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Low Back Pain: Should I Have Spinal Manipulation


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Decision Point

Low Back Pain: Should I Have Spinal Manipulation?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have Spinal Manipulation?

Get the facts

Your options

  • Have spinal manipulation for your low back pain.
  • Don't have spinal manipulation.

If your symptoms are very bad or are getting worse, this is not a decision you should make right now. See your doctor.

Key points to remember

  • Most people with low back pain get better with home treatment. Try using ice, moist heat, pain relievers, and mild exercise.
  • Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition. Consider talking to your doctor before you try spinal manipulation.
  • Spinal manipulation doesn't work any better for low back pain than medicines and physical therapy.
  • Spinal manipulation may work for some people but not for others.
  • You can't count on spinal manipulation alone. You will also need to learn how to take care of your back and do exercises that help your muscles better support your joints.
  • If spinal manipulation leads to more pain, new pain, or numbness in your legs or anywhere else, you should stop this treatment.
FAQs

What is spinal manipulation?

Spinal manipulation involves working on the head, shoulders, neck, back, or hips to help relieve back pain. It can range from massage and slow pressing to a quick thrust.

Sometimes heat, ultrasound, or electrical current is used first to relax your muscles.

This is the basis of chiropractic treatment. But not only chiropractors are trained to do spinal manipulation. Others include:

  • Osteopathic doctors.
  • Physiatrists.
  • Physical therapists.

Find out ahead of time whether your health insurance will cover treatment by the person you've chosen. And make sure that the person is willing to coordinate care with your other health professionals, like your doctor or physical therapist.

How well does spinal manipulation work for low back pain?

For low back pain that has lasted less than about 12 weeks, it is not clear whether spinal manipulation will help.1

Most studies that compare this treatment with others for long-term (chronic) low back pain show that spinal manipulation is likely to help.2 But studies also show that it is no better than physical therapy, exercise, or pain medicine.3

Some practitioners encourage long-term treatment to prevent future problems, although there is no evidence to support this.

After you have had your spine manipulated, you will still need to learn how to take care of your back. And you can learn how to strengthen your muscles so that they better support your spine.

How do you choose someone to do spinal manipulation?

How well this treatment works depends partly on the person's skill. Ask your medical doctor to help you find someone. Interview one or two before you start treatment.

Look for someone who:

  • Is willing to coordinate treatment with your doctor or other health care workers.
  • Will tell you about home treatment and exercises.
  • Diagnoses problems with a physical exam and an interview, using X-ray in unusual cases.
  • Is willing to refer you to a specialist when needed. This may include an orthopedist, neurosurgeon, or oncologist for further testing, or a registered dietitian for nutritional counseling.

Avoid someone who:

  • Uses X-rays as a standard diagnostic test, especially full-body X-rays or X-rays of children. These give unnecessarily high levels of radiation.
  • Uses manipulation to treat such problems as lung and ear infections, skin conditions, eye problems, and learning disabilities.
  • Promotes regular manipulation as a way to prevent illness or joint problems.

What are the risks of spinal manipulation?

Slow pressing movement, sometimes called mobilization, has no known risks.

Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition that needs medical treatment right away. If you have these symptoms, talk to your doctor before you try spinal manipulation.

If manipulation leads to more pain, new pain, or numbness in the legs or anywhere else, stop the treatment.

Why might your doctor agree with your decision to try spinal manipulation?

Your doctor might agree if:

  • Your symptoms aren't caused by any serious conditions.
  • You have tried home treatments for a few weeks, and your back pain is not better.
  • You have tried manipulation in the past and have been satisfied.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have spinal manipulation Have spinal manipulation
  • You lie on a special table while the practitioner puts pressure on your head, shoulders, back, or hips. The treatment can range from slow pressing to a quick thrust.
  • Some people get pain relief.
  • Slow pressing has no known risks.
  • Although it is very rare, forceful or rapid adjustments, especially to the neck, could cause problems. Manipulation is not recommended for people who have nerve-related problems that are very severe or getting worse.4, 1
Use other treatment Use other treatment
  • You can apply ice or heat to your back, find a comfortable position when you rest, and exercise regularly.
  • You can take pain medicine.
  • For most people, home treatments relieve low back pain within 4 to 6 weeks.
  • Some people keep having back pain even with home treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy was totally different from my old chiropractor—he wanted to use some treatments that have nothing to do with my spine. I talked to some friends and to my doctor and found a good chiropractor that way.

Tara, age 24

I've put up with bouts of this back pain over the years, but this time I couldn't walk right. After a couple of days, a friend of mine suggested I see his osteopathic doctor to have my spine adjusted. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after just one visit, my pain got a lot better.

