Back pain is the most common musculoskeletal complaint in chiropractic — and the most mismanaged. Not because it's complicated, but because it's almost always being looked at wrong. Around 80% of people experience significant back pain at some point in their lives. Most recover. Many don't — because the pattern that caused it was never identified, so it keeps coming back. The site of pain is almost never the source of the problem.
Why back pain keeps coming back
When back pain returns predictably — after sitting, after exercise, after a long day — that predictability is data. It means the pattern creating the conditions for pain is still running. Rest quiets it temporarily. But rest doesn't change a movement pattern, a hip restriction, or a disc that's being loaded asymmetrically every time you stand up from a chair.
The standard approach to back pain — treat the site of pain, prescribe exercise, wait — works for a subset of presentations and fails for everyone else. It fails because it's working backwards from the symptom rather than forward from the mechanism.
The American College of Physicians guidelines recommend spinal manipulation — chiropractic adjustment — as a first-line treatment for acute and chronic low back pain, before medications. The research on chiropractic for low back pain consistently shows outcomes comparable to or better than conventional medical management, without the risk profile of opioids, injections, or surgery. Patients who see a chiropractor as their first provider for low back pain have 90% decreased odds of early and long-term opioid use. That's not a marginal difference.
That said: not all chiropractors are the same. The TikTok version — crack and go — is a real thing, and it's not what we do. The Health Autobiography™ before your first visit, the full systems-level diagnostic, the ProActive Protocol™ applied throughout every session — these aren't marketing language. They're the difference between treating the site and finding the mechanism. If you've seen a chiropractor before and it didn't hold, that's worth understanding before you write off chiropractic entirely. You wouldn't stop dating because you had a bad date — you'd get clearer on what you were looking for. Same principle applies to finding the right clinician.
Back pain rarely starts in the back. It starts as a compensation pattern somewhere upstream — a hip that doesn't load symmetrically, a thoracic spine that doesn't rotate, a foot that overpronates and shifts load into the lumbar spine on every step. The back is where the compensation finally ran out of capacity. Treating the back without identifying what drove it there produces temporary relief and predictable recurrence.
Chiropractic as first-line care — and why it matters who you see
Clinical guidelines — including those from the American College of Physicians — now recommend non-pharmacological approaches including spinal manipulation as first-line treatment for low back pain before medications or imaging. That's a significant shift from how most primary care still operates in practice, where the default is still a prescription and a referral.
That said: not all chiropractic is the same. The crack-and-go model — high-volume, short sessions, same adjustment every visit — exists, and it's not what we do. At ProActive, every session involves the ProActive Protocol™: applied kinesiology and muscle testing throughout the appointment to test, adjust, and confirm that what's being done is actually landing. Before you arrive, you complete a Health Autobiography™ — a full map of your body's history. This isn't a 10-minute intake form. It's what lets Dr. Cohen walk into the room already oriented to the pattern, not starting from scratch.
What we treat
Low back pain
The most common presentation. Usually involves a combination of lumbar restriction, hip dysfunction, and altered movement patterns. The source is almost always upstream from where it hurts.
Sciatica
Sciatic nerve irritation from disc involvement, piriformis syndrome, SI joint dysfunction, or a combination. The mechanism determines the treatment — they're not all the same problem.
SI joint dysfunction
One of the most commonly missed diagnoses in low back pain. The sacroiliac joint is where the spine meets the pelvis — when it's restricted or hypermobile, it creates load patterns that express as back, hip, and sometimes leg pain.
Disc herniation
A disc herniates because it was loaded asymmetrically until it failed. When the area is acutely inflamed, Dr. Cohen often doesn't work directly on the affected segment — instead calming the nervous system and reducing load by addressing the contributing areas above and below it. The pain quiets. Then the pattern gets addressed. Most disc herniations don't require surgery.
Degenerative disc disease
A label, not a sentence. Degeneration happens faster in areas under chronic asymmetric load. Correcting the loading pattern slows it. Patients told their DDD is "just aging" often have a very addressable mechanical component.
Post-surgical back pain
Surgery can alter the biomechanics of the spine — which makes it even more important that everything above and below the surgical site is working correctly and distributing load evenly. We focus on the biomechanical imbalances that may have contributed to the original failure in the first place, and on ensuring the areas compensating for the surgery aren't creating new problems.
What the first visit actually looks like
Before you arrive, you complete a Health Autobiography™ — a systematic map of your body's full history. Dr. Cohen reviews it before you walk in. That means the appointment starts at the pattern, not at "so what brings you in today."
In the room: a full movement screen, postural and foot analysis, and hands-on assessment of the actual mechanical drivers. We're not looking at where it hurts. We're looking at what's loading it, what's not moving, and what the body has been compensating around. You leave with a clear ProActive Protocol™ — what's happening, why it's been happening, and what it will take to correct it.
We see a lot of patients who've had PT, injections, other chiropractic, and sometimes surgery — and the problem came back. That's not a coincidence. It means the mechanism was never identified. If you've tried everything and the pain keeps returning, you haven't had a full systems-level diagnostic yet. That's what the first visit is.
What about imaging?
X-rays and MRIs are useful for ruling out serious pathology. They're not useful for identifying the mechanical pattern driving most back pain — because that pattern is in how you move, not in a static image. Many patients arrive with impressive-looking imaging that correlates poorly with their actual symptoms. The pattern is in the body, not the picture.
The Brinjikji et al. systematic review — published in the American Journal of Neuroradiology — found that among people with no back pain at all, 37% of 20-year-olds had disc degeneration visible on MRI. By age 50, it was 80%. A disc bulge visible on imaging in a 50-year-old with back pain may have nothing to do with why their back hurts. Or it may be highly relevant. A clinical assessment determines which. The image doesn't.
That said: Dr. Cohen can order labs and imaging directly, without the referral lag that comes with going through a primary care physician. If something needs imaging, you won't wait three weeks for a referral.
Insurance, cost, and how it works
ProActive is out-of-network by design. Insurance reimbursement structures reward volume and speed — the opposite of what thorough diagnostic work requires. A one-hour intake with a doctor who has 20+ years of clinical experience doesn't fit in a billing code. Many patients use FSA/HSA accounts, and we provide superbills for out-of-network reimbursement if your plan supports it.