Short Answer First

There isn’t one universal “better” option.

For most people with back pain, both chiropractic care and physical therapy are evidence-supported treatments. The right choice depends on:

• What’s causing your pain
• How long it has been present
• Whether the issue is more structural, functional, or both
• Your goals (pain relief, returning to sport, preventing recurrence)

In many cases, the most effective approach is not choosing one over the other — but choosing the right tool at the right time. Typically, if you need one, you could likely benefit from the other.

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Understanding Back Pain (And Why the Answer Isn’t Simple)

“Back pain” isn’t one condition. It’s a symptom.

In active adults and athletes in Boulder, common causes include:

• Acute muscle strain from lifting or skiing
• Irritated spinal joints from long hours sitting
• Disc-related irritation (bulge, herniation)
• Nerve irritation (sciatica)
• Repetitive stress from running, climbing, or cycling
• Poor load tolerance after returning to training too quickly

Two people can have pain in the same spot but completely different underlying drivers.

That’s why the real question isn’t “Which profession is better?”
It’s “What is limiting your body right now?”

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Structure vs. Function: A Helpful Way to Think About It

One useful framework for understanding back pain is the difference between structure and function.

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Structural limitations

These involve mobility restrictions or joint mechanics that are not moving well.

Examples:

• A thoracic spine that is stiff and restricted
• A lumbar segment that feels “locked”
• Rib or spinal joints not moving normally
• Local joint irritation causing protective muscle guarding

If structure is limited, it can be difficult for the body to move efficiently.
Trying to strengthen around a segment that doesn’t move well often leads to compensation.

For example:

If your thoracic spine is very stiff, asking you to perform postural strengthening exercises may not be effective — because the segment that needs to extend and rotate simply can’t.

In those cases, restoring mobility first often makes functional training more productive.

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Functional limitations

These involve strength, endurance, coordination, and load tolerance.

Examples:

• Poor core stability
• Weak glutes contributing to lumbar strain
• Inability to control rotation while running
• Reduced tolerance to lifting or skiing volume

If mobility is adequate but stability and load capacity are low, strengthening and movement retraining become the priority.

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Why Structure Often Comes Before Function

In many cases:

1. Restore motion (structure)
2. Build strength and control (function)
3. Progressively load for long-term resilience

If a joint is restricted, the nervous system may limit strength output or alter movement patterns as protection.

Once mobility improves:

• Muscles activate more efficiently
• Movement becomes more symmetrical
• Strength exercises are more effective
• Results tend to last longer

This isn’t about one service being superior. It’s about sequencing.

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What Chiropractic Care Typically Focuses On

Chiropractic care often addresses structural limitations:

• Improving spinal joint mobility
• Reducing local irritation
• Decreasing muscle guarding
• Restoring normal movement in restricted areas

Research supports spinal manipulation and mobilization for reducing pain and improving short-term function in acute low back pain.

Chiropractic care may be particularly helpful when:

• Your back feels stiff, locked, or restricted
• Movement feels asymmetrical
• Pain began after a specific motion or load

Learn more about Chiropractic care for back pain in Boulder

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What Physical Therapy Typically Focuses On

Physical therapy often addresses functional limitations:

• Strength deficits
• Core stability
• Hip mechanics
• Movement coordination
• Progressive return to sport

Exercise-based rehab is strongly supported for longer-term outcomes and recurrence prevention.

Physical therapy may be particularly helpful when:

• Pain has been recurring
• You feel unstable or weak
• You want to return to lifting, skiing, running, or climbing safely

Learn more about Physical therapy for low back pain

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Why the Combination Often Makes Sense

Structure and function are connected.

If you only improve mobility without building strength, pain often returns.

If you only strengthen without restoring mobility, the body may compensate and overload other areas.

Addressing both allows:

• Better movement quality
• Improved load tolerance
• Reduced recurrence risk
• More durable results

This interplay between structure and function is why many multidisciplinary clinics offer both services and coordinate care rather than treating them as separate paths.

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Who This Is For / Who This Is Not For

This is for you if:

• You’re an active adult, athlete, or desk worker with back pain
• Your pain limits your training or work
• You’ve tried stretching or strengthening without lasting change
• You want a clear, structured plan

This may not apply if:

• You have severe neurological symptoms (progressive weakness, loss of bowel/bladder control)
• You experienced major trauma
• You have known infection, fracture, or systemic illness

Those require immediate medical evaluation.

