Welcome to Spine IQ’s Back Blog! This week we will engaging in a detailed discussion of a stepped process for chiropractic management of low back pain by “tying together” components from previous blogs into one helpful BACK FILE. To do so we will link to previous blogs and add new information. Our hope is that this will help new readers will discover our previous blogs, remind long time readers of previous blog topics and show you how this information can be pulled together to create a clear pathway for managing low back pain.

Process for management of low back pain

This stepped process for management of low back pain was created through consensus from Chiropractors working in the VA by Vining et al.1

  1. Perform an evidence-based assessment ( Vining et al2) as outlined in a December 19, 2021 blog post
    • Most importantly, conservative spine clinicians must screen for potential red flags that would indicate the ability to manage this patient in your office or to provide an appropriate referral. An international study on red flags was discussed in our December 17, 2021 blog and includes helpful reminders and referral considerations.
  2. After identifying that chiropractic care in your office is what is best for the patient, screening for yellow flags and other comorbid conditions that may impact, amplify, or influence prognosis is important
    • Our July 14, 2021 blog discusses yellow flag screening in terms of both the evidence and implementation
    • We know that patients are looking for help in understanding their pain experience and often view evaluation/assessment as a key part of the treatment process. Our September 1, 2021 blog discusses how reassurance and patient-centered dialogue can reduce pain intensity.
  3. Using a shared-decision making process is key to developing appropriate care pathways.
    • In our previous blogs we demonstrated care that is concordant with clinical practice guidelines leads to better patient outcomes
    • There are numerous evidence-based treatments approaches for spine care that could be discussed by the patient and clinician in order to ensure that the appropriate care is chosen from available guideline recommendations. This process was discussed in our February 2, 2022 blog
  4. Continuous monitoring and adjusting of the care plan is throughout the care continuim
    • Consistent with guideline recommendations, empowering patients to self-manage their pain and future flare-ups is an important goal that is desired by many patients. In our August 18, 2021 blog, we discussed tips and advice on how to work towards patient self-management with.
    • Guidelines also recommend that validated outcome measures are used to monitor patient symptoms. The how and why of implementing outcome measures in your clinic was outlined in our July 21, 2021 blog, which also includes tips on implementation.


We strive to make science and research easily accessible, understandable, and practical to the busy, hard-working clinician. We hope that this blog post achieves that goal. To our new readers: please take the time to read our previous blogs as they contain a wealth of information to help your everyday practice. To our long time readers: we hope that this blog brings together a wealth of information that, when used together, is helpful in your care of patients.


  1. Vining R, Shannon Z, Salsbury S, Corber L, Minkalis A, Goertz C. An evidence-based chiropractic clinical decision aid for managing low back pain: results of a consensus process study. J Manipulative Physiol Ther. 2019;42(9):677-693. doi:10.1016/j.jmpt.2019.03.009
  2. Vining RD, Minkalis AL, Shannon ZK, Twist EJ. Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain. J Manipulative Physiol Ther. 2019;42(9):665-676. doi:10.1016/j.jmpt.2019.08.003