Can Chiropractic Treatment Really Help Lower Back Pain?
Imagine waking up one morning with a stiff, painful lower back.
You try to get out of bed, but something doesn’t feel right.
Perhaps you bent over the previous day to pick something up.
Maybe you spent several hours working in the yard.
Or perhaps you simply woke up with back pain and have no idea what caused it.
You try stretching.
You take a hot shower.
You walk around the house, hoping the discomfort will disappear.
But by the afternoon, you’re still hurting.
A friend suggests seeing a chiropractor.
Another friend tells you chiropractic adjustments are dangerous.
Someone else says you should see a physical therapist instead.
And then you read something online suggesting that chiropractic treatment is either a miracle cure or completely ineffective.
So, whom should you believe?
After nearly four decades of practicing chiropractic and helping patients with spinal, joint, and nerve-related conditions, I understand why people become confused.
There is an enormous amount of information—and misinformation—about chiropractic treatment.
Some claims are exaggerated.
Others unfairly dismiss a treatment that has demonstrated benefits for certain patients.
The truth is more useful than either extreme.
Research supports spinal manipulation as one reasonable treatment option for certain types of lower back pain, but it is not appropriate for every patient or every spinal condition.
And chiropractic care involves much more than performing an adjustment.
At Advanced Integrated Medical, I believe the best approach begins with understanding the patient’s condition, identifying appropriate treatment options, and helping the patient return to the activities that matter most.
Let’s examine what the research actually tells us.
Not Sure Where to Start?
Choose the question that sounds most like yours:
- My lower back hurts, but I don’t know why. → Why Does My Lower Back Hurt?
- Pain travels into my buttock or leg. → What Is Sciatica, and What Causes It?
- My MRI shows a bulging or herniated disc. → What Is a Bulging or Herniated Disc?
- My legs hurt when I stand or walk. → What Is Lumbar Spinal Stenosis?
- My back hurts when I sit or drive. → Why Does My Back Hurt When I Sit?
- I want to know whether chiropractic care could help. → You’re in the right place.
- My feet burn, tingle, or feel numb. → Explore our Peripheral Neuropathy Learning Center.
What You’ll Learn
In this chapter, we’ll discuss:
- What chiropractic care actually involves
- What happens during a spinal adjustment
- What scientific research says about chiropractic treatment
- Which types of lower back pain may respond
- Chiropractic care for acute and chronic back pain
- Whether chiropractic adjustments help sciatica
- Chiropractic care for bulging and herniated discs
- Spinal stenosis and neurological symptoms
- How spinal manipulation may influence pain
- What adjustments cannot accomplish
- Chiropractic care versus physical therapy
- The importance of exercise and rehabilitation
- Ice versus heat for lower back pain
- When chiropractic treatment may be inappropriate
- Possible risks and side effects
- Whether X-rays or MRIs are necessary
- PRP injections and regenerative medicine
- When medical or surgical referral may be appropriate
- How we approach lower back pain at Advanced Integrated Medical
Quick Answer
Yes. Chiropractic treatment can help some patients with lower back pain.
Research suggests that spinal manipulation can produce modest improvements in pain and function, particularly for certain patients with nonspecific lower back pain.
However, the benefits vary.
Spinal manipulation is generally considered one of several reasonable treatment options—not a treatment that consistently outperforms all other approaches.
The best outcomes often involve more than adjustments alone.
A comprehensive treatment plan may include:
- Patient education
- Appropriate spinal manipulation or mobilization
- Exercise
- Strengthening
- Movement recommendations
- Activity modification
- Home care
- Referral when necessary
Chiropractic treatment is not appropriate for every condition.
Progressive neurological deficits, fractures, certain infections, tumors, and other serious conditions require different evaluation and management.
The goal of chiropractic care should be to improve pain, movement, and function—not simply to produce an adjustment or a popping sound.
First, What Is Chiropractic Care?
Chiropractic is a healthcare profession that focuses primarily on the evaluation and conservative management of musculoskeletal conditions, particularly those involving the spine.
Doctors of chiropractic receive training in:
- Anatomy
- Physiology
- Neurology
- Orthopedic examination
- Spinal biomechanics
- Musculoskeletal diagnosis
- Imaging interpretation
- Manual treatment
- Rehabilitation principles
The scope of chiropractic practice varies by state.
Many chiropractors use spinal manipulation.
But chiropractic care can also include:
- Joint mobilization
- Soft-tissue techniques
- Therapeutic exercise
- Posture and movement education
- Activity recommendations
- Home exercise programs
- Coordination with other healthcare professionals
The most appropriate treatment depends on the patient’s condition.
What Is a Chiropractic Adjustment?
A chiropractic adjustment is a form of spinal manipulation.
It typically involves applying a controlled force to a spinal joint.
The force may be delivered by hand or with an instrument.
Some adjustments involve a quick, low-amplitude movement.
Others use gentler techniques.
The objective is generally to influence joint movement, pain, and function.
What Causes the Popping Sound During an Adjustment?
Patients frequently ask me:
“Doctor, what was that popping sound?”
The sound is commonly associated with a process called joint cavitation.
Changes in pressure within the joint can lead to the formation of a gas cavity in the joint fluid.
