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Everyday, scientists and researchers are proving what doctors of chiropractic have known since 1895.
 
Click here for research that shows Chiropractic is VERY EFFECTIVE.
 
Click here for research that shows Chiropractic is MORE EFFECTIVE.

Click here for research that shows Chiropractic is COST-EFFECTIVE.
Click here for research that shows Chiropractic has the HIGHEST PATIENT SATISFACTION RATES.
 
Click here for research that shows Chiropractic is EXTREMELY SAFE.
 
Click here for research that shows many large-scale GOVERNMENT STUDIES, including American, Canadian, New Zealand, Swedish and Australian, which have strongly supported Chiropractic.
 
Click here for research that shows Chiropractic is superior for WORKERS' COMPENSATION injuries.
 
 
You want research?  We've got research!
 
 
 
 
 
Chiropractic Effectiveness Studies
 
THE AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY

On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

The following conclusions were made in this landmark study:

  • Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
  • Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

Other interesting finds included:

  • The risk of serious complications from lumbar spinal manipulation is rare;
  • There is currently no evidence supporting the use of trigger point, ligamentous and facet injections, needle acupuncture or dry needling as treatment for acute back problems;
  • The panel found no evidence of benefit from the application of physical agents and modalities such as ice, heat, massage, traction, ultrasound, cutaneous laser treatment, transcutaneous electrical nerve stimulation (T.E.N.S.) and biofeedback techniques.

      Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (U.S. Department of Health and Human Services) -1994.

    •  

      THE RAND CORPORATION STUDY

      Members of the Medical Community Recognize Chiropractic's Effectiveness

      This study, conducted by the prestigious RAND Corporation, marks the first time representatives of the U.S. medical community have gone on record stating that chiropractic is an appropriate treatment for certain low back pain conditions. A second, all-chiropractic panel's ratings show agreement with the multidisciplinary panel that spinal manipulation is appropriate for specific kinds of low back pain. A utilization study examining chiropractic patients' charts in multiple geographical locations in the United States is now underway. This will allow investigators to examine actual clinical cases and learn how prevalent each condition is in practice.

      The RAND Corporation ("Research and Development") is a nonprofit private corporation in Santa Monica, California. They conduct research and development for the U.S. government and private sector, commanding international respect. It's research programs include classified defense research for the military, applied economics, education, sociology, civil justice and health sciences.


      The Appropriateness of Spinal Manipulation for Lower Back Pain. Shekelle PG, et al. RAND Corporation, Santa Monica, California - 1992.




      THE MANGA REPORT

      As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.

      Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.

      The researchers also stated that studies on the prevalence and incidence of low back pain suggest that it is the leading cause of disability and morbidity in middle-aged persons, and is by far the most expensive source of workers' compensation costs North America.


      The Canadian Government report concluded with the following findings:

      • 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 low back pain. 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 (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain;
      • Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals;
      • There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management;
      • There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually;
      • Workers' compensation studies report that injured workers with the same specific diagnosis of low back pain returned to work much sooner when treated by chiropractors than by medical physicians;
      • There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management;
      • The use of chiropractic has grown steadily over the years and chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians;
      • In our view, the following offers an overwhelming case in favor of much greater use of chiropractic services in the management of low back pain:
        • the effectiveness and cost effectiveness of chiropractic management of low back pain
        • the untested, questionable or harmful nature of many current medical therapies
        • the economic efficiency of chiropractic care for low back pain compared with medical care
        • the safety of chiropractic care
        • the higher satisfaction levels expressed by patients of chiropractors.


      The following recommendations were also included in the report:

    • There should be a shift in policy to encourage and prefer chiropractic services for most patients with low back pain;
    • Chiropractic services should be fully insured under the Ontario Health Insurance Plan;
    • Chiropractic services should be fully integrated into the health care system;
    • Chiropractors should be employed by tertiary hospitals in Ontario;
    • Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients' needs;
    • Chiropractic should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients;
    • Since low back pain is of such significant concern to workers' compensation, chiropractors should be engaged at a senior level by Workers' Compensation Board to assess policy, procedures and treatment of workers with low back injuries;
    • A very good case can be made for making chiropractors the gatekeepers for management of low back pain in the workers' compensation system in Ontario;
    • The government should make the requisite research funds and resources available for further clinical evaluations of chiropractic management of low back pain, and for further socioeconomic and policy research concerning the management of low back pain generally;
    • Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public finding;
    • Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physiotherapy professions.

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. Pran Manga and Associates. University of Ottawa, Canada - 1993.




      • THE AV-MED STUDY

        In this study, 80 patients who previously received medical treatment were subsequently referred to the Silverman Chiropractic Center. Of the 80 patients, 21 percent had just been diagnosed with spinal disc problems, 12 percent had been diagnosed as requiring surgery and 5 percent had received emergency room treatment. Following chiropractic treatment, none of the patients were required to have surgery, 86 percent of the patients needed no further care, and the estimated health care savings in the group of 80 was estimated to be $250,000.

        The Av-Med Study - 1993.




        THE MIDWEST RESEARCH INSTITUTE STUDY

        This study examined clinical trials published in the professional literature between 1930 and 1981.

        The researchers concluded that:

        • manual therapy was superior to placebos,
        • there was greater mobility following manipulation,
        • the duration of treatment was shorter for the manipulated groups,
        • there was improved lateral flexion and rotation after manipulation,
        • the numerous case studies throughout the literature report the satisfaction of chiropractic patients with the outcome of treatments.

