• Symptoms of chronic lower back pain as measured with the Visual Analog Scale (VAS) [ Time Frame: VAS performed at baseline, immediately post baseline and at three months post baseline ] [ Designated as safety issue: No ]
  

• Medical Outcome Study Short Form 36(SF-36) bodily pain and physical functioning subscales [ Time Frame: 4 weeks of treatment ] [ Designated as safety issue: No ]
  
• Oswestry Disability Index (ODI) will improve to a greater extent with chiropractic management as compared to sham chiropractic management [ Time Frame: 4 weeks of treatment ] [ Designated as safety issue: No ]
  
• Performance of the timed up and go test will improve to agreater extent with chiropractic management as compared to placebo that uses a sham chiropractic management [ Time Frame: 4 weeks of treatment ] [ Designated as safety issue: No ]
  

The identification of alternative safe and effective interventions for chronic lower back pain in the elderly is critical in view of its high prevalence, negative impact on quality of life and the treatment risks associated with chronic medication use. This is particularly germane to the veteran population, with a prevalence of lower back pain in excess of 40%. In 1998, published guidelines from the American Geriatric Society listed chiropractic management among the non-pharmacologic strategies for treating chronic pain symptoms in older adults. A recent study showed that a substantial number of older patients who received chiropractic care were less likely to be hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously and more likely to be mobile in the community. Patient's undergoing chiropractic care have also reported greater satisfaction as compared to standard medical care. Despite the general clinical acceptance of chiropractic care and satisfaction with chiropractic services, evidence on the potential benefit and safety of chiropractic management of lower back pain in older adults is lacking. The purpose of this study is to evaluate the effectiveness of chiropractic management in older adults with chronic lower back pain, by comparing spinal manipulation to a sham intervention.

Inclusion Criteria:

1. Pain greater than three months in duration
2. Localized pain to the lumbosacral and gluteal regions and no focal radicular symptoms
3. Pain elicited upon deep palpation of the lumbar erector spinae musculature 4) Pain that can be either exacerbated or relieved by varying body position

Exclusion Criteria:

1. Patients will be excluded if they have a history of fragility fracture of radiographic evidence of lumbar compression fracture
2. Patient will be excluded if they have undergone a course of previous chiropractic care
3. Patients who are currently on anti-coagulation therapy

4. Severely demented patients, as indicated by their previous medical history and Mini Mental State scores of 22 or less, will not be selected.

   • The exclusion criteria are representative of the absolute contraindications for chiropractic management, specifically to mean high velocity, low amplitude spinal manipulation.