Chronic low back pain can change the shape of a person’s life. Work becomes harder. Sleep gets interrupted. Normal movement starts to feel risky. For someone in a physical trade, it can also threaten a career.

A case report by William J. Boro, DC, presented at the 2025 SOT Research Conference, follows one such patient over 20 years. The patient was a 40-year-old plumber with long-standing low back pain, radiating leg symptoms, MRI-documented discopathy, and significant weakness in both lower extremities. He had already tried common medical approaches, including medication and physical therapy, without lasting relief. Surgery and early retirement had become serious possibilities.

The report describes a different path: conservative chiropractic care, followed by brief episodic visits during flare-ups. One case does not prove that the same result will happen for every patient, but it does offer a useful look at how long-term management can work when care is tailored, monitored, and used conservatively.

Why this case matters for chronic low back pain

Low back pain is one of the most common reasons people seek health care. For many, symptoms improve with time. For others, pain becomes chronic and affects strength, balance, mobility, work, and daily function.

This case stood out because the patient’s condition was not mild or occasional. According to the report, he had:

• Chronic refractory low back pain

• MRI-determined discopathy

• Pain radiating into both legs

• Significant bilateral lower-extremity muscle weakness

• An antalgic posture or gait, meaning his body adapted to avoid pain

• Reduced ranges of motion

• A work situation that required bending, lifting, kneeling, and carrying

  
  

The patient had also been told he would likely need surgery and would need to retire from plumbing. That context matters. Conservative care was not being used for a minor ache. It was being considered in a situation where pain and function had become major life issues.

The most meaningful outcome in the report was not just less pain. It was the patient’s ability to return to work, avoid surgery, and maintain daily activities over a long follow-up period.

The chiropractic approach described in the report

The patient received a combination of chiropractic procedures over an initial two-month period. The report notes 10 treatments during that phase.

Care included:

Sacro-occipital technique block placement

Sacro-occipital technique, often called SOT, uses specific positioning and padded blocks to influence pelvic, spinal, and body mechanics. In the report, SOT block placement was part of the patient’s care plan.

Spinal and extremity adjusting

The patient received chiropractic adjustments to the spine and extremities. For someone with low back pain and altered movement, extremity mechanics may matter because hips, knees, ankles, and feet all affect how force travels through the lower back.

Chiropractic manipulative reflex techniques

The report also describes the use of non-musculoskeletal reflex techniques. These were included as part of the broader chiropractic treatment plan.

SOT and Van Rumpt cranial procedures

Cranial procedures associated with SOT and Van Rumpt methods were also used. The report presents these as part of the full package of care rather than as isolated treatments.

This mixed approach is one reason the case should be interpreted carefully. Because several methods were used, the report cannot show which part of care mattered most. It also cannot separate the effects of time, activity change, natural symptom variation, and treatment. Still, the outcome is notable because the patient had not found relief with prior interventions and had been facing a major surgical decision.

What happened after the first two months

After 10 visits over two months, the patient was able to return to work and did not proceed with surgery, according to the case report.

That short-term change is important, but the longer follow-up is what makes the report more unusual. Over the next 20 years, the patient was seen only episodically. The report states that he returned about one to three times per year for flare-ups. Those flare-ups typically resolved in one to three visits.

That pattern reflects a practical model of long-term management. The goal was not constant treatment. The patient did not receive frequent care indefinitely. Instead, care was used when symptoms returned and stopped once the flare-up settled.

For a person with a physically demanding job, that can be a meaningful outcome. Plumbing work often includes awkward positions, crawling into tight spaces, lifting materials, and working from the floor. Being able to keep doing that work for years after being told retirement may be necessary is a major functional result.

What this case can and cannot tell us

A case report is valuable because it shows what happened to one real patient in a clinical setting. It can help clinicians ask better questions. It can also help patients understand possible care pathways.

At the same time, a case report has limits. It does not compare treatment with a control group. It does not prove cause and effect. It does not show that every person with discopathy, leg pain, or chronic low back pain should expect the same result.

This distinction matters in health writing. The report supports a reasonable point, not an exaggerated one: some patients with chronic low back pain may benefit from a conservative trial of chiropractic care before moving toward more invasive options, when it is clinically appropriate and when serious red flags have been addressed.

The case also highlights the value of tracking function, not only pain. Meaningful recovery may include:

• Returning to work

• Walking with less compensation

• Improving range of motion

• Reducing frequency or severity of flare-ups

• Maintaining activities of daily living

• Avoiding or delaying surgery when appropriate

  
  

Pain scores are useful, but life function often tells the larger story.

Conservative care and the decision about surgery

Back surgery can be necessary and appropriate in some cases, especially when there are severe or progressive neurological deficits, certain structural problems, or symptoms that do not respond to appropriate care. Decisions about surgery should always involve qualified medical evaluation.

This case does not argue that surgery is never needed. It shows that conservative management may still be worth considering for some patients, even when symptoms have been long-standing and work-limiting.

The patient in the report had already tried other forms of care without satisfactory improvement. After chiropractic treatment, he avoided surgery and continued working. That outcome suggests the value of a careful, individualized approach rather than a one-size-fits-all plan.

For patients with chronic low back pain, the larger lesson is to ask clear questions:

• What is the likely source of symptoms?

• Are there signs that require urgent medical care?

• What conservative options are reasonable?

• How will progress be measured?

• If symptoms flare again, what is the plan?

• At what point should surgical consultation be revisited?

  
  

Good care does not ignore risk. It balances risk, function, patient goals, and measurable progress.

The long-term lesson from a 20-year follow-up

The most practical message from this case is that recovery from chronic low back pain may not always mean symptoms disappear forever. For many people, a better goal is durable function with a clear plan for flare-ups.

In this report, the patient did not need constant treatment to maintain progress. He used short episodes of care when symptoms returned. Over 20 years, that pattern helped him maintain quality of life, full activities of daily living, and his plumbing career.

That is a realistic and useful model. Chronic low back pain often requires more than a quick fix. It may require the right intervention at the right time, attention to work demands, and a plan that supports long-term function.

This article is for informational purposes only and is not medical advice. Anyone with severe back pain, progressive weakness, numbness, bowel or bladder changes, fever, trauma, or unexplained weight loss should seek prompt medical evaluation.

Reference

Boro, W. J., DC. Chiropractic treatment of a patient with chronic low-back pain followed over 20-years: A case report. Presented at the 2025 SOT Research Conference.