Does it Work?
Efficacy Of Chiropractic Treatment
Over the years, spinal manipulation, which is also referred to as adjustment, has undergone rigorous evaluation from researchers within the profession itself, and from the legislative, health care and scientific communities resulting in a significant body of evidence around the efficacy of spinal manipulation for musculoskeletal disorders such as back pain, neck pain and headache.
Cost Effective Health Care [top]
Numerous governments have evaluated the effectiveness of chiropractic care both from a public funding perspective and in terms of establishing clinical guidelines for the management of back pain. One of the most thorough analyses of the scientific literature on chiropractic treatment of low back pain was conducted in 1993 by health economists at the University of Ottawa.
This report concluded that spinal adjustment applied by chiropractors is more effective than alternate treatments for lower back pain, and that there would be significant cost-saving to the health care system if more management of lower back pain was transferred from physicians to chiropractors. 1
Recently, a major four-year study in the United States, published in the American Medical Association journal The Archives of Internal Medicine, concluded that benefit plan members with chiropractic coverage returned to work faster, had lower claim costs and experienced fewer interventions such as MRIs compared to plan members without chiropractic benefits. 2
Similarly, a United Kingdom study published in the British Medical Journal concluded that adding spinal manipulation to current “best care” in general practice was effective and cost-effective for patients with low back pain. 3
International Studies Agree [top]
In addition to independent studies, there have been a number of international reports. One of the most significant reports was produced by the Clinical Standards Advisory Group (CSAG) in the UK in 1994. The CSAG guidelines for the management of back pain recommend spinal manipulation along with active exercise and physical activity to modify pain mechanisms and speed recovery. 4
The 1997 New Zealand Acute Low Back Pain Guide is a government sponsored, evidence-based guideline based on an extensive review of the international literature and wide consultation with professional groups in New Zealand. The New Zealand guideline reinforced the CSAG recommendations by including adjustment as an appropriate treatment for pain relief and improvement in mobility and function for acute low back pain. 5
The Danish Institute for Higher Technology Assessment (DIHTA) produced a report in 1999 on frequency, management and prevention of low back pain. DIHTA states that spinal manipulation is indicated for management of acute pain and to improve function, and should be considered for use in patients who have been experiencing pain for longer than two to three days. DIHTA also recommends that manipulation be considered for recurrent, chronic low back pain and for nerve root/disc conditions. 6
Similarly, the U.K. Royal College of General Practitioners (RCGP) 2001 Clinical Guidelines for the Management of Acute Low Back Pain state that there is strong evidence that spinal manipulation can provide short-term improvement in pain and activity levels and demonstrates higher patient satisfaction than alternate treatments. The guidelines recommend that adjustment be considered for pain relief and for patients who are failing to return to normal activities. 7
The Ontario Workplace Safety and Insurance Board (WSIB) guidelines for the treatment of chronic pain, published in The Clinical Journal of Pain supplement in December 2001, state that manipulation is more effective for chronic low back pain than usual care by a general practitioner, bed rest, analgesics or massage in the short to intermediate term. 8 A 2004 review of the WSIB Program of Care for acute low back injuries found faster return to work and high satisfaction levels with chiropractic care. 9
Studies in other countries have reached similar conclusions and the international medical literature contains a broad range of published studies attesting to the effectiveness and safety of chiropractic care for musculoskeletal complaints including back pain, neck pain and headaches. 10
As research advances, evidence continues to accumulate to support the benefits of chiropractic care for a variety of conditions.
1. Manga P, Angus D, Papadopoulos C, Swan W. The Effectiveness and Cost-effectiveness of Chiropractic Management of Low-Back Pain, Commissioned by the OCA. Funded by the Ontario Ministry of Health, 1993.
2. Legoretta AP, Metz RD, et al. Comparative Analysis of Individuals With and Without Chiropractic Coverage. Arch Int Med 2004;164:1985-1992
3. United Kingdom back pain exercize and manipulation (U.K. BEAM) randomized trial and cost-effectiveness of physical treatment for back pain in primary care. British Medical Journal, Nov. 19, 2004
4. Epidemiology Review: The Epidemiology and cost of back pain. U.K. Clinical Standards Advisory Group. 1994 HMSO.
Back Pain. Report of a Clinical Standards Advisory Group Committee on Back Pain. U.K. 1994 HMSO.
5. New Zealand Acute Low Back Pain Guide. New Zealand Guidelines Group, 1997.
6. Danish Institute for Health Technology Assessment: Low-Back Pain. Frequency, Management and Danish Health Technology Assessment 1999; 1(1).
7. Waddell G, McIntosh A, Hutchinson A, Feder G, Lewis M. Low Back Pain Evidence Review London: Royal College of General Practitioners 1999.
8. Mior S. Manipulation and mobilization in the treatment of chronic pain. The Clinical Journal of Pain 2001; 17:S70-S76.
9. Program of Care for Acute Low Back Injuries: One Year Evaluation Report, Ontario Workers Safety and Insurance Board, June 2004.
10. Koes BW, Assendelft WJJ, van der Heijden GJMG et al. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ 1991a; 363:1298-1303.