Your best bet for low back pain, “hands down”

A new study published in the medical journal Spine found that spinal manipulation therapy (SMT) used by chiropractors and physical therapists is far more effective for treating back pain than “usual medical care.”

That’s great “news.” But we’ve known all about it for at least 20 years.

So why–when it comes to natural and “alternative” approaches to common medical problems–must we keep doing the same research over and over again?

During the 1990s, research showed for the first time that SMT “adjustments” were the safest, most effective and most cost-effective treatment for low back pain, the most common cause of pain and disability in working Americans. I wrote an editorial about these findings for the Annals of Internal Medicine in 1998.

The research was so strong, the Agency for Health Care Policy and Research (AHCPR) recommended that government agencies involved in health care–including Medicare and Veterans Affairs–endorse SMT as the first-line treatment of back pain.

Of course, the mainstream had a big problem with that recommendation.

Back surgeons lobbied Congress to cut the AHCPR’s budget. Eventually, they closed down the agency.

By the early 2000s, back surgery had become a complete disaster. There were so many botched surgeries, some back surgeons couldn’t even get malpractice insurance coverage to cover the dangerous procedure.

In my state at that time, Gov. Ed Rendell (D-PA) held emergency field hearings on the crisis of back surgery. I testified about the research, which showed at least 80 percent of back patients would never need, and should never have, surgery if they use SMT.

To his credit, Gov. Rendell listened and the crisis went away. (Unless you were among the one in four back surgery victims who never healed and ended up in intractable, unending pain. These patients spawned a whole new field of medicine called “failed back” management, an entire specialty of pain management.)

During this same time, I also obtained the last government research grant that I ever sought to study all the evidence worldwide on treatment of back pain. We put together a collaboration of a dozen universities like Harvard and Palmer College of Chiropractic to review more than 700 studies. Again, we reached a consensus that SMT is the most effective and cost-effective treatment for back pain. When I departed as director of Thomas Jefferson Center for Integrative Medicine in Philadelphia 10 years ago, I left all the piles of research on back pain sitting in the conference room on the table. Hopefully, somebody looked at it since.

Now, it’s 2015. And here we go again.

The new study published in Spine compared the Manual Thrust Manipulation (MTM) technique–the most common type of SMT–to “usual medical care.”

(Patients who received “usual medical care” went to see a medical physician, board certified in physical medicine and rehabilitation. The doctors told these patients that most new episodes of back pain are typically self-limiting. They told the patients to take an over-the-counter analgesic and/or a nonsteroidal anti-inflammatory drug for pain. And they recommended the patients stay physically active and avoid prolonged bed rest.)

Well–no big surprise–MTM technique provided greater short-term reductions in pain and disability than “usual medical care.”

The researchers also compared MTM to another chiropractic technique called Mechanical Assisted Manipulation (MAM). Results show there was no benefit to using the mechanical assist. So, when you visit the chiropractor, just say “No, MAM.”

Lower back pain is among the most common of all medical complaints. In fact, half of all working-age adults in the U.S. experience it each and every year. And one-quarter of adults report an episode within the previous three months.

Back pain is also the most common cause of disability for people younger than 45 years. And it’s one of the most common reasons for office visits to primary care physicians in the U.S., Europe and Australia.

The good news is, as this study shows (as well as a long line of studies before it), SMT is a safe, affordable and effective therapy for back pain. Plus, most insurance plans now cover it. And there are about 60,000 licensed chiropractors across the U.S., so chances are good you can get in to see one.

You can also try out therapeutic massage and acupuncture for back pain. But you usually have to pay those charges out-of-pocket to get the safe, effective healthcare you want.

Of course, thanks to Obamacare, we have seen health insurance costs skyrocket to “cover” the healthcare we don’t want…health care that’s not safe and effective. Insurance companies dole out these higher rates in a vain attempt to keep the sinking SS Titanic of mainstream hospital-based healthcare afloat while they continue to rake in the profits that don’t go toward providing any health services to anyone.

In the meantime, while you wait for the inevitable sinking of the ship, give SMT a try. It’s still your best treatment option for back pain.


“Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain,” Spine, 2015;40(4): 209-217