Orthotic Use for Chronic Low Back Pain

Inclusion Criteria: 1. At least 18 years old 2. Subjects must be symptomatic with current pain between T12 and the SI joints with or without radiating pain at an average score of 4 or higher on the NPRS scale 3. Symptoms must have been present for at least three months Exclusion Criteria: 1. Use of custom-made orthotics in the past 6 months 2. Ongoing active conservative care (such as physical therapy or chiropractic care) for the low back, leg, or foot received in the past 6 months (excluding the use of oral medications or daily at-home exercises for general well-being). 3. Current or future litigation for any healthcare concern 4. Not fluent or literate in the English language. We will not be able to provide multiple translators within this study 5. Brain disorders (e.g., dementia, Alzheimers Disease , etc.) that would lead to difficulty in questionnaire completion 6. Chronic pain other than low back pain, such as fibromyalgia or multiple sclerosis 7. Clinically significant chronic inflammatory spinal arthritis 8. Spinal pathology or fracture 9. Progressive neurologic deficits due to nerve root or spinal cord compression, including symptoms/signs of cauda equina syndrome 10. History of bleeding disorder 11. Known arterial aneurysm 12. Previous lumbar spine surgery 13. Severe skeletal deformity of the foot 14. Peripheral neuropathy due to disorders such as diabetes 15. Low back pain that is not reproducible 16. Current pregnancy 17. Other conditions that may affect the subjects' ability to participate throughout the duration of the study or exclude patients from participation in the study, including contraindications to orthotic use or chiropractic spinal manipulations