Chiropractic care for lower back pain
Lower back pain is not a disc slipping out of place. An assessment looks at what the back is being asked to carry, how long it holds one position, and what else in the week is loading it.
Sound familiar?
- “my back went”
- “a dull ache by mid-afternoon”
- “I threw my back out”
What it actually is
Your lower back is five vertebrae, the discs and ligaments between and behind them, a pair of small facet joints at each level, and the muscles either side. At its base the spine meets the pelvis at the two sacroiliac joints. The whole stack shares the load, and it is built to be loaded.
One way pain turns up is when the load and what the tissue is ready for stop matching. Sometimes that is one moment, the box heavier than it looked. Sometimes it is the shape of a week: hours in one position, a jump in training, a bad run of sleep. The same weight on a fresh Monday and a tired Friday is not the same job. The Royal Australian College of General Practitioners, in its 2022 guidance for GPs on imaging in adults with acute low back pain, writes that non-specific low back pain has a good prognosis and usually improves within four weeks where the person uses simple pain strategies, avoids bed rest and maintains their usual activities.
What people notice
- an ache low across the back that builds through the day
- a back that grabs when you stand up out of a chair
- stiffness first thing that eases once you are moving
- a sharp catch after a lift that leaves you moving carefully
- pain on one side that has you shifting your weight to stand
- aching that spreads into the buttock or the back of the thigh
- pain bending forward, to put shoes on or lift something off the floor
Where it sits in the body
- the lumbar spine, the five vertebrae at the base of the back
- the lumbar discs, and the ligaments behind them
- the joints of the lower back and the muscles either side
- the hips, the glutes and the muscles of the trunk
- the nerve roots leaving the lower back for the leg
- the sacroiliac joints, where the base of the spine meets the pelvis
What the assessment looks for
A first visit at Macquarie Street in the Sydney CBD starts with questions, because the history does most of the work. What you were doing when it started. What you can still do with it and what you have stopped doing. Whether it is worse getting out of the car or worse after an hour on your feet. Whether anything travels into the buttock or the leg, and whether anything has changed about your bladder, your bowels or the strength in your legs.
Then it is tested. The Low Back Pain Clinical Care Standard, published by the Australian Commission on Safety and Quality in Health Care in 2022, asks that a first assessment screens for specific and/or serious causes and takes account of the things in a person’s life that affect recovery.
- which direction of movement reproduces what you feel
- how the hips, the glutes and the trunk are sharing the load
- strength, reflexes and sensation when symptoms travel below the buttock
- how irritable it is today, which sets what is reasonable this week
- what your work, your sleep and your training actually look like
Imaging is a separate question. The standard asks that the limited role of imaging in diagnosing low back pain is discussed with you, and the Royal Australian College of General Practitioners’ 2022 guidance for GPs is blunt: imaging for acute low back pain is only recommended after a careful clinical assessment raises a high suspicion of a serious cause. So it is suggested when clinically indicated. Do I need a scan? takes that further.
Choosing between professions? Should I see a chiropractor, a physio or an osteopath? compares the three for a sore lower back.
What care involves
The work splits three ways. Hands-on care to the joints and muscles the examination pointed at. Movement chosen for your problem rather than a general set, so the back, the hips and the trunk are asked for a little more as they tolerate it. And how you sit, lift, train and pace a day.
Hands-on does not have to mean a thrust and a click. A traditional adjustment is one option rather than a requirement. Gentle joint mobilisation, instrument adjusting and drop-piece are all available, and where a back is still angry the early visits usually start with the gentlest of them. Nothing is automatic, and you can decline any part of it without it being awkward.
For an episode of less than six weeks, the Royal Australian College of General Practitioners’ Handbook of Non-Drug Interventions entry from 2019 says staying active, instead of resting in bed, is what is recommended, and that staying active means ordinary daily activity, including going to work. The Low Back Pain Clinical Care Standard, published by the Australian Commission on Safety and Quality in Health Care in 2022, says the same without the six-week frame: a person with low back pain is encouraged to stay active and continue, or return to, usual activity, including work, as soon as possible or feasible. How you lift while you do it is covered in lifting without hurting your back.
Where pain has persisted or kept returning for more than three months and is not reliably attributed to an underlying disease process or structural lesion, what the World Health Organization calls chronic primary low back pain, its 2023 guideline lists spinal manipulative therapy among the options it supports. That is a conditional recommendation in favour of use, on very low certainty evidence, which is the guideline’s own grading and worth carrying with it. The same guideline names 14 interventions it does not recommend for most people in most contexts, among them traction and lumbar braces, belts and supports. Both halves belong on the page.
What the work is aimed at is less pain, a back that tolerates more of your ordinary week, and enough confidence to load it again: built for lasting improvement rather than short-term relief.
