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Best Practices

A local study out of Vancouver General Hospital won the Spine Journal’s award for the Most Outstanding Paper in 2010 in the category of Medical and Interventional Science when it compared the use of clinical practice guidelines (CPG) to usual physician-directed care in the treatment of acute mechanical low back pain. The study was conducted by a collaboration of chiropractic and medical researchers and used chiropractors treating in a hospital setting. They found that patients fared better in the short term (24 weeks) if their treatments followed the suggested CPG for acute low back pain. The guidelines included:

  • Reassurance

  • Avoiding passive treatments such as bed rest, heat , and back supports

  • Acetaminophen at 650 mg every 6-8 hours as needed for 2-4 weeks

  • Progressive walking

  • Returning to work at 8 weeks

  • Avoiding muscle relaxants, narcotic based medications, and back exercise programs

  • 4 weeks of lumbar spinal manipulation at a frequency of 2-3 times per week


The patients under the physician-directed care group had a high rate of narcotic pain medications and passive coping mechanisms and were rarely instructed to follow any of the treatments suggested in the guidelines.


Other studies have found that lumbar manipulation was beneficial for the recovery of acute low back pain if the duration of symptoms was less than 16 days and no symptoms were found below the knee. Therefore, the best chance of recovery from acute low back pain would be to have early intervention (“I thought it would go away”) and take a multimodal approach which includes active exercises, medication if needed and spinal manipulation.



1. Bishop PB, Quon JA, et al. The Chiropractic Hospital-based Interventions Research Outcome (CHIRO) Study: A randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute low back pain. Spine Journal 2010;10: 1055-1065.


2. Fritz, J, Childs JD, Flynn TW. Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention. BMC Fam Pract. 2005;6:29.

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