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Low Back Pain

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

Low Back Pain: A Major Global Challenge

On the Chiropractic Forward podcast this week, we are going to do a review of The Lancet article on Low Back Pain. It is a recent paper published in march 2018 that we hope will have a powerful impact in the months and years to follow. 

Before we get started with this review of The Lancet article on Low Back Pain, I want to draw your attention our website at https://www.chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. 

You have illegally u-turned into Episode #16 and criminals are welcome so make yourself at home. Again, we are doing a review of The Lancet article on Low Back Pain.

I’ve been battling a head cold and depending on the day, the head cold is winning. I hope you’ll excuse my graveled voice and my nasal presentation. I’ll do my best on this review of The Lancet article on Low Back Pain. 

Those of us that are hungry for new research and the recommendations that arise from the body of literature being constantly created were excited last week about the release of significant reports coming out in a highly respected research journal called The Lancet. 

Founded in 1823, The Lancet is published weekly is is one of the oldest, most respected, and most well-known medical journals in the world so when it was announced a series of papers were to be published in The Lancet having to do with low back pain, as you may imagine, those of us interested in the research world and musculoskeletal complaints were all ears. 

Not only was the article noteworthy due to its being published in The Lancet, but it was also exciting for those of us in the so-called alternative healthcare world because there were several Doctors of Chiropractic sitting on the steering committee for the series of reports. For some reason, chiropractors are still considered by many to be alternative while this group of papers suggest chiropractic may be a lot more than simply “alternative.”

There are a couple of things in my mind that stand out as reasons for such a series of papers. The first being that low back pain has become a major problem globally and show no sign of stopping the growth of it impact. The second reason would be the ineffectiveness of the treatments commonly used or recommended. This includes surgery, epidural steroid injections, and, the most notable of failed treatments, opioids.

The series of Low Back Pain papers were compiled by a team of leading experts on back pain. The team was made up of an international spectrum  of varied backgrounds. They met for a workshop in Buxton, UK, in June, 2016, to start the journey and the process of setting the outline and some sort of structure for each paper. 

It was quite an undertaking from quite the group of experts. This is not a group of papers to be ignored since these authors and researchers are among the best of the best globally. 

The papers were broken down as follows:

      1. What low back pain is and why we need to pay attention.
      2. Prevention and treatment of low back pain: evidence, challenges, and promising directions. 
      3. Low back pain: a call for action

In this article, I will cover the first of the three papers with plans to highlight the next two papers in the coming weeks so be sure to return for those important discussions. 

How They Did It

For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:

  • MEDLINE (PubMed)
  • Scopus. 
  • Google Scholar
  • African Index Medicus Database

In this review of The Lancet article on Low Back Pain I think it’s important to re-iterate the authors assertion that, in order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.

Summary of the introduction of the first paper. 

  • Low back pain is now the leading cause of disability worldwide.
  • Only a small percentage have a well-understood, definite cause for their low back pain. Examples of well-known and udnerstood causes are things like a vertebral fracture, malignancy, or infection.
  • Things that seem to raise the risk of having low back pain complaints would be populations that smoke regulary, people that have physically demanding jobs or routine jobs or jobs that keep them mostly sedentary throughout the day and throughout the work week, people with physical and mental issues that add to a low back complaint or contribute to a low back complaint, and overweight/obese people. These populations are all at risk for developing low back pain.
  • 540 million people were affected at any one time globally.
  • A systematic review (3097 participants) found several MRI findings had a reasonably strong association with low back pain, including Modic type 1 change, disc bulge, disc extrusion, and spondylolysis. To further define Modic 1 changes, in regular vertebral endplate bone, the trabeculae shoud be like a type of scaffolding. Within the trabeculae there is red bone marrow producing blood cells. In a Modic type 1, the trabeculae are fractured intermittently and the patterns are more erratic and the marrow is absent. In the marrow’s place now is serum which is the same substance one can find in a blister. 

