Suffering from back pain? Chiropractic care, including spinal manipulation, may be the solution. Discover the benefits for your health.

Chiropractic Care and Functional Medicine: A Holistic Approach to Back Pain Relief

Back pain is a widespread health concern that impacts millions worldwide, disrupting daily activities, work, and overall well-being. Whether it’s a persistent ache in the lower back or sharp pain radiating down the leg, back pain can range from mildly uncomfortable to severely debilitating. Fortunately, nonsurgical treatments such as chiropractic care, spinal manipulation, targeted exercises, and functional medicine approaches—including nutrition, health coaching, and integrative therapies like massage and acupuncture—offer effective solutions for managing and alleviating back pain. This comprehensive guide explores the clinical rationale for chiropractic care and spinal manipulation, the factors contributing to back pain, and how a patient-centered, integrative approach rooted in functional medicine can promote natural healing and prevent long-term complications. Drawing on scientific research and clinical expertise, this article offers actionable insights to help you understand and effectively address back pain.

The Global Burden of Back Pain

Back pain is a leading cause of disability globally, affecting approximately 11% of the world’s population (Gevers-Montoro et al., 2021). It ranks as the fourth leading cause of years lost to disability, creating significant personal, social, and economic challenges (Gevers-Montoro et al., 2021). For many, back pain is not a one-time event but a recurrent condition characterized by periods of relief interspersed with flare-ups (Von Korff et al., 1996). Research indicates that 66% to 75% of patients experience at least mild pain one month after seeking treatment, with about one in three reporting moderate to severe pain after a year (Von Korff et al., 1996).

Most cases of back pain are classified as non-specific, meaning no single structural or pathological cause can be identified (Gevers-Montoro et al., 2021). This complexity makes diagnosis and treatment challenging, as the pain often stems from a combination of musculoskeletal, lifestyle, psychological, and environmental factors. Chronic low back pain, defined as pain persisting beyond three months, can significantly impair mobility and daily activities, highlighting the need for effective, non-invasive interventions (Petrozzi et al., 2020).

Why Addressing Back Pain Matters

Back pain affects individuals across all age groups, though its prevalence increases with age, with fewer individuals over 65 experiencing it compared to younger adults (Borenstein, 2001). It can result from acute injuries, such as improper lifting, or chronic issues like poor posture or sedentary lifestyles. Beyond physical discomfort, back pain can lead to emotional distress, reduced productivity, and increased healthcare costs. Understanding its causes and effective treatments is crucial for managing symptoms and preventing long-term disability.

Factors Contributing to Back Pain

Back pain is multifactorial, arising from a complex interplay of physical, lifestyle, psychological, and environmental factors. Below are the primary contributors to back pain, supported by research and clinical insights.

1. Musculoskeletal Factors

• Muscle Imbalances and Weakness: Weak or imbalanced core and paraspinal muscles can compromise spinal stability, increasing the risk of pain and injury (Alrwaily et al., 2019). For example, weak core muscles may fail to support the spine during movement, placing excessive stress on vertebrae and discs.
• Herniated Discs: A herniated disc occurs when the soft inner material of an intervertebral disc protrudes, potentially compressing nerves and causing localized or radiating pain (sciatica) (Borenstein, 2001).
• Spinal Misalignments: Misalignments or subluxations in the spine can disrupt normal biomechanics, leading to pain and restricted movement (Personal Injury Doctor Group, 2017).
• Degenerative Conditions: Conditions like spinal stenosis or osteoarthritis can narrow the spinal canal or degrade joint cartilage, resulting in pain and stiffness (Borenstein, 2001).

2. Lifestyle Factors

• Sedentary behavior, particularly prolonged sitting with poor posture, weakens back muscles and increases spinal pressure, contributing to pain (Lis et al., 2015).
• Physical Inactivity: A lack of regular exercise reduces muscle strength and flexibility, thereby heightening the risk of back pain (Alrwaily et al., 2019).
• Obesity: Excess weight places additional strain on the spine, particularly the lower back, exacerbating pain (Borenstein, 2001).
• Improper Lifting Techniques: Lifting heavy objects incorrectly can strain back muscles or cause acute injuries like sprains or disc herniations (Von Korff et al., 1996).

3. Psychological and Social Factors

• Stress and Anxiety: Psychological stress can cause muscle tension, particularly in the back and neck, worsening pain (Pinheiro et al., 2016).
• Fear-Avoidance Beliefs: Fear of pain or reinjury can lead to reduced activity, which may exacerbate symptoms and contribute to chronicity (Alrwaily et al., 2019).
• Work-Related Factors: Jobs involving repetitive motions, heavy lifting, or prolonged sitting increase the risk of back pain. Lower work ability is also a predictor of worse outcomes in chronic low back pain (Petrozzi et al., 2020).

