The Journal of the American Medical Association's latest paper on back pain states that chiropractic back pain patients in conjunction with their medical care experience more relief, less disability, and higher patient satisfaction when compared to medical care alone (1) with lower back pain treatment. You can read the summary of the study here. This study was done on members of the armed forces at Veteran's Administration facilities which have been gradually ramping up their utilization of doctors of chiropractic who work as employees within the VA system. Their findings are in line with many other previous studies that are showing that when chiropractic care is given full integration within the medical system and chiropractors are allowed to work as part of the medical team, lower back treatment becomes more effective, satisfaction improves and there is less disability which is costly to the system and to the lives of patients cared for by the system. These findings follow the paper in the Annals of Internal Medicine from February 2017 which showed that chiropractic methods were helpful, but hidden in their recommendation was the fact that movement was behind which treatments worked to safely relieve lower back problems. Chiropractic care is unique in that culturally, their practice is a holistic approach to movement using methods such as manipulation, exercise, active evaluation and soft tissue methods. While most healthcare professions address the symptoms including orthopedic's and physical therapy using protocol-based diagnosis and treatment and rely on medication to help reduce pain, the chiropractic approach tries to avoid medication if possible while enhancing the way people move and function. From an engineering perspective, movement problems require a holistic understanding of how things work. For example, if a person is having back pain, the causes may include the feet, an old injury, upper body problems, shoulder problems and core stability issues to name a few. By evaluating the person from the feet up, you will see visually mechanical adaptations that may be the reasons behind the pain the person is experiencing. While it is also important to rule out a disc problem, which is often a symptom of chronic malfunction of the musculoskeletal system that creates unnatural loading on the disc until it is damaged, it is more important especially with chronic back problems to understand the mechanism behind why they hurt. Medically, we are all taught to differentially diagnose and to follow treatment paths, but the newer developing methods of active evaluation and treat-test-treat protocols many sports chiropractors have adopted are more helpful since a thorough evaluation ultimately leads to better initial treatment and fewer expensive tests such as an MRI which are quite sensitive and may contain information that does not correlate with the symptoms the patient is having. An MRI will also lead to referrals to other more aggressive treatments, medication for symptoms, therapy that is protocol-driven, and not specific to the patient's actual reason behind their back pain, and ultimately much higher costs with poorer results and less patient satisfaction, a mainstay of this study. This also builds on the recommendations in Bottom Line Personal, Men's Health as well as Consumer Reports who have suggested that chiropractors will offer the best experience for a lower back problem. Combined with medical management who can offer medication if necessary, a patient's needs are better met when medical providers and primary spine providers (chiropractors) work together which is why that study shows. Whom should you see first for back pain or a sciatic pain problem? See your chiropractor first. If you see your primary doctor first, ask them to refer you to a local chiropractor. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain Comparative Effectiveness Clinical Trial JAMA Network Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105 Christine M. Goertz, DC, PhD; Cynthia R. Long, PhD; Robert D. Vining, DC; Katherine A. Pohlman, DC, MS; Joan Walter, JD, PA; Ian Coulter, PhD