In simple terms, chronic low back pain is pain affecting the lumbar spine region that lasts
longer than three months. However, chronic low back pain is not simply acute (new) low back pain
that has failed to resolve. Rather, it often reflects an overlap of two or even three distinct pain
mechanisms, each of which may need to be addressed to achieve an optimal outcome: nociceptive,
neuropathic, and nociplastic pain.
Nociceptive low back pain arises from injury or irritation of non-neural tissues, including
muscles, ligaments, tendons, and joints. This type of pain is typically localized and may feel achy,
throbbing, or sharp with movement or certain positions. During a physical examination, a doctor of
chiropractic can often reproduce symptoms with palpation or specific movements. The term nonspecific low back pain is commonly used to describe pain that is predominantly nociceptive in
nature.
Neuropathic low back pain is caused by damage or disease affecting the nervous system
itself. In the context of chronic low back pain, this is most often associated with disk herniation
compressing a nerve root, degenerative changes (such as arthritis) narrowing the spaces through
which nerves travel, or postsurgical nerve injury. This form of pain is commonly described as
burning, shooting, or electric and often radiates along the course of the affected nerve. Patients may
also experience non-painful neurological symptoms, including numbness, tingling, weakness, or
altered reflexes.
Nociplastic low back pain typically develops over time in response to an initial injury or
episode of pain. This pain is characterized by altered pain processing within the nervous system and
is often associated with widespread or shifting pain patterns, heightened pain intensity, and increased
sensitivity to touch or movement. Patients with nociplastic low back pain may restrict movement and
daily activities out of fear of worsening their condition (kinesiophobia), describe pain in amplified or
distressing terms, feel poorly equipped to manage their symptoms, and commonly report poor sleep
and elevated stress. Coexisting conditions such as headaches, irritable bowel syndrome, or
fibromyalgia are also more prevalent in this population.
Because chronic low back pain often includes a combination of nociceptive, neuropathic, and
nociplastic components, treatment approaches must be individualized. A multimodal care plan may
include manual therapies, targeted exercises, physical modalities, and anti-inflammatory strategies
aimed at restoring normal motion and function to affected nerves, joints, muscles, tendons, and
ligaments. In addition, chiropractors may employ pain education and graded activity exposure to
address nociplastic factors and help patients regain confidence in movement. When appropriate,
referral to a medical physician or specialist may also be indicated—all with the goal of helping the
patient return to normal activities of daily living in the safest and most pain-free manner possible.
The Pain Mechanisms of Chronic Low Back Pain
4 MarExcessive Smartphone Use Can Be a Pain in the Neck
18 FebSince their introduction and rapid adoption in the mid-2000s, smartphones have become an
integral part of daily life—not only by consolidating multiple technologies into a single device, but
also by helping us stay connected with family, friends, clients, and colleagues. However, alongside
these benefits, a growing body of evidence points to significant downsides. Excessive smartphone
use has been linked to poorer mental health—particularly among teens and young adults—and may
also negatively affect physical health.
Most notably, smartphone use typically involves prolonged downward gaze. While this
posture may seem harmless at first, over time the body adapts by rounding the shoulders and shifting
the head forward from its normal centerline. Beyond its impact on physical appearance, forward head
posture places increased strain on the muscles and tendons of the neck and upper back that work to
support the head. This pattern has been colloquially referred to as “tech neck” or “text neck.” In
addition to neck pain, forward head posture may increase the risk of headaches as well as pain in the
thoracic and lumbar regions of the spine. Moreover, screen time is often sedentary time, and
excessive device use is associated with prolonged sitting and reduced physical activity—factors that
can elevate overall chronic disease risk.
A 2017 study found that smartphone use tends to peak during young adulthood, with
approximately 1 in 5 university students meeting criteria for smartphone addiction—defined as a
pattern of compulsive smartphone use marked by loss of control, psychological distress when use is
restricted, and continued use despite negative impacts on daily functioning, relationships, or health.
Women were found to be at greater risk than men. In addition, up to half of young adults exhibit
problematic smartphone-related behaviors, suggesting that these devices exert a substantial influence
on this population.