4. Medical and Genetic Factors

• Previous Injuries: A history of back injuries can predispose individuals to recurrent pain or chronic conditions (Von Korff et al., 1996).
• Genetic Predispositions: Genetic variations related to disc degeneration may increase susceptibility to back pain (Borenstein, 2001).
• Comorbid Conditions: Conditions like depression, diabetes, or autoimmune disorders can amplify pain perception and complicate recovery (Pinheiro et al., 2016; El Paso, TX Health Coach Clinic, n.d.).

5. Environmental and Occupational Factors

• Poor Ergonomics: Inadequate workstation setups, such as non-ergonomic chairs or desks, can contribute to back strain (Lis et al., 2015).
• High Physical Demands: Occupations involving heavy lifting, bending, or twisting elevate the risk of back pain and injury (Petrozzi et al., 2020).

Understanding these factors is essential for developing personalized treatment plans that address the root causes of back pain. Chiropractic care, combined with functional medicine principles, targets these contributors to promote healing and prevent recurrence.

The Clinical Rationale for Chiropractic Care and Spinal Manipulation

Chiropractic care focuses on diagnosing and treating musculoskeletal disorders, particularly those affecting the spine, through manual techniques like spinal manipulation. Spinal manipulative therapy (SMT) involves applying controlled force to specific joints to restore mobility, reduce pain, and improve function. Below, we examine the clinical rationale for why chiropractic care and spinal manipulation are effective in treating back pain, supported by scientific evidence and insights from functional medicine.

How Spinal Manipulation Works

Spinal manipulation, often referred to as a chiropractic adjustment, involves high-velocity, low-amplitude thrusts or gentler mobilization techniques to realign the spine, reduce joint restrictions, and alleviate pain. According to the Personal Injury Doctor Group (2017), spinal manipulation restores proper alignment and motion to the spine, which can:

• Reduce Nerve Irritation: Misaligned vertebrae or subluxations can compress or irritate spinal nerves, causing pain or radiating symptoms like sciatica. Manipulation relieves this pressure, reducing pain signals (Personal Injury Doctor Group, 2017).
• Improve Joint Mobility: Restricted spinal joints can limit movement and cause stiffness. SMT restores range of motion, enhancing flexibility and function (Gevers-Montoro et al., 2021).
• Decrease Muscle Tension: Manipulation can relax tight muscles and reduce spasms, which are common in back pain patients (Personal Injury Doctor Group, 2017).
• Enhance Blood Flow: Improved circulation to the affected area supports tissue healing and reduces inflammation (Gevers-Montoro et al., 2021).

Scientific Evidence Supporting Chiropractic Care

Research supports the effectiveness of chiropractic care and spinal manipulation for managing back pain, particularly non-specific and chronic low back pain:

• Effectiveness Compared to Other Treatments: A 2021 review found that spinal manipulative therapy is as effective as other recommended therapies, such as physical therapy or standard medical care, for managing non-specific and chronic primary spine pain (Gevers-Montoro et al., 2021). This positions chiropractic care as a viable first-line treatment for low back pain.
• Clinical Practice Guidelines: Most clinical guidelines recommend SMT in combination with exercise for neck pain and as a frontline intervention for low back pain (Gevers-Montoro et al., 2021), reflecting its acceptance in evidence-based practice.
• Short-Term Benefits: Patients with acute low back pain often experience significant improvement within the first four weeks of treatment, with chiropractic care contributing to reduced pain and improved function (Von Korff et al., 1996).
• Prognostic Factors: Patients with lower work ability or recent consultations with medical specialists may have worse outcomes, indicating the need for tailored chiropractic interventions to address these risk factors (Petrozzi et al., 2020).

Functional Medicine Approach to Back Pain

Functional medicine emphasizes addressing the root causes of health conditions by considering the whole person, including their genetics, lifestyle, and environmental factors (El Paso, TX Health Coach Clinic, n.d.). When applied to back pain, functional medicine integrates chiropractic care with:

• Personalized Assessments: Detailed lab work and patient history help identify underlying factors like inflammation, nutritional deficiencies, or hormonal imbalances that contribute to back pain.
• Nutritional Wellness: Food is viewed as medicine, with diets rich in anti-inflammatory foods and supplements supporting tissue repair and reducing pain (El Paso, TX Health Coach Clinic, n.d.).
• Health Coaching: Health coaches provide ongoing support to help patients adopt lifestyle changes, improve compliance with treatment plans, and enhance overall well-being.