This can produce an audible pop.
The sound does not mean bones are grinding together.
It also does not prove that a joint was out of place and has been put back into position.
And importantly:
A successful treatment does not require a popping sound.
Some patients improve with techniques that produce no audible sound at all.
Are Spinal Bones Really Out of Place?
This is an area where traditional chiropractic terminology can create confusion.
Patients are sometimes told that their vertebrae are out of alignment.
However, most uncomplicated lower back pain does not involve a vertebra being visibly displaced in the way people often imagine.
True structural abnormalities, such as fractures, dislocations, and certain forms of spondylolisthesis, are different medical conditions.
Routine spinal manipulation should not be described as literally pushing a displaced vertebra back into place.
Instead, the clinical benefits of manipulation may involve changes in joint movement, nervous system responses, and pain processing.
How Might Chiropractic Adjustments Reduce Pain?
Researchers have investigated several possible mechanisms.
These include:
- Changes in Pain Processing
Spinal manipulation may influence how the nervous system processes pain-related information.
This does not mean the adjustment repairs every painful tissue.
It means that treatment may alter the patient’s experience of pain.
- Changes in Joint Movement
Manual treatment may improve comfort or movement tolerance in certain patients.
- Changes in Muscle Activity
Some patients experience temporary changes in muscular tension or movement after treatment.
- Improved Confidence in Movement
When treatment is combined with education and exercise, patients may become more comfortable returning to normal activities.
These mechanisms are still being studied.
No single explanation accounts for every patient’s response.
What Does the Scientific Research Say?
This is the question I believe every patient deserves to have answered.
Over the years, spinal manipulation has been studied in randomized clinical trials, systematic reviews, and professional guidelines.
The overall findings suggest that spinal manipulation can provide modest benefits for certain patients with lower back pain.
However, it is important to understand the size and limitations of those benefits.
What Does the American College of Physicians Recommend?
The American College of Physicians published a clinical practice guideline addressing noninvasive treatment of acute, subacute, and chronic lower back pain.
For acute and subacute lower back pain, the guideline recommends considering non-drug approaches, including:
- Superficial heat
- Massage
- Acupuncture
- Spinal manipulation
For chronic lower back pain, the guideline recommends beginning with non-drug approaches when appropriate.
Options include:
- Exercise
- Multidisciplinary rehabilitation
- Mindfulness-based stress reduction
- Tai chi
- Yoga
- Cognitive behavioral therapy
- Spinal manipulation
- Other selected treatments
This is important.
It demonstrates that spinal manipulation is recognized as a reasonable option within evidence-based care.
However, the guideline does not establish chiropractic manipulation as superior to all other treatments.
What Have Systematic Reviews Found?
Systematic reviews of spinal manipulation for lower back pain generally report:
- Small to modest average improvements in pain
- Small to modest improvements in function
- Outcomes that are often similar to other recommended conservative treatments
- Variation in individual patient responses
Some patients improve substantially.
Others experience limited benefit.
And some do not respond.
Research supports spinal manipulation as an option—not as a guaranteed solution.
What About Chronic Lower Back Pain?
Chronic lower back pain generally refers to pain lasting longer than approximately three months.
For these patients, treatment often needs to address more than the immediate pain.
Contributing factors may include:
- Reduced activity tolerance
- Muscle weakness
- Sleep disturbances
- Fear of movement
- Persistent pain sensitivity
- Other medical conditions
- Work and lifestyle demands
Spinal manipulation may be one component of care.
But exercise, education, and gradual return to meaningful activities are also important.
What About Acute Lower Back Pain?
Acute lower back pain is usually defined as pain lasting less than four weeks.
Many episodes improve naturally.
This is an important consideration when interpreting treatment results.
If a patient improves after an adjustment, the improvement may reflect several factors:
- The treatment
- Natural recovery
- Changes in activity
- Other treatments
- The interaction of these factors
That does not mean chiropractic treatment is ineffective.
It means we should avoid claiming that every improvement proves an adjustment corrected the underlying problem.
Can Chiropractic Treatment Help a Pulled Back Muscle?
Some patients with uncomplicated mechanical lower back pain experience relief with manual therapy.
However, an adjustment is not necessarily required for every muscular injury.
Treatment may also include:
- Activity modification
- Gentle movement
- Exercise
- Heat or cold therapy
- Gradual return to normal activity
A careful examination helps determine what is appropriate.
Can Chiropractic Care Help Sciatica?
Sometimes, but the evidence is less certain than it is for nonspecific lower back pain.
Sciatica often involves irritation or compression of a lumbar nerve root.
Possible symptoms include:
- Shooting leg pain
- Burning
- Tingling
- Numbness
- Weakness
Some patients with lumbar radicular symptoms may benefit from selected conservative treatments.
However, spinal manipulation has not been established as a reliable method of removing nerve-root compression.
And it is not appropriate for every patient with sciatica.
New or progressive neurological weakness changes the treatment decision.
Such symptoms require prompt medical evaluation.
Can Chiropractic Adjustments Fix a Herniated Disc?
This is one of the most common misconceptions.
A patient may ask:
“Doctor, can you push my herniated disc back into place?”
My answer is:
A spinal adjustment should not be described as physically pushing a herniated disc back into place.
