Chiropractic Research

Evidence Based Treatment

A growing list of research studies demonstrate that chiropractic care is both safe and effective. The following are excerpts and summaries from several research studies. The evidence strongly supports the effectiveness of chiropractic treatment for a variety of painful conditions.

Low Back Pain

The British Medical Journal published a 1990 study comparing chiropractic to hospital outpatient treatment in the treatment of mechanical low back pain (involving physical therapy and medication). The results were that “Chiropractic was more effective than hospital management, mainly for patients with chronic or severe low back pain.”–BMJ 1990 Jun 2;300(6737):1431-7.

Chiropractic vs. Physiotherapy

BMJ published another study in 1992. The objective stated was “to compare the effectiveness of manipulative therapy, physiotherapy, treatment by a general practitioner, and placebo therapy in patients with persistent non-specific low back and neck complaints.” The authors stated that “Improvement in the main complaint was larger with manipulative therapy.” –BMJ 1992 Mar 7;304(6827):601-5.

Chiropractic vs. Hospitals

Another BMJ study reported results of an extended follow-up—3 years after the initial study. The results were “improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear.”–BMJ 1995 Aug 5;311:349-351.

Chronic Back Pain

An excellent study reported in the world’s premier orthopedic journal, Spine, in 2003 compared medication, acupuncture, and chiropractic in the treatment of chronic spinal pain. Chiropractic treatment was more than 5 times more effective than medication, and three times more effective than acupuncture.–Spine 2003 Jul 15;28(14):1490-502.

Long Term Benefit

A follow-up to the previous article was published in 2005 in JMPT. This follow-up was performed more than a year after the initial study. The authors conclude that “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed treatment regimens that provides broad and significant long-term benefit.”–JMPT 2005;28:3-11.

Better than Exercise for Back Pain and Sciatica

A study in the European Spine Journal evaluated the effects of a chiropractic treatment called “flexion-distraction” compared to physical therapy. This is a technique common to chiropractors. The authors found that “Subjects randomly allocated to the flexion-distraction group had significantly greater relief from pain than those allocated to the exercise program.” They also noted that patients with radiculopathy did significantly better with flexion distraction.–European Spine Journal 2005 Dec 8;1-13

Safe for Disc Injury Treatment

Researchers sought to determine if chiropractic manipulation was safe for patients with injured discs. The reviewers concluded, “An estimate of the risk of spinal manipulation causing a clinically worsened disc herniation or cauda equina syndrome in a patient presenting with lumbar disc herniation is calculated form the published data to be less than 1 in 3.7 million.”–JMPT 2004 March 27;3:179-210.

Major Relief in 3 weeks

Another recent study published in the journal Spine reported on a dose dependent response for chiropractic care in patients with chronic low back pain. They found patients reported the best relief with care 3-4 times per week for 3 weeks. This study demonstrates that spinal changes and changes in the nervous system require both time and consistency of treatment..–Spine Sept-Oct 2004;4(5):574-83.

Recovered Sooner for Less Expense

Lastly, the Manga Report is an independent study funded by the Ontario Ministry of Health to evaluate the cost effectiveness of all types of treatment for low back pain, including medical treatment, physical therapy, and chiropractic. Here are some of the findings (you can read the entire report online, as it represents the most comprehensive study on the subject to date): “On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.”

“There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain.”

These researchers additionally found that injured workers returned to work earlier and care was considerably less expensive with chiropractic care.

For Acute and Chronic Pain

“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”– Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics

Neck Pain Better with Chiropractic vs. Physiotherapy

In a Randomized controlled trial, 183 patients with neck pain were randomly allocated to manual therapy (spinal mobilization), physiotherapy (mainly exercise) or general practitioner care (counseling, education and drugs) in a 52-week study. The clinical outcomes measures showed that manual therapy resulted in faster recovery than physiotherapy and general practitioner care. Moreover, total costs of the manual therapy-treated patients were about one-third of the costs of physiotherapy or general practitioner care.– Korthals-de Bos et al (2003), British Medical Journal

In Comparison to Other Treatment Alternatives

Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”– Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Chiropractic Twice as Effective

“In our randomized, controlled trial, we compared the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.”– Hoving et al (2002), Annals of Internal Medicine

For Neck Pain

In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.– Annals of Internal Medicine, Bronfort et al. (2012)

For Headaches

“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.”– Duke Evidence Report, McCrory, Penzlen, Hasselblad, Gray (2001)

“The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. . . Four weeks after cessation of treatment . . . the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values.” ‘– Journal of Manipulative and Physiological Therapeutics, Boline et al. (1995)

Cost Effectiveness

Low back pain initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), according to a study that analyzed data from 85,000 Blue Cross Blue Shield (BCBS) beneficiaries in Tennessee over a two-year span. The study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Researchers estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee. They also concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.– Liliedahl et al (2010), Journal of Manipulative and Physiological Therapeutics

“Chiropractic care appeared relatively cost-effective for the treatment of chronic low-back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulative efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.” – Haas et al (2005), Journal of Manipulative and Physiological Therapeutics

Popularity of Chiropractic

“Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”– Meeker, Haldeman (2002), Annals of Internal Medicine