When it comes to treating and managing low back pain there are many different options and opinions on how to deal with the condition, so how do you know whose advice to follow? Fortunately the new research that is emerging around this condition has us moving past bed rest and medication and towards newer, more effective treatments.
Based on guidelines from the US, the UK, Belgium and Denmark, current treatments recommend using a variety of non-pharmacological therapies such as physical exercise and cognitive behavioral therapy (CBT) to manage chronic low back pain. But how do you know what type of non-pharmacologic treatment to choose?
Chiropractor Or Physical Therapist For Low Back Pain?
Chiropractic care and physical therapy seem to be two of the main options when it comes to selecting some type of spinal manipulative care. Both of these treatments have significant research behind them that examines how effective they are when it comes to treating low back pain. This article takes a look at some of the key research surrounding these treatments and looks at the data to see which treatment is better for back pain - chiropractic care or physical therapy.
Overview Of Chiropractic Care For Low Back Pain
Chiropractic care is a type of treatment that focuses on the body’s ability to heal itself. It often consists of manual therapy, with an emphasis on spinal manipulation, but it can also include exercise and nutritional counseling.
More than 35 million patients will visit a chiropractor, and that is just in this year. Research has found that “compared to those who sought care from medical doctors, those who sought care from chiropractors were more likely to feel that treatment was helpful, more likely to be satisfied with their care, and less likely to seek care from another provider for that same episode of pain”. Patients typically rate their satisfaction with a chiropractor higher than with traditional medical care.
How Safe Is Chiropractic Care?
A study by Hurwitz et al found that ‘serious adverse reactions from cervical manipulation occurs once in 1 million manipulations’ while complications for lumbar region manipulations are even lower. Experts across the United Kingdom and the United States have reviewed the extensive evidence that has been done to measure the effectiveness of this treatment for low back pain. This research resulted in the production of two national clinical practice guidelines that were published.
The United Kingdom’s current national clinical practice guideline and evidence review states: “Within the first 6 weeks of acute or recurrent low back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which it has been compared” and “the risks of manipulation for low back pain are very low, provided patients are selected and assessed properly and it is carried out by a trained therapist or practitioner.”
Similarly, in 2017, the American College Of Physicians (ACP) recommended that “physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation”.
The review that was done, however, looked at 36 different clinical trials that compared spinal manipulation with other treatments and found that “the efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials”. Basically, this review totally disagrees with the two national clinical practice guidelines for both the UK and the USA.
One review that was published in the British Medical Journal looked at 47 randomized controlled trials with almost 10,000 participants between the ages of 35-60 years. What this review concluded was that spinal manipulative therapy “produces similar effects to recommended therapies for chronic low back pain” but that SMT did seem to be “better than non-recommended interventions for improvement in function in the short term”. The authors also suggested that “clinicians should inform their patients of the potential risks of adverse events associated with SMT” that were musculoskeletal and transient in nature.
What do spinal surgeons think of chiropractors?
So what do the “experts” think about this type of treatment for low back pain. In 2009 487 surgeons were surveyed about their attitudes towards chiropractic care. Their attitudes were diverse with 44.5% having a negative impression about chiropractic care, 29.4% having a favorable attitude towards the practice, and 26.1% being neutral.
Interestingly enough, the majority of surgeons believed that chiropractors did actually provide effective therapy for some musculoskeletal complaints (81.8%) but they did not believe that they could provide effective relief for non-musculoskeletal complaints (89.5%).
Furthermore, almost half of the surgeons interviewed had referred patients for chiropractic care, but mostly at the request of their patients, since 72.7% believed that chiropractors provided unnecessary treatment and that they bred dependency in patients for short-term symptomatic relief (52.3%).
Is It Worth The Cost?
When it comes to the costs involved in chiropractic care, visits can cost anywhere between $30 and $200. Adjustments can be done for around $50-75 while more intensive treatments are more expensive.
If you don’t have insurance, your costs may be a little higher with visits costing anywhere between $100 and $150. This is the average range, and some chiropractors have been known to charge as little as $60 while others may charge more than $200 for a session.
Most chiropractors will recommend around 18-20 sessions, depending on the severity of your condition, so your total cost could range anywhere from $1000 to $4000 without insurance or $1000 to $1800 with insurance.
When you consider how much chiropractic care costs, and the fact that there is still some conflicting information as to how helpful this treatment might be for lower back pain, it is understandable how guidelines might be inconclusive as to whether patients should try this therapy or not.
The fact remains, however, that positive results have been seen with treatment and that the side effects are still minimal when compared to other treatments such as surgery or medication. Chiropractic care might not be for everyone but the satisfaction rates among patients seems to be relatively high.
Physical Therapy For Low Back Pain
When it comes to low back pain, physical therapy is one of the top non-surgical treatments that experts recommend. The goal of physical therapy is to help clients improve their range of motion, get them more mobile again, and decrease pain levels. Physical therapists will also help clients manage their condition to help prevent future back pain problems. Physical therapy often consists of about 3 sessions over a period of six to 12 weeks. Obviously the length will depend on the severity of your low back pain and what your personal goals are.
Evidence To Support PT?
When it comes to physical therapy there is a wealth of data to support this type of treatment for low back pain. In one study, in 2015, 207 participants were followed for a year and the results found that “early physical therapy showed improvement relative to usual care in disability after 3 months”.
Another study conducted in 2017 found that “multidisciplinary approaches including physical therapy should be implemented to provide long-term improvement in pain and functional status in the treatment of non-specific chronic low back pain”.
A 2018 meta-analysis found that for patients with chronic low back pain, the McKenzie Method (one aspect of physical therapy) was “superior to other rehabilitation interventions in reducing pain and disability”.
Overall the research shows that physical therapy and exercise are two of the most important treatments for low back pain - helping patients get stronger, more mobile, and get back to doing their daily activities again.
Costs
When it comes to how much physical therapy costs, sessions can range anywhere from $20 to $150. If you are fortunate enough to have insurance rates co-pay rates can range from $20 to $55 after your deductible has been met. If you don’t have insurance rates can range from $75 to $150. Depending on the severity of your condition that could put your total amount anywhere from $240 to $1800.
Conclusions
When we look at the overall global recommendations, treatment recommendations for chronic low back pain should focus on therapies like physical exercise, cognitive behavioral therapy, and non-medical treatments like physical therapy and chiropractic care. Multi-disciplinary treatments are the gold standard and seem to have the best long term results for those with chronic lower back pain.