Disc herniations involve changes in spinal disc tissue.
Some symptomatic herniations improve naturally over time.
Certain conservative treatments may help reduce symptoms and improve function.
However, evidence does not establish that spinal manipulation reliably reverses a herniation or restores normal disc anatomy.
What If My MRI Shows a Bulging Disc?
A disc bulge does not automatically require treatment.
Many people have disc bulges without symptoms.
The important questions are:
Does the finding match the patient’s pain?
Is there nerve-root involvement?
Are reflexes or muscle strength affected?
Are symptoms improving or worsening?
Treatment should be based on the clinical findings rather than the MRI description alone.
Can Chiropractic Care Help Spinal Stenosis?
Some patients with lumbar spinal stenosis also experience mechanical lower back pain.
Selected conservative approaches may improve comfort and function.
However, spinal manipulation does not reverse structural narrowing of the spinal canal.
Patients with significant neurogenic claudication, progressive weakness, or other concerning neurological findings may require specialist evaluation.
Can Chiropractic Care Help Degenerative Disc Disease?
Some patients with degenerative spinal changes experience lower back pain.
Others have no symptoms.
Chiropractic treatment may help certain patients manage accompanying mechanical discomfort.
However, adjustments do not regenerate degenerated discs or reliably restore lost disc height.
The goal should be improved function—not promises of anatomical reversal.
Does Chiropractic Care Help Everyone?
No.
And this is important to acknowledge.
Some patients respond well.
Others experience only temporary relief.
And some may benefit more from:
- Exercise-based rehabilitation
- Physical therapy
- Medical management
- Psychological approaches to persistent pain
- Specialist evaluation
- Surgery for selected conditions
Good healthcare involves recognizing when a treatment is helping and when the plan should change.
Chiropractic Care vs. Physical Therapy: Which Is Better?
Patients often ask me this question.
The answer depends partly on the services being compared.
Both chiropractors and physical therapists may provide:
- Exercise instruction
- Movement education
- Manual therapy
- Rehabilitation
- Functional training
Some chiropractors emphasize spinal manipulation.
Some physical therapists emphasize exercise-based rehabilitation.
But there is substantial overlap.
Research does not establish that one profession is universally superior for all lower back pain.
The quality of the evaluation and treatment plan matters more than the title on the office door.
Chiropractic Care vs. Massage Therapy
Massage may help some patients with muscular discomfort or lower back pain.
Spinal manipulation and massage are different treatments.
Some patients benefit from one approach.
Others benefit from a combination.
The choice should reflect the diagnosis and treatment goals.
Should Chiropractic Care Include Exercise?
In many cases, yes.
This is an important part of modern conservative spine care.
Exercise may improve:
- Trunk strength
- Hip strength
- Movement tolerance
- General conditioning
- Functional capacity
- Confidence in activity
For patients with recurrent or chronic lower back pain, exercise and self-management are especially important.
An adjustment may provide temporary relief.
But strengthening and rehabilitation can help patients maintain function between visits.
Why Do Some Patients Feel Better Immediately After an Adjustment?
Some patients report rapid relief.
Possible explanations include:
- Changes in pain processing
- Changes in movement tolerance
- Reduced muscular guarding
- Other short-term physiological responses
However, immediate relief does not necessarily mean the underlying condition has been permanently corrected.
Why Does My Back Pain Sometimes Return After an Adjustment?
Lower back pain can be influenced by multiple factors.
These may include:
- Activity levels
- Sleep
- Physical conditioning
- Repeated mechanical demands
- Stress
- Other medical conditions
A temporary response to treatment does not necessarily indicate that something is repeatedly going out of alignment.
If pain continues to return, the treatment plan should be reassessed.
How Many Chiropractic Visits Should I Need?
There is no universal number.
The appropriate frequency and duration depend on:
- Diagnosis
- Symptom severity
- Functional limitations
- Response to care
- Patient goals
- Overall health
Treatment should include periodic reassessment.
Patients should know what improvement is being measured.
Examples include:
- Reduced pain
- Improved walking tolerance
- Improved sitting tolerance
- Better sleep
- Improved mobility
- Return to normal activities
A good treatment plan should have measurable goals—not an indefinite schedule of adjustments without reassessment.
Is Chiropractic Treatment Safe?
For appropriately selected patients, lumbar spinal manipulation is generally considered a relatively low-risk treatment.
However, no treatment is completely risk-free.
Possible short-term effects include:
- Temporary soreness
- Increased stiffness
- Local discomfort
- Fatigue
- Temporary symptom aggravation
These reactions are usually mild and short-lived.
Rare but serious complications have been reported, including neurological injury.
The precise frequency of serious complications is difficult to determine.
That is one reason appropriate screening and patient selection are essential.
When Should Chiropractic Manipulation Be Avoided?
Certain conditions may make spinal manipulation inappropriate or require substantial modification.
Examples include:
- Suspected spinal fracture
- Certain spinal infections
- Spinal malignancy affecting structural integrity
- Significant spinal instability
- Severe osteoporosis or substantial fracture risk
- Progressive neurological deficits
- Suspected cauda equina syndrome
- Other serious spinal conditions
Patients taking anticoagulant medications or those with certain connective tissue or bone disorders may require additional precautions.
