle spasms, arthritis, and strains. Chiropractors may also offer it to patients who wish to strengthen the back and stomach muscles, and keep the spine aligned. Further, physical therapy may also be essential following spine surgery.

Physical therapy utilizes ultrasound, heat or cold therapy, electrical stimulating, massage, and exercises to reduce pain. A doctor typically spends thirty to forty-five minutes on each patient, and the exercise can take place in the office. The doctor can prescribe stretching for active physical therapy and low impact aerobic conditioning to reduce the pain.

It helps in building flexibility, endurance, strength and mobility.

Risk of chiropractic care for back pain

The most common side effects associated with spinal manipulation include temporary soreness tiredness. When a licensed practitioner carries out the procedures, no adverse effects are linked to the use of spinal manipulation for low back pain. During the massage, the muscles may become sore, and joints may ache within the first hours of the treatment, however, a proper massage can reduce these occurrences.

Find a chiropractor near you

  • Search online

The internet is optimal in searching for recommendations for chiropractors with offices that are conveniently located. Websites such as ZocDoc, RateMDs, and Vitals allow you to make a thorough assessment of which chiropractor will offer your desired treatment at a location near you. Through these websites, you can find out the doctor’s background, specialities, and licensing information, read reviews, and book appointments.

  • Referrals

The best recommendations can come from family members and friends who have visited a chiropractor and can speak to his or her qualifications and performance. If you are a member of a pain support group, you can ask for advice and recommendations from people who have undergone the same procedures or health concerns. Seeking advice from others can help you more easily relax during the procedures.

  • Contact insurance providers

Insurance companies can provide a list of chiropractors that are covered by your plan. Using this information, you can find a chiropractor who is in network, so you don’t have to pay an exorbitant cost out of pocket.

Do you have a back pain? Book your appointment with an expert chiropractor Dr. Steven McMahon today!

You Should See A Chiropractor For Back Pain – Here’s Why

A chiropractor for back pain also often combines traditional spinal manipulation with therapeutic massage techniques, including Active Release Technique (ART) and trigger point therapy.

ART is a patented technique that involves breaking up any scar tissue that may have developed in soft tissue or muscles from overuse. Hardened scar tissue sometimes tugs on muscles, causing pain.

Trigger point therapy operates under a similar premise—that muscle knots developed from overuse cause pain. By working through these knots, the chiropractor helps patients reduce back pain.

3. Physical therapy

Finally, after receiving a spinal adjustment that reverts your bones to their right alignment, some patients find it helpful to undergo physical therapy. Chiropractors often offer physical therapy to help patients strengthen core, back, and stomach muscles to keep their spines aligned and in good health.

The following video shows some examples of stretches you may encounter while undergoing physical therapy for back pain.

Tools used by a chiropractor for back pain

A chiropractor for back pain may also use a few different tools to perform a chiropractic adjustment. These include:

  • Traction tables: These tables look like large massage tables but they can be automated. Traction refers to the act of pulling on a body part to help realign it. A traction table helps to create space in the spine.
  • Heat lamps: Chiropractors use infrared heat lamps to warm and loosen muscles that may make spinal adjustments difficult.
  • Activator adjusting instrument: This machine is handheld and uses gentle force to restore motion to a specific area of the spine. Patients may prefer this gentler alternative to the direct thrust technique.
  • Roller tables: A rolling function is sometimes built into a traction table, but they are also stand-alone pieces of equipment. This table looks like a massage table but has rollers built in. Patients lie face up and the rollers move up and down the spine.
  • Impulse adjusting instrument: This instrument provides a light, insistent tap to the area that is misaligned or tense.

Finding relief for your lower back pain

Lower back pain is one of the top reasons for a chiropractic visit. In the U.S., much of our days are spent sitting in front of a screen, hunched over with our spine in a C-shape. This can cause tremendous lower back pain. In some people, the lower back moves in the opposite direction, with an exaggerated curve called lordosis. This can compress the lumbar spine, causing pain.

