Chiropractic Treatment of Low Back Pain

A call to action to the chiropractic profession was published in the Chiropractic & Manual Therapies Journal. This call to action challenged the chiropractic profession to implement higher value care for low back pain, as has been suggested by the Lancet articles on low back pain.You can follow authors of Low Back Pain: a Major Global Problem for Which the Chiropractic Professions Needs to Take More Care on Twitter at: @french_simon, @aron2web, and @walkerbf1. 

Current Chiropractic Practice

The article points out that the current evidence supports the chiropractic profession in its approach to treating lower back pain. Chiropractic treatment, in most cases, is synonymous with spinal manipulation. While spinal manipulation is a recommended treatment option in the clinical practice guidelines, it is recommended as a second-line or adjunct treatment option. 

"Chiropractors have much to offer as the healthcare system transforms to accommodate more patient-centered evidence-based biopsychosocial approaches"

From an evidence-based practice perspective, this is good news because spinal manipulation is a viable treatment option for low back pain. However to also be evidence-based, chiropractors need to include first-line therapies into treatment plans for lower back pain. These first line treatment recommendations include: advice to remain active, education, cognitive behavior therapy, and exercise therapy. 

Areas for Improvement in Chiropractic

The call to action also highlights several areas that the chiropractic practice can improve on. Chiropractic treatment has often been focused on passive therapies, such as spinal manipulation and massage. These treatments can be beneficial in reducing low back pain, but should be used as supplemental treatments to returning the patient back to normal activity. 

“Chiropractors in clinical practice need to provide higher quality care in line with recommendations from evidence-based clinical practice guidelines”

There are also some chiropractors who over-utilize x-rays in clinical practice. Routine use of imaging is discouraged by all of the clinical practice guidelines unless the result is likely to change the treatment. This is similar to the recommendation by the ACA’s Choosing Wisely campaign. It’s important to note that the guidelines do not state that imaging should never be taken, but reserved for when there is clinical suspicion of a sinister pathology (ie. cancer, infection, fracture, etc). While not directly discussed in the article, chiropractors can also improve with educating patients with low back pain. Some of the education discussed on low back pain with the patient is nocebo in nature. This includes attributing low back pain to a bone out of place/vertebral dysfunction, leg length inequality, or core instability. These explanations can lead to catastrophization and fear avoidance behaviors by the patient. 

Creating a Better Future 

The call to action for the chiropractic profession concludes that chiropractic is in a position to be a major player in the treatment of low back pain. As with all professions, there are some areas that the chiropractic profession excels at and others that the profession needs to improve. And making these changes in the chiropractic profession will help to provide better treatment outcomes for patients.