The American Chiropractic Association recently released their Choosing Wisely® list of five recommendations for lower back pain. This list includes:
"1. Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.
2. Do not perform repeat imaging to monitor patients’ progress.
3. Avoid protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.
4. Do not provide long-term pain management without a psychosocial screening or assessment.
5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain."
These guidelines are consistent with standard of care amongst chiropractors and physical therapists. Spinal imaging (x-rays, MRIs, CT's) have been shown to have a low correlation with the spinal-related pain one has, and a high rate of false positives (for example, approximately 60% of middle aged men or women who do not have lower back pain would show a disc bulge or worse on MRI).
Often times passive modalities do not improve treatment outcomes (ultrasound, muscle stimulation, etc). The literature supports the use of modalities such as spinal manipulation and exercise for neck and lower back pain. In our clinic, our goal is to (after a thorough assessment to rule out possible red flags) find a directional preference for your exercise, and have you move into that direction frequently. Fortunately, this theory is not only applied to the neck and lower back. We can apply this concept to any pain stemming from a muscle, ligament, tendon, or joint and teach you how to treat yourself in the convenience of your home (for the most part).