Symptoms associated with low back pain

Radicular Pain and Radiculopathy

  • Radiculopathy is usually called sciatica and mostly occurs when there is involvement where the nerve root exits the spine.
  • The authors noted that the term sciatica is used inconsistently by doctors and the public in general and should probably be avoided all together. 
  • The diagnosis of radicular pain relies on clinical findings, such as history of dermatomal leg pain, leg pain that is actually worse than the back pain, aggravation of the symptom when bearing down such as in coughing, sneezing, lying on your back and raising heels off of the table or in going from seated to standing, and straight leg raise test. General rule of thumb for an SLR is that pain in the first 30 degrees of leg elevation hints at a disc origin since that is the movement that first starts to tension the nerve at the root.
  • Patients presenting with low back pain in addition to radicular pain or radiculopathy tend to have worse outcomes than those presenting with low back pain alone.

Lumbar Spinal Stenosis

  • I tell my patients that the simplest way to explain stenosis is to say that a hole that nerves run through has become smaller and, as a result, the nerves sometimes have pressure on them that can cause them to be somewhat dysfunctional. 
  • Lumbar spinal stenosis is clinically characterized by pain or discomfort with walking or standing that radiates into one or both legs and can be eased resting and almost always by lumbar flexion (neurogenic claudication). They call this the shopping cart sign. Meaning, if a person gets relief from leaning on a shopping cart, it sure may be stenosis. If it is aggravated by leaning back or by inducing a “swayback” type of movement, that sure may be stenosis. As a sidenote and from my own studies, if lumbar extension (or swayback) does not hurt, but then rotation in either direction at the endpoint of lumbar extenstion actually does increase the pain, then the patient is likely suffering from a lumbar facet complaint. 
  • Lumbar stenosis is commonly caused by narrowing of the spinal canal or intervertebral foramina as a result of a combination of degeneration such as facet osteoarthritis, ligamentum flavum hypertrophy, and bulging discs. Two or three of these factors can combine to reduce the size and space available for the neural structures to pass through. Obviously that can create issues.
  • Experts tend to agree that the diagnosis of stenosis requires both the presence of the symptoms in addition to imaging findings demonstrating stenosis.

Other causes of Low Back Pain

  • Vertebral fracture, inflammatory disorders, malignancy, infections, intra-abdominal causes.
  • The US guideline for imaging advises deferral of imaging pending a trial of therapy when there are weak risk factors for cancer or axial spondyloarthritis. What does that mean exactly? That means a trial of conservative care. The authors will delve further into this in the second paper from the Lancet series but I will butt my head in here with the opinion of the American College of Physicians. Their updated recommendations from February of 2017 reflect that doctors should be recommending Chiropractic, massage, and/or ice for acute low back pain and should recommend Chirorpactic, acupuncture, and/or exercise/rehab for chronic low back pain. These recommendations are to precede taking even ibuprofen. 


  • Approximately 40% of 9-18-year olds in high-income, medium-income, and low-income countries report having had low back pain.
  • Low back pain prevalence increased 54% since 1990.
  • It is the number one cause of disability globally

Work Disability

Social Identity & Inequality

  • MacNeela and colleagues reviewed 38 separate qualitative studies in high-income countries. They showed found common traits, including: worry and fear about the social consequences of chronic low back pain, hopelessness, family strain, social withdrawal, loss of job and lack of money, disappointment with health-care encounters (in particular with general practitioners), coming to terms with the pain, and learning self-management strategies.
  • Froud and colleagues reviewed 42 qualitative studies from high-income countries, and found that many people living with low back pain struggled to meet their social expectations and obligations and that achieving them might then threaten the credibility of their suffering, with disability claims being endangered. Sometimes we have to almost force low back patients back into the workforce and, did you know that studies show in general that the sooner people are returned to work, the better they tend to recover from the low back pain complaint?
  • Schofield and colleagues found that individuals who exit the workforce early as a result of their low back pain have substantially less wealth by age 65 years, even after adjustment for education. This is just an obvious statement. It makes sense that people that quit working earlier than 65 end up making less money by the time they reach 65. You can also throw the expense of dealing with a back pain complaint in on top of the loss of wages. 
  • Globally, low back pain contributes to inequality. At first, when I read this, it struck me as being silly. Everything’s about inequality these days isn’t it? Certainlly in America it seems. But, this is a little different when you read through the explanation. The authors go on to say that in low-income and middle-income countries, poverty and inequality might increase as participation in work is affected. In addition, regulations on how to properly re-introduce a person into the workforce are absent, and workers are likely to be placed right back into the job they were originally injured without proper re-introduction. The authors felt this might place more strain on family and community livelihoods.

