Can a chiropractor help with lower back pain?

For the mechanical kind, which is most of it, chiropractic care is one of the reasonable options. For back pain that is coming from something other than the joints, muscles and discs, it is not. Knowing which one you are dealing with is the whole job of an assessment, and it should happen before anyone starts treating you.

What "mechanical" actually means

Mechanical low back pain means the pain is coming from the moving parts: the joints of the lower back, the muscles and connective tissue around them, and the discs that sit between the vertebrae. It typically changes with position. Sitting makes it worse, or standing does, or you are stiff for the first ten minutes of the morning and better once you move.

That variability is the giveaway. Pain that responds to what you do is pain coming from structures that respond to what you do.

The great majority of low back pain sits in this category. It is also the category where movement, hands on care and loading have something to offer.

It is almost never the thing you were doing

Most people can tell me the exact moment it happened. Reaching into the boot, picking up a toddler, turning to grab a seatbelt. Something trivial, which is usually the confusing part, because the movement was nothing.

The movement was nothing. The four weeks before it were the problem.

Tissue has a tolerance, and that tolerance goes up and down depending on what you have been asking of it. A fortnight of long days at a desk, poor sleep and no walking lowers it. Then an ordinary movement lands on a lowered threshold and something objects. The bend over the boot gets the blame because it was the last thing to happen, not because it was the cause.

This matters because it changes what you fix. If the boot caused it, you avoid boots. If four weeks of sustained load caused it, you have a much more useful problem to work on.

When leg pain comes into it

Plenty of low back problems refer pain into the buttock or the back of the thigh. That is common, and on its own it does not mean anything is seriously wrong.

The landmark worth knowing is the knee. Pain that stays above the knee behaves quite differently from pain that travels below it. Pain that runs past the knee into the calf or the foot, particularly with numbness, pins and needles or a sense that the leg is weak, points more towards the nerve being involved rather than the joint alone.

Almost everyone calls anything down the leg sciatica. Most of it is not. The distinction changes the assessment, the expected timeline and sometimes whether a scan is worth considering at all, which is why it is worth being precise about where the pain actually reaches.

What care can realistically do

Two things, and they do different jobs.

The first is movement. Joints that have been guarded for weeks stiffen, and the muscles around them stay switched on long after they need to be. Hands on care is aimed at that, and it is the part that tends to feel better quickly.

The second is capacity, and this is the part that decides whether it stays better. Restoring movement without building the tolerance back is why some people feel great for three days and then find themselves back where they started. Capacity takes weeks to months and it is not glamorous, but it is the difference between managing an episode and changing the pattern.

What I would not tell anyone is that a course of care makes back pain a thing of the past. Low back pain recurs for a lot of people, and any honest account of it has to say so.

Three things that help, whatever the cause

Keep moving, at a level you can tolerate. Bed rest for acute low back pain fell out of favour a long time ago. Gentle, regular movement generally does better than waiting it out, even when the first few minutes are unpleasant.

Break up sustained positions. Fifteen seconds every fifteen minutes. Stand, walk to the kitchen, change what you are loading. The interruption is the point, not the exercise.

Build tolerance rather than chasing stretches. Stretching a tight lower back gives you twenty minutes. Walking, gradual loading and getting stronger through the hips and trunk is what raises the threshold that got lowered in the first place.

Where to start

An assessment should tell you which category your back pain falls into, what is realistic, and roughly how long it should take. If it turns out to be something outside what a chiropractor should be treating, that is a useful thing to find out early rather than after three months of appointments.

If you are in Toowong or nearby, you can read more about chiropractic care in Toowong, or about how our membership works. If your pain is mostly in the neck rather than the lower back, this one covers that.