How long that takes, and how often you would come in while it happens, are the questions people ask first, and the honest answer is longer than a number. What actually decides it, and what we do when a plan is not moving, is set out in how many visits will I need?.
Everyone moves through this differently, so the plan is paced to your body, reviewed with you as you progress, not read off a fixed schedule of visits.
What the guidelines say
- Australian Commission on Safety and Quality in Health Care, Low Back Pain Clinical Care Standard, 2022. https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard
- Royal Australian College of General Practitioners, First do no harm: A guide to choosing wisely in general practice. For GPs: Imaging in adults with acute low back pain, 2022. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/first-do-no-harm/gp-resources/imaging-in-adults-with-acute-low-back-pain
- Royal Australian College of General Practitioners, Handbook of Non-Drug Interventions (HANDI): Advice to stay active for people with acute low back pain, 2019. https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/musculoskeletal/advice-to-stay-active-for-people-with-back-pain
- World Health Organization, WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings, 2023. https://www.who.int/publications/i/item/9789240081789
When to get it looked at
A first assessment screens for the specific and/or serious causes of low back pain, because those are the presentations that change what happens next and they are the ones worth ruling out early.
Go to a hospital emergency department straight away if you have numbness or altered feeling around the saddle area, meaning the groin, the inner thighs, the buttocks or the genitals; a loss of normal sensation in the genitals, including during sex; trouble starting to pass urine, or any new change in your bladder or bowel control; weakness in both legs, particularly if it is getting worse; new or worsening pain running down both legs; weakness in one leg that is severe or getting worse, or a foot that has started to catch or drag when you walk; or numbness in a leg that is spreading or getting worse quickly. Go to a hospital emergency department straight away for back or neck pain after a serious fall or a high-impact accident, such as a car accident; back or neck pain with a fever or feeling generally unwell; or new back or neck pain if your immune system is weakened, for instance by long-term steroids or chemotherapy, if you inject drugs, or if you have recently had a spinal injection, spinal surgery or a dental procedure. Go to a hospital emergency department the same day if you have new clumsiness in both hands, or new unsteadiness on your feet.
The back signs above go to an emergency department because the Australian guidance on low back pain puts them there: the Low Back Pain Clinical Care Standard, published by the Australian Commission on Safety and Quality in Health Care in 2022, and the Royal Australian College of General Practitioners’ 2022 guidance for GPs on imaging in adults with acute low back pain both send suspected cauda equina syndrome, suspected spinal infection, a fracture after a high-impact injury and severe or rapidly worsening nerve weakness for emergency assessment.
See your GP promptly, before booking here, if you have a history of cancer, unexplained weight loss, pain at night that will not settle in any position, known osteoporosis with new severe pain, numbness that is spreading or getting worse slowly, or new, unexplained back pain as an older adult.
Book it when the back has stopped improving on its own after a week or two, when the pain has started travelling into the leg or bringing pins and needles with it, or when a back that goes every few months has begun deciding what you say yes to.
Common questions
My back goes every few months. Is that different from a one-off?
It changes what gets looked at. A back that has gone several times is telling you something about load and tolerance rather than about one bad lift, so the assessment spends longer on the weeks around each episode: the training, the sitting, the sleep, and what was different the day before.
Does a bulge on my report explain my pain?
Not on its own. The Low Back Pain Clinical Care Standard, published by the Australian Commission on Safety and Quality in Health Care in 2022, asks that the limited role of imaging in diagnosing low back pain is discussed with you, so a report is read alongside your story and what the examination found rather than ahead of them.
Do I need a referral from my GP?
No. You can book an assessment yourself and no referral is needed, from your GP or anyone else. If what we find belongs with your GP, we say so and write to them, and the work here runs alongside their care.
What if the pain has started going down my leg?
Say so early, because it changes what gets tested. Pain that travels down the leg, particularly with pins and needles, numbness or weakness, or leg pain that has become worse than the back pain, is what has us examining the nerve supply to the leg, and it is what most people mean by sciatica. Whatever it turns out to be, the leg gets its own examination. Go to a hospital emergency department straight away instead of booking if you have weakness in both legs, particularly if it is getting worse; new or worsening pain running down both legs; weakness in one leg that is severe or getting worse, or a foot that has started to catch or drag when you walk; or numbness in a leg that is spreading or getting worse quickly. The same goes for every other sign in the emergency list on this page.
The question underneath several of those, what the risks of hands-on care are and what the guidelines actually support it for, has an article of its own. Is chiropractic safe, and what does the evidence actually say?
Read next
Nearby: Chiropractic care for sciatica and Chiropractic care for posture.
The clinic is at Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. How to find us, or read all the conditions we see.
Take the first step towards better movement.
Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. No referral needed to book.