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Lower Back Pain

For some people, lower back pain feels like just a niggle, but for others, it can mean they can’t go for a walk with their family, lift and carry things at work, or compete in the sports they love to play.

Lower back pain is now the leading cause of disability worldwide. Over 500,000,000 people are affected by back pain at any one time

Lower Back Pain Causes

One of the frustrating things for those with back pain is that doctors often don’t know what’s causing the pain, because most of the time the pain is due to a change in the way your back is moving and functioning, which changes the way your brain senses what is going on in your back. Scientists now know that the feeling of pain is something your brain decides that you should experience – if it believes you have some tissue damage.

Research studies have shown that instead of taking muscle relaxants, opioids, or other drugs, people with back pain should first consider seeing a chiropractor or another non-drug-based healthcare provider.

This is because chiropractic care can improve the way your spine functions, it can change the way your brain functions and it can have a big impact on the pain and disability you’re feeling in your back.

Video Transcript

If you’ve ever suffered from back pain you’ll probably agree that it can be annoying…it can be frustrating… it can also be absolutely debilitating.1 For some people, back pain feels like just a niggle, but for others, it can mean they can’t go for a walk with their family, lift and carry things at work, or compete in the sports they love to play.1 It really can have a big impact on how you live and enjoy your life.2

One of the big problems with back pain is it is so common!1 Scientists have worked out that at any 1 time, over half a billion people around the world are suffering from low back pain that stops them from doing day-to-day tasks, or work or hobbies they want to do.1

In fact, back pain is now the leading cause of disability worldwide.1 And the problem is getting worse, with more and more people experiencing back pain every year.1

One of the most frustrating things for people suffering from back pain is that often, doctors don’t know what’s causing the pain, because most of the time back pain isn’t due to something like a fracture or an infection,1 it’s often due to a change in the way your back is moving and functioning, which changes the way your brain senses what is going on in your back.3-6 In fact, scientists now know that the feeling of pain is something your brain decides that you should experience – if it believes you have some tissue damage.7 8 Your brain can decide that you should feel pain even if it only thinks there is a potential threat of tissue damage 7 8 – This means that even if you have no actual tissue damage yet, or the tissue damage has healed already, you could still experience pain. 7 8  Science has shown beyond a doubt that pain is created in your brain.7 8 Knowing this does not really change the way it feels for you, if you are suffering from low back pain, but it has a big impact on how you can get better.

When it comes to long-term or chronic back pain, the initial change in the way your back was moving may have come from a minor muscle strain because you bent or twisted in an awkward way.9 Then nerves from the site of the muscle strain sent messages to your brain to say you’ve got a problem and you need to protect that area of your back by moving less, or bending to one side, or lying down. 3-6 So, your brain creates the experience of pain to let you know something is not ok. 7 8  Over the next few weeks the muscle strain heals, so you no longer have any physical damage in your spine, but your brain might not realize that, because it might have learned to be in pain. 7 8 So, your brain may continue to tell you that you have an injury that needs to be protected in your back, even after the sprain has healed. In this situation the pain feelings are no longer there because of any tissue damage messages coming from your back at all, the feelings of pain are now continuing from your brain – because it has learnt to be in pain.7 8

The way your brain learns to be in pain is very similar to the way your brain learns anything.10 It’s called neural plasticity – or brain adaptations. 10 11 The good news is that your brain can also learn to stop sending you pain feelings by adapting in a good way to new inputs or interventions.12 Brain scientists who have studied the effects of chiropractic care on the brain have discovered that chiropractic adjustments can change the way your brain functions.13 In other words, chiropractic has a neuroplastic effect on your brain.13 In particular, we know that chiropractic adjustments change function in a part of your brain called the pre-frontal cortex.14 This part of your brain is actually the part that’s very involved in pain becoming a chronic problem.10 15 This might be why the earlier you have chiropractic care the better, because early chiropractic care results in better long-term outcomes.16 It might be that chiropractic care can prevent pain from becoming chronic.16 17

