Chiropractic Treatments for Lower Back Pain

Chiropractors are doctors who focus on non-surgical treatment and healing of the musculoskeletal and/or nervous system.

Chiropractic care is considered an effective treatment for low back pain, for sciatica, a herniated disc, and many spinal conditions.

How Chiropractors Approach Treatment

Chiropractors believe in the close relationship between the spine and nervous system, emphasizing that:

• Spinal misalignment can impact the nervous system and overall health.
• Restoring spinal integrity can relieve pressure on sensitive nerves, promoting better function and pain relief.

The goal of chiropractic care is to improve spinal mobility, alleviate nerve irritation, and restore proper movement patterns.

See How To Select The Best Chiropractor

Conditions Commonly Treated by Chiropractors

Chiropractors use various manual therapies to address:

• Low back pain
• Sciatica (e.g., from a lumbar herniated disc)
• Neck pain
• Repetitive strain injuries
• Cervicogenic headaches
• Whiplash and car accident injuries
• Some sports injuries (e.g. biceps tendinopathy, back muscle strain)
• Arthritis-related discomfort

When necessary, chiropractors refer patients to a physiatrist, pain management physician, spine surgeon or other health professionals for further evaluation and care.

Chiropractors do not treat certain types of spine conditions.  For example, chiropractors do not treat:

• Advanced spondylolisthesis or other causes of spinal instability
• Severe osteoporosis, as weakened bones are at increased risk of fracture
• A vertebral fracture caused by a recent trauma
• A spinal tumor or malignancy
• Conditions requiring urgent surgery, such as cauda equina syndrome or abdominal aortic aneurysm
• Conditions involving significant spinal cord impingement, such as spinal stenosis with myelopathy
• Spinal cord infection or other infections, such as osteomyelitis
• Significant nerve damage causing progressive weakness or numbness in the arm or leg
• Advanced osteoporosis that has caused weak bones
• Advanced arthritis or ankylosing spondylitis
• Diseases that involve connective tissue damage, such as Ehler-Dans syndrome

For some medical conditions, chiropractors coordinate care with other medical professionals, and some chiropractors work in an integrated spine clinic along with a full range of spine specialists.

Some patients prefer to consult a medical doctor for some types of treatments and also see a chiropractor for holistic and complementary treatments, such as exercise, diet, massage and nutrition. See other Chiropractic Services

Chiropractic Adjustments and Techniques

Chiropractic adjustment, or spinal manipulation, is a core treatment used to improve joint function and reduce nerve irritation. Common techniques include:

• Spinal Manipulation (HVLA): A high-velocity, low-amplitude thrust applied to misaligned vertebrae, commonly producing an audible pop as gas is released from the joint.
• Mobilization: A gentler technique involving slow movements and stretching to enhance joint range of motion.

See Questions to Ask About Chiropractic Techniques

When to See a Chiropractor

Consider consulting a chiropractor for an evaluation if you experience unexplained neck or back pain or a condition related to the spine, such as sciatica, piriformis syndrome, or sacroiliac joint dysfunction, or a headache.

Potential Advantages and Disadvantages of Chiropractic Care

• Studies show that chiropractic care reduces the likelihood of using opioids to manage the pain, reducing the concomitant risks and adverse side effects of using opioids¹James M Whedon, Andrew W J Toler, Louis A Kazal, Serena Bezdjian, Justin M Goehl, Jay Greenstein. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. 2020 Dec 25;21(12):3567-3573. Available from: pubmed.ncbi.nlm.nih.gov/32142140/
• For many, chiropractic treatment prevents the need for more advanced medical treatments, such as an epidural steroid or other type of spinal injection, or surgery.  For example, chiropractic treatment for a lumbar herniated disc is an effective treatment to reduce pain and avoid microdiscectomy surgery²Gordon McMorland, Esther Suter, Steve Casha, Stephan J du Plessis, R John Hurlbert. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. 2010 Oct;33(8):576-84. Available from: pubmed.ncbi.nlm.nih.gov/21036279/
• Many patients find that the holistic approach of chiropractic care works well, as it focuses on long term healing with the goal of preventing and/or reducing the likelihood of back pain recurrence

There are risks of injury or worsening pain due to chiropractic care; however, these risks are rare.

There a few potential disadvantages of seeing a chiropractor:

• They do not prescribe medication, or do medical injections for pain relief
• Not all chiropractors accept insurance, and not all insurance policies cover chiropractic care
• While rare, there have been reports of a risk of stroke or vertebral artery damage with a neck adjustment

Like all health interventions, seeing a chiropractor is largely a matter of personal preference, and chiropractors have varying levels of skill and expertise.

If you do experience an adverse reaction after a chiropractic adjustment, seek medical attention and/or get a second opinion from another doctor.

Chiropractic Examination for Back Pain

A comprehensive chiropractic exam typically includes:

1. Consultation: Discussing symptoms, pain triggers, and relief methods.
2. Case History: Assessing family history, diet, past treatments, and lifestyle factors.
3. Physical Examination: Evaluating spinal motion, joint function, and possible neurological concerns.

Additional diagnostic tools may include:

• X-rays to assess spinal alignment and potential subluxations.
• Thermal scans to detect inflammation along the spine.

Chiropractors classify back pain into three primary categories:

1. Serious Conditions: Tumors, infections, fractures, or major neurological issues requiring referral to a spine specialist such as a physiatrist or orthopedic or neurological spine surgeon.
2. Nerve-Related Pain: Conditions like sciatica, caused by nerve compression from a herniated disc, mild or moderate spinal stenosis or spondylolisthesis.
3. Non-Specific Back Pain: The most common category treated by chiropractors, involving mechanical or axial pain with no clear cause.

Back pain and sciatica are further classified by how long the symptoms have been present:

• Acute: Lasting less than 6 weeks
• Subacute: Lasting 6-12 weeks
• Chronic: Lasting over 12 weeks
• Recurrent/Flare-Up: Symptoms that return sporadically

Chiropractors work alongside medical professionals when necessary, ensuring comprehensive patient care. If a condition is outside their scope, their education and training is to refer patients to the appropriate specialists.

Chiropractic Treatment Costs and Insurance Coverage

As with all health treatments, there is a range of costs depending on several variables, such as:

Type of treatments. Certain treatments cost more, for example, a simple adjustment would typically cost less than an adjustment that includes exercise instruction, massage or hydrotherapy.

Experience and Training. A chiropractor with extensive experience and/or higher level of training is likely to charge more. For example, some chiropractors have advanced degrees in areas such as sports medicine or orthopedics.

Location. Some clinic locations have higher rent and other cost factors, so they may charge more.

While there is a wide range of fees, a typical cost for a chiropractic adjustment is usually around $60 - $200.

Many health insurance plans, including Medicaid and Medicare plans, cover some of the costs of chiropractic care. If the treatment is not covered by insurance, it may be eligible under an HSA.

Final Thoughts

Chiropractic treatment offers a non-invasive approach to managing spine-related conditions.

Whether through spinal adjustments or gentle mobilization, chiropractors aim to restore function, reduce pain, and improve overall well-being.