Seeing a chiropractor for back pain is a highly effective way of managing low back pain, in addition to other types of pain. For many people, low back pain will resolve on its own after a few days, weeks, or months. For many others, though, low back pain can become chronic, even debilitating. When this happens, the best way to manage low back pain is by adopting lifestyle changes. This may mean incorporating regular exercise and a healthy diet. Or, it could mean utilizing a variety of pain management techniques, such as chiropractic care, medications, physical therapy, and yoga. Chiropractic care provide another potential pain management technique to help control low back pain. It might even be more effective than other pain management techniques!

Other spinal disorders may also be treated with chiropractic care. Scoliosis, intervertebral disc syndrome, spinal stenosis, and sciatica pain are different spinal disorders that may respond well to treatment. Seeing a chiropractor for back pain is the number one reason people visit, but chiropractic care can be useful for other conditions.

Other conditions treated by chiropractic adjustment

In addition to visiting a chiropractor for back pain, some patients first experience chiropractic as a result of injuries or accidents. These can include:

  • Whiplash
  • Falls
  • Injuries due to lifting
  • Sports injuries
  • Illiotibial band syndrome (ITBS, sometimes called “runner’s knee”)
  • Injuries to the rotator cuff
  • Plantar fasciitis
  • Injuries due to car accidents

Other conditions that may respond well to chiropractic care include:

  • Neck pain
  • Arthritis
  • Asthma
  • Chronic fatigue syndrome
  • Bursitis
  • Fertility issues
  • Ear infection
  • Colic
  • Frequently occurring colds or the flu
  • Gastrointestinal syndromes
  • Multiple sclerosis
  • Thoracic outlet syndrome
  • Loss of equilibrium
  • Temporomandibular joint disorders
  • Respiratory infection
  • Tendinitis
  • Menstrual disorders (e.g., pre-menstrual syndrome)

Risks of chiropractic care

Few risks are associated with seeing a chiropractor for back pain.

The most notable risk of chiropractic care is soreness at the site of adjustment. Rarely, chiropractic care can lead to disc herniation or nerve compression; in extremely rare cases, chiropractic care can lead to stroke. Chiropractic care may not be the best choice of alternative pain therapy for people with severe osteoporosis, cancer in the spine, increased risk of stroke, or an unstable spine. If in doubt about whether or not chiropractic care is safe for you, speak to your physician or to a chiropractor and discuss your concerns.

However, for almost everyone, chiropractic care is safe. Specialized chiropractic care is even indicated for infants in some cases. One study used test dummies to measure the force applied by chiropractors during an adjustment. Results indicated that even when chiropractors use maximum force during an adjustment, the likelihood of an injury is very low.

As compared to other methods of pain control, such as medications, surgery, or interventional procedures, chiropractic care is indeed very low risk. Because chiropractic care is a drug-free method of pain management, it’s also safe to utilize while taking medications. This is as long as your chiropractor is aware of any medications you’re taking.

Back pain chiropractic care results

What does the research say about seeing a chiropractor for back pain? Although chiropractic care is now covered by many insurance plans and is low-risk in terms of side effects, neither of those things matter if it does not work. There is ample evidence, however, that chiropractic care for many conditions is as effective as more traditional or invasive treatments.

Back pain chiropractic care has positive research backing it. A study analyzing improvements in lower back pain for military veterans found that adding chiropractic care to a traditional course of treatment significantly decreased pain and improved function over just traditional care.

In one study, it was found that seeing a chiropractor for back pain produced equivalent or superior results when compared to therapies like exercise, education, or medication. In fact, the National Center for Complementary and Integrative Health (NCCIH), considered evidence of chiropractic care as a means of treating lower back pain. The NCCIH found that chiropractic adjustment produces results comparable to several other types of pain treatments, stating:

“Overall, studies have shown that spinal manipulation is one of several options – including exercise, massage, and physical therapy – that can provide mild-to-moderate relief from low-back pain. Spinal manipulation also appears to work as well as conventional treatments such as applying heat, using a firm mattress, and taking pain-relieving medications.”

Another study found that combining therapies, such as chiropractic care, with traditional therapies, like medication, can significantly improve lower back pain.

