Back pain: when should you see a chiropractor?

Between 60 and 80 percent of the population get troublesome back pain during their lifetime [2]. Pain lasting less than four weeks is called acute, four to twelve weeks subacute and more than twelve weeks chronic [2].

Most people with acute back pain improve within one to two weeks without treatment. With sciatica, about 70 percent improve within two to four weeks [2]. You can read more about symptoms and treatment on the page about low back pain.

Stay active and limit bed rest to a minimum [2]. For most people with uncomplicated back pain, being at work is good medicine [2]. The British NICE guideline recommends tailored information and continuing normal activities, regardless of phase [3]. If you need pain relief, a doctor or pharmacy can advise you.

Many people with back pain do not need treatment, since the problem usually goes away on its own [2]. It can still be relevant to see a chiropractor in these situations:

• the pain has not subsided after a couple of weeks
• the back pain returns from time to time
• you are unsure of the cause, or of how much load your back can take
• the pain makes it difficult to stay active and at work, which is recommended with uncomplicated back pain [2]

A chiropractor is authorised healthcare personnel in primary care. You do not need a referral from a doctor to receive reimbursement from Helfo.

The appointment starts with a conversation about your history. A clinical examination follows, which often begins with posture and movement patterns and continues with orthopaedic tests and examination by hand.

After the examination the chiropractor makes a diagnosis and explains it. When in doubt, the chiropractor can refer you for imaging or to a specialist. The treatment plan is made together with you and includes exercises and guidance.

NICE describes manual therapy as an option that can be considered, but only as part of a package that also includes exercise [3]. Read more about chiropractic care at Dr.Dropin.

The Norwegian Directorate of Health guideline on diagnostic imaging lists warning signs that may raise suspicion of serious underlying disease [1]:

• problems that start before age 20 or after age 55, or that feel different from before
• constant pain that increases over time, or pain at rest
• general feeling of illness, fever or weight loss
• injury, known cancer, use of steroids or immunosuppressants, or substance use
• widespread or progressive neurological deficits
• spinal deformity
• marked morning stiffness lasting more than one hour

NHI also mentions one-sided radiating pain below the knee and long-standing problems that do not improve with self-care as reasons to see a doctor [2].

A single warning sign does not in itself mean that something serious is wrong. A systematic review shows that many of the flags listed in guidelines change the probability of serious disease little when they appear alone, while combinations of several give a higher probability [4].

If you have back pain together with reduced sensation in the buttocks or groin area, urinary retention or leakage, loss of control over bladder and bowel, or progressive paralysis, you should seek immediate help [1][5]. The condition is called cauda equina syndrome. It can also occur without leg pain [5].

Time is critical. NHI writes that surgery should preferably be done within 24 hours and at the latest after 48 hours, and that permanent damage can occur after about six hours of urinary retention [5].

The Norwegian Directorate of Health does not recommend imaging for acute or subacute low back pain, nor for nerve root involvement without warning signs. If the symptoms have not improved after four to six weeks of treatment, imaging is recommended [1]. NICE recommends that imaging is not used routinely outside specialist care [3]. Read more about nerve root involvement on the page about lumbar disc herniation.

If you have had back pain for several weeks, or are unsure whether the problem is of the usual kind, a chiropractor can examine you and assess whether there is reason to refer you on. If you have the symptoms in the section on immediate help, do not wait for an appointment. Contact a doctor or emergency primary care.

When should you see a chiropractor about back pain?

When the pain has not subsided after a couple of weeks, keeps coming back, or when you are unsure of the cause. Most acute back pain goes away on its own [2].

Do I need a referral to see a chiropractor?

No. As a patient you do not need a referral from a doctor to receive reimbursement from Helfo.

When should you see a doctor about back pain?

With constant pain that increases, pain at rest, fever, weight loss, widespread neurological deficits or problems that do not improve with self-care [1][2]. With reduced sensation in the groin area or loss of control over bladder and bowel, seek immediate help [1][5].

How long does back pain last?

Most acute back pain improves within one to two weeks without treatment. With sciatica, about 70 percent improve within two to four weeks [2].

Do I need an MRI or X-ray for back pain?

The Norwegian Directorate of Health does not recommend imaging for acute or subacute low back pain without warning signs. If the symptoms are not better after four to six weeks, it is recommended [1].

What is cauda equina syndrome?

A condition in which the nerves at the bottom of the spinal canal are compressed. Typical signs are reduced sensation in the groin area and loss of control over bladder and bowel, and the condition requires prompt treatment [5].

Read about symptoms and treatment on the pages about low back pain and lumbar disc herniation. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. National clinical guideline for diagnostic imaging in non-traumatic musculoskeletal disorders. Recommendations for primary care. Norwegian Directorate of Health, IS-1899, 2014. Link

2. Korsryggsmerter, lave ryggsmerter, veiviser (low back pain guide). NHI.no. Last updated 5 October 2020. Link

3. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). Published 30 November 2016, updated 11 December 2020. Link

4. Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RWJG, de Vet HCW, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095. doi:10.1136/bmj.f7095. Link

5. Cauda equina-syndromet (cauda equina syndrome). NHI.no. Last updated 14 January 2026. Link