low back pain: should i have spinal manipulation?

spinal manipulation, also called spinal adjustment, is a therapy that uses pressure on a joint of the spine. it is used to ease pain and help the body function better. manipulation can be done with the hands or a special device. the careful, controlled force used on the joint can range from gentle to strong, and from slow to rapid. sometimes other joints of the body are also worked on to help treat the spine.

spinal manipulation can be used with other treatments. these may include heat or ice, medicines, physiotherapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive behavioural therapy.

spinal manipulation can work as well as other treatments for low back pain, whether the pain is new or has lasted a long time.^{footnote 1} but pain relief may only last for a short time. like most low back pain treatments, spinal manipulation works for some people but not for others.

if you are looking for a health care provider who is trained to do spinal manipulation, ask friends about who they do and don't like, and why. check the background and education of providers you're interested in. it may help to have a visit to make sure you are comfortable with a provider's practice style.

health care providers who are commonly trained to do spinal manipulation include:

• chiropractors.
• osteopathic physicians.
• physiotherapists.
• medical doctors, such as physiatrists.

make your family doctor aware of your other providers and the treatments you are getting.

check with your provincial or private health insurance to see if your plan covers this treatment.

spinal manipulation is safe when performed by a trained health care provider. some people feel tired or sore after treatment.

spinal manipulation is not recommended for people who have certain health problems like osteoporosis, bone fractures, or spondylolisthesis.

there are many treatments you can try. you can do these whether or not you are doing spinal manipulation. these include:

• medicines. non-steroidal anti-inflammatory drugs (nsaids) such as ibuprofen or naproxen seem to be the most effective over-the-counter pain relievers for low back pain. if you can't take nsaids, you can try acetaminophen. be safe with medicines. read and follow all instructions on the label.
• physiotherapy. this helps you learn stretching and strength exercises that may reduce pain and other symptoms. the goal of this treatment is to make your daily tasks and activities easier.
• massage. massage may reduce low back pain for a short time. you can do it yourself, or you can have a massage therapist do it.
• mobilization. slow, measured movements are used to twist, pull, or push bones and joints into position. this can help loosen tight tissues around a joint. it can also help with flexibility and alignment.
• acupuncture. it involves putting tiny needles into your skin at certain points on the body. some think that the needles help release the body's natural painkillers.
• cognitive behavioural therapy. this treatment focuses on helping you change how you think about the pain and find ways to deal with it.

home treatments

there are several things you can do at home to help reduce your pain. for example:

• heat or ice. you can try using either heat or cold, whichever helps you the most.
• exercise. walking is one of the best things you can do for your back. you can try other activities too, like swimming. you can also do exercises that gently stretch and strengthen your stomach, back, hips, and leg muscles. the stronger those muscles are, the better they're able to protect your back.
• changing the way you do your activities. try other ways of doing your activities that don't cause pain or make your symptoms worse. for example:
  • bend forward carefully. when you must bend forward to empty the dishwasher, pick up clothes, make the bed, or do other chores, bend carefully in a way that doesn't cause pain.
  • when you lift, use your leg muscles and your stomach muscles to do most of the work. and keep whatever you're lifting as close to your body as you can.
  • sit in a chair that is low enough that you can place both feet flat on the floor. if your chair or desk is too high, use a foot rest to raise your legs. and change positions often when you sit. take brief standing breaks about every 10 minutes.
  • take rest breaks. don't do any one type of movement for too long without taking a break. and try to alternate chores so you're not doing the same movement (even with breaks) for a long time.
  • in bed, try lying on your side with a pillow between your knees. or lie on your back on the floor with a pillow under your knees.
  • if you must stand in one position for a long time, put one foot on a low stool. alternate feet.

• you want a treatment that involves hands-on contact.
• you have tried other treatments—heat or ice, medicine, physiotherapy, exercise, massage, mobilization, acupuncture, changing the way you do your activities, or getting cognitive behavioural therapy—for a few weeks, and your back pain is not better.
• you want a treatment that does not involve medicines.
• you have had spinal manipulation before, and it has helped.