Non-specific low back pain (LBP) is defined as soreness, tension, and/or stiffness in the lower back region for which it is not possible to identify a specific cause of pain [64] – i.e. there is not a pathological cause nor can it be categorised as sciatica. A variety of conditions affecting the joints and ligaments in the lumbar spine and sacro-iliac region may fit into this category including joint tension (hypomobility), joint irritation, sprain-strains, very early degenerative/ osteoarthritic changes and muscle spasms. For references please see home page/ chiropractic/ research evidence.

Diagnosis

Diagnosis of non-specific LBP is derived from the patient’s history with an unremarkable neurological exam and no indicators of potentially serious pathology. Imaging (X-Rays or MRI scans) are only indicated in patients with a positive neurological exam or presence of a “red flag” [64-67].

Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing). X-Rays or MRI scans may be requested.

Evidence based summary for manual therapy [53]

Randomised controlled research trials (RCT) and reviews (the highest current standards of scientific evidence) suggests that there is high quality evidence (on a scale of inconclusive, moderate and high) that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in adults [63,64,65]. There is moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in older adults [69]. There is also moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for acute LBP in adults [63,67]. It has been found that for massage there is moderate quality evidence that it is an effective treatment for subacute and chronic LBP in adults [66,68]. For references please see home page/ chiropractic/ research evidence.

Other effective evidence based non-invasive treatments or patient education [53]

Advice to stay active, interdisciplinary rehabilitation, exercise therapy [70,71], acupuncture, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic LBP and superficial heat for acute LBP [63,66].

Back-in-Action clinical comment

Chiropractic assessment and treatment of simple low back pain is aimed at finding and reducing tension and the causes of tension in the joints and muscles. We find much of the discomfort associated with simple low back pain arises from joint dysfunction (tension) or injury through too much movement (sprain). The joints most often involved are the facet joints in the lumbar spine or the sacroiliac joints. Chiropractors usually like to address the reasons why there is an increase in stress in this area.

In our experience treating the symptoms and underlying causes of simple low back pain benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates a combination of spinal manipulation, mobilisation, muscle release techniques, cranial work, back exercises (individually tailored self mobilisation, stretching and strengthening), referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling.