Low back pain and smoking

Low back pain and smoking are strongly correlated.

Today I have something different. Every lover of cigarettes and pipes knows what they are doing to their bodies so I tell new patients once, and then hold my tongue.

This week, in stark contrast, we look at three patients from the clinic, one of whom I have not seen for 18 months.

  • First let us discuss the new patient; he is nearly 70 years old. He has routine LBP, but what caught my attention was that seven years ago he spontaneously decided to quit nearly fifty years of the weed. He is in amazingly good form. It was his decision with no bullying; he just wanted to enjoy his retirement, he exclaimed. It can be done. He responded remarkably quickly to half a dozen treatments and a set of exercises.
  • The second is a young woman with a small toddler; she has very severe LBP radiating down her leg.

She did not respond well to her doctor's pills. By the time she reached my clinic she had fifty percent numbness down the back of her thigh and calf, and Braggard's test was strongly positive in both legs at naught degrees. That is an ominous sign.

This page was last updated on 22nd February, 2020.

She improved nicely with chiropractic care for the first two weeks, reaching 60 percent better and then, for no obvious reason, had a setback. Now she has leg pain.

That disc just does not get enough oxygen to heal in smokers. And when you have a toddler, it is just plain difficult. Surgery is coming up methinks.

  • The third patient is also just seventy this year; she consulted me eighteen months ago with a painful shoulder. I have recently received this email.

"My wife has just been diagnosed with primary lung neoplasm which has metastasized to her spine, sternum, both shoulders and pelvis. The next medical appointment is in two days, and we expect the chemotherapy to start then. They are not sure about radiation yet. Meanwhile the pain the last two nights has been horrendous but with good days. She called the doctor, who has prescribed another pill, and will visit tomorrow.

About a year after we saw you she began to cough a lot; initially she had a chest x-ray, followed by a scan. In retrospect the shadow seen was misinterpreted; a followup three months later was conclusive."

A second email stated that the doctor increased her medication five times. That set her into morphine toxicity, and he thought he was losing her, but she recovered and now has much less pain.

Did I miss a tumour in the shoulder?

Or did that metastasis arrive much later? We will never know.

Low back pain and smoking

Low back pain and smoking is the largest factor in failed back surgery too.

Smoking is the greatest risk factor in lower back surgery. It is also huge in chiropractic care, though that is unresearched. Add to that another complication; the young woman also has a toddler, and you have grave difficulties, be it as a DC or surgeon caring for the lumbar spine.

So, it is your call. Are you going to stop before the back operation, lung tumour, osteoporotic fracture and emphysema, or afterwards?

And now I have an appeal. If you are a smoker, and have small children, please make sure their clothes are clean smelling, and do not light up on the way to the school. That is not something too hard to do for your kid's sake.

My granddaughter, aged six, reported this story to me. A new girl joined their school this quarter but, within a few days, when she walked into the class, the whole class grasped their noses. She stank of cigarette smoke; and no one befriended her. Friday was the last day of the quarter; the new lass declared she was leaving because everyone was so unfriendly.

Not unfriendly, my granddaughter protested, but they could not abide the smell of her clothes. Kids are perhaps refreshingly frank. Adults just tolerate the stink.

Research done in Sweden in which autopsies of the lumbar arteries were made, found a very high correlation between atheroslerosis, smoking and a long history of lower back pain.

Smoking primarily is the cause of atherosclerosis, but there are other causes. The inner lining of arteries becomes inflamed; in this instance it is the blood vessels that supply the lumbar spine that were autopsied. The vessels become narrowed and there simply is not enough oxygen and nutrients reaching the spine. Consequently, if you slip a disc, it simply does not heal properly.

I know that quitting is the very devil. This page is not about preaching you to you concerning the evils of smoking. But if you are suffering from significant lower back, and the pain starts to radiate to your leg, then either give up smoking completely and totally right now, or face the fact squarely that within weeks you will probably go under the knife.

And even then, smoking is the biggest risk factor for failed back surgery. Face the fact that not only your chiropractor may well fail in the treatment of your low back pain, but the surgeon may well frustrated too. Then it is a second operation, and possibly a third.

Intermittent claudication is another condition that is directly caused by smoking. The temptation with leg pain is to assume that it is a pinched nerve, but sometimes it is an artery that is pinched; from the inside, blocked with an antheroma.

Leg pain is a not uncommon complaint at the chiropractic coalface. There are many causes but one which often mystifies is a condition in which the artery supplying the legs is partially blocked.

The result is leg pain associated with exercise and relieved by sitting for a few moments. If there is associated but unrelated lower back symptoms then there is a temptation to jump to conclusions and assume it is sciatica. Enjoy this short story on the subject by chiropractor Bernard Preston.

Low back pain and smoking

Intermittent claudication

Intermittent claudication is a relatively uncommon complication of smoking; one of the arteries supplying blood to the legs becomes partially blocked. There's enough oxygen for the muscles when the person is at rest but, as soon as they exercise, excruciating pain begins in the leg, starved of sufficient oxygen. As soon as they stop the activity, the pain recedes.

Because the same arteries supply the pelvis and hips, for example, serious disease of other organs, starved of oxygen is likely to occur too.

A simple test for intermittent claudication exists, though the diagnosis is often made simply from the history. Are the pulses in the ankle and foot present?

If you have an aching leg with exercise, and perhaps no lower back pain and smoking, then the place to start is an examination of the pulses.

Nine coloured food research

Recent research into the so called Coronary Artery Risk Development in Young Adults has found, particularly in women, that those eating up to nine coloured foods were forty percent less likely, twenty years later, to have plaque lining the arteries.

Or, those eating three or less coloured fruit and veg had 40% more atherosclerosis leading to lowered blood flow, increased blood pressure and decreased oxygenation of the tissues.

Leg ache

Leg ache is can be caused by many things; in the chiropractor's office it is usually a sciatica or damaged femoral nerve; then the stretch tests, like that of Slump will be positive.

But, in the above instance, it's starvation of oxygen that is the spoke in the wheel. Leg pain induced by exercise, and relieved as soon as you stop the activity.

The key sign is no palpable dorsalis pedis pulse. Low back pain and smoking, with an aching leg are strongly correlated.

More ominous signs

Most folk suffering from low back pain will recover whether you are a smoker or not. The trick is to recognise and acknowledge ominous lumbar signs when they appear; ignore them and the situation changes. What appeared to start out as something routine has suddenly become serious; do the ostrich trick and now you have a high risk of lumbar surgery.


The chiropractic profession is committed to the health of your whole body which is why we stick our necks out and risk addressing subjects like smoking, obesity and the dangers of being a couch potato.

Yes, we lose some patients when talk about low back pain and smoking; but if we can save just 10% of our patients from the ravages of these habits, it's worth the breath.

It is painful, I know; at the end of the day we live and die by our choices. Do not take it out on your chiropractor, or medical either, when they choose to raise such issues. They do it because they care; it would be much easier to look the other way, and give you pills.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

Do you have a problem that is not getting better?

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Interesting questions from visitors

CLS writes:

Greetings, Dr B.

You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.

The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.