The appropriate decision depends on the patient’s history and examination.
What If I Have Osteoporosis?
Osteoporosis can increase fracture risk.
High-force spinal manipulation may be inappropriate for patients with significant osteoporosis.
Some patients may be candidates for gentler approaches, but the decision requires individualized assessment.
What If I Have a History of Spinal Surgery?
Previous spinal surgery does not automatically rule out all chiropractic care.
However, the type of surgery, spinal stability, hardware, neurological findings, and other factors matter.
Manipulation directly over certain surgically altered regions may be inappropriate.
Medical records and imaging may need to be reviewed.
What If Chiropractic Treatment Makes My Pain Worse?
Mild temporary soreness can occur.
However, worsening pain should not automatically be dismissed as a normal healing reaction.
If symptoms become substantially worse, treatment should be reassessed.
New weakness, progressive numbness, or bowel and bladder changes require urgent medical attention.
Ice or Heat: Which Is Better After Chiropractic Treatment?
This is a practical question.
Some patients experience mild soreness after manual therapy.
Others have muscle tightness or stiffness.
Either ice or heat may provide temporary relief, depending on the patient’s symptoms and preference.
Ice may feel helpful during a painful flare-up.
Heat may be more comfortable when stiffness or muscular tightness is prominent.
Neither should be described as necessary for every patient after an adjustment.
Can Ice Reduce Inflammation After an Adjustment?
Cold therapy can lower local tissue temperature and temporarily reduce pain sensitivity.
However, mild post-treatment soreness is not necessarily caused by significant inflammation.
Evidence does not establish that applying ice after every adjustment improves long-term outcomes.
Ice may be a comfort measure, but it is not a required part of chiropractic recovery.
How Should I Apply Ice Safely?
A practical approach is:
- Wrap a cold pack in a thin towel.
- Apply it over the sore lower back region for approximately 10–15 minutes.
- Remove the pack and allow the skin to return to normal temperature.
- Repeat later if needed and if the skin tolerates it.
Never place ice directly against the skin.
Do not fall asleep with a cold pack in place.
Stop if the skin becomes unusually painful, pale, excessively numb, or irritated.
When Might Heat Be Better?
Heat may be more comfortable when a patient experiences:
- Muscle tightness
- Lower back stiffness
- Generalized aching
- Discomfort after prolonged inactivity
A comfortably warm pack may be used for approximately 15–20 minutes.
Avoid excessive heat.
Do not sleep on a heating pad.
Important Precautions for Patients With Neuropathy
Some patients with lower back pain also have peripheral neuropathy.
Reduced sensation can make it difficult to detect excessive cold or heat.
This increases the risk of skin injury.
Patients with impaired circulation or certain temperature-sensitive conditions may also require special precautions.
If you have reduced sensation or impaired circulation, seek professional guidance before using ice or heat.
Ice vs. Heat After Chiropractic Care
| Situation | Ice | Heat |
| Mild post-treatment soreness | May provide temporary relief | May also help |
| Muscle tightness | Sometimes helpful | Often preferred |
| General lower back discomfort | May provide comfort | May provide comfort |
| Acute painful flare-up | May be helpful | May also be helpful |
| Herniated disc | Does not repair the disc | Does not repair the disc |
| Nerve-root compression | Does not reverse compression | Does not reverse compression |
| Reduced temperature sensation | Requires special caution | Requires special caution |
The best choice depends on comfort and safety.
Do I Need an X-Ray Before Seeing a Chiropractor?
Not necessarily.
Routine spinal X-rays are generally not recommended for uncomplicated lower back pain without warning signs.
Imaging may be appropriate when there is concern for:
- Fracture
- Serious pathology
- Significant structural abnormality
- Other conditions where imaging would change management
A chiropractor should not require routine X-rays for every patient simply to determine whether an adjustment is needed.
When Is an MRI Appropriate?
MRI may be considered when there are:
- Progressive neurological deficits
- Suspicion of serious spinal pathology
- Persistent disabling symptoms where imaging would change management
- Consideration of surgery or selected spinal procedures
- Other clinically significant findings
MRI findings should always be interpreted alongside the patient’s symptoms and neurological examination.
What About Spinal Decompression?
Some clinics offer mechanical traction or nonsurgical spinal decompression.
These systems apply controlled pulling forces to the spine.
Some patients may experience temporary relief.
However, evidence does not establish that commercial nonsurgical decompression systems reliably reverse disc herniations or provide superior long-term outcomes compared with other appropriate conservative treatments.
They should not be presented as guaranteed methods of repairing spinal discs.
What About PRP Injections and Regenerative Medicine?
At Advanced Integrated Medical, we also recognize the growing interest in regenerative medicine.
One approach being investigated for selected musculoskeletal and spinal pain conditions is:
Platelet-Rich Plasma (PRP)
PRP is prepared from a sample of the patient’s own blood.
The blood is processed to produce a preparation containing an increased concentration of platelets.
Platelets contain growth factors and other biologically active substances involved in tissue signaling and repair processes.
Researchers are studying PRP for certain spinal pain conditions.
However, the evidence varies by diagnosis and injection technique.