Joe, age 40

I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the names of a physical therapist and a chiropractor. I talked to each of them on the phone ahead of time about how they practice. They both sounded great. But it turns out my insurance will help pay for physical therapy, so I made an appointment with the physical therapist. I've been really happy with her and the back pain relief I've had after a few spinal adjustments and daily exercises at home.

Sandra, age 37

I hurt my back from using a posthole digger, and I also had pain in the back of my thigh. I went to the guy who worked on my friend's back, and he had me get an X-ray and gave me a spinal adjustment. After a week of seeing him, I began having pain farther down my leg, into my calf. I went to my family doctor and eventually I had a test called an MRI. It showed that I had a herniated disc. I'll hold off on manipulation and try some other treatments for now.

Dave, age 55

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I feel confident that I can find a practitioner with a good reputation.

I am worried about finding a good practitioner.

More important
Equally important
More important

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

More important
Equally important
More important

I'm not worried about the risks of spinal manipulation, because I know they are rare.

Even though side effects are rare, I still worry that they could happen to me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Do most people with low back pain get better with home treatment?

  • YesThat's right. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
  • NoNo, that's wrong. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
  • I'm not sureIt may help to go back and read "Compare your options." Research shows that for most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.
2.

Is spinal manipulation a back pain treatment that works for everyone?

  • YesSorry, that's wrong. This treatment works for some people but not others.
  • NoCorrect. This treatment works for some people but not others.
  • I'm not sureIt may help to go back and read "Key points to remember." This treatment doesn't work for everyone.
3.

Should you stop treatment right away if a spinal manipulation makes your pain worse or causes new pain in your legs or anywhere else?

  • YesYou're right. Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.
  • NoSorry, but the right answer is "yes." Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.
  • I'm not sureIt may help to go back and read "What are the risks of spinal manipulation?" Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical ReviewerRobert B. Keller, MD - Orthopedics

References
Citations
  1. McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  2. Chou R (2010). Low back pain (chronic), search date April 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  3. Rubenstein SM, et al. (2011). Spinal manipulative therapy for chronic low-back pain (Review). Cochrane Database of Systematic Reviews (6).
  4. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have Spinal Manipulation?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have spinal manipulation for your low back pain.
  • Don't have spinal manipulation.

If your symptoms are very bad or are getting worse, this is not a decision you should make right now. See your doctor.

Key points to remember

  • Most people with low back pain get better with home treatment. Try using ice, moist heat, pain relievers, and mild exercise.
  • Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition. Consider talking to your doctor before you try spinal manipulation.
  • Spinal manipulation doesn't work any better for low back pain than medicines and physical therapy.
  • Spinal manipulation may work for some people but not for others.
  • You can't count on spinal manipulation alone. You will also need to learn how to take care of your back and do exercises that help your muscles better support your joints.
  • If spinal manipulation leads to more pain, new pain, or numbness in your legs or anywhere else, you should stop this treatment.
FAQs

What is spinal manipulation?

Spinal manipulation involves working on the head, shoulders, neck, back, or hips to help relieve back pain. It can range from massage and slow pressing to a quick thrust.

Sometimes heat, ultrasound, or electrical current is used first to relax your muscles.

This is the basis of chiropractic treatment. But not only chiropractors are trained to do spinal manipulation. Others include:

  • Osteopathic doctors.
  • Physiatrists.
  • Physical therapists.

Find out ahead of time whether your health insurance will cover treatment by the person you've chosen. And make sure that the person is willing to coordinate care with your other health professionals, like your doctor or physical therapist.

How well does spinal manipulation work for low back pain?

For low back pain that has lasted less than about 12 weeks, it is not clear whether spinal manipulation will help.1

Most studies that compare this treatment with others for long-term (chronic) low back pain show that spinal manipulation is likely to help.2 But studies also show that it is no better than physical therapy, exercise, or pain medicine.3

Some practitioners encourage long-term treatment to prevent future problems, although there is no evidence to support this.

After you have had your spine manipulated, you will still need to learn how to take care of your back. And you can learn how to strengthen your muscles so that they better support your spine.

How do you choose someone to do spinal manipulation?

How well this treatment works depends partly on the person's skill. Ask your medical doctor to help you find someone. Interview one or two before you start treatment.

Look for someone who:

  • Is willing to coordinate treatment with your doctor or other health care workers.
  • Will tell you about home treatment and exercises.
  • Diagnoses problems with a physical exam and an interview, using X-ray in unusual cases.
  • Is willing to refer you to a specialist when needed. This may include an orthopedist, neurosurgeon, or oncologist for further testing, or a registered dietitian for nutritional counseling.

Avoid someone who:

  • Uses X-rays as a standard diagnostic test, especially full-body X-rays or X-rays of children. These give unnecessarily high levels of radiation.
  • Uses manipulation to treat such problems as lung and ear infections, skin conditions, eye problems, and learning disabilities.
  • Promotes regular manipulation as a way to prevent illness or joint problems.

