A growing list of research studies and reviews demonstrate that the services provided by
chiropractic phyisicians are both safe and effective. Following are excerpts and summaries
from a few of the more recent studies. The evidence strongly supports the natural, whole-body
and cost-effective approach of chiropractic care for a variety of conditions.
What is Chiropractic?
Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system
and the nervous system, and the effects of these disorders on general health. Chiropractic care
is used most often to treat neuromusculoskeletal complaints, including but not limited to back
pain, neck pain, pain in the joints of the arms or legs, and headaches.
Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice
a drug-free, hands-on approach to health care that includes patient examination, diagnosis and
treatment. Chiropractors have broad diagnostic skills and are also trained to recommend
therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle
counseling.
The most common therapeutic procedure performed by doctors of chiropractic is known as
“spinal manipulation,” also called “chiropractic adjustment.” The purpose of manipulation is to
restore joint mobility by manually applying a controlled force into joints that have become
hypomobile – or restricted in their movement – as a result of a tissue injury. Tissue injury can
be caused by a single traumatic event, such as improper lifting of a heavy object, or through
repetitive stresses, such as sitting in an awkward position with poor spinal posture for an
extended period of time. In either case, injured tissues undergo physical and chemical changes
that can cause inflammation, pain, and diminished function for the sufferer. Manipulation, or
adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and
muscle tightness, and allowing tissues to heal.
Chiropractic adjustment rarely causes discomfort. However, patients may sometimes
experience mild soreness or aching following treatment (as with some forms of exercise) that
usually resolves within 12 to 48 hours.
In many cases, such as lower back pain, chiropractic care may be the primary method of
treatment. When other medical conditions exist, chiropractic care may complement or support
medical treatment by relieving the musculoskeletal aspects associated with the condition.
Doctors of chiropractic may assess patients through clinical examination, laboratory testing,
diagnostic imaging and other diagnostic interventions to determine when chiropractic
treatment is appropriate or when it is not appropriate. Chiropractors will readily refer patients
to the appropriate health care provider when chiropractic care is not suitable for the patient’s
condition, or the condition warrants co-management in conjunction with other members of the
health care team.
Chiropractic Superior to PT's and MD Care for Low Back Pain
Chiropractic has always said – fix the root cause don't just bandaid the pain and this study
validates this simple chiropractic principle and we have always known we were safe – but not
necessarily how safe – until you read this!
Approximately 900 patients were followed for one year after being treated for disabling low
back pain that was caused on the job. It was discovered that patients that utilized physical
therapy and/or medical interventions had a higher recurrence of disability as opposed to
patients that underwent chiropractic care. Patients were TWICE as likely to end up with
disabling low back pain with a physical therapist (PT) and almost 66% more likely to be in
disabling pain when receiving traditional medical care.
This study is was conducted by the Center for Disability Research at the Liberty Mutual
Research Institute for Safety and the University of Massachusetts Lowell, Hopkinton, Mass; and
the Center for Health Economics & Science Policy at United BioSource Corporation, London,
United Kingdom.
Their objective was to compare the occurrences of repeated disability episodes between types
of health care providers, who treat claimants with new episodes of work-related low back pain
(LBP). They followed 894 patients over 1-year, using workers’ compensation claims data.
The authors concluded: “In work-related nonspecific LBP, the use of health maintenance care
provided by physical therapist or physician services was associated with a higher disability
recurrence than with chiropractic services or no treatment.”
Health Maintenance Care in Work-Related Low Back Pain and Its Association With Disability
Recurrence. Journal of Occupational and Environmental Medicine 2011 (Mar 14)
Chiropractic: A Safe Treatment Option
Chiropractic is widely recognized as one of the safest drug-free, non-invasive therapies
available for the treatment of back pain, neck pain, joint pain of the arms or legs, headaches,
and other neuromusculoskeletal complaints. Although chiropractic has an excellent safety
record, no health treatment is completely free of potential adverse effects.
The risks associated with chiropractic, however, are very small. Many patients feel immediate
relief following chiropractic treatment, but some may sometimes experience mild soreness or
aching, just as they do after some forms of exercise. Current literature shows that minor
discomfort or soreness following spinal manipulation typically fades within 24 hours.1
In addition to being a safe form of treatment, spinal manipulation is incredibly effective, getting
patients back on their feet faster than traditional medical care. A March 2004 study in the
Journal of Manipulative and Physiological Therapeutics found that chiropractic care is more
effective than medical care at treating chronic low-back pain in those patients who have been
experiencing the symptoms for one year or less. In addition, a study published in the July 15,
2003, edition of the journalSpine found that manual manipulation provides better short-term
relief of chronic spinal pain than a variety of medications.