This approach aligns with research indicating that multimodal treatments, including SMT, exercise, and education, are effective for managing chronic low back pain (Petrozzi et al., 2020; Gevers-Montoro et al., 2021).

Mechanisms of Pain Relief

The clinical effectiveness of spinal manipulation can be attributed to several physiological mechanisms:

• Neurophysiological Effects: SMT may modulate pain perception by influencing the central nervous system, reducing pain sensitivity, and altering pain processing pathways (Gevers-Montoro et al., 2021).
• Biomechanical Corrections: By restoring proper spinal alignment, SMT reduces stress on surrounding muscles, ligaments, and discs, alleviating pain and improving function (Personal Injury Doctor Group, 2017).
• Inflammation Reduction: Manipulation may decrease inflammatory markers in the affected area, promoting tissue healing (Gevers-Montoro et al., 2021).
• Muscle Activation: SMT can enhance neuromuscular function, improving muscle coordination and strength, which supports spinal stability (Alrwaily et al., 2019).

These mechanisms collectively address the musculoskeletal and neurological components of back pain, making chiropractic care a cornerstone of functional medicine treatment plans.

---

Lower Back Pain Relief- Video

---

Nonsurgical Treatments for Back Pain

In addition to chiropractic care and spinal manipulation, other nonsurgical treatments rooted in functional medicine principles can complement back pain management, promoting the body’s natural healing processes and preventing long-term issues.

1. Targeted Exercises

• Stabilization Exercises: Exercises targeting the core and paraspinal muscles, such as abdominal, side support, and quadruped exercises, strengthen the spine’s supporting structures, reducing pain and preventing recurrence (Alrwaily et al., 2019).
• Aerobic Exercise: Regular aerobic activities like walking or swimming are as effective as more complex exercise programs for chronic low back pain, improving fitness and reducing pain (Borenstein, 2001).
• Stretching and Flexibility: Stretching exercises improve flexibility, reduce muscle tension, and enhance range of motion, complementing chiropractic adjustments.

2. Massage Therapy

• Massage therapy, often integrated into chiropractic care, reduces muscle tension, improves circulation, and promotes relaxation. It is particularly effective when combined with SMT as part of a multimodal approach (Petrozzi et al., 2020).
• Clinical evidence suggests that massage can alleviate pain and improve function in patients with chronic low back pain, especially when paired with other therapies.

3. Acupuncture

• Acupuncture involves inserting thin needles into specific points to stimulate the body’s natural healing processes and reduce pain. It is thought to modulate pain signals and promote endorphin release (Borenstein, 2001).
• While evidence for acupuncture’s efficacy is mixed, it can be a valuable complementary therapy for some patients, particularly those with chronic pain (Borenstein, 2001).

4. Functional Nutrition and Nutraceuticals

• Functional nutrition emphasizes the role of diet in reducing inflammation and supporting tissue repair. Anti-inflammatory foods (e.g., omega-3-rich fish, berries, leafy greens) and nutraceuticals (e.g., natural supplements like turmeric or collagen) can enhance recovery (El Paso, TX Health Coach Clinic, n.d.).
• A personalized nutrition plan, guided by lab work, addresses deficiencies and supports overall health, complementing chiropractic care.

5. Health Coaching and Patient Education

• Health coaching offers ongoing support to help patients adopt lifestyle changes, such as a balanced diet, regular exercise, and stress management, which are essential for achieving long-term relief from back pain (El Paso, TX Health Coach Clinic, n.d.).
• Educating patients about their condition and self-care strategies reduces fear-avoidant behaviors and improves treatment adherence (Alrwaily et al., 2019).

Specialized Care for Motor Vehicle Accident (MVA) Injuries

Motor vehicle accidents (MVAs) can cause a range of musculoskeletal injuries, from whiplash-associated disorders (WAD) to spinal misalignments and soft tissue damage. A functional medicine approach, combined with chiropractic care, addresses these injuries by:

• Treating Whiplash: Whiplash involves rapid neck movement that strains muscles and ligaments. Chiropractic adjustments and soft tissue therapies restore alignment and reduce pain.
• Rehabilitating Spinal Injuries: SMT corrects misalignments caused by collision forces, while targeted exercises strengthen supporting muscles.
• Integrating Nutritional Support: Anti-inflammatory diets and supplements support tissue repair, particularly for soft tissue injuries sustained in MVAs (El Paso, TX Health Coach Clinic, n.d.).

