Which is better for low back pain chiropractic or physiotherapy?

I get asked this question quite often and I have discussed this at length with my friends who are physiotherapists. So what does the research show? Which is better for low back pain chiropractic or physiotherapy? If you have an acute muscle strain of the spinal muscles then physiotherapy is the best for this and in the past when I have had a similar problem my physio has been great for me.

However when we talk about chronic low back pain there are different options. Chronic low back pain is at least 3 months after an injury. You need to realise that for the majority of people if you had an MRI scan to look at the joints, discs, ligaments and muscles often there is nothing really wrong there. There is no signs of physical damage.

Chronic low back pain is actually in your brain. Having had pain long enough in a part of your body now  your brain has made connections associating any information from that part of your body as painful. With this comes a slow deconditioning of the nerves, ligaments and muscles over time and your body goes into a stiff mode.

Is Your Body In A Stiff Mode?

Stiff mode is where your brain is trying to protect your body from further injury. Instead of your spine moving one segment at a time like a snakes body twisting to move it ends up moving in blocks like a train for example.

Your brain has a very detailed MAP of where your body is in space and this is based on the length and the tension of the muscles, ligaments, joints and tendons. With chronic pain this map becomes blurred/smudged and ill defined. For example when someone uses a finger print scanner and with each sweep the finger print is better defined. However if we don’t do it long enough the image will not be clear. It is the same with your brains map of where your body is and it becomes a big problem.

If we have this loss of segmental control releasing the muscles which span more than 3 levels wont help restore that finite control. Chiropractic treatment for low back pain is far superior to physiotherapy particularly with chronic spinal pain. Mechanoreceptors are in the joints, joint capsules and muscles and when these are stimulated they inhibit or stop pain. The more often a mechanoreceptor is stimulated the more readily they fire and the more nociceptive inhibition occurs. Here is more information about this if you are interested.

How Movement Decreases Pain

Mechanoreceptors are only stimulated when a joint is stimulated at a particular frequency.  So chiropractic treatment stimulates mechanoreceptors that aren’t normally stimulated. As the  mechanoreceptor function improves and this decreases nociception it improves the somatosensory input to the cerebellar -brainstem cortical loops. These coordinate movement, muscle tone and posture as well as cognition and affect.

Proprioceptive stimulation (movement) of the facet joints inhibits annulous pain. Improved movement with what we do reduces venous stasis around the disc. Less muscle spasm aids in healing time and improves neuromuscular control.

This process requires substantial repetition to change neuroplasticity and synaptogenesis for long term functional change.

Ive attached the research study where chiropractic is found to be the only treatment modality that provides broad and significant long term benefits to chronic low back pain.

When it comes to which is better for low back pain physiotherapy or chiropractic research shows chiropractic is better.

J Manipulative Physiol Ther. 2005 Jan;28(1):3-11.doi: 10.1016/j.jmpt.2004.12.004.

Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes

https://www.sciencedirect.com/science/article/abs/pii/S0161475404002581

https://pubmed.ncbi.nlm.nih.gov/15726029/