Low Back Pain: Chiropractic vs. Physical Therapy 

Low back pain (LBP) is a significant burden on health levels and healthcare costs in the United States [1]. Not only can sufferers of LBP experience severe, often disability-inducing pain, but they may also require costly medical care to treat their conditions [1]. Unfortunately, neither the chief cause nor the ideal treatment for LBP is certain [2]. Fortunately, many treatment options for low back pain are available to patients, including chiropractic care and physical therapy (PT) [2]. When deciding whether to opt for one over another, there are a few key characteristics and discoveries that patients and their medical teams should keep in mind. 

Chiropractic care consists of a wide array of treatments, including electrical stimulation, heat or ice application, and, most commonly, joint manipulations for the correction of subluxations [3]. In the context of LBP treatment, there has been disagreement among experts about the appropriate role of chiropractic care [2]. 

Some of this debate may have been quelled by a 2018 study [2]. The study sought to analyze the efficacy of chiropractic in treating LBP [2]. The researchers compared how active-duty military personnel complaining of LBP fared with usual care alone (ranging from pharmaceutics to PT) versus usual care combined with up to twelve chiropractic treatments [2]. At the end of the six-week treatment period, the usual care plus chiropractic group reported less severe pain, reduced disability, diminished pain medication use, improved function, and higher satisfaction [2]. According to these results, chiropractic appears to be an effective treatment for LBP.  

Similarly, physical therapy has reportedly contributed to improved outcomes when compared to no treatment or medical intervention alone [1]. The central objective of PT is to prevent further disability and improve functional capability [4]. For combating low back pain, the most effective forms of physical therapy appear to be active strategies, such as yoga, tai chi, and other forms of exercise [4]. Because no single form of PT has emerged as superior to all others, researchers suggest that patients employ a diversity of techniques, chosen according to personal preference [4]. 

Multiple studies have compared chiropractic care and PT’s respective effects on LBP. For instance, a 2006 UCLA study focused on the differences in disability, remission, and pain intensity among LBP patients sorted into four groups: chiropractic with and without physical modalities, and medical care with and without PT [5]. After 18 months of analyzing their subjects, Hurwitz et al. found that the groups were relatively equivalent across the primary outcomes [5]. However, the chiropractic group had a “greater likelihood of perceived improvement,” suggesting that this technique may be associated with a boost in confidence [5]. 

Further evidence suggests that each method may have unique benefits. Gudavalli and colleagues compared flexion-distraction (FD), a chiropractic technique, with active trunk exercise protocol (ATEP), a form of PT [6]. The FD patients experienced greater pain relief, leading the researchers to conclude that FD may be more appropriate for patients with chronic LBP or those with radiculopathy [6]. Meanwhile, patients with recurrent pain improved most under ATEP [6].   

Besides the severity of the patient’s condition, cost may also influence which treatment they choose. A 2020 study found that the total average cost for LBP patients who opted for chiropractic treatment was $48.56 lower than those who chose physical therapy [1]. 

Nevertheless, there is no ideal treatment for low back pain. However, by considering their degree of pain, their desire for extra motivation, and budget concerns, patients can make a more informed choice between physical therapy and chiropractic care. 


[1] N. Khodakarami, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation,” Healthcare, vol. 8, no. 44, p. 1-8, February 2020. [Online]. Available: https://doi.org/10.3390/healthcare8010044

[2] R. H. Shmerling, “Should you see a chiropractor for low back pain?,” Harvard Health Publishing, Updated August 16, 2019. [Online]. Available: https://www.health.harvard.edu/blog/should-you-see-a-chiropractor-for-low-back-pain-2019073017412

[3] B. Sears, “Here’s How Chiropractors and Physical Therapists Are Different,” VeryWell Health, Updated September 3, 2021. [Online]. Available: https://www.verywellhealth.com/chiropractor-vs-physical-therapy-5194093

[4] E. A. Shipton, “Physical Therapy Approaches in the Treatment of Low Back Pain,” Pain and Therapy, vol. 7, no. 2, p. 127-137, September 2018. [Online]. Available: https://doi.org/10.1007/s40122-018-0105-x

[5] E. L. Hurwitz et al., “A Randomized Trial of Chiropractic and Medical Care for Patients With Low Back Pain: Eighteen-Month Follow-up Outcomes From the UCLA Low Back Pain Study,” Spine, vol. 31, no. 6, p. 611-621, March 2006. [Online]. Available: https://doi.org/10.1097/01.brs.0000202559.41193.b2

[6] M. R. Gudavalli et al., “A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain,” European Spine Journal, vol. 15, no. 7, p. 1070-1082, December 2005. [Online]. Available: https://doi.org/10.1007/s00586-005-0021-8.