Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back

Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back PainThis study was published in The Spine Journal, 2010 October 2.

The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and high-quality, ethical, evidence-based spine care, including basic science and clinical investigations.

This study compared family physician-directed usual care with evidenced-based clinical practice guidelines (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks) on patients with acute low back pain.

BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.

PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.

STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.

PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks' duration. Exclusion criteria included "red flag" conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).

OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.

METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).

CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

Spine J. 2010 Oct 2. [Epub ahead of print]

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Bishop PB, Quon JA, Fisher CG, Dvorak MF.

Dr. Schaffnit's Comments:

This study reaffirms numerous published studies on the effects of chiropractic manipulation for lower back and neck pain. Chiropractic is a safe, effective and superior form of lower back pain management systems. There is no longer an “if it works” factor regarding chiropractic. The research is there, the results have always been there.

Interested in more?

Disc Herniation and Radiculopathy

After recently attending a workshop on lumbar radiculopathy by Dr. Mir Ali, M.D., of OAD orthopedics, spinal surgery, I was reminded just how many different treatment options there are to this complex problem. Here is an overview of Disc Herniation and its symptoms.


The disc can be viewed a lot like a jelly donut. It is somewhat circular with an outer area and a center or core (nucleus). When the core bulges into the outer layer it is a bulging disc and can press on sensitive nerve structures. When it breaks into the outer layer (like the dough but with the consistency of crab meat) it is a herniation. Sometimes it breaks totally out of the disc and becomes a free fragment which can be a serious condition causing loss of bowel or bladder function or numbness in the groin (cauda equina syndrome)-usually a surgical emergency.


What Causes a Herniated Disc? The causes are many. Basically, weakness in the outer layer of the discs or the inability of the disc to handle the pressure load of the nucleus causes the fibers to rupture allowing the nuclear material to escape its containment. Lifting improperly, traumatic injuries, coughing, sneezing, and straining activities have all resulted in disc herniations.

What are the Symptoms of a Herniated Disc?

•Pain: pain can be severe in the back and leg(s). If the pain is immediately more severe in the leg, we are concerned about a free fragment (sequestered disc). Pain is usually worse with sitting.
•Radiating sciatic pain (radiculopathy).
•Muscle weakness
•Numbness and Tingling
How are disc injuries diagnosed? An orthopedic and neurological and x-ray examination normally needs to be performed to determine other possible sources (piriformis syndrome, osteoarthritic spurring, etc.). A MRI may be necessary to establish the location and severity of the herniation.

What are my Treatment Options?

•In less severe cases, conservative management works effectively including: spinal manipulation (chiropractic), physical medicine modalities for pain control (interferential current, ice, laser, Massage Therapy), acupuncture, rehabilitation exercises, medications.
•More severe cases may require epidural steroid injections, surgical excision of the herniation, disc replacement or fusion.
•Cauda equina symptoms generally require emergency surgery.

Many other conditions may mimic a disc herniation and are effectively treated non-surgically.

In any case a through evaluation is needed by a competent healthcare professional. If you or anyone you know suffers from disc herniation please call 630-474-9500.

-Dr. Blake Schaffnit , D.C.