Cost of Low Back Pain

  • Costs associated with low back pain are commonly tallied as direct medical costs, meaning the cost of the doctor’s bill. They are also tallied in terms of indirect costs; meaning the cost of being out of work and the loss of productivity at the work place.
  • Most studies underestimate the total costs of low back pain
  • Although we do not think of low back pain in these terms yet, the truth is that low back pain, in terms of a real problem as far at the cost to treat and the overall indirect costs, are right up there with the biggest issues the global pupulation faces. Issues such as cardiovascular disease, cancer, mental health, and autoimmune diseases. That’s huge. 
  • In the USA, 44% of the population used at least one complementary or alternative health-care therapy in 1997; and the most common reason was low back pain. with 70,000 plus chiropractors in the United States, I can tell you with some confidence the profession most associated with alternative treatment for low back pain or spinal pain of any sort is chiropractic care. 
  • The USA has the highest costs, attributable to a more medically intensive approach as well as higher rates of surgery compared with other high-income countries. We see patients every week that have gone through needless surgeries. Surgeries for which there is plenty of high-level research proving its ineffectiveness yet you see the popularity for these surgeries continuing to rise. 

Natural History

  • A systematic review (33 cohorts; 11?166 participants) provides strong evidence that most episodes of low back pain improve substantially within 6 weeks, and by 12 months average pain levels are low. However, two-thirds of patients still report some pain at 3 months and 12 months
  • The best evidence suggests around 33% of people will have a recurrence within 1 year of recovering from a previous episode.

Risk Factors and Triggers for Low Back Pain Episodes

      • A systematic review (5165 participants) found consistent evidence that people who have had previous episodes of low back pain are at increased risk of a new episode. Likewise, people with other chronic conditions, including asthma, headache, and diabetes, are more likely to report low back pain than people in good health
      • a UK cohort study found psychological distress at age 23 years predicted incident low back pain 10 years later. The Canadian National Population Health Survey with 9909 participants found that pain-free individuals with depression were more likely to develop low back pain within 2 years than were people without depression
      • systematic reviews of cohort studies indicate that lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of low back pain episodes. We know that obesity and lack of exercise has become an American trait that needs to be reversed. 
      • A systematic review found the genetic influence on the liability to develop low back pain ranged from 21% to 67%, with the genetic component being higher for more chronic and disabling low back pain than for inconsequential low back pain.Don’t we all have patients that present to us claimng that their bad back just runs in the family? Mom and Grandma had a bad back so that must be why they have a bad back is the common sentiment. It seems there may be a bit of validity there. 
      • An Australian case-crossover study (999 participants) showed that awkward postures, heavy manual tasks, feeling tired, or being distracted during an activity were all associated with increased risk of a new episode of low back pain. Similarly, work exposures of lifting, bending, awkward postures, and tasks considered physically demanding were also associated with an increased risk of developing low back pain in low-income and middle-income countries

Psychological Factors

For this review of The Lancet article on Low Back Pain, the presence of psychological factors in people who present with low back pain is associated with increased risk of developing disability even though the mechanisms are not fully understood

Social and Societal Factors

      • Cross-sectional data from the USA (National Health Interview Survey 2009–10, 5103 people) found that those with persistent low back pain were more likely to have had less than high-school education and had an annual household income of less than US$20,000. 
      • Suggested mechanisms for the effect of low education on back pain include environmental and lifestyle exposures in lower socioeconomic groups, lower health literacy, and health care not being available or adequately targeted to people with low education.
      • To go along with lower wages, the lower socioeconomic groups are commonly in routine and manual occupations and ahve increased physical workloads is associated with disabling low back pain


