Why not everyone with low back pain chooses chiropractic care.

Introduction It has been estimated that low back pain (LBP) will affect 84% of the general adult population at some point in their life, with 49% reporting some LBP in the previous 6 months, 23% suffering from chronic LBP, and 11% experiencing physical impairment due to LBP.1,2 Numerous therapies are available for LBP from a variety of clinicians, including primary care providers (PCPs), pain management specialists, spine surgeons, physical therapists, and chiropractors. This vast array of therapies available for LBP was previously compared to a supermarket in which patients can wander down a particular aisle to choose among the many competing products and brands vying for their attention through marketing claims.3 Each clinician likely perceives that the care they offer for LBP is superior to the alternatives, and would like to believe that they hold the solution to the vast public health and economic problem presented by LBP. Chiropractors are probably no different in this regard, believing that nearly everyone with LBP would benefit from receiving spinal manipulation therapy (SMT). However, various surveys suggest that only 5-10% of adults in Canada and the United States visit a chiropractor in any given year.4-10 The goal of this commentary is to speculate about some of the reasons why not everyone with LBP chooses to seek chiropractic care, which are presented below as factors related to LBP, public perceptions about chiropractic, patient preferences, and the chiropractic profession.