Lower Back Pain

Evidence-Informed Chiropractic Care

Lower back pain is one of the most common reasons adults seek healthcare worldwide. Most people will experience at least one episode in their life, and for many it becomes chronic, disruptive, and frustrating.

Understanding the evidence helps you choose care that is safe, effective, and tailored to your condition

Why Lower Back Pain Happens


Lower back pain often arises from:


  • Restricted spinal movement
  • Altered nervous system signalling
  • Compensatory movement patterns
  • Postural strain and repetitive load


These factors can contribute to ongoing pain, stiffness, and functional limitations.


Scans (like X-ray or MRI) are excellent at ruling out infections, fractures, and serious pathology, but do not assess how well the spine moves or how well the nervous system is functioning.

What the Research Says About Chiropractic Care

Effectiveness of Chiropractic Adjustments


Chiropractic Adjustments, sometimes referred to as Spinal Manipulative Therapy (SMT) is the core clinical intervention used in Chiropractic, has been extensively studied for lower back pain. It's important to note that SMT does not always include Chiropractic Adjustments and in-fact, a significant amount of research that concludes SMT wasn't effective didn't include specific Chiropractic Adjustments performed by a trained Chiropractor. Research shows this is the most effective form of SMT for Lower Back Pain.


Large systematic reviews have shown that SMT produces meaningful improvements in pain and function for chronic lower back pain, with outcomes comparable to other recommended conservative treatments such as exercise therapy and standard medical care (Rubinstein et al., 2019; Bronfort et al., 2008).


Randomised controlled trials have also demonstrated that patients receiving Chiropractic care alongside usual medical care experience greater improvements in pain, disability, and functional capacity compared to medical care alone (Bishop et al., 2010; Goertz et al., 2018).

Dose Matters in Recovery


Lower back pain does not resolve from a single intervention.


Research consistently shows a dose-response relationship with Chiropractic care. Patients receiving a structured course of care, rather than isolated visits, demonstrate greater and more sustained improvements in pain and disability
(Haas et al., 2014; Haas et al., 2004).


This mirrors what we understand about rehabilitation, training, and neurological adaptation: change requires repetition over time.

Comparisons with Other Treatments


When compared to other conservative approaches:

  • Chiropractic care performs as well as or better than physiotherapy and medical management for  lower back pain
    (Blanchette et al., 2016; Cifuentes et al., 2011)
  • Patients under Chiropractic care demonstrate lower use of opioid medications and reduced likelihood of surgery
    (Cifuentes et al., 2011; Goertz et al., 2018)
  • Long-term outcomes improve when spinal manipulation is maintained rather than discontinued once pain temporarily settles (Senna and Machaly, 2011)


Clinical guidelines now recognise Chiropractic adjustments as a frontline conservative option for lower back pain before invasive procedures are even considered (Chou et al., 2017).

Safety Profile


When delivered by registered Chiropractors following proper clinical examination, spinal manipulation has a strong safety profile.

Most reported side effects are mild and short-lived, such as temporary soreness or stiffness. Serious adverse events are rare and comparable to other conservative healthcare interventions (Cassidy et al., 2008; Whedon et al., 2022).


Safety depends on:

  • Thorough history taking
  • Neurological and orthopaedic assessment
  • Identifying when care is appropriate, and when it is not



This is why assessment always comes before treatment.

Why Many GPs Now Refer for Lower Back Pain


As research has evolved and standards of care have improved,
many GPs now refer patients for Chiropractic assessment, particularly for:


  • Non-specific lower back pain
  • Recurrent or chronic symptoms
  • Patients not improving with medication alone


This reflects growing recognition that movement-based, conservative care produces better long-term outcomes than symptom suppression alone (Bishop et al., 2010; Goertz et al., 2018).

When Chiropractic May Not Be Appropriate


Chiropractic care is not suitable when:


  • Red flags for serious disease are present
  • Symptoms suggest systemic or inflammatory conditions
  • Progressive neurological deficits require urgent medical investigation



In these cases, referral is immediate and appropriate.

Research


Bishop, P.B., et al. (2010) The Chiropractic Hospital-Based Interventions Research Outcomes (CHIRO) Study. The Spine Journal, 10(12), pp.1055–1064.


Blanchette, M.A., et al. (2016) Effectiveness and economic evaluation of chiropractic care for low back pain. PLOS ONE, 11(8).


Bronfort, G., et al. (2008) Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal, 8(1), pp.213–225.


Cassidy, J.D., et al. (2008) Risk of vertebrobasilar stroke and chiropractic care. Spine, 33(4), pp.S176–S183.


Chou, R., et al. (2017) Systemic pharmacologic therapies for low back pain. Annals of Internal Medicine, 166(7), pp.480–492.


Cifuentes, M., et al. (2011) Health maintenance care and disability recurrence in work-related low back pain. Journal of Occupational and Environmental Medicine, 53(2), pp.190–198.


Goertz, C.M., et al. (2018) Effect of usual medical care plus chiropractic care vs usual medical care alone. JAMA Network Open, 1(1).


Haas, M., et al. (2004) Dose-response for chiropractic care of chronic low back pain. The Spine Journal, 4(5), pp.574–583.


Haas, M., et al. (2014) Dose-response and efficacy of spinal manipulation for chronic low back pain. The Spine Journal, 14(7), pp.1106–1116.


Rubinstein, S.M., et al. (2019) Benefits and harms of spinal manipulative therapy for chronic low back pain. BMJ, 364.


Senna, M.K. and Machaly, S.A. (2011) Does maintained spinal manipulation therapy result in better long-term outcomes? Spine, 36(18), pp.1427–1437.


Whedon, J.M., et al. (2022) Risk of adverse events following spinal manipulation. Journal of Manipulative and Physiological Therapeutics, 45(2).