In this review of The Lancet article on Low Back Pain, the authors concluded, “Low back pain is now the number one cause of disability globally. The burden from low back pain is increasing, particularly in low-income and middle-income countries, which is straining health-care and social systems that are already overburdened. Low back pain is most prevalent and burdensome in working populations, and in older people low back pain is associated with increased activity limitation. Most cases of low back pain are short-lasting and a specific nociceptive source cannot be identified. Recurrences are, however, common and a few people end up with persistent disabling pain affected by a range of biophysical, psychological, and social factors. Costs associated with health care and work disability attributed to low back pain are enormous but vary substantially between countries, and are related to social norms, health-care approaches, and legislation. Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden.”

Key Takeaway:

Obviously, if you followed us all the way through on this review of The Lancet article on Low Back Pain, low back pain is an issue that must be addressed in a more effective way globally and irregardless of national ranking in terms of the economy. Just because it’s musculoskeletal doesn’t mean it can be ignored and kicked to the curb while the big stuff like heart disease, diabetes, and cancer are treated. The research for the big stuff is adequately funded but, honestly, in general, most general practitioners don’t have the first clue of what to do for low back pain. I personally suggest they turn to their own American College of Physicians for updated recommendations on chronic and acute low back conditions if I were them. 


Steering Committee

Rachelle Buchbinder – Australia

Jan Hartvigsen – Denmark

Dan Cherkin – United States

Nadine Foster – UK

Chris Maher – Australia

Martin Underwood – UK

Maruits van Tulder – Netherlands

For this week’s Next Steps in this review of The Lancet article on Low Back Pain, be sure to send us an email at dr.williams@chiropracticforward.com and let us know what you thought or contribute to the show for next week. We love hearing from you all. Also, go and follow Jan Hartvigsen https://twitter.com/JanHartvigsen, and Chris Maher https://twitter.com/CGMMaher on Twitter. 

Next week we will review the second paper of this three paper series. Next week’s paper is called “Prevention and treatment of low back pain: evidence, challenges, and promising directions.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn. This review of The Lancet article on Low Back Pain is just an example of what you can look forward to.

We cannot wait to connect again with you next week for review of The Lancet article on Low Back Pain Part Two. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Be sure to check out part of our Chiropracrtors Cause Strokes Myth. This is a link to Part Two:

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)



CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

Today’s episode is all about chronic low back pain and some great, brand new research. By now, as I’ve said in the past, even traditional Chiropractor-hating, torch-wielding, quasi-scholastic chiropractic detractors are admitting that, yes, Chiropractic is indeed helpful for low back pain.

If you love what you hear, be sure to check out www.chiropracticforward.com. As the podcast builds, so too will the website content, educational products, webinars, seminars, and speaking dates as they get added.

For now though, it’s time for bumper music!

We will dive into the research in a few minutes but first, I have to introduce my guest this week. His name is Dr. Craig Benton. Dr. Benton is the owner/operator of Benton Chiropractic down in Lampassas, Texas but that’s not where the intro stops. Dr. Benton is the chair of Scientific Affairs for the Texas Chiropractic Association. He is where I have found a healthy percentage of the material that I have covered over the years for my blog, my YouTube videos, and now for the Chiropractic Forward podcast. Dr. Benton has been unknowingly instrumental in keeping me in business and making my life easier.

Welcome to the show Dr. Benton, how is life in Lampassas this week? My first question today is, have you been playing any guitar lately?

Dr. Benton and I are both in active practice. In fact, there’s a chance we may both have a patient show up at any time. That’s how actively we are practicing. I think that’s incredibly important to note because, so many times, you hear podcasts and attend seminars where the guys and gals speaking don’t really know a thing about actively practicing for 20 plus years. I’ve always felt that experience matters. Even when I was young and green. I was well-aware that I didn’t know it all and I’m even more aware of that today than ever.

So Dr. Benton, I’m looking forward to hearing your opinions and insight today.