Other research on chiropractic care

For neck pain, there numerous studies that indicate rapid improvement of neck pain over physical therapy, medications, and surgery alone. These studies are scientifically-valid trials with a random control group. One neck pain study looked at improvement over one year and found that chiropractic care worked better than physiotherapy and general practitioner care.

Also, the effectiveness of seeing a chiropractor for back pain has been called into question before because some suggest that the expectation of relief from spinal manipulation therapy provides relief. In other words, it’s been suggested that the expectation of relief creates a placebo effect. In this case, the spinal manipulation itself is not responsible for pain relief. However, a study by the American Pain Society found that it is, in fact, spinal manipulation therapy that causes pain relief. It is not simply a placebo pain relief effect.

Have you visited a chiropractor for back pain before? What was your experience like? Ready to make an appointment with one of our chiropractors today?


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Back Pain: 3 ways chiropractors can help!

With the fall season upon us, it’s back to school—and back to work—for a majority of Canadians. With many students and workers sitting for much of the day, back pain might start setting in.

Back pain is a problem that affects millions of Canadians. When your back hurts, many other things suffer too. Simple everyday tasks like getting in and out of a car, putting on a coat, picking up a child, sitting at a desk, or standing for periods of time may become unmanageable. There are many causes of back pain: injuries, heavy lifting, ageing, recreational activities, pregnancy, and the stress of everyday life.


If you experience back pain that lasts more than a few days, consult a chiropractor for an assessment. Your chiropractor will recommend a course of treatment specific to you. Most people respond well to treatment and get back to their regular activities faster than if they chose to wait it out. Here are three common treatment techniques chiropractors use to help you become pain-free:

  1. Soft Tissue Therapy: This is where your chiropractor works to relax and treat tight and sore muscles. There are a variety of ways to bring relief to muscles when they are the source of pain, such as manual release therapy (stretching the muscle while applying pressure), trigger point therapy (applying direct pressure on the area of the muscle that is most tense), or instrument-assisted soft tissue therapy (using a tool to apply gentle pressure and sweep over the area).
  2. Manual Therapy: When a joint isn’t moving as well as it should, your chiropractor may utilize this treatment technique to help regain motion within a joint. This can be accomplished through joint mobilization (slow, gentle stretches of the affected joint) or manipulation (a quick but gentle movement that stretches the joint).
  3. Exercise Therapy/Self-Management: Your chiropractor will be able to provide simple exercises that you can do at home to help with your pain and to help prevent it from coming back. They will also be able to provide you with safe lifting techniques, tips for good posture, and other strategies you can incorporate into your day to prevent re-injury.

Many people choose to just “tough it out,” but ignoring back pain doesn’t make it go away. It can even make it worse. It’s important to treat not only the symptoms but also the cause. If back pain is affecting your ability to get through the day and keeping you away from your favourite activities, consider chiropractic care.

For more information about what sort of treatment is right for you, please consult with your local chiropractor.

Yes, Science Says Your Chiropractor Can Help Solve Your Back Pain

Even though chiropractic care works wonders for some people, others are not convinced that it can be an effective treatment.

But research has shown that while chiropractic care hasn’t helped issues like asthma, it can be a huge help for pain, especially in the lower back.

A recent study in JAMA Network Open focused on U.S. military personnel. It found that those who used chiropractic care — along with traditional medical care — had better pain relief outcomes than those who only sought out traditional medical care.

It’s a key finding for this group since low back pain is one of the leading causes of disability among U.S. military personnel.

Chiropractic care can include different forms of spinal manipulation commonly known as adjustments. Not all chiropractic care involves cracking bones directly. One technique uses a handheld device called an activator, a gentler way to align your spine. Another involves moving the table to align the patient’s body.

This care is different than the typical medical remedies for back pain which include anti-inflammatory medications, opioids, spinal fusions, and epidural steroid injections.

But with the ongoing opioid crisis in the United States, the medical community is looking at alternative nonaddictive treatments.

What did the study researchers find out?

