Brian Mandelker had experienced low back pain before. “Mostly standing around coaching kids’ baseball and hockey teams,” says the 64-year-old entrepreneur from Thornhill, Ontario. But nothing like the constant, searing pressure that hit him in the autumn of 2017. Fortunately, a chiropractor’s manual therapy helped treat his lumbar spinal stenosis.

“I couldn’t sit through dinner, I couldn’t sit at my desk to do my work,” recalls Brian, who was unable to put in the usual long hours at his family business, AFL Display Group, which designs and manufactures store fixtures and displays. “I was miserable.”

He’d dealt with flare-ups in the past with massage, or anti-inflammatory medications prescribed by his family doctor, but this time nothing like that helped. A physiotherapist’s treatments and exercises seemed to work, “but then the pain came back with a vengeance,” and this time it was also shooting down his legs. An MRI he had after a frustrating five-month wait showed he has spinal stenosis, a narrowing of the spaces within the spine that puts pressure on the nerves travelling through it. A subsequent appointment with a spinal surgeon, which Brian says “also took forever to get,” was over in less than five minutes. “He said surgery was not going to do me any good.”

Meanwhile, Brian was referred by his family doctor to a Toronto-based chiropractor, Dr. Joel Weisberg, who started him on a “boot camp” manual therapy regimen for lumbar spinal stenosis. It included cycling on an upright stationary bike to get blood flowing to the area alongside stretching and strengthening exercises. There were also two sessions a week in which chiropractor Dr. Weisberg gave him manual therapy, with deep stretches and adjustments to treat his spinal stenosis.

When he “graduated” after six weeks, “I felt like I was a new guy…It was night and day,” says Brian, who continues the daily cycling and stretching routine. “It’s something I need to do for the rest of my life.”

That’s a conclusion many patients and health care practitioners are coming to, with the rising incidence and cost of chronic musculoskeletal (MSK) disorders such as back pain, neck disorders and arthritis.

“Low back pain is a human condition that is not curable, but it is manageable,” says Toronto chiropractor Dr. Andrew Bidos, program manager of the Inter-professional Spine Assessment and Education Clinics (ISAEC) program.

Back pain is one of the most common reasons that patients see doctors, says Dr. Bidos, with enormous costs in terms of medical care and lost productivity. “They bounce around from specialist to specialist,” he says, “who often can’t do anything for them.”

Some chronic conditions may call for a surgical fix, but “surgery is always the last resort” and it doesn’t always work, cautions Dr. Brian Drew, an orthopaedic spine surgeon at Hamilton General Hospital. “Of course, that patient does need to take meaningful steps to try to fix it.”

Brian Mandelker has done just that. Indeed, he’s semi-retired and structures his lifestyle around his low-back exercise routine each morning. “I’ve made it a priority that nothing gets in the way of, or I know the pain will come back.”

If it does, he intends to return to Dr. Weisberg for further chiropractic treatment and guidance. “Knowing that I’ve got somebody I can relate to who can come up with a solution that can make me feel better if I have trouble is comforting,” Brian adds. “He’s got my back.”

This story is adapted from this article: What to understand about chronic pain, which was produced by Globe Content Studio and published as an advertising feature in The Globe and Mail.