Does chiropractic work? An important question if you’re considering consulting a chiropractor for your back or neck pain. Chiropractors are best known for treating back pain and their trademark is spinal manipulation therapy (SMT).
Many years ago the chiropractic profession relied only on experience and patient satisfaction levels to know whether chiropractic could reduce back pain. As a result, chiropractic was considered an alternative therapy, secondary to conventional care. However, after decades of research opinions have changed. A recent literature review in the highly prestigious British Medical Journal (BMJ) has found that SMT and mobilisation are just as effective for offering short and long term pain relief as other front line therapies (Rubinstein et al. 2019).
Importantly, chiropractors rarely use SMT in isolation. Education and exercise feature heavily in most treatment plans, which have also been shown to be effective by the influential Lancet Journal series. Massage is frequently employed and is also recommended by the NICE guidelines for low back pain. In short, chiropractic is much more than just one treatment technique.
Contrary to popular belief, paracetamol and muscle relaxants are ineffective (Foster et al. 2018) and anti-inflammatory medications should be used alongside other therapies if needed. In fact, guidelines for the UK and US recommend against using medication initially. Instead, they focus on the need for active care, focusing on self-management, physical and psychological therapies (Foster et al. 2018). We need to move and be social, unfortunately in todays society we move too little, while many suffer from stress, anxiety and depression. Sadly, ‘74% of UK adults have felt so stressed at some point over the last year they felt overwhelmed or unable to cope.’ (Mentalhealth.org.uk) Stress increases our sensitivity to pain and this is why many chiropractors recommend mindfulness exercises.
Many suffering from back pain feel that an x-ray or MRI will be helpful. However, for acute back pain imaging isn’t recommended (NICE). 37% of 20-year-old without back pain already have disc degeneration and this rises to 96% of 80-year-old individuals (Brinjikji et al. 2015). Essentially, it’s normal to have degenerative change in the spine. When in pain MRI findings can mislead the clinician and patient. We fixate on them as the cause of pain when they may have nothing to do with it. Instead imaging should only be used if it will change the treatment plan (NICE) or if there is significant neurological injury.
Surgery should be a last resort, used only if conservative care has failed or in the presence of progressive neurological injury.
If you’re suffering from back pain and you want to know where to start. The best thing you can do is keep active, avoid bed rest, and if possible, continue with work. If you’ve had pain for less than six weeks and it’s too painful to handle by yourself, seek help from a suitable healthcare professional e.g. chiropractor or physiotherapist. Equally, if your pain has lasted longer than twelve weeks consider asking for help (Foster et al. 2018).
Who you see is more important than what profession you see. Regardless of their background you want a healthcare professional who listens to you, takes your needs, ability and values into account, and is flexible in using a range of skills to help your reduce your symptoms. They should provided you with the tools to look after yourself but be supportive when you need them. As with all professions there are some incredible people, some average people and some people I’d rather you didn’t meet. Don’t be shy about interviewing you potential therapist to find out about their background and their approach to back pain.