When To See A Chiropractor For Lower Back Pain, And What To Expect

Up to 80% of working individuals¹ are affected by lower back pain during their lifetime, and it is the second most common cause of work disability and doctors visits. To put that in financial terms, back pain makes up approximately $25 billion in yearly medical costs in the U.S alone.

Around 4.5% to 32% of² people have back pain that's severe enough to visit a doctor. Even though it's common, it’s not always possible to diagnose the exact cause of pain.

There is no single treatment that works for back pain. Because of this, recommendations by doctors tend to vary. What's considered "standard care" includes a balance of:

• Exercise

• Stretching

• Pain relievers

• Heat

• Time

Some doctors also recommend chiropractic care. So, exactly what does a chiropractor do for lower back pain?

What does a chiropractor treat?

Chiropractors are not medical doctors but practitioners who may or may not have a doctorate in chiropractic, a form of complementary and alternative medicine. Chiropractic is concerned with diagnosing, treating, and preventing musculoskeletal disorders. That includes a particular focus on spine-related conditions, including the lower back (lumbar spine), the neck (cervical spine), and the upper and middle back (thoracic spine).

Muscle spasm and disc problems are common causes of spine pain. Many people have arm or leg pain and headaches along with neck or back pain. Chiropractors frequently work with other body parts, such as shoulder and knee injuries. Most, however, focus primarily on the spine.

At this point, you might be asking yourself, "should I see a chiropractor for lower back pain?" 

According to a 2016 review of several studies and clinical trials³, chiropractic care for lower back pain is just as effective as physical therapy (PT). However, there is limited evidence showing that chiropractic care is as effective as medical care and exercise therapy.

Other research⁴ shows that chiropractic care and physical therapy are good techniques for treating lower back pain compared with other non-medication type treatments. Research also found that chiropractic care was a more cost-effective alternative to physical therapy in the short term for acute lower back pain.

What does a chiropractor do for lower back pain?

There are various techniques a chiropractor uses to treat lower back pain. Treatment is very individualized and depends on many factors. Generally, chiropractors use spine adjustment techniques throughout the course of treatment (six to 10 visits for a typical person).

The core of chiropractic care typically involves lower back pain treatment through manual therapy, which may include:

Spinal mobilization

Spinal mobilization can be used to treat lumbar pain in some people. This is a more gentle chiropractic approach that involves muscle and joint stretching.

Chiropractors may use spinal mobilization for many reasons, such as:

• Treating people with sensitive nervous systems: Gentle chiropractic approaches may benefit this group in keeping their bodies from reactive muscle spasms.

• Patient preference: Certain individuals prefer spinal mobilization approaches over spinal manipulation approaches.

• Chiropractor’s choice: They may use spinal mobilization for patients in the acute stage of their condition and experiencing severe pain.

Spinal manipulation

Most chiropractic treatments usually involve some type of spinal manipulation, also referred to as chiropractic adjustment. It is thought that a properly aligned spine can improve overall bodily function, which may allow better functioning of:

• Vertebrae

• Joints

• Organs

• Muscles

Chiropractors achieve spinal alignment through manual manipulation. This often involves applying force in short bursts to align the joints.

The common goal of many chiropractic approaches is restoring joint function by reducing pain and fixing joint inflammation. 

What is involved with a first-time visit to a chiropractor?

Your initial visit to the chiropractor will be similar to what you'd expect from any other healthcare provider. They ask you questions to gather information, some examples of which include:

• What symptoms are you experiencing?

• How did your pain begin?

• What's the effect on your pain when you do this?

• What level of pain are you at?

• They'll look at any images (x-rays, MRIs) or blood work you've had.

They'll then perform an examination that evaluates both the mechanical and medical components of your pain. For instance, they'll look at:

• Nerve function

• Muscle tone

• Alignment

• How well you can bend, twist, or turn

• How your body is moving

• What type of movements reproduce the symptoms you're experiencing.

If required, your chiropractor will also request imaging, such as an x-ray. Most individuals, however, don't require imaging during their first visit.

