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If you have not already seen it, Annals of Internal Medicine gave you and I a very nice Valentine’s Day Gift. This past Tuesday, Annals published an updated Clinical Practice Guideline for Managing LBP from the American College of Physicians. (1) Among the recommendations: Implement spinal manipulation and postpone pharmacologic management.

  • “Recommendation 1: For most patients with acute or subacute low back pain, clinicians and patients should initially select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation.”
  • “Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”
  • “Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

When assessing the potential harm of various treatments, the guideline concluded that the type of care administered by chiropractors (spinal manipulation, exercise, and massage) posed no serious threat and was associated with only transient “muscle soreness”.

The paper concluded: Clinicians should also provide patients with evidence-based information with regard to their expected course, advise them to remain active as tolerated, and provide information about effective self-care options (including exercise).

ChiroUp is exactly that system; allowing you to stay abreast of current guidelines, automatically equip your patients with evidence-based information including the most appropriate condition-specific exercises, and measure your outcomes. If you’re not already a ChiroUp subscriber, click here to start your free trial today.


  1. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. [Epub ahead of print 14 February 2017]doi: 10.7326/M16-2367

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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