Guidelines - Low Back Pain

Scope and Purpose of Guideline


Objective: This guideline covers the initial assessment, management, and monitoring of acute and chronic low back pain (LBP) in adults.

Target population: 

  • Adults with low back pain

Title of Guideline: Spinal manipulative therapy and other conservative treatments for low back pain (LBP) in adults

Author(s): ​Bussières A. et al.

Year of Publication: ​2018

Link for Full Guideline: link

Key Recommendations


Educate on the nature and course of low back pain, provide reassurance and advise on physical activity and self-management strategies. Based on patient and practitioner preference, we suggest: ​

Acute low back pain (0-3 months duration):

  • We suggest SMT, other commonly used treatments, or a combination of SMT and commonly used treatments to decrease pain and disability in the short term, based on patient preference and practitioner experience.

    • Other commonly used treatments may include advice on posture and physical activity, as usual, medical care when deemed beneficial.​

Chronic low back pain (>3 months duration):

  • We suggest SMT over minimal intervention to decrease pain and disability in the short term.

    • Minimal intervention includes manually applied forces with diminished magnitude or 5-minute light massage​

  • We recommend SMT or other treatments for short-term reduction in pain and disability.

    • Other treatments include extension exercises, advice plus exercise, myofascial therapy, usual medical care when beneficial. Pain relief is most effective within the first 6 months and functional improvement was more effective at 1 month.​

  • We suggest multimodal therapy with or without SMT to decrease pain and disability.

    • Multimodal therapy with SMT treatment may also include exercise, myofascial therapy, advice, educational material, usual medical care when deemed beneficial.​

    • SMT (2 sessions per week for 4 weeks) plus usual medical care has shown better pain and functional outcomes than usual medical are alone.

    • Pain and functional improvement was also shown at 3 and 12 months.

Chronic back-related leg pain (sciatica or radicular LBP):

  • We suggest SMT plus home exercise and advice to reduce back pain and disability. 

    • Reduced chronic back-related leg pain (sciatica or radicular low back pain) and disability were observed at 12 weeks follow-up. ​

    • Home exercise includes positioning and stabilization exercises.

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CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

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