Lower back pain touches nearly everyone at some point, and the causes span a wide range: a single awkward lift, months of desk-bound sitting, or years of small compensations catching up. The good news is that its course is often favorable, and most of it can be managed with conservative care.[1]
The usual suspects
Most lower back pain is mechanical, coming from joints, muscles, or discs, but pinning it on one exact tissue is often difficult or impossible.[1][2] Pain radiating down a leg can point to nerve involvement, which changes the treatment approach, though only about 1% of people with low back pain have actual nerve deficits on exam.[2]
How chiropractic care addresses it
Treatment usually combines spinal adjustments to restore motion to stiff joints, soft-tissue work on tight muscles around the hips and pelvis, and specific core and hip exercises so the improvement holds. Both pieces have support: spinal manipulation works about as well as other recommended treatments for long-lasting low back pain,[3] and exercise therapy probably reduces pain compared with no treatment or usual care.[4]
What to do (and not do) early on
Complete bed rest doesn't speed recovery: for recent low back pain, advice to stay active leads to slightly better pain relief and function than advice to rest in bed.[5] Gentle movement, short walks, and avoiding long stretches of sitting generally serve people better than staying still. What to do in the first 24 to 48 hours after a serious injury is a different conversation, and worth having at a visit.
When to get it looked at
Pain lasting more than a few days, pain that radiates into a leg, or numbness and weakness are all reasons to get evaluated rather than wait it out. Seek medical care right away for loss of bladder or bowel control, numbness in the groin or inner thighs, fever, or back pain after a serious fall.[2][6]
Sources
Retrieved through PubMed, plus Souza's chiropractic differential diagnosis text. Numbers in brackets above refer to this list.
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9
- Souza TA. Differential Diagnosis and Management for the Chiropractor: Protocols and Algorithms. 3rd ed. Sudbury, MA: Jones and Bartlett; 2005:127-128.
- Rubinstein SM, de Zoete A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ. 2019;364:l689. doi:10.1136/bmj.l689
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. doi:10.1002/14651858.CD009790.pub2
- Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;(6):CD007612. doi:10.1002/14651858.CD007612.pub2
- Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. doi:10.2519/jospt.2020.9971