Low back pain (LBP) is a common health  problem among the elderly, affecting up to 90% of the over 65  population, and accounting for nearly $1 billion per year in Medicare  payments alone. By far the greatest single cause of low back pain in the  elderly is mechanical derangements occurring within the confines of the  lumbar spine as a consequence of chronic degenerative joint disease  which, in itself, is often painless and of little or no clinical  significance. Most of these cases (many of whom are presently being  unsuccessfully treated in medical clinics and/or hospitals) would quite  likely respond very well to routine office-based conservative  chiropractic care. However, insofar as there is no conclusive data to  support any particular method of chiropractic treatment for these cases,  nor has there been any standardized procedures established by which  such data might be collected for analysis, the issue is problematic  inasmuch as most chiropractic physicians have had little training in  clinical research methodology. Therefore, a “practitioner scientist”  protocol was developed whereby selected office-based chiropractic  physicians would collect the necessary data and provide treatment  according to specified procedures under the direction of an experienced  clinical researcher. Basic inclusion/exclusion criteria were chosen for a  standardized approach to the diagnosis of mechanical low back pain in  the elderly and its treatment by conservative chiropractic technics.

Inclusion criteria are as follows:

  1. Age: 65 and over
  2. Present episode of LBP greater than three months duration
  3. Greater than 20 percent Modified Oswestry disability score (MODS)
  4. Primary pain localized to the lumbar spine (L1-S1)
  5. No prior chiropractic or medical treatment for present episode of LBP
  6. No radicular or neurological symptoms
  7. Any three of the following positive orthopedic tests:
    1. Kemp’s test (include only if it increased lumbar pain)
    2. Adam’s and supported Adam’s test (both equally cause pain in the lumbar spine)
    3. Goldthwait’s test (evokes lumbar pain or makes it worse, does not increase radiation of pain into the leg)
    4. Hyperextension test
    5. Pain evoked on spinous process percussion which seated patient’s lumbar spine is flexed


    Exclusion criteria are as follows:

    1. History of serious medical illness
    2. Psychological disturbances
    3. Recent trauma (major bruises; fractures; auto accidents; etc.)
    4. Leg or buttock pain of suspected neurological involvement
    5. Obesity
    6. Anomalies such as spondylolisthesis
    7. Uncertain diagnosis
    8. referred pain of viscero-somatic origin
    9. Change in diagnosis; new symptoms; deteriorating health while study is underway
    10. More than two weeks of missed appointments

    Reference: Paul J. Osterbauer, DC, Tom DeVita, DC,  Arlan W. Fuhr, DC. Proceedings of the FCER’s Third Annual International Conference on  Spinal Manipulation. Washington. D.C., April 12-13. 1991. pp. 230-1.