Low Back Pain

Almost everyone will experience low back pain sometime in their lives. Around a quarter to a third of the population are experiencing it at any given point in time. It's been noted to place a heavy burden on society due to lost time from work as well as costs associated with treatment for it. Poor emotional well-being, obesity, and smoking are all associated with a higher risk of low back pain. 

While research on low back pain has been prolific over the past three decades, there still remains no diagnostic gold standards to determine the causes for most cases. Generally, practitioners agree that the spinal joints, spinal muscles, or spinal discs are usual culprits for pain. Poor trunk muscle coordination or strength is also implicated as a cause of low back pain as it may lead to irritation to any of the former. Your history, the examination, contemporary theories, and the doctor’s clinical experience together provide clues to determine the causation of the pain as well as ruling out more serious causes of low back pain. Contrary to what you may have heard, x-ray imaging is generally unnecessary for management of most cases of low back pain. 


Very frequently, cases of low back pain are not serious and will resolve on its own within a short period of time without requiring a health care professional. However, if you’re reading this, chances are it may have yet to resolve on its own, or perhaps you’ve been dealing with low back pain for a long time and the treatment you’ve been receiving has not adequately addressed the problem. Whatever it may be, if you’re in the Kirkland, Bellevue, or Redmond area, Integrity Chiropractic provides exceptional chiropractic and massage treatment to help you get back to living life.


*Before reading on- if you are experiencing low back pain and have abnormal or loss of sensation in your inner thigh, groin, genitalia, and/or have difficulty trying to going to the bathroom, you may have a serious medical emergency. Seek medical help immediately.

What does the research say about Chiropractic and Massage for low back pain?

For research purposes, low back pain is typically classified as acute (less than 3 months duration) or chronic (more than 3-6 months duration). There is also low back pain associated with leg symptoms (which you may know as sciatica) that we will cover in separate article. While this framework is a convenient way to conduct and generalize research, it is important to understand that the presentation and experience of low back pain is very unique to the individual. 


For example, people with acute low back pain are extremely varied in practice compared to research studies. Clinically, we tend to see people with acute low back pain brought on by exercise, strenuous activity, or sudden unguarded/uncoordinated movements. This can present as low to moderate level pain, causing difficulties in performing certain movements or difficulty in being comfortable at rest- all the way to severe levels of pain, seizing the individual’s back, inhibiting normal function and mobility. While research patients tend to be like the former, the findings still have good implications for practice. 

While the cause of low back pain isn’t always clear, it is often shown to respond well to many types of treatment in research studies. We summarize findings relevant to our scope of practice below.

Research Findings for Acute Low Back Pain:

  • Spinal manipulation has been shown to be effective for reducing pain and improving function

  • Spinal manipulation has been shown to be better than spinal mobilization in reducing pain

  • Heat has been shown to be helpful in reducing pain

  • Exercise has shown to not be helpful in reducing pain

  • There is a lack of published studies for the use of massage therapy for acute low back pain
     

Research Findings for Chronic Low Back Pain:

  • Many popular treatment options are comparable in reducing pain and it is highly unlikely that a single therapeutic approach will be the optimal strategy for most patients

  • Supervised exercise, spinal manipulation, and home exercise were shown to each be effective at reducing pain, and more satisfaction was reported with supervised exercise

  • Spinal manipulation has been shown to be effective alone in reducing pain but tends to perform better when combined with exercise

  • Spinal manipulation with exercise is as effective for pain relief compared to pain medication with exercise

  • Motor control exercises may help with pain for chronic low back pain but are not more effective than general exercise

  • Massage therapy has shown to produce favorable results alone and with exercise therapy

What’s treatment like at Integrity Chiropractic for Acute Low Back Pain?

For chiropractic treatment, we agree with the research and employ heat to help relax and calm the low back prior to applying spinal manipulation, relieving pain. We may also employ soft tissue work depending on the degree of muscular involvement that we find to calm things further. While the research does not show exercise to be helpful for treating acute low back pain patients, we believe certain types of exercises may be beneficial for some patients depending on their presentation. Furthermore, because some people who experience a case of acute low back pain may experience another episode, we believe there is value in exercises as a preventative measure. While there is little research in regards to massage therapy for acute low back pain, clinically we find that it is helpful for more mild cases of pain (i.e. overexertion from working out). Usually, most of our acute low back pain patients tend to be resolved around 3-6 visits, but this may vary depending on your presentation, response, and goals.

What’s treatment like at Integrity Chiropractic for Chronic Low Back Pain?

Research has also demonstrated that chronic low back pain is complex and multifactorial. Because of that, many other treatments may help with chronic low back pain, including ones not covered in our article such as acupuncture, behavioral therapy, and yoga.

From the research it is shown that spinal manipulation and exercise are beneficial for chronic low back pain sufferers. Some studies demonstrate each to be individually effective and some in combination, with better results with the latter. Furthermore, spinal manipulation tends to produce good short-term results on pain while exercise produces good long term results. Because of this, we typically use a combined approach to chronic low back pain sufferers as exercise therapy can continue to be done independently outside of the office for self-treatment. While research shows that any exercise is beneficial to a patient with chronic low back pain (which we also highly encourage), our protocol is to condition and strengthen the core, hips, and glutes as well as give exercises that integrate all three to help patients learn to move in ways that are efficient and reduce loads to the low back, thus preventing injury.

Another approach, which demonstrated favorable results in only one study to date, is to receive regular maintenance spinal manipulation on a biweekly or monthly basis to keep chronic low back pain in control. This may be a suitable option for patients who are not yet ready to commit to increasing their physical activity level.