Can PRP Help Lower Back Pain?
Possibly for selected conditions, but important limitations remain.
PRP has been investigated for:
- Certain chronic disc-related pain conditions
- Selected facet joint-related pain conditions
- Certain other spinal pain disorders
Some small studies have reported improvements in pain or function.
However, the evidence remains limited and inconsistent.
PRP is not established as a routine treatment for nonspecific lower back pain.
Can PRP Regenerate a Damaged Spinal Disc?
At present, there is insufficient high-quality clinical evidence to conclude that PRP reliably regenerates human spinal discs.
PRP has not been proven to:
- Restore normal disc height
- Rehydrate degenerated discs
- Repair herniated discs
- Reverse spinal stenosis
- Eliminate nerve-root compression
- Regenerate damaged spinal nerves
A patient may experience symptom improvement without structural regeneration.
These are different outcomes.
Could PRP Be Used Alongside Chiropractic Care?
Some patients may ask whether PRP could complement conservative spinal treatment.
The answer depends on the diagnosis.
For most uncomplicated lower back pain, evidence-based conservative care is generally the appropriate starting point.
PRP should not be considered automatically because a patient has persistent pain or has received chiropractic treatment.
If an injection is being considered, the patient should understand:
- The specific diagnosis
- The proposed injection site
- The quality of supporting evidence
- Potential benefits
- Risks
- Costs
- Reasonable alternatives
Are PRP Injections Around the Spine Risk-Free?
No.
Potential risks depend on the injection site and technique.
They may include:
- Temporary pain flare-ups
- Bleeding
- Infection
- Injury to nearby structures
- Neurological complications
- Other procedure-specific risks
Spinal injections require appropriate training, sterile technique, careful patient selection, and imaging guidance when indicated.
Is PRP FDA-Approved for Spinal Disc Regeneration?
No PRP injection has been established as an FDA-approved treatment for regenerating spinal discs or reversing spinal nerve compression.
Certain PRP preparation devices may have FDA clearance for specific processing purposes.
However, device clearance does not establish that a particular PRP injection is approved or proven effective for spinal disc regeneration.
What About Wharton’s Jelly and Umbilical Cord–Derived Products?
Some clinics market umbilical cord–derived products, including preparations described as Wharton’s jelly, for spinal and musculoskeletal conditions.
These products are different from PRP.
They should not automatically be described as stem-cell treatments.
Their contents, manufacturing methods, and regulatory status can vary.
Importantly, there are no FDA-approved umbilical cord–derived regenerative products for treating lower back pain, disc degeneration, sciatica, or spinal stenosis.
Individual patient improvement or clinical experience does not establish that these products regenerate spinal discs or nerves.
Because of important safety, effectiveness, and regulatory considerations, they should not be presented as established treatments for spinal disorders.
At Advanced Integrated Medical, we believe patients deserve clear information about the difference between emerging research and established clinical treatments.
Dr. Dee’s Clinical Pearl: Chiropractic Care and Regenerative Medicine
A patient may ask:
“Doctor, should I try chiropractic care first, or would PRP be better?”
My response begins with another question:
“What is actually causing your pain?”
If the patient has uncomplicated mechanical lower back pain, conservative treatment may be appropriate.
If there are neurological deficits, significant structural problems, or other concerning findings, the evaluation and treatment plan may be different.
And if an injection is being considered, we need to understand the evidence for that particular condition.
The right treatment begins with the right diagnosis—not with choosing a procedure before understanding the problem.
When Should I See a Medical Specialist Instead?
Chiropractic care can be one part of an integrated healthcare approach.
However, certain symptoms require medical evaluation.
Examples include:
- Progressive neurological weakness
- Significant or worsening numbness
- Persistent disabling radicular pain
- Suspected fracture
- Possible infection
- Concern for malignancy
- Other serious medical conditions
A responsible chiropractor should recognize when referral is appropriate.
When Is Lower Back Pain an Emergency?
Most lower back pain is not an emergency.
However, certain symptoms require immediate medical attention.
Seek Emergency Care For:
- New inability to urinate or significant urinary retention
- New loss of bowel or bladder control
- Numbness in the saddle or groin region
- Rapidly progressive leg weakness
- Symptoms suggesting cauda equina syndrome
New foot drop or significant new weakness warrants urgent medical assessment.
Other concerning findings, including major trauma, fever with back pain, or a history of cancer with new unexplained symptoms, require prompt evaluation.
Do not delay emergency care in order to receive an adjustment, use ice, or try another conservative treatment.
How We Approach Lower Back Pain at Advanced Integrated Medical
At Advanced Integrated Medical, I believe the first step is understanding the patient’s symptoms and determining whether chiropractic treatment is appropriate.
We want to know:
Where is the pain located?
How long has it been present?
Did it begin after an injury?
Does it travel into the buttock or leg?
Is there burning, tingling, or numbness?
Are reflexes or muscle strength affected?
Does sitting aggravate symptoms?
Does standing or walking make them worse?
Could a disc problem be involved?
Could spinal stenosis be contributing?
Could peripheral neuropathy also be present?
Are there warning signs requiring referral?
