Low back pain (LBP) has been a challenge to treat for centuries and evidence exists that back pain has been a concern since the origins of man. Chiropractic offers one of the most patient satisfying and fastest treatment approaches available. But, when you go to a chiropractor, there seems to be a lot of different approaches utilized from doctor to doctor. Is there any evidence that suggests one approach is favored over another? How are the patient’s goals addressed?
Let’s look at what chiropractors actually do. Sure, they manipulate the spine and other joints in the upper and lower limbs using a variety of techniques, which seems to be the "brand" of chiropractic. This is good as joint manipulation has consistently been reported to be safe and effective, with few side effects. Since this is the staple of chiropractic, it’s safe to say that regardless of your chiropractor's preferred or chosen technique, obtaining a good result is highly likely.
But, chiropractic includes SO MUCH MORE than just joint manipulation! For example, they focus on the whole person, not just their isolated issue or complaint. Using low back pain as an example, a "typical" evaluation includes a detailed history of the patient’s general health, past history, illness history, family history, personal habits including sleep quality, exercise habits, dietary issues, quality of life measurements and a review of systems. By gathering this information, a chiropractor can identify areas that may be directly related to low back pain care, indirectly related, or possibly not related at all, but interferes with the person’s quality of life which, in turn, increases LBP. It’s really difficult to separate our low back from the rest of our body.
For example, if a person has plantar fascitis, a heel spur, an ingrown toe nail, diabetic neuropathy in their feet, pes planus or flat feet, an unstable ankle from multiple sprains, knee or hip problems, their gait pattern will be affected and the "domino effect" can trickle up to change the low back/pelvic function—resulting in low back pain! Proper management must address all of the issues that are affect the patient’s gait if long-term success in low back pain management is expected, rather that just putting a "band aid" on the problem.
Let’s talk about what treatment goals we like to address when we treat our low back pain patient population. The most obvious first goal is pain cessation or getting rid of pain! Since this is what usually drives the patient into the office, patient satisfaction with the care received will not be significant unless the pain is managed. This is achieved through advice, reassurance, and training. Doctors of chiropractic often recommend ice (vs. heat) aimed at reducing inflammation, activity modification (teaching proper bending, lifting, pulling, and pushing techniques), and gentle stretching exercises when LBP is present in this acute stage.
Once the pain becomes more manageable and activities become less limited, the second goal is structural restoration. This usually includes managing the flat foot possibly with foot orthotics, a short leg with a heel lift, sole lift or combination, an unstable ankle, knee or hip with exercise often emphasizing balance challenge exercises, and sometimes an orthotic that can be as simple as an elastic wrap to a more elaborate brace. This goal also includes "functional restoration" or transitioning the patient back into real life activities they may be afraid to try such as work, golf, gardening, walking or running, etc.
The third goal is prevention oriented. This may include nutrition (including vitamin/mineral recommendations), weight management (though this is also part of the 2nd goal), exercises (aerobic, stabilization, balance, stretch), and stress management (yoga, lifestyle coaching, etc.).