Since the podcast today is about chronic pain, I think we should begin with a definition of what Chronic really is. When we define “chronic” in the context of neuromusculoskeletal complaints, we define it as being a complaint that is greater than 12 weeks in duration. Right at 3 months. Some patients will come into the office having had a condition for 15-20 years. I tell them that they are more than a little stubborn to have put up with something for so long.

It is common sense that a condition that is chronic will be more difficult to treat. Also, most chronic conditions can be traced back to a biomechanical, neuromusculoskeletal origin. One of my favorite quotes is from Dr. Lee Green, Professor of Family Medicine at the University of Michigan. He said, “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.” Although Dr. Green is referring to neck pain in this instance, “low back pain” can easily be substituted. What he says could not make more sense. It’s an easy and very concise way to understand why Chiropractic, manipulation, mobilization is so incredibly effective above and beyond anything else for this sort or issue, including medication.

Do you have a quote or quotes that you love sharing that make sense to you and that help you boil down what it is we chiropractors are doing to help our patients?

I have overhead medical doctors (more than once) talking about having back pain and just injecting themselves with something to try to get over it. If they asked me, I’d tell them that they’re just covering up an underlying trigger or cause and ignoring it is to their detriment.

A good metaphor I came across for using medication for neuromusculoskeletal complaints is that it’s like unplugging a smoke alarm because you don’t like the noise. But, the fire is still slowly growing. What have they done to treat anything in a responsible and effective way? Nothing at all. We tend to live in a society that wants a pill for this and a potion for that so they can get over it and get on with life. But it doesn’t work that way.

Dr. Benton, has this been your experience as well?

Dr. Benton, don’t you treat soldiers through the VA program? Can you tell us all a little bit about that?

Let’s go over some low back pain statistics just we can try to stress the importance of what we’re talking about here. Dr. Benton, please feel free to jump in with anything you’d like to add:

  • Low back pain is the single leading cause of disability worldwide.
  • 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fit’s into the 20% that apparently never suffers from any low back pain. Dr. Benton….have you ever met anyone that has never had back pain? Is it just me?
  • Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
  • With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
  • More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact. It’s good to be a chiropractor I guess. Our patients keep us up and moving most of the day.
  • Dr. Benton, did you know that….now…an equal number of patients seek help with a chiropractor first as seek help with a medical practitioner first for back pain? That’s new information to me that I found interesting.
  • Back pain in general costs $100 billion dollars every year when you factor in lost wages, productivity as well as legal and insurance overheads.

Now that we all know more about low back pain, let’s go through some things that may put you at greater risk of suffering from the condition. Dr. Benton, with your experience on the research, stop me if you have anything to add to any of these:

  • Age: as the spine and supporting structures begin to age and decline, the rate of low back pain will understandably increase.
  • Fitness Level: physically active people do not suffer low back pain to at the rate inactive people suffer. A healthy exercise and core building protocol can help reduce symptoms or instances of low back pain.
  • Weight Gain: Being overweight or obese and gaining weight quickly places increased strain on the low back.
  • Pregnancy: This one goes without saying. Pelvic changes and weight gain both contribute.
  • Genetics: Some forms of arthritis or other systemic conditions are genetic in nature
  • Work: Jobs that include heavy labor and or twisting or expose people to vibration consistently can be problematic. Jobs that require long periods of sitting in a chair can be equally problematic.
  • Mental health factors: Many people are able to deal with chronic pain but anxiety and depression are conditions that can cause a person to focus on the pain which tends to raise the perceived severity and significance for the person suffering from the condition. Dr. Benton, have you come across any patients that fit this description in your practice?
  • Improper backpack use: Kids suffer back pain needlessly since they are not traditionally in an age range we would consider to be a risk factor. However, backpacks used improperly are a common culprit. A backpack should never be more than 15%-20% of a child’s weight and should be carried on both shoulders with the bottom being at or about waste level.

What does the research say?

As I’m sure Dr. Benton will agree…..the research says a lot, to be honest. In fact, I’d say that there’s more research for the effectiveness of manipulation/mobilization in low back pain than for any other conditions chiropractors commonly treat. Am I out of bounds here Dr. Benton?