Preventive or maintenance chiropractic care has actually been shown by researchers to help people who have recurrent back pain, even when they aren’t suffering from back pain at the time they get adjusted.16 In one study,16 that was conducted in Sweden, a group of people with recurrent low back pain were adjusted by a chiropractor on a regular basis over the course of a year, even when they were not in pain. Another group saw a chiropractor only when their back pain flared up. What the researchers found was the group who were adjusted regularly experienced, on average, 13 fewer days of pain over the course of the year long study, compared to the group who only saw the chiropractor when their back pain symptoms flared up. The amazing thing from this study was that the maintenance care group only on average needed less than 2 extra visits to their chiropractor over the course of the year to have those 13 extra days without pain. So this study suggests that if you have recurring low back pain it’s a good idea to have a monthly visit with your family chiropractor! And some of the participants in this study only needed to see their chiropractor once every two months.

In another recent study,18 researchers looked at how 4-weeks of chiropractic care changed back pain, lifting strength, and trunk muscle endurance in 110 active-duty military personnel with low back pain. What they found was that the group who received chiropractic care had reduced pain intensity and less back pain related disability compared to the waiting-list control group, and they also had better lifting strength and back muscle endurance than the control group at the end of the trial. This means that those active-duty military personnel who had low back pain who got to see the chiropractor for four weeks found they had less back pain and experienced less disability from their back problem and their back muscles were stronger. Again this suggests that chiropractic care is really good for your spine – it’s a bit like exercise for your spine to function better! That might be why you benefit from seeing your family chiropractor on a regular basis. You cannot exercise once or twice and expect to be fit for life! it appears to be the same way with your spine.

In another similar, larger study of 750 military personnel with low back pain, 19 scientists explored what happened when they adding chiropractic care to the usual medical care that they were receiving.. In this study they found that over 6-weeks, the group that saw a chiropractor had less back pain intensity and less disability compared with the group that only received their usual medical care. What’s more, is that the chiropractic group were more satisfied with the care they received, they thought they’d improved more, and they reported taking fewer drugs to help control their back pain compared with those who only got the usual medical care.    

Studies like these are one reason that current back pain guidelines now recommend that instead of taking muscle relaxants, opioids or other drugs, people with back pain should first consider seeing a chiropractor or another non-drug-based healthcare provider.20 21 This is because chiropractic care can improve the way your spine functions,22 it can change the way your brain functions,13 14 17 and it can have a big impact on the pain and disability you’re feeling in your back,18 19 even if it has become a chronic brain problem! And we know if you see a chiropractor you are less likely to take opioid drugs,23-25 so you are less likely to become a statistic of the opioid crisis.

And keep in mind that chiropractic care has so much more to offer than just helping you with your back pain. Chiropractic care is all about improving the communication between your brain and body so you can function at your optimal potential. So, if you want to keep your back pain at bay, or you simply want to function at your best, see your family chiropractor because the research suggests your spine and brain will love you for it!

Video References

  1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391(10137):2356-67. doi: 10.1016/s0140-6736(18)30480-x [published Online First: 2018/03/27]

  2. Mutubuki EN, Beljon Y, Maas ET, et al. The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 2020;29(1):275-87. doi: 10.1007/s11136-019-02302-w [published Online First: 2019/09/17]

  3. Hodges PW, Danneels L. Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. J Orthop Sports Phys Ther 2019;49(6):464-76. doi: 10.2519/jospt.2019.8827 [published Online First: 2019/06/04]

  4. van Dieën JH, Reeves NP, Kawchuk G, et al. Motor Control Changes in Low Back Pain: Divergence in Presentations and Mechanisms. The Journal of orthopaedic and sports physical therapy 2019;49(6):370-79. doi: 10.2519/jospt.2019.7917 [published Online First: 2018/06/12]

  5. Hodges PW. Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol 2011;21(2):220-8. doi: 10.1016/j.jelekin.2011.01.002 [published Online First: 2011/02/11]