To help curb excessive smartphone use, consider the following strategies: turn off nonessential notifications; establish phone-free times (such as before bed) and keep the phone in another
room to reduce temptation; avoid bringing the phone into the restroom; use “Do Not Disturb” mode
during focused tasks; install third-party apps to track and limit daily screen time; delete time-wasting
apps; rediscover hobbies to fill leisure time; keep a paper book on hand for passive commutes or
waiting periods; and tell friends and family about your goals so they can provide accountability and
support.
Finally, if you are experiencing chronic spinal pain related to prolonged smartphone use,
consider consulting a doctor of chiropractic. Chiropractors can provide in-office care to help reduce
pain and disability, as well as prescribe simple exercises and posture strategies that can be performed
between visits to help restore healthy spinal alignment.
Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888
The Neck and Low Back Connection
15 JanWhen a patient seeks chiropractic care for a condition like neck pain or low back pain, it’s natural to assume the underlying cause is located in the region where the patient feels symptoms. But this isn’t always the case. Sometimes, the primary or contributing factor to the patient’s chief complaint can be elsewhere in the body. A July 2024 study involving patients with cervical myelopathy helps illustrate this point.
Cervical myelopathy is a condition in which the spinal canal narrows due to a variety of potential causes—age-related degeneration, cervical spinal stenosis, herniated disks, trauma, rheumatoid arthritis, ossification of the posterior longitudinal ligament, or even tumors, infections, or congenital narrowing—and compresses the spinal cord. While neck pain is common, irritation of the spinal cord can produce downstream effects in the areas those nerve fibers reach. In this study, which involved 786 individuals with cervical myelopathy, two-thirds also reported low back pain.
Following treatment for cervical myelopathy, about half of those with concurrent low back pain experienced meaningful improvement in both lower back pain and function, and some even reported complete resolution. This suggests that for roughly half of these patients, the issue in their neck was a major contributing factor to their low back symptoms.
Beyond cervical myelopathy itself, several soft-tissue systems span the entire spine—including fascia, long spinal muscles, and ligamentous structures—making it possible for restrictions or dysfunction in the upper spine to influence symptoms in the lower spine. The reverse is also true: issues affecting the feet, ankles, knees, hips, or low back can lead to compensatory postural changes that place additional strain on the neck as the body works to keep the eyes level.
This helps underscore the importance of evaluating the whole patient rather than narrowing attention to the immediate area of complaint—something doctors of chiropractic are trained to do. The good news is that the hands-on care chiropractors provide can often help resolve these contributing issues, and when necessary, your doctor of chiropractic will coordinate with allied healthcare providers to support the best possible outcome.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Conservative Treatment for Hip Bursitis
12 JanHip bursitis most often refers to trochanteric bursitis, an inflammation of the trochanteric bursa, a small fluid-filled sac located on the outer side of the hip. The primary symptom is pain on the outside of the hip near the greater trochanter—the bony bump at the top of the femur. The pain may be sharp, dull, or throbbing and often worsens with activities that load the hip, such as walking, climbing stairs, or lying on the affected side. Other possible symptoms include swelling and tenderness around the hip, redness (less common), difficulty walking or running, and limping. What role can chiropractic play in managing this condition?
While hip bursitis can result from direct trauma, infection, or complications following hip surgery—which are red flags requiring medical or emergency evaluation—the majority of cases are musculoskeletal in nature and can be managed conservatively. Common contributors include overuse or repetitive stress (friction between the iliotibial band and the greater trochanter), biomechanical abnormalities that alter gait mechanics, prolonged pressure on the hip from poor sitting posture, lumbar spine or sacroiliac joint dysfunction, or tight/overactive musculature that increases tension on the iliotibial band and irritates the bursa. Many of these factors overlap and can work together to inflame the hip bursa.
When a patient presents for chiropractic evaluation, the chiropractor will assess for postural and biomechanical changes beginning with the feet, as excessive pronation, flat feet, knee valgus (“knocking in”), and pelvic imbalance can contribute to functional leg-length differences—one of the factors associated with hip bursitis. The exam typically includes orthopedic tests to assess hip range of motion and pain provocation patterns. Imaging such as X-ray or MRI may be ordered when needed to exclude other pathology.
