According to the 2012 National Health Interview Survey (NHIS), spinal manipulation is the most commonly used complementary and alternative medicine therapies used by adults and children in the United States, second only to dietary supplements.
So if you’re experiencing back pain, it’s likely your friends or acquaintances have suggested the use of chiropractic care to help, and for good reason!
In this article, we’ll help you understand how chiropractic treatment may help, the risks and side effects, and what to expect during treatment to assist you in making the best decision.
Here’s what you’ll find…
Table of Contents
Does Chiropractic Help Back Pain?
According to this meta analysis published in the Spine Journal, there is credible evidence to support that spinal “manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain.”
This conclusion is also supported by a systematic review conducted for the Department of Veteran Affair.
Further, this 2010 report on complementary and alternative therapies for back pain from the Agency for Healthcare Research and Quality (AHRQ) concluded that chiropractic treatment is significantly better than placebo and no treatment in reducing pain intensity. However, it was not shown to improve disability or range of motion.
Low Back Pain
According to the American College of Physicians (ACP), “low back pain is one of the most common reasons for all physician visits in the U.S.” In 2017, the ACP offered recommended spinal manipulation for the treatment of low back pain, along with several other recommendations.
The ACP states: “For patients with chronic low back pain, ACP recommends that physicians and patients initially select non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”
For short-term relief from acute or subacute low back pain, spinal manipulation was shown in this study to produce “statistically significant reductions in their pain-related disability after treatment.”
And in this study on chiropractic for patients with acute and chronic low back pain, “both acute and chronic [low back pain] chiropractic patients experienced somewhat greater relief up to 1 year” compared with patients receiving primary care from a physician for their back pain.
Another way to demonstrate the effectiveness of a treatment is to compare the treatment to a sham treatment. When this was done in this study, the researchers concluded that spinal manipulation, “has specific treatment effects and is more effective at reducing nonspecific low back pain when compared with an effective sham intervention.”
Lastly, the results of this study on 750 active duty U.S. military personnel with low-back pain concluded that “chiropractic care in addition to usual care had better short-term improvements in low-back pain intensity and pain-related disability than those who only received usual medical care.”
Risks and Side Effects
Undergoing chiropractic treatment or other manual spinal manipulation does come with some risks and potential side effects, ranging from mild to severe. These are outlined in this systematic review of the adverse effects of spinal manipulation and include:
Moderate to severe risks include:
- Cauda Equina Syndrome (CES) – the compression of nerves connected to your lower extremities and may disrupt motor function.
- Fracture – a complete or partial break in the bone
- Radiculopathy – in which a compressed nerve in the spine causes pain, numbness, tingling, or weakness, and compressed nerve in the spine that can cause pain, numbness, tingling, or weakness
- Vertebral artery dissection – a tear in the inner lining of the vertebral artery.
- Stroke – interrupted or blocked blood flow to the brain
Cost and Treatment
Cost is always a consideration for whether or not to seek chiropractic care for low back pain. Contact a chiropractor in your area to determine the specific costs associated with your treatment.
According to studies cited in this report from the Agency for Healthcare Research and Quality on complementary and alternative therapies for back pain, in 2010, the adjusted mean outpatient costs of low back pain in 18 months were:
- $765 for medical care plus physical therapy
- $565 for chiropractic plus physical modalities
- $550 for chiropractic
- $463 for medical care
In addition, this systematic review concluded that “overall, 11/12 (92 %) studies in private health plans reported that health care costs were lower for members whose spine pain was managed by chiropractic care, by a mean of 36%.”
At an average of $65 per treatment and a total of 12 sessions for back pain, you may expect to pay just under $800 for initial chiropractic treatment.
While the cost of treatment will vary by practitioner and geographic area, there are also affordable options for chiropractic care. This includes places like The Joint, where your monthly membership of $79 includes 4 adjustments, bringing the cost of each adjustment down to just $17.25 per session.
Does Medicare cover chiropractic for back pain?
Yes, medicare covers chiropractic treatment for back pain. However, Medicare doesn’t cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture (except for low back pain).
How many sessions for back pain?
Based on this study with over 400 participants, the best results from chiropractic treatment for lower back pain were provided through 12 sessions.
Do I need maintenance treatments?
Another study on the effectiveness of chiropractic maintenance care for persistent low back pain demonstrated that continued maintenance care was more effective than just undergoing the initial 12 treatments. However, because this resulted in a substantially greater number of treatments, those who respond well to initial care may consider forgoing maintenance treatment.
Other Complementary and Alternative Treatments for Back Pain
Other complementary therapies you may wish to consider for back pain include:
- Massage Therapy
- Tai Chi
Bialosky JE, George SZ, Horn ME, et al. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). Journal of Pain. 2014;15(2):136-148.
Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013
Dagenais, S., Brady, O., Haldeman, S., & Manga, P. (2015). A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC health services research, 15, 474. https://doi.org/10.1186/s12913-015-1140-5
Eklund, A., Jensen, I., Lohela-Karlsson, M., Hagberg, J., Leboeuf-Yde, C., Kongsted, A., Bodin, L., & Axén, I. (2018). The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain-A pragmatic randomized controlled trial. PloS one, 13(9), e0203029. https://doi.org/10.1371/journal.pone.0203029
Ernst E. (2007). Adverse effects of spinal manipulation: a systematic review. Journal of the Royal Society of Medicine, 100(7), 330–338. https://doi.org/10.1177/014107680710000716
Goertz, C. M., Long, C. R., Vining, R. D., Pohlman, K. A., Kane, B., Corber, L., Walter, J., & Coulter, I. (2016). Assessment of chiropractic treatment for active duty, U.S. military personnel with low back pain: study protocol for a randomized controlled trial. Trials, 17, 70. https://doi.org/10.1186/s13063-016-1193-8
Haas, M., Vavrek, D., Peterson, D., Polissar, N., & Neradilek, M. B. (2014). Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 14(7), 1106–1116. https://doi.org/10.1016/j.spinee.2013.07.468
Haas, M., Goldberg, B., Aickin, M., Ganger, B., & Attwood, M. (2004). A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of manipulative and physiological therapeutics, 27(3), 160–169. https://doi.org/10.1016/j.jmpt.2003.12.020
McMorland, G., & Suter, E. (2000). Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. Journal of manipulative and physiological therapeutics, 23(5), 307–311.
Peregoy JA, Clarke TC, Jones LI, et al. Regional variation in use of complementary health approaches by U.S. adults. NCHS data brief, no 146. Hyattsville, MD: National Center for Health Statistics. 2014.
Ruddock, J. K., Sallis, H., Ness, A., & Perry, R. E. (2016). Spinal Manipulation Vs Sham Manipulation for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis. Journal of chiropractic medicine, 15(3), 165–183. https://doi.org/10.1016/j.jcm.2016.04.014