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How We Decide Treatment

Treatment decisions are based on evaluation — not preference.

A thorough assessment examines:

• Segmental mobility
• Muscle activation patterns
• Core stability
• Hip strength
• Nerve tension signs
• Load tolerance
• Symptom behavior

We ask:

• Is mobility restricted?
• Is strength insufficient?
• Is there nerve irritation?
• Is this acute, subacute, or persistent?

From there, care may include:

• Chiropractic adjustments or mobilization
• Physical therapy exercises
• Dry needling
• Soft tissue therapy
• Shockwave therapy
• Laser therapy
• Guided strength progression

Learn more about:
→ Spinal decompression therapy for disc-related pain
→ Shockwave therapy for chronic back pain
→ Dry needling for muscle-related back pain

The intervention follows the findings.

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What the Research Suggests

For uncomplicated low back pain:

• Manual therapy can reduce pain and improve short-term mobility
• Exercise improves long-term outcomes
• Education and staying active matter
• Passive care alone is rarely enough

Most guidelines support combining mobility restoration with progressive strengthening.

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The Real Question to Ask

Instead of asking:

“Should I see a chiropractor or a physical therapist?”

Ask:

“Do I need mobility restored, strength built, or both?”

That framing leads to better decisions.

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A Calm, Practical Takeaway

Back pain is common in active adults in Boulder. It’s often multifactorial — part mobility, part strength, part load management.

Chiropractic care and physical therapy are not opposing approaches. They address different parts of the same system.

When structure improves, function becomes easier.
When function improves, structure is better supported.

The goal is not choosing sides.
It’s restoring movement, building resilience, and progressing in a way that fits your body and your goals.

If you’re unsure where you fall on the structure–function spectrum, a thoughtful evaluation is the best starting point.

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Frequently Asked Questions

Is chiropractic or physical therapy better for lower back pain?

Both are supported by research. Chiropractic care often helps restore mobility and reduce pain in the short term. Physical therapy focuses on strengthening and long-term load tolerance. Many people benefit from a combination depending on their presentation.

Should I try chiropractic first or physical therapy first?

It depends on what is limiting you.

If your back feels stiff, locked, or restricted, restoring mobility may be the first step.
If mobility is adequate but you feel weak or unstable, strengthening and movement retraining may be more appropriate.

A proper evaluation helps determine sequencing rather than guessing.

Can chiropractic and physical therapy be done together?

Yes. They address different components of the same system.

Mobility restoration (structure) and strengthening (function) often complement each other. Coordinating care can allow progress in one area to support progress in the other.

Is back pain usually structural or muscular?

Most back pain is multifactorial.

There may be joint restriction, muscle guarding, strength deficits, and movement inefficiencies all at once. It is rarely just one thing.

That’s why assessment is more important than choosing a category.

How long does it take to see improvement?

Acute back pain often improves within a few weeks with appropriate care and activity modification.

Persistent or recurring back pain may require a longer plan focused on progressive strengthening and load tolerance.

The timeline depends on:

• Duration of symptoms
• Activity demands
• Previous injury history
• Consistency with rehabilitation

What if I’ve already tried one and it didn’t work?

Sometimes it’s not about the method — it’s about the sequencing.

If mobility was never addressed, strengthening may not stick.
If strengthening was never progressed, manual care alone may not create lasting change.

Reassessing the full structure–function picture often clarifies next steps.

About the Author

Dr. Steve Brown, DC
Co-Owner, Boulder Sports Clinic
Chiropractor | Sports Injury & Performance Focus

Dr. Steve Brown has over 13 years of experience treating active adults and athletes in Boulder. His clinical focus is on understanding how mobility restrictions (structure) and strength deficits (function) interact to drive pain and performance limitations.

He works with endurance athletes, weightlifters, climbers, desk workers, and outdoor enthusiasts — as well as collegiate and high school athletes. His approach integrates spinal mobility restoration, soft tissue therapy, progressive rehabilitation, and strength-based return-to-sport planning.

Dr. Brown believes that back pain is rarely about choosing a profession — it’s about identifying what the body needs at that moment and building a plan that restores movement and resilience over time.

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