Depending on the findings, the evaluation may include:
- Lumbar range of motion
- Orthopedic testing
- Muscle strength testing
- Reflex testing
- Sensory testing
- Straight leg raise testing
- Slump testing
- Hip assessment
- Functional movement assessment
- Review of existing imaging
When appropriate, additional imaging, electrodiagnostic testing, or specialist referral may be recommended.
What Might an Individualized Treatment Plan Include?
Depending on the diagnosis and examination, treatment may involve:
- Chiropractic manipulation or mobilization
- Therapeutic exercise
- Stretching when appropriate
- Strengthening
- Activity modification
- Movement education
- Home care recommendations
- Selected supportive therapies
- Coordination with other healthcare professionals
At Advanced Integrated Medical, we may also discuss other available services when clinically appropriate.
However, not every treatment is suitable for every patient, and the evidence supporting individual modalities varies.
The objective is to select treatments based on the patient’s condition and measurable goals.
What Should We Measure During Treatment?
I believe patients deserve to know whether their treatment is helping.
Useful measurements may include:
Pain: Is discomfort becoming less intense or less frequent?
Mobility: Can the patient move more comfortably?
Sitting tolerance: Can the patient sit longer without significant symptoms?
Walking tolerance: Can the patient walk farther?
Strength: Are relevant muscle functions improving?
Daily activities: Can the patient return to work, hobbies, and family activities?
Medication use: Has the need for symptom-relieving medication changed, when medically appropriate?
These measurements help determine whether the treatment plan should continue, change, or involve referral.
About Dr. Dee
Dr. D. Scott (“Dee”) Stevens has spent nearly four decades helping patients with spinal pain, joint conditions, and nerve-related symptoms.
Throughout his career, he has worked with patients from many backgrounds, including professional, collegiate, and Olympic athletes.
Over those years, I’ve learned that no single treatment works for every patient.
Some patients respond well to chiropractic care.
Others need rehabilitation, medical management, or specialist evaluation.
And sometimes the most important service I can provide is helping a patient understand why a particular treatment may not be appropriate.
I believe chiropractic care is most valuable when it is practiced thoughtfully, with realistic expectations and respect for the evidence.
Dr. Dee’s Clinical Pearl
A patient may ask:
“Doctor, if you adjust my back, will that fix the problem?”
My response is:
“An adjustment may help reduce your pain or improve movement, but first we need to understand what’s causing the symptoms.”
Sometimes the problem is relatively straightforward.
Other times, neurological or structural conditions require a different approach.
The purpose of treatment is not simply to adjust the spine. It’s to help the patient improve safely and function better.
Dr. Dee’s Office Conversation
The following is an illustrative conversation, not an actual patient testimonial.
Patient: “Doctor, I’ve never been to a chiropractor. Do adjustments really work?”
Dr. Dee: “For certain types of lower back pain, research shows spinal manipulation can provide modest improvements in pain and function.”
Patient: “Will you be putting my bones back into place?”
Dr. Dee: “That’s not how I would describe it. Most uncomplicated back pain doesn’t involve bones being out of place. Manual treatment may help with pain and movement.”
Patient: “Will it hurt?”
Dr. Dee: “Some patients experience temporary soreness. We would first determine whether manipulation is appropriate and discuss the technique and alternatives.”
Patient: “Should I use ice or heat afterward?”
Dr. Dee: “Either may help if you’re sore. Ice may provide comfort during a flare-up, while heat may help stiffness. Neither is required after every adjustment.”
Patient: “And what about PRP injections?”
Dr. Dee: “PRP is being investigated for selected spinal conditions, but it’s not an established treatment for ordinary lower back pain. We’d first need to identify the diagnosis and consider the evidence.”
Patient: “So chiropractic isn’t necessarily the only treatment?”
Dr. Dee: “Exactly. My goal is to help you understand your options and choose an appropriate plan.”
Facing One of the Biggest Fears
“Could a Chiropractic Adjustment Make My Back Worse?”
It’s a reasonable concern.
Most patients who receive appropriately selected lumbar manipulation do not experience serious complications.
However, temporary soreness or symptom aggravation can occur.
And rare serious complications have been reported.
That’s why a careful history and examination are important.
Patients should understand the proposed treatment and its alternatives.
They should also feel comfortable asking questions.
A patient should never feel pressured to receive spinal manipulation when the diagnosis is uncertain or when they are uncomfortable with the procedure.
Back & Spine Health Success Principle #6
Treat the Condition—Not Just the Spine
An adjustment may be helpful.
But it is not the entire treatment plan for every patient.
A good approach considers:
The diagnosis.
The neurological findings.
The patient’s daily activities.
The evidence supporting treatment.
The patient’s preferences.
The response to care.
The need for rehabilitation or referral.
The best chiropractic care is patient-centered, evidence-informed, and focused on measurable improvement.
Ask Dr. Dee
“Doctor, how do I know whether chiropractic treatment is right for me?”
I would begin by asking:
What type of back pain do you have?
Are there neurological symptoms?
How long have you been hurting?
What activities are limited?
Have you tried exercise or other conservative treatments?
Are there warning signs?
What are your goals?
For many patients with uncomplicated lower back pain, chiropractic care may be a reasonable option.
For others, different treatment or additional evaluation may be more appropriate.