Preventing Long-Term Problems

Preventing chronic back pain and long-term disability requires a proactive, integrative approach. Chiropractic care and functional medicine contribute by:

• Promoting Natural Healing: Techniques like SMT, exercise, and nutrition enhance the body’s ability to heal without invasive procedures or medications (Gevers-Montoro et al., 2021).
• Addressing Root Causes: Correcting musculoskeletal imbalances, improving posture, and addressing lifestyle factors reduce the likelihood of recurrence (Personal Injury Doctor Group, 2017).
• Empowering Patients: Health coaching and education empower patients to take control of their health, reducing reliance on passive treatments and fostering self-management (El Paso, TX Health Coach Clinic, n.d.).
• Tailoring Treatment to Risk Factors: Identifying patients with risk factors like low work ability or recent specialist consultations allows for customized interventions to improve prognosis (Petrozzi et al., 2020).

Challenges and Future Directions

While chiropractic care and functional medicine are effective for many patients, challenges remain:

• Limited Evidence on Efficacy: The efficacy of SMT compared to placebo or no treatment is uncertain due to low-quality evidence, highlighting the need for further research (Gevers-Montoro et al., 2021).
• Individual Variability: Not all patients respond equally to chiropractic care, and factors like psychological distress or comorbidities can influence outcomes (Pinheiro et al., 2016).
• Access to Care: Ensuring access to qualified chiropractors and functional medicine practitioners is essential for widespread adoption of these treatments.

Future research should focus on identifying predictors of treatment success, optimizing multimodal approaches, and clarifying the specific effects of SMT and functional medicine interventions to validate their role in back pain management (Gevers-Montoro et al., 2021).

Conclusion

Back pain is a complex condition with physical, lifestyle, and psychological contributors, but nonsurgical treatments like chiropractic care, spinal manipulation, and functional medicine offer effective solutions. Chiropractic care addresses the musculoskeletal and neurological components of back pain through spinal manipulation, while functional medicine targets root causes through nutrition, health coaching, and integrative therapies. By combining these approaches with targeted exercises, massage, acupuncture, and patient education, individuals can achieve lasting relief and prevent long-term issues. This holistic, patient-centered approach empowers patients to take control of their health and promotes natural healing for a better quality of life.

References

• Alrwaily, M., Timko, M., Schneider, M., Stevans, J., Bise, C., Hariharan, K., & Delitto, A. (2019). Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: A randomized controlled trial. Brazilian Journal of Physical Therapy, 23(6), 506–515. doi.org/10.1016/j.bjpt.2018.10.003
• Borenstein, D. G. (2001). Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Current Opinion in Rheumatology, 13(2), 128–134. doi.org/10.1097/00002281-200103000-00006
• El Paso, TX Health Coach Clinic. (n.d.). Functional medicine and wellness. Retrieved September 16, 2025, from healthcoach.clinic/
• Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical effectiveness and efficacy of chiropractic spinal manipulation for spine pain. Frontiers in Pain Research, 2, 765921. doi.org/10.3389/fpain.2021.765921
• Lis, A. M., Black, K. M., Korn, H., & Nordin, M. (2015). Association between sitting and occupational LBP. European Spine Journal, 26(2), 49–54. pubmed.ncbi.nlm.nih.gov/16736200/
• Personal Injury Doctor Group. (2017, April 4). The connection between chiropractic spinal manipulation. Retrieved September 16, 2025, from personalinjurydoctorgroup.com/2017/04/04/the-connection-between-chiropractic-spinal-manipulation/
• Petrozzi, M. J., Rubinstein, S. M., Ferreira, P. H., Leaver, A., & Mackey, M. G. (2020). Predictors of low back disability in chiropractic and physical therapy settings. Chiropractic & Manual Therapies, 28(1), 41. doi.org/10.1186/s12998-020-00328-3
• Pinheiro, M. B., Ferreira, M. L., Refshauge, K., Maher, C. G., Ordoñana, J. R., Andrade, T. B., … Ferreira, P. H. (2016). Symptoms of depression as a prognostic factor for low back pain: A systematic review. The Spine Journal, 16(1), 105–116. pubmed.ncbi.nlm.nih.gov/26523965/
• Von Korff, M., Deyo, R. A., Cherkin, D., & Barlow, W. (1996). The course of back pain in primary care. Spine, 21(24), 2833–2837. doi.org/10.1097/00007632-199612150-00004