There are few studies on massage therapy for chronic low back pain, and the high quality ones available have demonstrated massage to be beneficial. One study has shown Swedish, deep tissue, trigger point therapy, and NMT styles of massage given for an hour at a time, once a week for 10 weeks was favored when compared to acupuncture and self-care. When massage was compared to exercise alone, massage showed to be significantly better, and when the two were combined they produced favorable results. 


Treatment duration tends to be more variable for chronic low back pain sufferers. Chiropractic or massage treatment generally requires visits once to twice a week for an initial period of 4-8 weeks and then tapered down to an infrequent maintenance schedule or ceased depending on the response of the patient.

What to Expect with Massage or Soft Tissue work for Low Back Pain

We will likely address the erector spinae muscles which consists of 3 muscles that run parallel on each side of the spine, and attach at the lower back and run all the way to the skull. Their primary function is to extend the back, help side bend, and maintain posture. We find that clinically these muscles are flared up due to poor posture, or over-exertion from bending over to pick up items.

We may also address the quadratus lumborum (QL) muscles, which attach from the top of your pelvis, lower spine, and 12th rib. The QL stabilizes the spine and pelvis, as helps to extend and side bend at the waist. Knots or tension in the QL can make performing these actions difficult.

One area patients may sometimes not think about is the iliopsoas muscle. The iliopsoas attaches from your lumbar vertebrae and to the front of your hip. Its job is to help you flex your hip and assist in motions such as a sit-up. The iliopsoas is often overactive in today's society due to sitting and may require work as well. When the Psoas muscles are tight or have trigger points they may influence low back mechanics, contributing to low back pain.

The gluteal muscles may also be the source of low back pain. The glutes attach from the broad part of your pelvis called the ilium and the lower part of the spine known as the sacrum and coccyx. It also is connected to the erector spinae fascia which one factor of why it can contribute to LBP. The glutes are responsible in maintaining posture and returning one upright after bending over. The gluteals are at times responsible for trigger points that can radiate throughout the lower back.

Lastly, the legs, front and back may be important to work on, as when certain leg muscles are tight they can pull on the pelvis which effects the spine, causing pain in the low back.

References

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  • Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clinical Rehabilitation [serial online]. December 2015;29(12):1155-1167. Available from: CINAHL Complete, Ipswich, MA. Accessed January 24, 2017.

  • LAST A, HULBERT K. Chronic Low Back Pain: Evaluation and Management. American Family Physician [serial online]. June 15, 2009;79(12):1067. Available from: Publisher Provided Full Text Searching File, Ipswich, MA. Accessed January 24, 2017.

  • Gomes-Neto M, Lopes J, Arcanjo F, et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Physical Therapy In Sport [serial online]. January 2017;23:136-142. Available from: CINAHL Complete, Ipswich, MA. Accessed January 24, 2017.

  • Rubinstein S, van Middelkoop M, Assendelft W, de Boer M, van Tulder M. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (03622436) [serial online]. June 2011;36(13):E825-46. Available from: CINAHL Complete, Ipswich, MA. Accessed January 24, 2017.

  • Bronfort G, Maiers M, Transfeldt E, et al. Clinical Study: Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. The Spine Journal [serial online]. January 1, 2011;11:585-598. Available from: ScienceDirect, Ipswich, MA. Accessed January 24, 2017.

  • Dagenais S, Tricco A, Haldeman S. Review Article: Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. The Spine Journal [serial online]. January 1, 2010;10:514-529. Available from: ScienceDirect, Ipswich, MA. Accessed January 24, 2017.

  • Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal [serial online]. January 2008;8(1):213-225. Available from: Academic Search Index, Ipswich, MA. Accessed January 24, 2017.

  • Senna M, Machaly S. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?. Spine (03622436) [serial online]. August 15, 2011;36(18):1427-1437. Available from: CINAHL Complete, Ipswich, MA. Accessed January 24, 2017.

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  • Furlan A. Massage for low-back pain. Cochrane Database Of Systematic Reviews [serial online]. August 31, 2015;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed January 24, 2017.

  • Saragiotto B, Maher C, Macedo L, et al. Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane Review. Spine (03622436) [serial online]. August 15, 2016;41(16):1284-1295. Available from: CINAHL Complete, Ipswich, MA. Accessed January 25, 2017.

  • Menke J. Do Manual Therapies Help Low Back Pain? A Comparative Effectiveness Meta-analysis. Spine (03622436) [serial online]. April 2014;39(7):E463-72. Available from: CINAHL Complete, Ipswich, MA. Accessed January 25, 2017.

  • Walker B, French S, Grant W, Green S. A cochrane review of combined chiropractic interventions for low-back pain. Spine (03622436) [serial online]. February 2011;36(3):230-242. Available from: CINAHL Complete, Ipswich, MA. Accessed January 25, 2017.

  • Dagenais S, Gay R, Tricco A, Freeman M, Mayer J. Review Article: NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain. The Spine Journal [serial online]. January 1, 2010;10:918-940. Available from: ScienceDirect, Ipswich, MA. Accessed January 25, 2017.

  • Brosseau L, Wells G, Cohoon C, et al. Systematic review massage: low back pain: Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. Journal Of Bodywork & Movement Therapies [serial online]. October 1, 2012;16:424-455. Available from: ScienceDirect, Ipswich, MA. Accessed January 25, 2017.

  • Preyde M. Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. CMAJ: Canadian Medical Association Journal [serial online]. June 27, 2000;162(13):1815-1820. Available from: CINAHL Complete, Ipswich, MA. Accessed January 25, 2017.

  • Cherkin D, Eisenberg D, Deyo R, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives Of Internal Medicine [serial online]. April 23, 2001;161(8):1081-1088. Available from: CINAHL Complete, Ipswich, MA. Accessed January 25, 2017.

Integrity Chiropractic

610 Market Street, Suite 103

Kirkland, WA 98033

425.298.0665

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