Neck Adjustments
Neck pain and some types of headaches are treated through precise cervical manipulation.
Cervical manipulation, often called a neck adjustment, works to improve joint mobility in the
neck, restoring range of motion and reducing muscle spasm, which helps relieve pressure and
tension.
Neck manipulation is a remarkably safe procedure. While some reports have associated upper
high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection,
recent evidence2 suggests that this type of arterial injury often takes place spontaneously, or
following everyday activities such as turning the head while driving, swimming, or having a
shampoo in a hair salon.
Patients with this condition may experience neck pain and headache that leads them to seek
professional care—often at the office of a doctor of chiropractic or family physician—but that
care is not the cause of the injury. The best evidence indicates that the incidence of artery
injuries associated with high-velocity upper neck manipulation is extremely rare – about 1 case
in 5.85 million manipulations.3
To put this risk into perspective, if you drive more than a mile to get to your chiropractic
appointment, you are at greater risk of serious injury from a car accident than from your
chiropractic visit.
It is important for patients to understand the risks associated with some of the most common
treatments for neck and back pain—prescription nonsteroidal anti-inflammatory drugs
(NSAIDS)—as these options may carry risks significantly greater than those of manipulation.
According to a study from the American Journal of Gastroenterology, approximately one-third
of all hospitalizations and deaths related to gastrointestinal bleeding can be attributed to the
use of aspirin or NSAID painkillers like ibuprofen.4
Furthermore, surgery for conditions for which manipulation may also be used carries risks many
times greater than those of chiropractic treatment. Even prolonged bed rest carries some risks,
including muscle atrophy, cardiopulmonary deconditioning, bone mineral loss and
thromoembolism.5
If you are visiting your doctor of chiropractic with upper-neck pain or headache, be very specific
about your symptoms. This will help your doctor of chiropractic offer the safest and most
effective treatment, even if it involves referral to another health care provider. If the issue of
stroke concerns you, do not hesitate to discuss it with your doctor of chiropractic. Depending
on your clinical condition, he or she can forego manipulation, and instead can recommend joint
mobilization, therapeutic exercise, soft-tissue techniques, or other therapies.
Research Ongoing
The ACA believes that patients have the right to know about the health risks associated with
any type of treatment, including chiropractic. Today, chiropractic researchers are involved in
studying the benefits and risks of spinal adjustment in the treatment of neck and back pain
through clinical trials, literature reviews and publishing papers reviewing the risks and
complications of neck adjustment.
All available evidence demonstrates that chiropractic treatment holds an extremely small risk.
The chiropractic profession takes this issue very seriously and engages in training and
postgraduate education courses to recognize the risk factors in patients, and to continue
rendering treatment in the most effective and responsible manner.
References
1. Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy.
Spine 1997 Feb 15;435-440.
2. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008;
33:S176–S183.
3. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic
experience. Can Med Assoc J 2001;165(7):905-06.
4. Lanas A, et al. A nationwide study of mortality associated with hospital admission due to
severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug
use. Am J Gastroenterol 2005;100:1685–1693.
5. Lauretti W. The Comparative Safety of Chiropractic. In Daniel Redwood, ed., Contemporary
Chiropractic. New York: Churchill Livingstone, 1997, p. 230-8.
For Acute and Chronic Pain
“Many treatments are available for low back pain. Often exercises and physical therapy can
help. Some people benefit from chiropractic therapy or acupuncture.”
–Goodman et al. (2013), Journal of the American Medical Association
“[Chiropractic Manipulative Therapy] in conjunction with [standard medical care] offers a
significant advantage for decreasing pain and improving physical functioning when compared
with only standard care, for men and women between 18 and 35 years of age with acute low
back pain.”
–Goertz et al. (2013), Spine
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
“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
In Comparison to Other Treatment Alternatives
"Reduced odds of surgery were observed for…those whose first provider was a chiropractor.
42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only
1.5% of those who saw a chiropractor."
– Keeney et al (2012), Spine
“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
“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 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.”
— McCrory, Penzlen, Hasselblad, Gray (2001), Duke Evidence Report
“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.” ‘
— Boline et al. (1995), Journal of Manipulative and Physiological Therapeutics
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.
— Bronfort et al. (2012), Annals of Internal Medicine
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
Patient Satisfaction
“Chiropractic patients were found to be more satisfied with their back care providers after four
weeks of treatment than were medical patients. Results from observational studies suggested
that back pain patients are more satisfied with chiropractic care than with medical care.
Additionally, studies conclude that patients are more satisfied with chiropractic care than they
were with physical therapy after six weeks.”
— Hertzman-Miller et al (2002), American Journal of Public Health
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
