The majority of low back pain cases are classified as non-specific in nature, meaning they
are not attributable to an identifiable, single structural cause such as a fracture, infection, tumor,
or nerve compression. But, in roughly 5–10% of cases, the cause of localized pain in the lower
back can be linked to injury to the intervertebral disks—which sit between each of the lumbar
vertebrae and function as shock absorbers while facilitating spinal movement. If a nearby nerve
root is affected, the patient may experience symptoms that radiate along the course of the nerve
into the leg. What role, if any, can chiropractic play in managing lumbar disk–related low back
pain?
When a patient presents with low back pain, the chiropractor evaluates specific patterns
to determine whether a disk lesion may be contributing to the patient’s symptoms. Disk-related
pain is more likely when symptoms worsen with sitting, bending, leaning forward, or lifting, and
improve with standing, walking, or extension-based movements. Pain may be centralized in the
low back or refer into the buttock or thigh. In some cases, symptoms can extend further down the
leg. A particularly important clinical finding is centralization, where pain that radiates into the
leg moves back toward the spine during repeated movements.
In contrast, findings such as localized tenderness, pain primarily with extension and
rotation, no change in symptoms with repeated movement, or pain unaffected by loading patterns
suggest that a disk may not be the primary pain generator. Advanced imaging is typically not
recommended as an initial step in the diagnostic process. This is because a significant portion of
middle-aged adults have disk abnormalities visible on MRI that are often asymptomatic, and
treating these findings may not benefit the patient. Imaging is more appropriately reserved for
cases involving red flags such as progressive neurological deficits, bowel or bladder dysfunction,
or suspicion of serious pathology such as cancer, infection, or fracture.
The goal of treatment is to reduce mechanical stress on the affected disk and surrounding
structures, particularly when herniation is irritating nearby nerve roots, allowing the condition to
improve over time. Doctors of chiropractic often use a multimodal approach that may include
spinal manipulation or mobilization, soft tissue therapies, physiotherapy modalities, traction,
therapeutic exercise, and postural education. Patients who continue to experience significant
symptoms after 6–12 weeks may be referred for further evaluation. Fortunately, the prognosis is
favorable. Studies show that more than 4 in 5 cases of lumbar disk herniation improve with
conservative care and do not require surgery.
Brent Binder, D.C.
4909 Louise Dr. Suite 102
Mechanicsburg, PA 17055 (717) 697-1888
Pain Relief Chiropractic 
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