I just spent the better part of the last 45 minutes listening to a Mayo Clinic presentation about the “current” Clinical Guidelines Concerning Low Back Pain.

The presenter was Dr. Ralph E. Gay, M.D., M.S., Mayo Clinic Associate Professor of PM&R, and he lectured on what his conclusions are about diagnosis, treatment and proper care protocols for patients suffering from low back pain.

Here is the video:

Let me save you the 45 minutes of having to watch this and have you fast forward to the 24:12 mark and he will give you his sentiments in just under one minute.

After watching the entire presentation it is in my conclusion that the medical community (as pertains to this video) does NOT have a clue on how to manage and care for the patient with low back pain. Their answer to patient management (see image below) is to prescribe copious amounts of medication (which potentially could be toxic to the patient), tell them to walk and then suggest that it could be a long time before their back pain feels better. Are you serious? Is this really the best answer that we as doctors can provide for those people who are suffering?


In my opinion if this was a Chiropractor giving this lecture he/she would surely have been burned at the stake for giving such a presentation.

Now, I will say that this presentation was more about how to assess patient outcomes than management protocols. However, it is still named; “Clinical Practice Guidelines for Low Back Pain

At the end of the presentation Dr. Gay opens for audience questions and is asked, “Are you saying that the patient may be better off not even coming into the office, if all we are going to do is prescribed Tylenol and exercise?”…. and Dr. Gay agreed!  He went on to say that most patients with low back pain should mainly be seen by a PA or nurse practitioner, as if it is not even worth the doctors time.


Apart from being completely blown away by a Mayo Clinic Professor getting on stage and giving a presentation that basically states that they have no understanding or care protocol for low back pain, I am more saddened by the thought of the thousands if not millions of people whom have never heard of alternatives, like Chiropractic care, due to medical negligence of presentations like this happening around the world.


I am disheartened that people, even Mayo Clinic Professors, are not aware of what the Chiropractic profession and Chiropractic manipulation can do to help people suffering with musculoskeletal pain including low back pain. I am more in shock to see that Dr. Gay lists manual medicine/manipulation as one of his interests on his bio.

Let me be so kind as to say, “In this entire presentation Dr. Gay  I believe you missed out on the most important thing concerning the low back pain patient.”

The reason that it may “take a long time” for a patient to feel better is not because they didn’t take their medication or exercise enough.  You failed to understand the correlation between structure and function.  The body innately is functioning poorly (hence the pain, decreased range of motion, decline in ADL’s) because structurally they are misaligned.  The only thing that medication will do is mask the symptoms (pain) and not addressing the CAUSE (dysfunction in the spine/pelvis) will lead to further and further functional issues.

No matter how much you “treat” the problem with drugs,  you are only treating the SYMPTOMS!

back1Lets break it down a little more:  Say a patient walks in to your office with a dislocated shoulder, what do you do?  Prescribe medications and send them to the PA down the hall?  No!  You reduce that shoulder and then set up protocols for rehab, exercise, nutrition, and home care.

Low back pain and/or other musculoskeletal pain is no different! You need to address the issue, (both structural and neural) and correct  the dysfunction (adjustment). Chiropractors are highly trained in detecting and caring for these types of cases.

Your answer during this whole presentation could have been; When any musculoskeletal patient that comes in and the attending doctor suspects it is a non-surgical case, a option should be presented that they be referred to a Chiropractor to be managed. If problems should persist or worsen then we can co-manage with the doctor and patient.

It has already been clearly demonstrated that Chiropractic care is better for low back pain than medication.

Dr. Gay I know that the information I just presented is not something that you may have considered, or a person of your stature would surely have mentioned it in your presentation.  But as a fellow colleague and someone who is also evidence based and research driven, I will fall back onto research to help further my point.

Here is a piece of research showing the decreased cost and utilization of medical services associated with Chiropractic care.

Another study concerning patients with low back pain and disc herniation that Chiropractors are effectively managing and lastly a piece of research about how incorporating Chiropractic in a “wellness environment” that is based on the contention that misalignments and/or abnormal motion of vertebral motion units may compromise neural integrity and may influence organ system function and general health and well-being.”

In conclusion, my reasons for writing this article are not to say poor things about the medical environment, but rather that people know that there are alternatives for people suffering with low back pain and that Chiropractors are more than ready, willing and able to handle these cases.

I understand that no profession is perfect, and what the great doctors in the medical world do to save lives is incredible, but what we as Chiropractors do with caring for low back pain and instilling the wellness paradigm that the body wants to be healthy should prove beneficial for all parties involved.