What are the risks of spinal manipulation?

Slow pressing movement, sometimes called mobilization, has no known risks.

Certain symptoms, such as sharp pain or low back pain with leg pain or numbness, can be a sign of a serious condition that needs medical treatment right away. If you have these symptoms, talk to your doctor before you try spinal manipulation.

If manipulation leads to more pain, new pain, or numbness in the legs or anywhere else, stop the treatment.

Why might your doctor agree with your decision to try spinal manipulation?

Your doctor might agree if:

  • Your symptoms aren't caused by any serious conditions.
  • You have tried home treatments for a few weeks, and your back pain is not better.
  • You have tried manipulation in the past and have been satisfied.

2. Compare your options

Have spinal manipulation Use other treatment
What is usually involved?
  • You lie on a special table while the practitioner puts pressure on your head, shoulders, back, or hips. The treatment can range from slow pressing to a quick thrust.
  • You can apply ice or heat to your back, find a comfortable position when you rest, and exercise regularly.
  • You can take pain medicine.
What are the benefits?
  • Some people get pain relief.
  • For most people, home treatments relieve low back pain within 4 to 6 weeks.
What are the risks and side effects?
  • Slow pressing has no known risks.
  • Although it is very rare, forceful or rapid adjustments, especially to the neck, could cause problems. Manipulation is not recommended for people who have nerve-related problems that are very severe or getting worse.4, 1
  • Some people keep having back pain even with home treatment.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about spinal manipulation for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I grew up in a family that swears by spinal manipulation. When I moved out on my own in another city, I went to the chiropractor down the street from me when I hurt my back. I didn't feel comfortable. This guy was totally different from my old chiropractor—he wanted to use some treatments that have nothing to do with my spine. I talked to some friends and to my doctor and found a good chiropractor that way."

— Tara, age 24

"I've put up with bouts of this back pain over the years, but this time I couldn't walk right. After a couple of days, a friend of mine suggested I see his osteopathic doctor to have my spine adjusted. I didn't know much about spinal manipulation, but I thought I'd give it a try. And you know, after just one visit, my pain got a lot better."

— Joe, age 40

"I'm pretty careful about who I choose for my medical care. So I did some research before going to see someone about treating my back pain. I'd heard about some people who actually felt worse after spinal manipulation. I'd also heard from friends that manipulation helped them a lot. So I talked to my doctor and got the names of a physical therapist and a chiropractor. I talked to each of them on the phone ahead of time about how they practice. They both sounded great. But it turns out my insurance will help pay for physical therapy, so I made an appointment with the physical therapist. I've been really happy with her and the back pain relief I've had after a few spinal adjustments and daily exercises at home."

— Sandra, age 37

"I hurt my back from using a posthole digger, and I also had pain in the back of my thigh. I went to the guy who worked on my friend's back, and he had me get an X-ray and gave me a spinal adjustment. After a week of seeing him, I began having pain farther down my leg, into my calf. I went to my family doctor and eventually I had a test called an MRI. It showed that I had a herniated disc. I'll hold off on manipulation and try some other treatments for now."

— Dave, age 55

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose spinal manipulation

Reasons not to choose spinal manipulation

I feel confident that I can find a practitioner with a good reputation.

I am worried about finding a good practitioner.

More important
Equally important
More important

I am comfortable with treatment that involves hands-on contact.

I don't like the idea of treatments that involve physical contact.

More important
Equally important
More important

I'm not worried about the risks of spinal manipulation, because I know they are rare.

Even though side effects are rare, I still worry that they could happen to me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Trying spinal manipulation

NOT trying spinal manipulation

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Do most people with low back pain get better with home treatment?

  • Yes
  • No
  • I'm not sure
That's right. For most people, home treatments—such as ice, moist heat, pain relievers, and mild exercise—relieve low back pain within 4 to 6 weeks.

2. Is spinal manipulation a back pain treatment that works for everyone?

  • Yes
  • No
  • I'm not sure
Correct. This treatment works for some people but not others.

3. Should you stop treatment right away if a spinal manipulation makes your pain worse or causes new pain in your legs or anywhere else?

  • Yes
  • No
  • I'm not sure
You're right. Sharp pain or low back pain with leg pain or numbness can be signs of a serious condition that needs medical treatment right away.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical ReviewerRobert B. Keller, MD - Orthopedics

References
Citations
  1. McIntosh G, Hall H (2011). Low back pain (acute), search date December 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  2. Chou R (2010). Low back pain (chronic), search date April 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  3. Rubenstein SM, et al. (2011). Spinal manipulative therapy for chronic low-back pain (Review). Cochrane Database of Systematic Reviews (6).
  4. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: February 7, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics


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