Back pain care in Clarksville, starting with an exam that looks for the cause

Back pain is one of the most common reasons people see a doctor of any kind, and most of it comes from the joints, muscles and discs of the spine. That's what a chiropractor examines and treats. At Source Chiropractic in Clarksville, Dr. Jeff, Dr. Cindy and Dr. Ali see people with low back pain, a stiff or sore back, and back pain that runs into the hip or leg. Every plan starts with an exam that looks for where the pain is coming from.

What happens at your first visit for back pain?

Your first visit starts with a detailed history. You'll sit down with Dr. Jeff, Dr. Cindy or Dr. Ali and go over your health history, your symptoms, your concerns and your goals, such as sitting through a meeting, walking the dog, lifting at work or sleeping more comfortably. We'll ask how long you've had the pain, exactly where it is, if you've had it before, and what makes it better or worse.

Then comes a full evaluation, with full-spine X-rays when they're clinically appropriate. The exam looks at how the joints of your spine move, where muscles are tight or swollen, and for signs of an irritated nerve. That means range of motion, strength, sensation and reflexes, and when pain travels into the leg, tests such as a straight-leg raise. You'll hear what we found before we recommend anything, and the plan is built around your condition and those goals.

The new-patient chiropractic offer has its own terms.

What care do we use for back pain?

Care for back pain here includes the chiropractic adjustment. An adjustment is a controlled force applied to a specific joint of the spine, usually by hand, aimed at a joint that isn't moving well. Many people hear a pop, which comes from gas in the joint fluid, not from bone moving against bone.

Depending on what the exam finds, the plan may add:

• Spinal decompression when the exam points to a disc, especially with pain running into the leg. That page also goes through what its research shows.
• Dry needling for tight bands and trigger points in the back and hip muscles.
• Class IV laser therapy for muscle and joint pain and stiffness in the low back.
• Rehab exercises to build strength and movement back up, so the work carries on between visits.

A licensed massage therapist also works out of our office, and we'll put you in touch when soft-tissue work fits.

What the research shows about chiropractic care for low back pain

Spinal manipulation, the technique behind a chiropractic adjustment, has been tested in dozens of randomized trials for low back pain, and the major reviews and guidelines include it:

• New back pain (six weeks or less). A 2017 review of 26 trials in JAMA found spinal manipulation was associated with modest improvements in pain and function at up to six weeks, rating the evidence moderate in quality.
• Recent back pain at higher risk of lasting. PACBACK, a 1,000-person trial, tested self-management coached by physical therapists and chiropractors, exercise included, alongside spinal manipulation and medical care. Jeffrey T. Morrey, D.C., walks through the PACBACK trial and what it found.
• Back pain that has lasted three months or more. A 2019 review of 47 trials with 9,211 people in The BMJ found moderate-quality evidence that spinal manipulation and mobilisation had similar effects to other recommended therapies for short-term pain relief in chronic low back pain, and a small, clinically meaningful edge over them in function. It also seemed better than non-recommended treatments for function in the short term.
• Clinical guidelines. The American College of Physicians notes that most recent back pain improves over time whatever the treatment, and lists spinal manipulation among the non-drug treatments it recommends for both recent and chronic low back pain, alongside options such as heat and massage for recent pain and exercise for chronic pain, and rates the evidence for manipulation low in quality. NICE, which writes the clinical guidelines for England's NHS, says to consider manual therapy, including spinal manipulation, only as part of a treatment package that includes exercise.

The benefits in these reviews are modest on average and vary a lot from trial to trial, and they describe groups of people rather than predicting your own result.

Is chiropractic care for back pain safe?

The most common side effects are short-lived. In the large case series the 2017 JAMA review looked at, more than half of patients reported minor, temporary effects such as increased pain, muscle stiffness or headache, and none of its trials reported a serious adverse event. Serious events after spinal manipulation are reported rarely, but there's no systematic reporting system for them, so published counts show what's been written up and the true rate isn't known.

Your history and paperwork are part of how we check for any reason an adjustment, or another treatment, isn't right for you before we start.

