In a chiropractor’s ideal world, people would do everything possible to reduce their risk for a condition like low back pain, and in the event a low back injury occurs, they’d seek care right away. Barring any red flags that necessitate a referral to a specialist or a trip to the emergency room, the patient would receive care tailored to their unique situation and soon be back to carrying out their everyday activities. Unfortunately, this is rarely the case, and a patient with low back pain may receive no care or inadequate treatment early on, and their condition may progress to becoming chronic low back pain before they make an appointment with a local chiropractic clinic.

A hallmark of chronic low back pain that can complicate recovery is clinical instability or dysfunction in one of the three subsystems that work together to maintain the stability of the spine: the spinal column, the spinal muscles, and the neural control unit. This can lead to excessive movement of one or more spinal segments, overworking and stressing the surrounding muscles, joints, and other soft tissues, causing inflammation and nociceptive (localized) pain.

The key for muscle stabilization in the lumbar spine, which accounts for 60% of the spine’s stiffness, is the multifidus muscle. Unlike superficial muscles that contract to achieve movement, deep muscles like the multifidus work to help maintain posture. Unfortunately, when the lower back is injured, the superficial muscles take on a protective role, which can interfere with the role of the deep muscles. Within days, the multifidus muscle can weaken, and to maintain stability, the body will recruit the superficial muscles and/or adopt new movement patterns, both of which can increase mechanical stress in the low back and elsewhere and prolong or worsen the patients’ condition. This is why treatment guidelines no longer recommend prolonged bed rest for low back pain but rather maintaining usual activities as much as possible.

When a patient seeks chiropractic care for chronic low back pain, not only will treatment focus on restoring normal motion to the spine using manual therapies (like spinal manipulation) but also core strengthening exercises that can be performed at home to strengthen the core muscles (including the multifidus) and increase the stability of the spine. This strategy will not only speed up recovery but help reduce the risk for a future low back episode.