Between 2012 and 2016, a research team evaluated chiropractic care on 750 active-duty U.S. military service members. The mean age of participants was 30.9 years old.

The patients were put into two groups. One group received traditional medical care for back pain along with chiropractic care; the other group only received traditional care. While traditional care can include medication, the chiropractic care included spinal manipulation adjustments along with manual therapies such as ice, heat, cryotherapy, and rehabilitative exercises.

After six weeks, those who got both types of care reported moderately higher improvements in pain intensity and disability compared with those who only received traditional medical care.

“The current study provides the strongest evidence to date that chiropractic care is safe, effective, and results in high levels of patient satisfaction and perceived treatment benefit, thus strengthening our knowledge regarding this conservative nondrug option for low back pain,” Christine M. Goertz, DC, PhD, a chiropractor with the Spine Institute for Quality in Iowa, told Healthline.

In an accompanying editorial, Daniel C. Cherkin, PhD, a senior investigator at Kaiser Permanente Washington Health Research Institute, said the study will help medical experts better treat military personnel.

“This trial represents an important contribution to our minimal knowledge of the potential of chiropractic care to improve outcomes of care in military populations,” he wrote.

But, Cherkin said integrating chiropractic care into the military health system will require communication and referrals.

Doing so has the “potential for more effectively and efficiently serving patients,” he explained.

A successful military model could also help civilians get more access to chiropractic care as well.

Can chiropractic care catch on?

Back or neck pain is common among adults in the United States — not just those in the military — and both patients and physicians are looking for better ways to treat pain.

Recent Gallup studies found that about 1 in 4 adults saw a medical professional for neck or back pain in the last year and 65 percent sought care at some point during their lives.

The American College of Physicians, the U.S. Food and Drug Administration, and the Joint Commission all recommend nondrug therapies for back pain as an initial treatment approach, Goertz said.

“Yet, I am hearing… that the use of these therapies, including chiropractic care, has not increased since these guidelines were issued,” she added.

But research shows that patients are becoming wary of pills as a single solution. At least 78 percent of American adults would like to try ways other than medication to relieve their pain, according to Gallup.

A 2016 study Goertz contributed to showed that about 14 percent of people have seen a chiropractor in the last year. Of those with significant neck or back pain, 33 percent said chiropractic care was safest compared with 12 percent who say pain medications are safer (physical therapy was perceived as safest), according to Gallup data. Also, 29 percent say chiropractic care is more effective than pain medication for those who have neck or back pain, while 22 percent preferred medication over chiropractic care.

The Gallup data found that 53 percent of U.S. adults say they would most like to see a medical doctor about their neck or back pain, while 28 percent would prefer to see a chiropractor.

So why are some Americans still popping pills when a chiropractic adjustment may be just as, or even more, effective?

Goertz said patient preferences and evidence-based guidelines for low back pain are disconnected from what’s happening in our healthcare systems. People may turn to medication as part of a regular habit, though financial incentives could come into play.

Some health plans only consider chiropractic care after traditional treatments have failed instead of making it a first-line treatment option, Goertz explained.

What to expect at the chiropractor

Peter Ottone, DC, a chiropractor from New Jersey, said that many people are simply afraid of chiropractic care — until they’ve tried it. Once people become chiropractic patients, they usually call their chiropractor first for pain relief.

“Patients who have already used chiropractic as part of their healthcare program will generally call their chiropractor first,” Ottone said.

He pointed out that people who have never visited a chiropractor may be apprehensive and fearful.

“I regularly have first-time chiropractic patients present to my office and tell me how scared they are to get adjusted,” he said. “Once it’s explained how chiropractic works and the types of treatments rendered are presented to them, I find most patients are much more at ease and comfortable with their choice to try chiropractic.”


  • back pain
  • osteoporosis
  • spinal manipulation
  • chiropractic

The effectiveness of chiropractic spinal manipulation for back pain is uncertain

Sports medicine clinicians with varied training include joint mobilisation and manipulation among their therapeutic skills. Examples include chiropractors, physiotherapists, and osteopaths, not to mention the doctors and massage therapists who treat various joint pathologies. Although athletes rarely have osteoporosis, the broad field of sports medicine includes the use of exercise therapies and treatment of the musculoskeletal system in people of all ages. Therefore this leader focuses on the role of chiropractic joint manipulation.

