Many people have injured their low backs and have wondered what treatment to try first. Should they go to the chiropractor first for an adjustment? What about a physical therapist for exercises? Or should they spend their money on lumbar traction or an in-home inversion table?
In the past few years researchers have made advances on understanding low back pain which has enabled doctors to determine the treatment that is most likely to be successful for them. Below are the categories for different treatments. See which one you fall into.
Getting an adjustment by the chiropractor
Someone who is the most likely to drastically improve by a chiropractic adjustment typically has several or all of these traits.
Low back pain is centered on one side of the back
There is minimal radiation down the legs, particularly below the knee
Their back has been injured for less than 16 days
They have a positive Kemp’s test on the side of pain. (This is an orthopedic test that your chiropractor will perform at the office)
Their pain is located on one side over their sacroiliac joint.
Has tested positive on up to five different sacroiliac tests (This is a series of orthopedic tests that your chiropractor can perform. They are called the “Laslett Cluster” if you want to look them up)
Here’s an example of a low back adjustment.
Doing “direction specific exercises”
This is less well known but it is a category of low back pain treatments which involves doing very simple stretches that are aimed at pushing a herniated disc away from the nerve that it is irritating. The most well-known method for doing this is called the Mckenzie Method and a chiropractor or physical therapist can walk you through which of these exercises you need to do if you fall into this category very quickly. People that do very well with these exercises have the some or all of the traits below.
Has had an MRI that showed a lumbar disc herniation
Has pain that radiates down their leg especially past the knee
Has had a positive Straight Leg Raise test or Femoral Nerve Stretch test (orthopedic tests)
Has had a diagnosis of spondylolisthesis
Has had a diagnosis of spinal stenosis
Has more leg pain than back pain
Has pain with walking and standing and relief with sitting
Is older in age
If you fall under this category I would recommend that you see a chiropractor to determine what specific exercises would be beneficial for you. On our website under Instructional Videos you will see a link that has videos of the three most common Direction Specific Exercises. I would encourage you check them out but it is imperative to be evaluated and prescribed which direction is beneficial and which are detrimental before starting them. Here’s an example below.
Getting Lumbar Traction or doing an Inversion table at home
If you fall under the direction specific category but those exercises have not helped, traction would be the best treatment for you. This is usually a small set of people. There are clinics that sell pricey packages of lumbar traction treatments but I always recommend to my patients to get an inversion table first before spending $1500-$3000 at a traction clinic. Inversion tables are very affordable and are accomplishing the same thing as traction.
Stabilization Exercises
Everyone needs to do core exercises if they want to get out of low back pain and keep it from coming back. If you have a few or all of the traits below however, the research shows that you will have the best outcomes from core training for your low back pain.
Age less than 40 years old
Has a Straight Leg Raise of 90 degrees or greater (orthopedic test)
Has a positive Prone Instability Test (orthopedic test)
Has an aberrant movement pattern when toe touching (a physical therapy and chiropractic test)
A good place to start when doing stabilization training is by working on your inner core. We have created a page on our website with the most important exercises that involve your inner core. You can access that page here. After you have mastered these a physical therapist can train you on more advanced core work. One thing to note on your inner core is that you have to start with your breathing which is often overlooked.
If you have had a low back injury, I hope this will help you to decide on what to do next. Any good chiropractor or physical therapist can help determine what category you fall into then treat you with what the research says is most likely to succeed.