by: Dr. Mark Walter

Low back pain is a common health care and social problem associated with disability and absence from work. One 2005 medical study of chronic spinal pain stated that the “lifetime prevalence of spinal pain has been reported as 54 to 80 percent, with as many as 60 percent of patients continuing to have chronic pain five years or longer after the initial episode.” The long-term and disabling conditions of chronic and recurrent low back problems are of major concern, both from a cost perspective and in terms of morbidity.

Chiropractic care has been shown to compare favorably in many cases to medical care with respect to long-term pain and disability outcomes. However, any chiropractor should carefully consider the optimum treatment plan for each patient on an individual basis. For most cases of chronic low back pain, I recommend a three-step program of spinal adjustments, postural stabilization and rehabilitative exercise. Combining these three elements can make the difference between a successful care program and a lingering, recurring low back condition.

Spinal Adjustments

As far back as 1985, medical research was reporting that “a two- to three-week regimen of daily spinal manipulations by an experienced chiropractor” brought significant improvement in 81 percent of completely disabled patients with chronic low back and referred leg pain.³ The subjects in the study were from a university back pain clinic for patients who had failed to respond to previous conservative or surgical treatment. The researchers stated, “In our experience, anything less than two weeks of daily manipulation is inadequate for chronic back pain patients.” In addition, several chiropractic research studies published between 1979 and 1993 described various procedures that assisted patients in regaining lumbopelvic structural function and alignment.^4-6

Postural Stabilization

A significant factor in reducing excessive biomechanical forces on the lumbar spine is frequently overlooked- the use of external supports to decrease external forces. Positioning aids such as sitting postural supports (e.g., postural back rests or ischial lifts for chairs and car seats), standing postural supports (e.g., foot orthotics and heel lifts) and sleeping postural supports (e.g., mattresses and pillows) can all greatly assist in the long-term management of painful lumbar spine conditions.

Rehabilitative Exercises

Home corrective exercises to strengthen supporting muscles are recommended as an adjunct to chiropractic adjustments and postural stabilization. Active involvement of the chronic low back pain patient in an appropriate exercise program has been found to be very beneficial, even for patients with herniated discs. Flexibility and strength exercises can bring about rapid improvements in lumbar spinal function, as well as decreases in pain levels. Activity should focus on developing strength in the abdominals and supporting pelvic and low back muscles. This also can enhance the shock-absorbing properties of the tissues.

Specific exercises must develop “dynamic control of lumbar spine forces in order to eliminate repetitive injury to the intervertebral discs, facet joints, and related structures.” Recommending specific exercise(s) is not easy, as some research supports the need for abdominal strengthening, others advise pelvic tilts, and other reports focus on the importance of strengthening the lumbar extensor muscles. The bottom line is that patients’ needs vary, and exercises that work for one patient will not necessarily work for the next.  It is essential to make sure your provider has performed a complete structural and functional assessment before recommending any exercise program.

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By: Dr. Mark Walter

There are many misconceptions in the public’s view as to what chiropractic care is and what it treats.  Here is a brief and limited introduction to chiropractic.

Chiropractic is a health profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.  Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints and arms or legs and headaches.  A growing view is expanding the focus from pain and injury management to a more progressive approach of injury prevention, structural management and health/wellness promotion.

Doctors of chiropractic- often referred to as chiropractors or chiropractic physicians- practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment.  Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling.

The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,” also called “chiropractic adjustment.”  The purpose of the manipulation is to restore joint mobility by manually applying controlled force into joints that have become hypomobile- or restricted in their movement- as a result of a tissue injury.  Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for extended period of time.  In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for the sufferer.  Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, and allowing tissues to heal.

Chiropractic adjustment rarely causes discomfort.  However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) that usually resolves within 12 to 48 hours.

In many cases, such as lower back pain, chiropractic care may be the primary method of treatment.  When other medical conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition.

Doctors of chiropractic may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate or when it is not appropriate.  Chiropractors will readily refer patients to the appropriate health care provider when chiropractic care is not suitable for the patient’s condition, or the condition warrant co-management in conjunction with other members of the health care team.

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