Back pain sufferers from more than 60 countries consult chiropractors.1 A booklet by the British Chiropractic Association boldly states that “95% of back pain is mechanical in origin, and can be treated by a chiropractor in a primary care setting”.2 Yet there are many who doubt such promotional statements. A recent, perhaps more sober, assessment of the data reads differently: “43 randomised trials of spinal manipulation for treatment of acute, subacute and chronic low back pain have been published. 30 favoured manipulation over the comparison treatment in at least a subgroup of patients and the other 13 found no significant differences”.3 However, these trials used mostly non-chiropractic spinal manipulation. The only systematic review of exclusively chiropractic spinal manipulation concluded that “the available RCTs provided no convincing evidence of the effectiveness of chiropractic for acute or chronic low back pain”.4 Since the publication of this article, the emerging trial data have not tended to be encouraging. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain. More specifically, for osteoporotic back pain no trial data are available at present. Similarly it is unclear whether this approach is superior to other treatments used for this back pain.5 These statements are true regardless of the many national guidelines that seem to suggest the opposite.

“Risk factors are not identifiable, which means that everyone receiving chiropractic treatment is at risk”

If the documented benefit from a treatment is uncertain, any (even a relatively small) risk can weigh heavily. Spinal manipulation, especially the chiropractic variety which often uses relatively high forces (up to about 500 N),6 is far from risk-free. About half of all patients will experience transient, mild to moderate problems, mostly local pain, after treatment.7 Dramatic complications have also been noted with some degree of regularity.8 They mostly relate to cerebrovascular accidents after upper spinal manipulation. Risk factors are not identifiable, which means that everyone receiving chiropractic treatment is at risk.

Estimates of that risk (by chiropractors) vary from 1 in 400 000 to 1 in about 4 million manipulations.9 But underreporting can be as large as 100%,10 a fact that renders the above estimates nonsensical. In a recent case-control study,8 582 cases of vertebrobasilar accidents were matched with healthy controls. Patients under 45 years of age who had experienced a vertebrobasilar accident were five times more likely than controls to have visited a chiropractor in the preceding week, and five times more likely to have made more than three visits for cervical treatment in the preceding month. There were no significant associations for older patients. For every 100 000 chiropractic patients below the age of 45 years, approximately 1.3 cases of vertebrobasilar accidents attributable to that treatment would be observed within one week of treatment. These data indicate that the incidence of serious complications has previously been underestimated.

Serious complications occur mostly with upper spinal manipulation. However, chiropractors view the spine as a functional entity, thus often manipulating the spine at levels at which “subluxations” are detected regardless of the location of pain. In other words, patients with low back pain often also receive upper spinal manipulation for treatment. One could furthermore argue that manipulation is much safer than other treatment options such as non-steroidal anti-inflammatory drugs.1 This may well be true, but one needs to point out that the risk-benefit relation, not the absolute risks, must inform therapeutic discussions.

“Osteoporosis should be regarded as a contraindication for chiropractic spinal manipulation”

A special case is the patient suffering from osteoporotic back pain. About 4% of all back pain originates from osteoporosis,11 a figure that increases with age, particularly in women. Plain radiography, as often used by most chiropractors, is unhelpful in diagnosing mild to moderate osteoporosis (or most other causes of back pain). Its use as a diagnostic tool in mechanical back pain is limited because “it does not provide adequate clinically relevant findings”.11 Osteoporosis should be regarded as a contraindication for chiropractic spinal manipulation. Yet, in practice, no reliable diagnostic methods are available to chiropractors for identifying osteoporosis, and no threshold values have been determined for people at risk.

