Medicine and Low Back Pain
Some of you may have visited your General Practitioner before for back pain. If you did then it is likely that they recommended one of three interventions: 1) Drugs 2) Physical Therapy 3) Lifestyle Education. The use of drugs to treat back pain is somewhat controversial with the possibility of side effects. Most back pain is mechanical so a pharmaceutical approach will not completely resolve a mechanical issue. As for physical therapy an article in the Journal of the American Medical Association states the following about physical therapy for back pain: "Modalities...used by physical therapists... may provide short-term symptomatic relief, but there is no evidence that they alter the long-term course of acute or chronic low back pain." (JAMA. 2008;299(17):2066-2077). Lifestyle education is effective but slow to react. When you have back pain you need help right away and proper lifting mechanics and posture training is effective for prevention but once you have a problem it isn't very quick at decreasing back pain.
So what about the approach that a chiropractor would take? The treatment used most frequently used by chiropractors is spinal manipulation. The goal of this treatment is to correct the mechanical problem causing the back pain. What does the JAMA article previously cited say about spinal manipulation?
"...Spinal manipulation generally results in more rapid recovery if applied within 3 weeks of onset of acute low back pain.
...Spinal manipulation for chronic low back pain provides benefits similar to a prescription nonsteroidal anti-inflammatory drug;
it is more effective in the short-term than placebo and general practitioner care and in the long term vs physical therapy."
Remember, this is not from a chiropractic journal. This is published by the American Medical Association and it clearly states that spinal manipulation is an effective treatment for acute low back pain and superior to general practitioner care and physical therapy for chronic low back pain. So you may wonder why your General Practitioner never uses spinal manipulation to treat your back pain. The reason is that they receive very little training in how to perform these techniques. Physical Therapists are prohibited by the limits of their license from performing the types of manipulations described in the cited article. So both of these practitioners treat back pain the best way they know how. Genereal Practitioners who understand the prevailing research refer low back pain patients to an expert in spinal manipulation such as a chiropractor. According to their research, it seems to be the most sensible approach.
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