The important thing is to make that decision based on the patient’s condition—not simply because chiropractic treatment is available.
A Lesson I’ve Learned in Nearly 40 Years
A Good Doctor Should Know When Not to Treat
Early in my career, like many healthcare professionals, I was eager to help every patient who came through the door.
And I still am.
But experience teaches an important lesson.
Not every patient needs an adjustment.
Not every patient needs an injection.
Not every patient needs an MRI.
And not every patient needs surgery.
Sometimes the best approach is education and exercise.
Sometimes it’s a carefully selected course of conservative treatment.
Sometimes it’s a referral.
The important thing is to recognize what the patient actually needs.
Good healthcare is not about providing the most treatment. It’s about providing the most appropriate care.
The Hope Principle
Lower back pain can be discouraging.
Especially when it interferes with:
- Work
- Sleep
- Driving
- Exercise
- Family activities
- Travel
- Everyday movement
Some patients become afraid to bend.
Others worry that their spine is permanently damaged.
And some feel frustrated because they’ve already tried several treatments without lasting relief.
But many patients improve.
Chiropractic care may help some people.
Exercise and rehabilitation may help others.
And sometimes a combination of approaches is appropriate.
The important thing is to understand the condition and develop a realistic plan.
You don’t need a perfect spine to enjoy a more active and comfortable life.
“I believe the best healthcare decisions are made when patients understand their condition. My job isn’t simply to treat symptoms—it’s to help you understand why they’re happening and what your options are.”
— Dr. D. Scott (“Dee”) Stevens
Frequently Asked Questions
- Does chiropractic treatment really work for lower back pain?
Research suggests spinal manipulation can provide modest improvements in pain and function for certain patients with lower back pain.
- Is chiropractic treatment supported by scientific research?
Yes, for selected lower back pain conditions. However, benefits vary, and spinal manipulation is not established as superior to every other recommended treatment.
- What happens during a chiropractic adjustment?
A chiropractor applies a controlled force to a spinal joint using a manual or instrument-assisted technique.
- What causes the popping sound?
The sound is commonly associated with joint cavitation, involving pressure changes and gas cavity formation within the joint.
- Does an adjustment put my vertebrae back into place?
Routine manipulation should not be described as literally repositioning displaced vertebrae in uncomplicated lower back pain.
- Can chiropractic treatment help sciatica?
Some patients may benefit from selected conservative approaches, but evidence for manipulation specifically for lumbar radiculopathy is less certain than for nonspecific lower back pain.
- Can chiropractic care fix a herniated disc?
Spinal manipulation has not been proven to reliably reverse a disc herniation or restore normal disc anatomy.
- Can chiropractic treatment help spinal stenosis?
Selected conservative care may help accompanying symptoms, but manipulation does not reverse structural spinal canal narrowing.
- Is chiropractic treatment safe?
Lumbar manipulation is generally relatively low-risk in appropriately selected patients, but temporary soreness and rare serious complications can occur.
- Should I use ice or heat after an adjustment?
Either may provide temporary comfort. Ice may help during a painful flare-up, while heat is often preferred for stiffness or muscle tightness.
- Does ice reduce inflammation after chiropractic treatment?
Ice may reduce pain sensitivity, but it is not established as a required treatment after an adjustment or as a way to improve long-term outcomes.
- Is ice safe if I have peripheral neuropathy?
Not always. Reduced temperature sensation increases the risk of skin injury. Professional guidance is recommended before using ice or heat.
- Do I need an X-ray before chiropractic treatment?
Not routinely. Imaging is generally reserved for situations where clinical findings suggest it would change management.
- How many chiropractic visits will I need?
There is no universal number. Treatment should be individualized and periodically reassessed using measurable goals.
- Is chiropractic care better than physical therapy?
Neither profession is universally superior. Both may provide evidence-based care, and the most appropriate approach depends on the patient and treatment plan.
- Should I exercise while receiving chiropractic treatment?
Appropriate exercise is often an important part of recovery and long-term management, particularly for recurrent or chronic lower back pain.
- Can PRP injections help lower back pain?
PRP is being investigated for selected spinal pain conditions, but it remains investigational and is not established routine treatment for nonspecific lower back pain.
- Can PRP regenerate spinal discs?
There is insufficient high-quality clinical evidence to conclude that PRP reliably regenerates human spinal discs.
- Are Wharton’s jelly injections approved for spinal pain?
No. Umbilical cord–derived regenerative products are not FDA-approved for treating lower back pain, disc degeneration, sciatica, or spinal stenosis.
- When should I seek emergency care?
New urinary retention, bowel or bladder dysfunction, saddle numbness, or rapidly progressive weakness requires emergency evaluation.
Key Takeaways
- Chiropractic care may help selected patients with lower back pain.
- Research supports modest average improvements in pain and function with spinal manipulation.
- Spinal manipulation is one of several evidence-based conservative treatment options.
- Chiropractic care involves more than adjustments.
- The popping sound during an adjustment does not prove that bones have been repositioned.
- Adjustments do not reliably reverse herniated discs or spinal stenosis.
- Exercise and rehabilitation are important parts of many treatment plans.
- Chiropractic care and physical therapy have overlapping approaches.
