Back pain is one of the most common—and debilitating—ailments we face. And finding the right pain relief is no easy feat: A paper in The Spine Journal likened choosing a treatment to relieve back pain to supermarket shopping, comparing the wide array of treatment choices to the vast inventory on grocery-store shelves.
Many people choose to see a chiropractor about their back pain. In fact, an estimated 27 million Americans are evaluated and treated by a chiropractor each year, according to a 2015 National Institutes of Health report, mostly for back-pain relief. The hallmark therapy of chiropractic care is spinal manipulation.
Getting your back on track
Modern chiropractic treatment is based on the assumption that many pain problems are caused by misalignment of the spine. Spinal manipulation involves physical pushing, pulling, and methodical repositioning of the head, shoulders, neck, back, or hips to help alleviate back pain.
Once considered a fringe medical treatment for back pain, the practice of spinal manipulation for low back problems is being adopted by more medical doctors.
In their 2007 patient-care guidelines, the American College of Physicians and the American Pain Society included spinal manipulation as one of several treatment options for trained practitioners to consider using when ordinary, uncomplicated back pain (pain not caused by a more serious underlying problem such as compression fractures or a herniated disc) doesn’t improve with self-care. Adjustments may help with acute back pain of six weeks or less or with flare-ups of chronic back pain.
Other treatments can also relieve back pain, from over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), to physical therapy, massage, or a combination of therapies.
“Research finds spinal manipulation works about as well as anti-inflammatory and pain-relief medications and other traditional interventions,” says John Flynn, M.D., M.Ed., medical director of the Spondyloarthritis Center at Johns Hopkins School of Medicine in Baltimore. “Your decision to see a chiropractor over other therapies should be based on your preferences, as well as on costs and guidance from your other doctors.”
A 2011 Cochrane review found that spinal manipulation, when compared with other interventions, slightly improved chronic low back pain and disability in the short term. But the researchers reported that there’s no evidence to support or refute that manipulation is better than therapies such as physical therapy, pain-relief drugs, and exercise. A 2013 Cochrane review reported similar results for acute low back pain. Other evidence suggests spinal manipulation might also help with conditions such as neck pain, headaches (including migraines), and shoulder pain.
Often, patients may not need any treatment and back pain will go away on its own. “If you have acute back strain, you may feel your pain improve after chiropractic treatment—but it will typically improve over time no matter what you do,” says Flynn, who generally doesn’t refer his patients to a chiropractor for acute back strain.
“But,” he says, “if someone has chronic back pain, depending on the cause, he or she may get temporary relief. That’s why some people keep returning to the chiropractor. People may prefer the therapy because of the hands-on nature of the treatment and the time the chiropractor spends with them.”
Why consider a chiropractor?
According to the American Chiropractic Association (ACA), chiropractors treat not only back pain but also a variety of health conditions, including neck pain; headaches; and muscle, ligament, and joint injuries and disorders. Doctors of chiropractic (DCs) undergo extensive training to diagnose and treat musculoskeletal problems. “We have to know what produces the pain before we can effectively treat it,” says Robert Hayden, D.C., Ph.D., FICC, who is a spokesperson for the ACA.
Chiropractors take a holistic, or whole-body, approach to patients, counseling them on diet, nutrition, and healthy lifestyle habits. Treatments generally consist of six to 12 visits over two to four weeks. Conservative pain management is emphasized over drugs and surgery, but a good chiropractor will refer patients to other medical professionals if the diagnosis is beyond the scope of his or her practice.
Chiropractors perform spinal manipulation by using their hands or a device to apply a small amount of force—or a more forceful thrust—to readjust the bones in the spine and neck. “We have over 150 chiropractic techniques we can use to adjust joints or treat soft-tissue problems,” Hayden says.
Spinal manipulation is typically most effective when combined with more traditional therapies to treat back pain. These approaches include:
• Heat and cold therapies
• Relaxation techniques
• Electrical stimulation or ultrasound
• Exercise and stretching
• Patient education
The risk of injury from chiropractic treatment is generally low when performed by a trained and licensed practitioner. Spinal manipulation has fewer risks than nonsteroidal anti-inflammatory drugs (NSAIDs). Most of the technique’s side effects are mild: sore, stiff, or achy muscles, lasting a day or two after treatment. Some people may experience temporary dizziness, headache, or numbness after a visit.
Though rare, there have been reports of more serious side effects after chiropractic manipulation, including spinal cord injury, spinal fluid leakage, herniated disc or progression of an existing herniated disc, and compression of nerves in the lower spine, called cauda equina syndrome. Your doctor should discuss with you any possible risks before you undergo treatment.
Neck manipulation carries a rare risk of stroke, according to a 2014 American Heart Association (AHA) scientific statement. High-velocity rotation of the head has been linked to a tear in an artery in the neck, referred to as vertebral artery dissection (also called VAD). If left untreated, vertebral artery dissection may potentially block blood flow in the brain and lead to a stroke.
It’s not certain whether manipulation directly causes vertebral artery dissection and stroke, or if people who have undiagnosed vertebral artery dissection are simply more likely to visit a chiropractor for care. For example, whiplash, certain sports movements, and violent coughing or vomiting can result in dissection, says the AHA.
“People with vertebral artery dissections frequently present with neck pain and headache,” Hayden says.
Hayden has seen dramatic improvements in many of his patients after treatment. “[I have] the joy of seeing someone get off a table who maybe would not have been able to before, or someone regaining the use of a limb or becoming free from headaches,” he says. “Every day we see those kinds of things happen in a chiropractic clinic with no risk of drug interactions, no liability from surgeries, and no risk from anesthesia.”
But spinal manipulation isn’t for everyone. If you’ve seen a chiropractor and your back pain isn’t improving—or it’s getting worse—you might need to visit your primary care doctor or see a specialist.