The research shows Chiropractic beating general practitioners in effectiveness as well as cost. The research shows Chiropractic beating common medications prescribed for low back pain. The research shows Chiropractic beating physical therapy and exercise alone. The research shows Chiropractic beating epidural spinal injections for low back pain. And the two of us can point you to randomized controlled trials proving it. Basically, the research is clear.

In January of 2018, a brand new research paper dealing with manipulation and mobilization was published in Spine Journal by Ian Coulter, PhD et. al. titled “Manipulation and mobilization for treating chronic low back pain: a systematic review” and funded by the National Center for Complementary and Integrative Health.

Now, to be clear, Spine Journal sounds a little bit like it may be a Chiropractic publication for those of you that don’t commonly read research abstracts…… but it is not.

Dr. Benton, can you describe Spine Journal for us?

Here’s why the authors took this project on.

The authors of the paper stated that there remained questions about manipulation and mobilization efficacy, the proper dosing of the techniques, how safe they are, as well as how they compare to other treatment protocols commonly used for chronic low back pain.

I have to say that I had no remaining questions regarding really ANY of those topics but it seems that these authors did.

Dr. Benton, again, please feel free to jump in anywhere you’d like as we go through the hows, why’s and the what’s here.

Here’s How They Did It

  • This paper was a systematic review and meta-analysis.
  • They searched databases for relevant studies from January 2000-March 2017
  • They chose randomized controlled trials that compared manipulation or mobilization to sham treatment, no treatment, other therapies, and multimodal therapeutic approaches.
  • They assessed the risk of bias using the Scottish Intercollegiate Guidelines Network.
  • Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates.
  • 51 trials were included

What They Found

  • Within 7 of those trials on manipulation and/or mobilization there was reduction of disability when compared to other forms of therapy.
  • Further analyses showed that manipulation specifically was responsible for significant reduction in pain and disability when put up against therapies such as exercise and physical therapy.
  • Mobilization was also was significantly more effective when compared to exercise regimens for pain reduction but not for disability.

Wrap It Up

In the conclusion of the paper abstract, the authors say, “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.”

As I’ve said many times, “a lot of research in your favor becomes fact.” Chiropractic has A LOT of research in its favor.

Dr. Benton, would you like to add any final thoughts?

I’d like to thank Dr. Benton for taking the time to be with us today. He really is one of the guys out here in the real world trying his best to help change things for Chiropractors in Texas and in the world.

I want to finish off by saying that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good or excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically and do it with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Please remember, we need your help to spread the word and grow this podcast. If you would help us out by sharing our podcast information, our website, and social media entities, we would greatly appreciate your help.

We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Research Citation:

Coulter I, et. al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” The Spine Journal, Volume 0 , Issue 0 ,


CF 003: Great News: Chiropractic Outpaces Muscle Relaxants

Great News: Chiropractic Outpaces Muscle Relaxants

Hey hey, Dr. Jeff Williams with the Chiropractic Forward podcast coming to you directly from the flight deck at Creek Stone Care in icey Amarillo, TX and you have stumbled head first into Episode numero 3.

Welcome welcome, this week we’re going to be talking about people that I believe may be related to unicorns because I can’t hardly believe they exist, we’ll talk about something I pondered while in the shower, and we’ll talk about what research has to say about low back pain, muscle relaxants, and chiropractic care.

I like to be an honest person so I’m just going to speak directly here and say that….I have yet to get the hang of the whole podcast thing but, I’m at least screwing it up regularly and consistency is half the battle I’m told. We’re going to have more fun than chopping wood and I firmly believe it. If you believe it, it must be true. What’s the saying? Perception is reality? I sometimes enjoy living in my own reality to tell the truth. Who doesn’t?

Speaking of unbelievable, Did yo u know that you are 75% to 85% likely to experience low back pain in your lifetime? Those are some pretty good odds. Or, bad, odds depending on how you look at it. That’s where the unicorn reference comes in here. I have a hard time believing these people exist.

