Love Was (and remains) In the Air

Person with low back pain

If you have not already seen it, Annals of Internal Medicine gave you and I a very nice Valentine’s Day Gift. This past Tuesday, Annals published an updated Clinical Practice Guideline for Managing LBP from the American College of Physicians. (1) Among the recommendations: 

Implement spinal manipulation and postpone pharmacologic management.

“Recommendation 1: For most patients with acute or subacute low back pain, clinicians and patients should initially select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation.”



“Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.”

“Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

When assessing the potential harm of various treatments, the guideline concluded that the type of care administered by chiropractors (spinal manipulation, exercise, and massage) posed no serious threat and was associated with only transient “muscle soreness.”

The paper concluded: Clinicians should also provide patients with evidence-based information with regard to their expected course, advise them to remain active as tolerated, and provide information about effective self-care options (including exercise).

About the Authors: Drs. Bertelsman and Steele are co-founders of ChiroUp, a system designed to connect chiropractors to an online platform of exceptional evidence-based clinical and business resources that are simple to access and implement thus aiding clinical outcomes, patient satisfaction, and practice incomes.  Find out more about the authors or ChiroUp at


1. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. [Epub ahead of print 14 February 2017] doi: 10.7326/M16-2367

Editor’s Note: Bonus!  The Wall Street Journal mentioned chiropractic specifically in its analysis of the publication.

About Author

Tim Bertelsman, DC, DACO

Dr. Bertelsman graduated from Logan College of Chiropractic with honors in 1991 and has been running a large successful multi disciplinary practice in Belleville, IL for over 20 years. He is an expert on establishing relationships within the medical community.He has lectured nationally for many years on clinical and business topics and has been published extensively. He has served in various leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board. Dr. Bertelsman is a Co-founder of ChiroUp.


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