Chiropractic treatments for back pain

Introduction to chiropractic care
Spinal manipulation (like that used by chiropractors in chiropractic medicine) is not a new or recent concept. Records show that manipulation of the spine can be traced back to the time of Hippocrates (1, 2).

Since the inception of chiropractic medicine in 1895, chiropractors have held as a primary tenet that biomechanical and structural derangement of the spine can affect the nervous system. Because the nervous system is so intimately related to the spine from an anatomical standpoint, identifying and restoring spinal structural integrity through chiropractic treatments can improve the health of the individual by reducing pressure on sensitive neurological tissue. This tenet continues to be the emphasis that many chiropractors embrace and chiropractic patients seek.

The research status of chiropractic medicine, or manipulative therapy, was reviewed in a 1975 NINCDS (National Institute of Neurological and Communicative Disease and Stroke) conference held in Bethesda, Maryland that included experts from many of the disciplines that utilize manipulation (3). Dr. Joseph Janse, DC, who was president of the National College of Chiropractic at the time, was the spokesperson for chiropractic medicine.

Chiropractic treatment for lower back pain
In his presentation, Dr. Janse reviewed the literature from the time of the founding of chiropractic in 1895 to the 1975 conference date. From that review, various chiropractic hypotheses were identified and research recommendations were drafted in order to dispel the myths and/or to support the tenets of the chiropractic hypotheses. Much of the chiropractic research conducted to the 1975 date supports the proposed hypotheses while others continue to be investigated.

It is important to note that doctors of chiropractic do not utilize drugs or surgery in their practice. However, there are times when a chiropractor  will recommend that the patient consult another practitioner if these or other methods of treatment are indicated.

This article will restrict its focus to the chiropractic treatment of lower back pain, which is included in the biomechanical hypothesis and carries perhaps the greatest level of research evidence for chiropractic care.

There appears to be firm literature support for chiropractic treatment of lower back pain. Many of the published guidelines recommend spinal manipulation to be included in the treatment plan early in the care of lower back pain (4-12).

It is difficult to discuss the relationship of chiropractic medicine to the treatment of lower back pain without addressing the history and concepts behind the chiropractic profession. Therefore, one of the goals of this article is to introduce to the reader some of the concepts of chiropractic and address the issues surrounding a typical chiropractic visit.