The Code of Practice of the General Chiropractic Council determines that “before instituting any examination or treatment, a chiropractor shall ensure that informed consent . . .has been given . . . Informed consent means consent that is given by a person who has been supplied with all the necessary relevant information”.12 This opens a range of important questions. What information do patients find necessary and relevant? Are patients routinely informed about the evidence on effectiveness and safety of chiropractic spinal manipulations? Are they fairly advised about other treatment options? Are they told about the dubious value of radiographs? Are they told that osteoporosis is a contraindication? The sooner the chiropractic profession addresses these issues the better for their patients.

In conclusion, the proven benefit of chiropractic spinal manipulation is far less certain than chiropractors tend to admit and its risks are not negligible. This is true for back pain in general and for osteoporotic back pain in particular.

The effectiveness of chiropractic spinal manipulation for back pain is uncertain

  1. ↵ Dagenais S, Haldeman S. Chiropractic. Primary Care Clinical Office Practice2002;29:419–37.
  2. ↵ British Chiropractic Association. Chiropractic…a helping hand for you and your patients. London: British Chiropractic Association, 2000.
  3. ↵ Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med2002;136:216–27.
  4. ↵ Assendelft WJJ, Koes BW, van der Heijden GJMG, et al. The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling. Journal of Manipulation and Physical Therapy1996;19:499–507.
  5. ↵ Shekelle PG. What role for chiropractic in healthcare? N Engl J Med1998;339:1074–5.
  6. ↵ Triano J, Schultz AB. Loads transmitted during lumbosacral spinal manipulation therapy. Spine1997;22:1955–64.
  7. ↵ Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain Symptom Management2001;21:238–42.
  8. ↵ Rothwell DM, Bondy SJ, Williams SJ. Chiropractic manipulation and stroke: a population-based case-control study. Stroke2001;32:1054–60.
  9. ↵ Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation. Spine2002;27:49–55.
  10. ↵ Stevinson C, Honan W, Cooke B, et al. Neurological complications of cervical spine manipulation. J R Soc Med2001;94:107–10.
  11. ↵ Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med2002;137:586–97.
  12. ↵ General Chiropractic Council. Code of practice. London: General Chiropractic Council, 1999.

This leader identifies the lack of trial data on the safety and efficacy of spinal manipulation for back pain in people with osteoporosis. Although the applied forces in spinal manipulation (high velocity thrust techniques) are high,1,2 the forces applied in spinal mobilisation (low velocity techniques), as commonly used by physiotherapists and osteopaths, are much lower (approximate maximum 250 N).3–5 As the number of people with osteoporosis increases, there is an urgent need to assess the safety and efficacy of spinal mobilisation techniques for osteoporotic back pain.

Specifically, there is a need to quantify (a) the forces that will fracture the osteoporotic spine in the direction of typical mobilisation procedures, and (b) the forces that a clinician applies when performing spinal manual therapy. This research will require close collaboration of clinicians with bioengineers.

Professor Ernst clearly describes the problems associated with inadequate measures of bone density by plain radiography, yet this is the conventional method used in chiropractic offices. Although many clinicians still think of osteoporosis as a disease of the frail elderly, clinical experience in Canada suggests that many middle aged adults have compromised bone health and are at high risk of fragility fractures. Dual energy x ray absorptiometry is the optimum diagnostic method for osteoporosis.6 Yet many patients seen in British Columbia’s provincial Osteoporosis Program are having chiropractic spinal manipulation despite obvious risk factors for osteoporosis. All clinicians, not just physicians, need to recognise the risk factors for osteoporosis and consider the risks and benefits of spinal manipulation for these patients.

Evidence of the therapeutic effects of spinal mobilisation techniques suggests that they can reduce spinal pain,3,7–9 stimulate sympathetic nervous system activity,8–10 and promote motor activity.8 As patients with osteoporosis and back pain could potentially benefit from spinal mobilisation, trials are needed to examine its safety and efficacy in this population.