Other options for back pain

Exercise is a well-supported option. A Cochrane review found that exercise probably improves pain in chronic low back pain compared with no treatment, usual care or placebo, and NICE puts staying active and exercise first. Medicines can ease pain enough to keep moving, physical therapy adds supervised exercise, and for the few people whose pain is driven by something a surgeon needs to see, a surgical assessment answers that. Adjustments are often combined with exercise, and we'll go over the options that fit you at your exam.

When is back pain an emergency?

Most back pain isn't urgent. These are the exceptions.

Seek emergency care now (call 911 or go to an emergency room), not an appointment with us, if back pain comes with any of the following:

• any new change in bladder function: difficulty starting or stopping the stream, difficulty emptying, not being able to urinate, not feeling the need to go, or leaking without knowing it
• loss of control of your bowels, or any new numbness in the area that would contact a saddle
• new loss of sexual function
• weakness in one or both legs that is getting worse
• sudden severe tearing pain in the back or abdomen, particularly if you are older or have a known aneurysm

Don't wait for these to become obvious. Early bladder changes are easy to explain away. They can signal pressure on the nerves, and when they do, how quickly you're assessed is what matters.

Get a prompt medical assessment instead of starting manual care if you have:

• fever alongside back pain, or back pain following a recent infection or procedure
• a weakened immune system, injecting drug use, or a long course of steroids, each of which raises the risk of spinal infection
• back pain after a fall or collision, and after even a minor injury if you have osteoporosis or are older
• a history of cancer, unexplained weight loss, or pain that is worse at night and does not ease with a change of position

None of these is a reason to panic. Each one is a reason to see the right person first, and if you mention one to us, that's exactly what we'll tell you.

Could your back pain be coming from somewhere else?

Some pain that feels like back pain doesn't come from the muscles and joints at all. Kidney stones and urinary tract infections are the common examples: both can cause pain in the flank or lower back. Stone pain is often described as coming in waves, and a urinary infection often brings burning when you urinate, or needing to go more often. Blood in the urine, and especially fever or chills with pain in the flank, need a prompt medical assessment.

We don't treat kidney stones or urinary tract infections. Part of examining anyone with back pain is working out if the problem looks like a muscle-and-joint one, and when it doesn't, we'll refer you for a medical evaluation.

What causes most back pain?

A bulging or herniated disc. The discs between your vertebrae have a tough outer ring and a softer center. A bulging disc spreads broadly past its normal edge. A herniated disc is one where disc material has pushed out through the outer ring. They are different findings, and the words aren't interchangeable. Either one may press on a nerve root, and then pain can travel into the buttock and leg, sometimes with pins and needles or numbness. Our disc injury page goes into more detail.

Restricted spinal joints. When chiropractors say subluxation, they generally mean a perceived dysfunction in a spinal motion segment: a joint in the spine that isn't moving well. Medical doctors use the same word differently, closer to a partial dislocation, and practitioners don't all use it the same way either, so it can mean something different depending on where you read it.

Sprains and strains. Ligament sprains and muscle or tendon strains usually happen during something unfamiliar, or a lift with a twist in it. Pain, swelling and bruising are typical. For uncomplicated acute low back pain, clinical guidelines encourage staying as active as you can manage and advise against bed rest. How long recovery takes varies a lot from one person to the next.

Muscle tension that comes with stress. Long stretches of stress tend to go along with long stretches of muscle tension, often across the upper back and neck, and tender spots in tight bands of muscle are a common exam finding. The stress behind that tension is a problem of its own, and knowing about it helps us read what the exam finds.

Do you need an X-ray or MRI for back pain?

Not automatically. For an uncomplicated episode, NICE recommends against routine imaging in a non-specialist setting, with specialist imaging considered only when the result is likely to change management. A scan finding doesn't, on its own, show what's causing your pain. Bulges and herniations turn up on scans of people with no back pain at all, which is why imaging has to be read against the exam. At our office, X-rays are part of the first visit when they're clinically appropriate, and they're read alongside what the exam shows.

Book a visit

If your back has been stiff, sore or painful and none of the warning signs above fit, a first visit in Clarksville is where we start working out what's behind it. We'll tell you what we find, including when what we find isn't something we treat. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider. Book online or contact us.