  6. Meier ML, Vrana A, Schweinhardt P. Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception. Neuroscientist 2019;25(6):583-96. doi: 10.1177/1073858418809074 [published Online First: 2018/11/06]

  7. Koyama T, McHaffie JG, Laurienti PJ, et al. The subjective experience of pain: Where expectations become reality. Proceedings of the National Academy of Sciences 2005;102(36):12950-55. doi: 10.1073/pnas.0408576102

  8. Hadjistavropoulos TD, S; Goubert, L.; Mogil J.S.; Sullivan, M.J.L.; Vervoort, T.; Craig K.D.; Cano, A.; Jackson, P.L.; Rainville, P.; Williams, A.C.; Fitzgerald, T.D. A Biopsychosocial formulation of pain communication. Psychological Bulletin 2011;137(6):910- 39. doi: 10.1037/a0023876

  9. A BA, Simic M, Pappas E, et al. Is occupational or leisure physical activity associated with low back pain? Insights from a cross-sectional study of 1059 participants. Braz J Phys Ther 2019;23(3):257-65. doi: 10.1016/j.bjpt.2018.06.004 [published Online First: 2019/05/28]

  10. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain 2011;152(3 Suppl):S49.

  11. Cooke SF, Bliss TV. Plasticity in the human central nervous system Brain 2006;129(Pt 7):1659-73.

  12. Nijs J, Clark J, Malfliet A, et al. In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clin Exp Rheumatol 2017;35 Suppl 107(5):108-15. [published Online First: 2017/10/03]

  13. Haavik H, Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyogr Kinesiol 2012;22(5):768-76. doi: 10.1016/j.jelekin.2012.02.012 [published Online First: 2012/04/10]

  14. Lelic D, Niazi IK, Holt K, et al. Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study. Neural Plast 2016;2016:3704964. doi: 10.1155/2016/3704964

  15. Seminowicz DA, Moayedi M. The Dorsolateral Prefrontal Cortex in Acute and Chronic Pain. The journal of pain : official journal of the American Pain Society 2017;18(9):1027-35. doi: 10.1016/j.jpain.2017.03.008 [published Online First: 2017/04/13]

  16. Eklund A, Jensen I, Lohela-Karlsson M, et al. 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 2018;13(9):e0203029. doi: 10.1371/journal.pone.0203029 [published Online First: 2018/09/13]

  17. Navid MS, Lelic D, Niazi IK, et al. The effects of chiropractic spinal manipulation on central processing of tonic pain – a pilot study using standardized low-resolution brain electromagnetic tomography (sLORETA). Sci Rep 2019;9(1):6925. doi: 10.1038/s41598-019-42984-3 [published Online First: 2019/05/08]

  18. Vining R, Long CR, Minkalis A, et al. Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial. J Altern Complement Med 2020;26(7):592-601. doi: 10.1089/acm.2020.0107 [published Online First: 2020/06/17]

  19. Goertz CM, Long CR, Vining RD, et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among us service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open 2018;1(1):e180105. doi: 10.1001/jamanetworkopen.2018.0105

  20. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine 2017;166(7):514-30. doi: 10.7326/m16-2367 %m 28192789

  21. Corp N, Mansell G, Stynes S, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. European journal of pain (London, England) 2021;25(2):275-95. doi: 10.1002/ejp.1679 [published Online First: 2020/11/12]

  22. Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, et al. Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review. J Altern Complement Med 2017;23(9):667-75. doi: 10.1089/acm.2017.0002 [published Online First: 2017/07/22]

  23. Corcoran KL, Bastian LA, Gunderson CG, et al. Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis. Pain Med 2020;21(2):e139-e45. doi: 10.1093/pm/pnz219 [published Online First: 2019/09/29]

  24. Whedon JM, Toler AW, Goehl JM, et al. Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. The Journal of Alternative and Complementary Medicine 2018;24(6):552-56.

  25. Whedon JM, Toler AW, Kazal LA, et al. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. Pain Medicine 2020


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