  1. ↵ Gal JM, Herzog W, Kawchuk GN, et al. Forces and relative vertebral movements during SMT to unembalmed post-rigor cadavers: peculiarities associated with joint cavitation. J Manip Physiol Ther1995;18:4–9.
  2. ↵ Triano J, Schultz AB. Loads transmitted during lumbosacral spinal manipulative therapy. Spine1997;22:1955–64.
  3. ↵ Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals with low-back pain. J Manipulative Physiol Ther2000;23:332–42.
  4. Harms MC, Bader DL. Variability of forces applied by experienced therapists during spinal mobilization. Clin Biomech1997;12:393–9.
  5. ↵ Simmonds MJ, Kumar S, Lechelt E. Use of a spinal model to quantify the forces and motion that occur during therapists’ tests of spinal motion. Phys Ther 1995;75:212–22.
  6. ↵ Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Cmaj2002;167:S1–34.
  7. ↵ Farrell JP, Twomey LT. Acute low back pain. Comparison of two conservative treatment approaches. Med J Aust1982;1:160–4.
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Spinal Manipulation: What You Need To Know

  • Bialosky JE, George SZ, Horn ME, et al. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). Journal of Pain. 2014;15(2):136-148.
  • Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(10):3155-3174.
  • Black LI, Barnes PM, Clarke TC, Stussman BJ, Nahin RL. Use of yoga, meditation, and chiropractors among U.S. children aged 4–17 years. NCHS Data Brief, no 324. Hyattsville, MD: National Center for Health Statistics. 2018.
  • Boyle E, Côté P, Grier AR, et al. Examining vertebrobasilar artery stroke in two Canadian provinces. Journal of Manipulative and Physiological Therapeutics. 2009;32(2 Suppl):S194-S200.
  • Bronfort G, Evans R, Anderson AV, et al. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine. 2012;156(1 Pt 1):1-10.
  • Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy. 2010;18:3.
  • Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal. 2008;8(1):213-225.
  • Cassidy JD, Boyle E, Côté P, et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Journal of Manipulative and Physiological Therapeutics. 2009;32(2 Suppl):S201-S208.
  • Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. Journal of Headache and Pain. 2011;12(2):127-133.
  • Clarke TC, Barnes PM, Black LI, Stussman BJ, Nahin RL. Use of yoga, meditation, and chiropractors among U.S. adults aged 18 and over. National health statistics reports; no. 325. Hyattsville, MD: National Center for Health Statistics. 2018.
  • Furlan AD, Yazdi F, Tsertsvadze A, et al. Complementary and Alternative Therapies for Back Pain II. Evidence Report/Technology Assessment, no. 194. Rockville, MD: Agency for Healthcare Research and Quality; 2010. AHRQ publication no. 10(11)-E007.
  • Goertz CM, Long CR, Vining RD, et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: a comparative effectiveness clinical trial. JAMA Network Open. 2018;1(1):e180105.
  • Gross A, Langevin P, Burnie SJ, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database of Systematic Reviews. 2015;(9):CD004249. Accessed at on August 13, 2018.
  • Haas M, Vavrek D, Peterson D, et al. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine Journal. 2014;14(7):1106-1116.
  • Haynes MJ, Vincent K, Fischhoff C, et al. Assessing the risk of stroke from neck manipulation: a systematic review. International Journal of Clinical Practice. 2012;66(10):940-947.
  • Hebert JJ, Stomski NJ, French SD, et al. Serious adverse events and spinal manipulative therapy of the low back region: a systematic review of cases. Journal of Manipulative and Physiological Therapeutics. 2015;38(9):677-691.
  • Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database of Systematic Reviews. 2005;(2):CD001002. . Accessed at on August 13, 2018.
  • Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine Journal. 2015;15(6):1461-1477.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back Pain. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Accessed at on September 12, 2018.
  • Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. Journal of Manipulative and Physiological Therapeutics. 2004;27(3):197-210.
  • Paanalahti K, Holm LW, Nordin M, et al. Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskeletal Disorders. 2014;15:77.
  • Paige NM, Miake-Lye IM, Booth MS, et al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. Systematic review and meta-analysis. JAMA. 2017;317(14):1451-1460.
  • Rubinstein SM, Terwee CB, Assendelft WJ, et al. Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews. 2012;(9):CD008880. Accessed at on August 13, 2018.
  • Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews. 2011;(2):CD008112. Accessed at on August 13, 2018.
  • Schneider M, Haas M, Glick R, et al. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine. 2015;40(4):209-217.
  • Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Comparative Effectiveness Review No. 209. AHRQ Publication No 18-EHC013-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2018.
  • Stussman BJ, Black LI, Barnes PM, Clarke TC, Nahin RL. Wellness-related use of common complementary health approaches among adults: United States, 2012. National health statistics reports; no 85. Hyattsville, MD: National Center for Health Statistics. 2015.
  • Terhorst L, Schneider MJ, Kim KH, et al. Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials. Journal of Manipulative and Physiological Therapeutics. 2011;34(7):483-496.
  • Todd AJ, Carroll MT, Robinson A, et al. Adverse events due to chiropractic and other manual therapies for infants and children: a review of the literature. Journal of Manipulative and Physiological Therapeutics. 2015;38(9):699-712.
  • Vohra S, Johnston BC, Cramer K, et al. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-e283.
  • Whedon JM, Song Y, Mackenzie TA, et al. Risk of stroke after chiropractic spinal manipulation in Medicare B beneficiaries aged 66 to 99 years with neck pain. Journal of Manipulative and Physiological Therapeutics. 2015;38(2):93-101.