- Appropriate patient selection is essential for safety.
- Temporary soreness may occur after manipulation.
- Serious complications are uncommon but possible.
- Ice and heat may provide temporary comfort.
- Thermal therapy requires special caution in patients with neuropathy or impaired circulation.
- Routine imaging is not necessary for every patient.
- PRP remains investigational for selected spinal conditions.
- PRP has not been proven to regenerate spinal discs or compressed spinal nerves.
- Umbilical cord–derived regenerative products are not FDA-approved for spinal pain conditions.
- Treatment should include measurable goals and periodic reassessment.
- The best treatment plan is based on the diagnosis, evidence, neurological findings, and patient’s functional goals.
Why Patients Choose Advanced Integrated Medical
At Advanced Integrated Medical, we believe patients deserve more than a quick adjustment without understanding the cause of their symptoms.
We want to know:
What is causing the lower back pain?
Is chiropractic treatment appropriate?
Are there neurological symptoms?
Could a disc problem or spinal stenosis be involved?
Could peripheral neuropathy be contributing?
Are there warning signs requiring referral?
Would exercise or rehabilitation help?
Could ice or heat provide safe temporary relief?
What measurable improvements should we expect?
When should the treatment plan be reassessed?
Would another medical approach be more appropriate?
Our goal is to help patients understand their condition and make informed decisions about their care.
Continue Exploring the Back, Neck & Sciatica Learning Center
You may also want to read:
- Article #66: Why Does My Lower Back Hurt? Understanding the Most Common Causes of Back Pain
- Article #67: What Is Sciatica, and What Causes It? Understanding Pain That Travels Down Your Leg
- Article #68: What Is a Bulging or Herniated Disc—and Does It Always Cause Pain?
- Article #69: What Is Lumbar Spinal Stenosis—and Why Do My Legs Hurt When I Walk?
- Article #70: Why Does My Back Hurt When I Sit? Understanding Disc Pain, Posture, and Prolonged Sitting
You may also find helpful information in our Peripheral Neuropathy Learning Center, especially:
- What Are the First Signs of Peripheral Neuropathy?
- Can a Pinched Nerve Cause Symptoms That Feel Like Peripheral Neuropathy?
- What Tests Are Used to Diagnose Peripheral Neuropathy?
- Can Peripheral Neuropathy Affect My Balance?
Medical Disclaimer
This article is intended for educational purposes only and does not replace individualized medical diagnosis or treatment.
Spinal manipulation may be an appropriate conservative treatment for selected patients with lower back pain. However, its effectiveness varies, and it is not suitable for every spinal or neurological condition.
Spinal manipulation has not been established as a reliable method of reversing disc herniations, spinal stenosis, or nerve-root compression.
Temporary soreness or symptom aggravation may occur after manual therapy. Rare serious complications have been reported.
Ice and heat may provide temporary symptom relief but are not established methods of repairing spinal discs or reversing nerve-root compression. Patients with reduced sensation, peripheral neuropathy, impaired circulation, or certain temperature-sensitive conditions should seek professional guidance before using thermal therapies.
PRP injections for spinal conditions remain investigational. Their safety and effectiveness depend on the indication, preparation, injection site, and procedure. FDA clearance of a PRP preparation device does not establish FDA approval of PRP as a treatment for spinal disc regeneration.
Umbilical cord–derived regenerative products are not FDA-approved for treating lower back pain, disc degeneration, sciatica, or spinal stenosis.
Spinal manipulation, traction, injections, medications, and surgery are not appropriate for every patient.
New urinary retention, bowel or bladder dysfunction, saddle numbness, or rapidly progressive neurological weakness may indicate a serious neurological emergency and require immediate medical evaluation.
New foot drop or significant new weakness warrants urgent assessment.
Treatment decisions should be individualized based on the patient’s history, examination, neurological findings, imaging when appropriate, medical conditions, available evidence, and preferences.
Ready to Learn More?
If you’re considering chiropractic treatment for lower back pain, don’t automatically assume:
“An adjustment will fix everything.”
Or:
“Chiropractic care doesn’t work.”
Instead, ask:
What is causing my pain?
Is spinal manipulation appropriate for my condition?
What does the research say?
Would exercise or rehabilitation help?
Are there neurological symptoms that require further evaluation?
Would ice or heat provide safe temporary relief?
How will we measure improvement?
When should the treatment plan change?
At Advanced Integrated Medical, we believe informed patients make better healthcare decisions.
Understand the diagnosis. Choose evidence-informed treatment. Measure progress. Work toward better function and quality of life.
Advanced Integrated Medical
1635 N 200 E
Logan, UT 84341
Phone: (435) 999-3953
Advanced Care • Natural Healing • Real Results
Selected Scientific References and Further Reading
- Qaseem A, et al. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine.
- Paige NM, et al. (2017). Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA.
- Rubinstein SM, et al. (2019). Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-analysis of Randomised Controlled Trials. BMJ.
- World Health Organization (2023). WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.
- National Institute for Health and Care Excellence (NICE). Low Back Pain and Sciatica in Over 16s: Assessment and Management (NG59).
These references support the discussion of evidence-based conservative care. They should not be interpreted as endorsements of every treatment or service mentioned in this article.