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Low Back Pain Clinical Guidelines & Discussion


Many of you, if not all of you, reading this have either suffered from low back pain or (unfortunately) will suffer from low back at some point in your life.  When this happened/happens who will/did you go see for help?  Your options are plentiful:

  • Nobody
  • Medical Doctor / Emergency Room
  • Chiropractor
  • Physiotherapist
  • Massage Therapist
  • Osteopath
  • Acupuncturist
  • Psychologist
  • Naturopath
  • Your Mother!

If you went to the ER or your family doctor, the likely course of treatment would include:

  • Rest
  • Pain Medication
  • Referral to someone in the list above

If you went to anyone else on that list, or were referred to anyone else on that list, then the treatment options became much more involved.  This is a good thing because treating low back pain is a complicated blend of art and science.  And, everybody’s back pain is a bit different.  Many anatomical structures near the low back can be the source of pain:

  • Spinal Joints
  • Spinal Discs
  • Pelvic Joints
  • Ligaments
  • Tendons
  • Muscles
  • Fascia
  • Organs
  • Or, in all likelihood, a combination of these things

Even when one anatomical structure seems to be the cause of the pain, it gets more complicated.  The mechanical interplay between all of these pieces of anatomy is usually where the problem begins.  If we were all perfectly strong and flexible, with pristine spinal and pelvic joints, and performed all activities with perfect posture (static and dynamic) then we probably wouldn’t run into any back problems.  Sadly, this is near impossible.  Poor mechanics lead to damaged structures leading to inevitable pain.

So, what do we do about it?  The reality is that most people (~80%) do either nothing or take medication.  In my opinion, this is what leads to the snowball effect of damage on the body leading to more serious ailments later in life (eg. Joint replacements, muscle tear surgeries, etc.).  The other ~20% do a variety of things offered by the list of alternative health practitioners on the list above:

  • Spinal Manipulation
  • Massage
  • Manual Therapy
  • Acupuncture
  • Prescription Exercise
  • Modalities: Laser, TENS, Ultrasound
  • And others

Most people pick one thing and see if it helps.  Is this the right approach?  Well, instead of giving you my opinion, I’ll tell you what science says.  The following is the best and latest science has to offer with regards to low back pain.  Below are the four scientific papers comprising the current LOW BACK PAIN CLINICAL GUIDELINES.  As a chiropractor, I often incorporate spinal manipulation into my treatment for low back pain and as you’ll see, the clinical guidelines support this.  I also typically recommend additional care, such as massage therapy, or acupuncture.  As you’ll see in #3, this again is supported by science.  I, and the rest of us at Satori, not only rely on the science, but also the art of treating both the condition and the patient.  So, we also incorporate other methods that may not (yet) be supported by the official scientific guidelines.

I hope this article helps capture both the complexity of low back pain and also the simplicity of following the guidelines to help you recover as fast and complete as possible.  My recommendation is, “Let us guide you through your injury recovery”.


 Low Back Pain Clinical Guidelines

1. Toward Optimized Practice and Institute of Health Economics (2011).  Guideline for the evidence-informed primary care management of low back pain.

    •  Recommendations include:
      • Use of chiropractic and manual therapy
      • “Patients with disabling back or leg pain, or significant limitation of function including job related activities should be referred within 2 to 6 weeks to a trained spinal care specialist“, such as a chiropractor.
      • “Patients who are not improving may benefit from referral for spinal manipulation provided by a trained spinal care specialist”, including a chiropractor.

2. National Institute for Health and clinical Excellence (2009).  Low back pain early management of persistent non-specific low back pain.

    • “Consider offering a course of manual therapy, including spinal manipulation, comprising up to nine sessions over a period of up to 12 weeks.

3.  Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society.

    • “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits:
    • Acute Low Back Pain: Spinal Manipulation
    • Chronic/Subacute Low Back Pain: Intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioural therapy, relaxation

 4.  European Guidelines for the management of acute nonspecific low back pain in primary care.

    • Recommendations:
    • Spinal Manipulation

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