Other References

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  • Bronfort G, Hondras MA, Schulz CA, et al. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Annals of Internal Medicine. 2014;161(6):381-391.
  • Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Annals of Internal Medicine. 2017;166:493-505.
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How Chiropractors Treat Back Pain

One option for people who are seeking back pain treatment is to seek the help of a chiropractor. This specially trained health professional believes that alignment of the spine is related to the overall health and wellbeing of the individual.

By incorporating that belief into treatment, with particular attention to the spine, chiropractic care may be able to provide pain management for back pain patients using a variety of methods to achieve that goal.

Close to 18 million adults and 2 million children receive chiropractic treatments for pain therapy and other conditions every year.

Chiropractic methods have been shown to be effective in reducing pain among people with back pain. For example, a study of 42 patients who visited chiropractors for pain management over a period of two months found that low force spinal adjustments successfully helped ease lower back pain.

How Chiropractic Treatment Works

Regular chiropractic treatments usually focus on spinal manipulation and alignment to aid pain management and stimulate the body’s self-healing abilities. Realignment of the spine is thought to reduce pressure on the central nervous system. Headaches and lower back pain are among the most common conditions treated by a chiropractor.

Your first visit is likely to be an evaluation, not unlike what you go through on the first visit to a doctor’s office. You will be asked to describe your symptoms and your chiropractor may order tests and X-rays that could help her understand your condition better.

You and your chiropractor will then develop a treatment plan. Pain management likely requires multiple visits over a long period to provide the best pain therapy.

At each visit, your chiropractor may use forceful pressure on key parts of your back or other parts of your body to realign your spine and manage pain. This pressure may be abrupt or it may be low in force, and may be delivered by hands or with the help of a specially designed instrument. Massage may also be incorporated into your treatment. Talk to your chiropractor about the different methods she likes to use before agreeing to a treatment plan.

You may also be given:

  • Nutritional supplements
  • A change in diet
  • Recommendations for physical activity
  • Hot and cold packs
  • Electrical stimulation

A Closer Look at a Chiropractor

Chiropractors go through four years of training at accredited institutions. They are trained in the classroom on theory and knowledge and then gain hands-on training in clinics. Many chiropractors also participate in two- or three-year residencies in order to specialize in certain practice areas. Chiropractors are required to have a license in order to practice.

If you are considering including chiropractic care in your pain management plan, you should:

  • Talk to your doctor, family, and friends to get referrals for good chiropractic care.
  • Find out if your health insurance program covers chiropractic care. Many do, but you may need a referral from your primary care doctor.
  • Ask the chiropractors you are considering about their training, certification, and areas of specialization.

It is okay to shop around until you find a chiropractor you like and who is convenient for you to visit. Pain management will require an ongoing relationship, so you want to make a good match.

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