Earlier this month, the American College of Physicians (ACP) released new clinical practice guidelines for the treatment of low back pain.  Spoiler alert: they’re good for chiropractic.

So what’s the deal with these guidelines?

In healthcare, there is a constant flow of new research being done on potential new treatments or the effectiveness of current treatments and so on.

Every so often, different professional groups will take a look at all the research related to their field and drill it down into some clinical guidelines or best practices.  These guidelines let doctors and other healthcare professionals know what the current research collectively says is the best way to treat patients.

In the new ACP guidelines,  they recommend a departure from first using traditional methods of drugs and surgery for back pain, especially chronic pain, and instead suggest starting with conservative care such as massage, acupuncture, and spinal manipulation (chiropractic).

Why the change from “drugs first” to conservative therapy first?

The research shows that most of the pills that we reach for first when we are hurting, like Tylenol or NSAIDs like ibuprofen, really don’t help as much as we’d like to think they do.  Not only do they not help as much as was once believed, there is a risk for some significant adverse effects.


For instance, common side effects with NSAIDs can be abdominal cramps or diarrhea but long-term use can lead to stomach bleeding, which can be fatal.

To contrast, the most common side effect of spinal manipulation for low back pain (the primary treatment used by chiropractors) is muscle soreness.

So, when looking at treatment recommendations, groups like the ACP have to decide is the risk of an adverse event worth the benefit of the treatment and in the case of traditional medications, the answer is no.

To be fair though, the guidelines do say that if you’ve given conservative care a trial and have not experienced any improvement, then you need to try a different treatment, such as NSAIDs.

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What does all this mean for you?

If you've been struggling just to get through the past 300 or so words and are just wondering, what's the point? Here it is.

When it comes to not just low back pain but your health in general, you need to start with the most conservative treatment first and the progress to the more invasive treatments if the others don't work.

This is a perspective I've advocated many times throughout my blog; changing from sickcare (waiting till we're sick to worry about our health) to actual healthcare (proactively making our health a priority).

So many of our health problems would go away if we just ate foods that were good for us and moved around on a daily basis.  That's about as conservative as care gets, diet and exercise.

Sure, you may spend some money on chiropractic care or physical therapy and it doesn't help your low back.  There's always that chance.

No treatment works 100% of the time for everyone but, it's a better option than starting a treatment, like surgery, that costs thousands and may or may not help or worse, cause more pain or even disability.

I'm not saying you shouldn't ever take a medication or ever get surgery.  Those forms of treatment are life-savers for the people that need them, they just shouldn't always be our first choice, which is what tends to happen in our healthcare system.

You are your best health advocate.  Make your health a priority, take care of yourself, and when you need help, start with the most conservative treatment first.