Vol.3 Issue 1
Low Back Pain

I'm a Family Practitioner, and some of my patients have been experiencing chronic low back pain. I know that the medications they receive only provide temporary relief, but is there any alternative therapy, in lieu of surgical intervention, that may offer a better, longer-lasting approach? Some of my patients have been inquiring about chiropractic therapy, but I've heard that there can be some serious risks.

The effectiveness of different therapies depends primarily on the cause of the low back pain i.e. does the diagnosis support the use of a conservative approach? In the case of chronic low back pain, conservative approaches may provide more benefit because, in all likelihood, a diagnosis that warrants a more severe intervention, such as decompressive surgery, has been ruled out.The chiropractic physician is trained to identify functional lesions in the spine, specifically areas of joint motion loss in the intervertebral facet joints (sometimes referred to as “subluxation”). These functional lesions have been implicated as primary sources of chronic pain, and their presence, coupled with postural and biomechanical deficits, can persist for long periods of time. Chiropractic manipulative therapy has been shown to be particularly effective in cases of low back pain. In one study, a two-to-three-week regimen of daily chiropractic spinal manipulations brought significant improvement in 81 percent of totally disabled patients with chronic low back pain¹. In addition to the manipulations, the chiropractic physician also incorporates spinal rehabilitative exercises in order to stabilize the postural alterations and deficits in muscle coordination that perpetuate the low back pain.There have been concerns that chiropractic can cause significant damage to the spine as reported in the media and questioned in the literature, but this is unfounded. Chiropractic has been implicated as causing herniated discs, but a review of the anatomy will show that this isn't possible. The facet joints in the lumbar spine limit spinal rotation to 2-3° at any single lumbar level, yet studies demonstrate that you can axially torque discs up to 22° before they will herniate (rupture)6; clearly another mechanism is responsible, including compressive loading that isn't present during the manipulation. In fact, there are a number of studies that indicate that manipulation is the therapy of choice for patients with a herniated lumbar disc³-5. With regard to chiropractic and treatment of other spinal segments, there is risk associated with cervical spine manipulations. Proper screening and testing for susceptible individuals lowers the risk for any procedure, including manipulation.

Patrick Downie, DC
Assistant Director
CAM Education Program for Nurses,
Rush University College of Nursing,
Chicago, Illinois

References:

1. Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low back pain. Can Fam Phys 1985;31:528-40.
2. Bogduk N. Clinical Anatomy of the Lumbar Spine (2nd ed), Churchill Livingstone, New York, 1991.
3. Quon J. Lumbar intervertebral disc herniations: Treatment with rotational manipulation. JMPT 1989;12(3):220-27.
4. Chrisman O. A study of the results following rotatory manipulation in the lumbar intervertebral disc syndrome. J Bone Joint Surg 1964;46-A(3):517-24.
5. Cassidy J. Side posture manipulation for lumbar intervertebral disc herniation. JMPT 1993;16:96-103.
6. White A, Panjabi M., Clinical Biomechanics of the Spine (2nd ed), p.44, J.B. Lippincott, New York, 1990.