After the examination, they'll sit down and discuss your condition. They'll let you know what they think is happening with your back or spine, the treatments they suggest,  and how they think treatment will help. If they feel you'd also benefit from seeing a physical therapist, spine surgeon, or other health care professional, they'll provide a referral.

Are there any risks involved with chiropractic care?

Chiropractic treatments for lower back pain may seem intimidating or uncomfortable, but they're generally effective and safe when performed by a properly trained chiropractor.

Mild side effects are common following manual treatments, and they've been more frequently reported in patients following manual spinal interventions. More severe side effects can happen but are rare, according to research. Mild side effects are short-term and should resolve in a few hours to a couple of days.

According to a large-scale review of 250 studies, around 23% to 83% of adult patients⁵ experience mild side effects following a specific chiropractic manual thrust method for neck and/or back pain.

These reported side effects include:

• Increased musculoskeletal discomfort or pain

• Headache

• Stiffness

• Feeling faint

• Tiredness

• Lightheadedness or dizziness

• Numbness or tingling in the upper limbs.

Severe side effects also occur but are rarer. Estimates from studies reviewed show a wide range in the reporting - from 1 per 2,000,000 manipulations to 13 per 10,000 patients.

Severe side effects consisted of:

• Cauda equina syndrome 

• Lumbar disk herniation

• Fracture

• Hemorrhagic cyst or hematoma

• Vascular or neurologic compromise

• Muscle abscess formation

• Soft tissue trauma

• Esophageal rupture

• Disrupted fracture healing.

The chiropractor will look closely at your medical history and any coexisting condition you have, as this can determine their approach to treatment.

Chiropractic care may not be a good treatment choice for certain ailments, such as:

• Arthritis

• Some cancers

• Osteoporosis

• Vertebral artery stenosis

• Spinal abnormalities

Are there any other health professionals you might want to consider seeing for lower back pain?

Along with chiropractors, numerous treatment specialties exist for lower back pain. Some include:

1. General and family practitioners

When your back and neck pain begins, a primary care physician (PCP), general practitioner (GP), or family healthcare provider is likely your best bet. They will examine you properly, order tests to establish an initial diagnosis, and assess whether they should refer you to a specialist. Your GP may also provide you with several exercises you can try, prescribe you some pain medication, and possibly refer you to a physical therapist.

2. Orthopedists

An orthopedist is a board-certified surgeon specializing in head-to-toe musculoskeletal system issues, including the spine. They may address problems such as:

• Scoliosis

• Ruptured discs

• Low back pain

• Neck pain.

3. Rheumatologists

This type of doctor is a board-certified doctor who treats many types of arthritis. Many specialize in inflammatory arthritis. If this occurs in the spine, it can turn into ankylosing spondylitis and other related disorders.

4. Neurologists

A neurologist specializes in diagnosing and treating nervous system problems like Parkinson's disease and other brain, peripheral nerve, and spinal cord disorders. Your doctor may recommend a neurologist if your back pain results from a possible nerve injury or sometimes if it is longstanding and chronic, as they're experts in the origins of pain.

5. Pediatricians

These doctors diagnose and treat a wide range of childhood health issues, including back injuries and pain. They are the family doctors for children from birth into the early adult years. If you have a child dealing with a spine disorder of some type that requires a specialist, the pediatrician would likely refer you.

6. Emergency room doctors

When you require immediate medical attention for back pain due to falls, car accidents, or other traumas, the ER is where to go.

The lowdown

You may require a visit to the chiropractor if other treatments for lower back pain have failed. Whether it be heat therapy, massage therapy, or another type of treatment, if you've found no relief, chiropractic care may help. A chiropractor will develop an approach tailored for you, which should include holistic and comprehensive treatment for your lower back pain.

All strategies of treatments are based on an accurate back pain diagnosis. You'll need to ensure you inform your chiropractor of your medical history, including any medications you're currently taking, ongoing medical conditions you have, surgical/traumatic history, and lifestyle factors. Always check with your primary doctor first to ensure your particular condition will even benefit from chiropractic care and other types of pain relief alternatives.