By the way, I’d like to meet the 15%-25% that don’t have back pain. Wouldn’t you? Maybe these folks have been marked by God for greatness that just can’t be achieved if they’re suffering from back pain. They’re the ones looking at everyone else like, “What the heck is wrong with you people?”

How do you make it through a lifetime without back pain? That just doesn’t seem right to me. Someday, I plan on having a talk with God about this deal. I’m kind of mad about it.

Believe it or not, I remember life without back pain. I specifically remember being a kid, taking a hot shower, and thinking about adults that always gripe about back pain. I had recently heard an adult talking about how standing in a hot shower made their back feel better so that’s what made me think about it.

I thought, “That must really stink to always be hurting like that.” Well then I was smart enough to play college football and go to chiropractic school where chiropractors get to use each other as guinea pigs to learn how to help others. Yes, you could say I donated my body to science in a way. Regardless of the reasons, I am well-acquainted with the occasional back  pain. It has been intense a few times. To the point of crawling to the bathroom because I couldn’t walk to get there. It’s been years since that was the case but I certainly have empathy for my patients that come through the doors like that. It can be pure misery and it’s no wonder at all why people would look to medication for a quick fix for such intense, non-stop pain. If I’m being honest, when I remember that pain, I would be be looking for anything and everything to make it stop too.

Here’s the problem though: there arebut a few things that can help immediately. The good news here is that Chiropractic is one of the very BEST answers for this issue. The even better news is that the American Medical Association and the American College of Physicians now agree with me on this as of 2017.

That leads us into this article’s source material which is a research paper by KT Hoiriis called “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” It was published in the Journal of Manipulative Physiological Therapeutics in July-August issue in 2004 and can be found on pages 388-398.

Why They Did It

Considering the fact that we are almost all going to suffer from low back pain at some point in our lives and considering the fact that acute pain will generally resolve and chronic pain is tough to treat, the authors of this paper were interested in trying to assess the reponsiveness of SUBacute low back pain to different treatments available. The treatment the authors chose to compare were Chiropractic treatments vs. muscle relaxants and placebo.

How They Did It

  • The platform chosen by the researchers was a randomized, double-blind clinical trial. It is high-quality information when done with this sort of design.
  • They chose 192 patients that had suffered low back pain for a time period of between 2 and 6 weeks in duration.
  • The patients were randomly split into three different groups for the purpose of the project.
  • They each underwent 2 weeks of treatment. One group with Chiropractic, one with muscle relaxants, and one with placebo.
  • The Outcome Assessments were performed through the use of the Visual Analog Scale (VAS), the Oswestry Disability Questionnaire, and the Modified Zung Depression Scale.
  • These assessments were performed at the beginning of treatment (baseline), at two weeks, and at the conclusion of the treatment which was at the four week mark.
  • In addition to the Assessments previously mentioned, Schobers’s flexibility test, acetaminophen usage, and the Global Impression of Severity Scale (GIS) were assessed at the 2 week mark and at the 4 week mark.

What They Found

  • The baselines were essentially the same in all of the Outcome Assessments except for in the Global Impression of Severity Scale.
  • The subjects that actually finished the trial, 146 in all, had their data combined revealing pain, disability, depression, and the Global Impression of Severity Scale had ALL decreased significantly while flexibility for the low back was not altered.
  • Statistical differences through the groups showed that the chiropractic patients improved more than the control group and in terms of the Global Impression of Severity Scale, the chiropractic patients also improved more than the placebo group AS WELL AS the muscle relaxants group.

Wrap It Up

Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.

While this is good news from 2004, there are studies subsequent to this one showing how Chiropractic outpaces medication in the treatment of low back pain. These are part of the reason that they American Medical Association and the American College of Physicians recently published articles and papers recommending Chiropractic as first-line treatment for acute and chronic low back pain before even taking acetaminophen or aspirin. That’s huge folks.

Source Material

Hoiriis KT, et. al., “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” J Manip Physiol Ther. 2004 Jul-Aug;27(6):388-98.


Just another reason to call a chiropractor TODAY!



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