Low Back Pain: Chiropractic Adjustments vs. Muscle Relaxants

Low back pain is one of the most common maladies
among the general population and the incidence of
occurrence was reported
by Ghaffari, Alipour, Farshad, Yensen, and Vingard (200
6) to be between 15% and 45% yearly. Hoiriis et al.
(2004) reported it to be between 75% and 85% over an
adult lifetime in the United States. Chou (2010) writes
that, "Back pain is also the fifth most common reason for
office visits in the US, and the second most common
symptomatic reason…" (p. 388). Historically and based
upon this authors 3+ decades of treating low back pain
with treatment options that range from heating pads, ice
packs, over-the-counter drugs, prescription drugs,
surgery, acupuncture and beyond, the most important
questions are, "What works? What's proven and what
has the best results with the least side effects allowing
the patient to regain a normal lifestyle as quickly as

Muscle relaxers are a common drug that has been
prescribed by medical doctors for years for nonspecific
low back pain. According to Chou (2010), " The term
‘skeletal muscle relaxants’ refers to a diverse collection
of pharmacologically unrelated medications, grouped
together because they are approved by regulatory
agencies for treatment of spasticity or for
musculoskeletal conditions such as tension headache or
back pain." They are drugs that has been long studied
and the effects and side effects have been well
documented. Van Tudlar, Touray, Furlan, Solway,
and Bouter (2003) concluded that, "Muscle relaxants are
effective in the management of nonspecific low back
pain, but the adverse effects require that they be used
with caution"(p. 1978).
Chou (2010) also stated that, "Skeletal muscle relaxants
are an option for acute nonspecific low back pain,
although not recommended as first-line therapy because
of a high prevalence of adverse effects" (p. 397). He
reported that muscle relaxants had a moderate success
rate defined by a 1-2 decrease in pain scales rated out of
10. Simply put, if a patient had a pain scale of 9, one
could expect the muscle relaxers prescribed to bring the
pain to an 8 or 7 at best and include all of the side
effects. According to Drugs.com, side effects of muscle
relaxants include:
          More common

          Blurred or double vision or any change in vision;
dizziness or lightheadedness; drowsiness
          Less common
          Fainting; fast heartbeat; fever; hive-like swellings
(large) on face, eyelids, mouth, lips, and/or tongue;
mental depression;  shortness of breath, troubled
breathing, tightness in chest, and/or wheezing; skin rash,
hives, itching, or redness; slow heartbeat
(methocarbamol injection only); stinging or burning of
eyes; stuffy nose and red or bloodshot eyes
          Less common or rare
          Abdominal or stomach cramps or pain; clumsiness
or unsteadiness; confusion; constipation; diarrhea;
excitement, nervousness,   restlessness, or irritability;
flushing or redness of face; headache; heartburn;
hiccups; muscle weakness; nausea or vomiting; pain or
peeling of skin at place of injection
(methocarbamol only); trembling; trouble in sleeping;
uncontrolled movements of eyes
(methocarbamolinjection only)
          Blood in urine; bloody or black, tarry stools;
convulsions (seizures) (methocarbamol injection only);
cough or hoarseness; fast or irregular breathing; lower
back or side pain; muscle cramps or pain (not present
before treatment or more painful than before treatment);

painful or difficult urination; pain, tenderness, heat,
redness, or swelling over a blood vessel (vein) in arm or
leg (methocarbamol injection only); pinpoint red spots on
skin; puffiness or swelling of the eyelids or around the
eyes; sores, ulcers, or white spots on lips or in mouth;
sore throat and fever with or without chills; swollen
and/or painful glands; unusual bruising or bleeding;
unusual tiredness or weakness; vomiting of blood or
material that looks like coffee grounds; yellow eyes or
skin (http://www.drugs.com/cons/skeletal-muscle-
When comparing chiropractic spinal adjustments to
muscle relaxants for low back pain, it first must be
clarified that we are not discussing physical therapy or
osteopathic manipulation. While different specialists
render tremendous benefits to patients specific to
various diagnoses, this research review is limited to a
chiropractic spinal adjustment.
Wilkey, Gregory, Byfield, & McCarthy (2008) studied
randomized clinical trials comparing chiropractic care to
medical care in a pain clinic. "The treatment regimens
employed by the pain clinic in this study consisted of
standard pharmaceutical therapy (nonsteroidal anti-
inflammatory drugs, analgesics, and gabapentin), facet
joint injection, and soft-tissue
injection. Transcutaneous electrical nerve stimulation
(TENS) machines were also employed. These modalities
were used in isolation or in combination with any of the
other treatments. Chiropractic group subjects followed an

equally unrestricted and normal clinical treatment
regimens for the treatment of [chronic low back pain]
were followed. All techniques that were employed are
recognized within the chiropractic profession as methods
used for the treatment of [low back pain]. Many of the
methods used are common to other manual therapy
professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals
based on the raw scores showed improvement was 1.99
for medicine and 9.03 for the chiropractic group. This
research indicates that chiropractic is 457% more
effective than medicine for chronic low back pain.
Within that group of 457% falls patients cared for by
muscle relaxants.
Hoiriis et al. (2004) reported in their raw data that the
chiropractic groups responded 24% better in reducing
pain and concluded that, "Statistically, the chiropractic
group responded significantly better than the control
group with respect to a decrease in pain scores" (p.
396). This was done in "blinded, randomized clinical
trials [which] are considered the gold standard of
experimental design" (Hoiriis et al., 2004, p. 396).
1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I.,
& Vingard, E.(2006).Incidence and recurrence of

disabling low back pain and neck-shoulder pain. Spine,
31(21), 2500-2506.
2. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis,
G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A
randomized clinical trial comparing chiropractic
adjustments to muscle relaxants for subacute low back
pain. Journal of Manipulative and Physiological
Therapeutics, 27(6), 388-398.
3. Chou, R. (2010). Pharmacological management of low
back pain. Drugs, 70(4) 387-402.
4. van Tudlar, M. W., Touray, T., Furlan, A. D., Solway,
S., & Bouter, L. M. (2003). Muscle relaxants for
nonspecific low back pain: A systematic review within the
framework of the cochrane collaboration. Spine, 28(17),
5. Drugs.com, (2004). Skeletal muscle relaxants
(systemic). Retrieved
6. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P.
W. (2008). A comparison between chiropractic
management and pain clinic management for chronic
low-back pain in a national health service outpatient
clinic. The Journal of Alternative and Complementary
Medicine, 14(5), 465-473.