Is Chiropractic Effective?

Spinal Manipulation

Some people are still skeptical of Chiropractic and wonder if it really works or if its just "all in your head". Below are some great research articles to help show just how much Chiropractic can help all sorts of different problems.

"An Actuarial Analysis of the Impact of Chiropractic Care on the Costs of Medical Care for Patients with Common Spinal Diagnoses" indicates "that spinal patients who seek chiropractic coverage have materially lower health care costs than those who do not. The difference is consistent in all years and in between the two data sets. The difference range from 10% to 23% lower costs for those patients who sought [chiropractic] care." Milliman USA, September, 2009.

"Conclusion: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy." Clinical Rehabilitation, January, 2010.

"...best evidence synthesis suggests that therapies involving manual therapy (manipulation) and exercise are more effective than alternative strategies for patients with neck pain..." Spine, 2008.
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"For chronic spinal pain in general, when compared to acupuncture and traditional medical approaches, chiropractic has generally been shown to be more effective." Journal of Manipulative and Physiologic Therapeutics, 2005.

"Low back pain patients with chiropractic coverage in their insurance plan needed less surgery and fewer x-rays than patients on the same insurance plan without chiropractic coverage." Archives of Internal Medicine, 2004.

Listed under Mayo Clinic's Top 10 Complementary Therapies is spinal manipulation. One of the criteria used at the world-renowned Clinic is"...Does it meet a need that cannot be met by conventional medicine?" Listed under BEST TREATMENTS is "Spinal Manipulation. Practiced by chiropractors,...this hands-on technique adjusts the spine to properly align the vertebrae with muscles, joints and nerves. Standout scientific evidence. At the University of California, Los Angeles, School of Public Health, a study of 681 patients with low back pain showed that chiropractic care was as effective as medical care, including painkilling drugs, in relieving discomfort." Mayo Clinic's Top 10 Complementary Therapies, Mayo Clinic College of Medicine, Amit Sood, M.D., 2008.

Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back

Chiropractic Vs. Family Physician Directed Care for Acute Mechanical Low Back PainThis study was published in The Spine Journal, 2010 October 2.

The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and high-quality, ethical, evidence-based spine care, including basic science and clinical investigations.

This study compared family physician-directed usual care with evidenced-based clinical practice guidelines (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks) on patients with acute low back pain.

BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.

PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.

STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.

PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks' duration. Exclusion criteria included "red flag" conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).

OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.

METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).

CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.

Spine J. 2010 Oct 2. [Epub ahead of print]

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.

Bishop PB, Quon JA, Fisher CG, Dvorak MF.

Dr. Schaffnit's Comments:

This study reaffirms numerous published studies on the effects of chiropractic manipulation for lower back and neck pain. Chiropractic is a safe, effective and superior form of lower back pain management systems. There is no longer an “if it works” factor regarding chiropractic. The research is there, the results have always been there.

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