Short-term management focuses on reducing inflammation through rest, activity modification, and sometimes dietary changes or supplements with anti-inflammatory properties. Applying an ice pack for 15–20 minutes or performing brief ice massage (3–4 minutes) can help reduce pain and swelling. The main treatment goal is to correct the underlying mechanical issues irritating the bursa. This may involve manual therapy to improve mobility in the hip and related joints, targeted stretching and strengthening exercises to address muscle imbalances, and even a heel lift to reduce leg-length inequality, if needed. Because hip bursitis has multiple contributing factors, the specific treatment plan is individualized for each patient. If a patient does not respond to conservative care, they may be referred to their medical physician or a specialist for further evaluation to determine whether more invasive options—such as corticosteroid or platelet-rich plasma injections, or in rare cases surgery—may be appropriate.
As with many conditions, prevention is key. Maintaining a healthy weight, following an anti-inflammatory diet, stretching the hip muscles regularly, using proper posture and movement strategies during daily activities, keeping the core strong, and staying physically active all support hip health. Periodic chiropractic checkups can also help identify biomechanical issues early—before they become painful or interfere with normal function.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Nocturnal Wrist Bracing for Carpal Tunnel Syndrome
8 JanCarpal tunnel syndrome occurs when pressure within the wrist restricts the function of the median nerve, leading to numbness, tingling, pain, and eventually weakness in the parts of the palm, thumb, index, middle and thumb-side of the ring finger. Management focuses on reducing pressure inside the carpal tunnel, which may include manual therapies, exercises, and activity modifications designed to decrease inflammation and help the tendons passing through the wrist glide more freely. In some cases, addressing hormonal or metabolic factors that contribute to inflammation, water retention, or impaired nerve health may also be necessary. One of the simplest and most effective strategies is using a wrist brace at night. But why is this so commonly recommended in clinical guidelines?
A key point is that the shape of the carpal tunnel is not fixed. The carpal bones form a concave arch, and the transverse carpal ligament forms the roof of the tunnel. When the wrist bends out of neutral alignment, the arch narrows and compresses the structures inside. These pressure increases are not subtle. A wrist positioned just 30 degrees into flexion or extension can triple pressure inside the carpal tunnel. At the extremes of flexion or extension, pressures can increase ten-fold. Even side-to-side wrist deviation can double or triple pressure on the median nerve and surrounding tendons. Not only does this directly stress the median nerve, but using the fingers while the wrist is bent causes the flexor tendons to generate heat and friction in a crowded space, which can promote inflammation and worsen symptoms.
During waking hours, we can consciously monitor our hand positions and adjust our activities to avoid these high-pressure postures. Overnight, however, this is impossible. Many patients with carpal tunnel syndrome experience sleep disturbances because their wrists naturally drift into prolonged flexion or extension while they sleep. A nocturnal wrist brace prevents this by keeping the wrist in a neutral, nerve-friendly position. Most braces look like a soft short arm cast that supports the wrist from the palm to the mid-forearm and prevents bending.
Wearing such a brace during the day would be impractical and could interfere with manual tasks—and continuous daytime bracing may even cause irritation where the ends of the brace contact the skin. For daily activity, other types of bracing and non-bracing options are more appropriate, such as ergonomic modifications for work tasks and using a soft, beanbag or memory-foam wrist support during computer use to reduce carpal tunnel pressure. However—and your chiropractor will likely emphasize this—over-reliance on bracing can hinder long-term recovery, as the muscles controlling the hand and fingers can weaken without regular use. That’s why it’s important to pair nighttime bracing with prescribed wrist exercises, frequent breaks, avoidance of extreme wrist postures, and healthy lifestyle habits that reduce systemic inflammation.
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA, 17055
The Evidence Map of Low Back Pain Treatment Options
5 JanLow back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
- Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
- Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
- Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
- Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
- Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
- Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
- Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
- Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
- Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.
The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!
Pain Relief Chiropractic
4909 Louise Drive Suite 102
Mechanicsburg, PA 17055
Pain Relief Chiropractic 