        Chiropractic Evaluation Study Task III Report of the Relevant Literature. MRI Project No. 8533-D. MacDonald MJ, Morton L. For Department of Defense, OCHAMPUS, Aurora, Colorado - 1986.




        THE ANNALS OF INTERNAL MEDICINE STUDY

        The Third Most Widely Read Medical Journal Finds Chiropractic A Winner In Low Back Pain

        The use, complications, and efficacy of spinal manipulation for low back pain was reviewed in the Annals of Internal Medicine, the third most widely read medical journal. The article concluded that spinal manipulation clearly helps patients with uncomplicated, acute low back pain.

        Spinal Manipulation for Low Back Pain. Shekelle P, et al. Annals of Internal Medicine - 1992;117:590-598.

         

        Landmark Legal Decision Supports Chiropractic

        Further validation of chiropractic care evolved from an antitrust suit which was filed by four members of the chiropractic profession against the American Medical Association (AMA) and a number of other health care organizations in the U.S. (Wilk et al v. AMA et al, 1990). Following 11 years of litigation, a federal appellate court judge upheld a ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a "lengthy, systematic, successful and unlawful boycott" designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the U.S. health care system. Judge Getzendanner rejected the AMA's patient care defense, and cited scientific studies which implied that "chiropractic care was twice as effective as medical care in relieving many painful conditions of the neck and back as well as related musculo-skeletal problems." Since the court's findings and conclusions were released, an increasing number of medical doctors, hospitals, and health care organizations in the U.S. have begun to include the services of chiropractors.

        Chiropractic Antitrust Suit Wilk, et al., v. AMA, et al. September 25, 1987.

         

         

        Comparison Studies

        Do You Know That Chiropractic Care Is Second To None?

        According to a study conducted by Ontario's Ministry of Health "...for the management of low-back pain, chiropractic care is the most effective treatment, and it should be fully integrated into the government's health care system." The same study also found, "...injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."

        According to the British Medical Research Council Study, spinal manipulation performed by chiropractors was found more effective than alternative treatments for low-back pain.

        According to medical researcher TW Meade, M.D. "...chiropractic is a very effective treatment, more effective than conventional hospital outpatient treatment for low-back pain, particularly in patients who had back pain in the past and who got severe problems".

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

        Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment. Meade, TW et al British Medical Journal - 1990;300:1431-1437.

         

         

        Chiropractic Treatment vs. Standard Medical Care

        Patient Evaluations
        Chiro Care
        Family M.D.
        Mean number of days incapacitated after first visit
        11 days
        40 days
        Restricted for greater than one week
        17%
        48%
        Perception of doctor's confidence in diagnosing and treating low-back pain
        60%
        23%
        Satisfied With Their Treatment
        66%
        22%

        Patient Evaluations of Care from Family Physicians and Chiropractors. ACA Journal of Chiropractic - 1989.

         

         

        Chiropractic Treatment vs. Acupuncture and Medication for Chronic Spinal Pain

        Chiropractic Treatment vs. Outpatient Hospital Treatment by P.T.'s and M.D.'s

        In this study, British medical researchers found chiropractic treatment significantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Significantly fewer patients needed to return for further treatments at the end of the first and second year in those who received chiropractic care (17% compared with 24%). In addition, "two and three years after patients with back pain were treated by chiropractors, they experienced far less pain than those who were treated by medical doctors."

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

         

        Chiropractic Treatment vs. Physiotherapy

        Spinal manipulation provided greater improvement of symptoms in those suffering from persistent back and neck complaints compared with physical therapy. The patients receiving spinal manipulation also had greater improvements of physical functioning in fewer visits.

        Randomized Clinical Trial of Manipulative Therapy and Physiotherapy for Persistent Back and Neck Complaints: Results of One Year Follow Up. Koes, B.W. et al. British Medical Journal - 1992;304:601-605.

         

         

         Chiropractic Treatment vs. Physiotherapy 

        Chiropractic Treatment vs. Physiotherapy + Corset + Analgesics

        Statistical benefit for spinal manipulation at 3 weeks.

        Manipulation in the Treatment of Low-back Pain: A Multicentre Study. Doran D and Newell DJ. British Medical Journal - 1975;2:161-164.

         

         

        Chiropractic Treatment vs. Mobilization

        Those receiving spinal manipulation achieved a 50% reduction in their pain levels more rapidly than those receiving mobilization (therapy commonly used by Physical Therapists).

        A Benefit of Spinal Manipulation as Adjunctive Therapy for Acute Low-back pain: A Stratified Controlled Trial. Hadler NM et al. Spine - 1987;12:703-706.

         

        Chiropractic Treatment (spinal manipulation) vs. Massage

         

        Chiropractic Treatment vs. Exercise Combined With Deep Heat Applications

        Those receiving spinal manipulation experienced pain relief in a shorter period of time (3.5 vs. 5.8 treatments).

        Acute Low-back Pain: Comparison of Two Conservative Treatment Approaches. Farrell JP and Twomey LT. Med J Aust - 1982;1:160-164.

        Chiropractic Treatment vs. Bed Rest

        50% of the individuals in the spinal manipulation group were pain free in 1 week compared with only 27% of those receiving bed rest only.

        Low-back pain Treated by Manipulation. Coyer AB and Curwin I. British Medical Journal - 1955;1:705-707.

        Chiropractic Treatment vs. Codeine

        Spinal manipulation provided significant improvement in the subjects overall pain score compared with the commonly prescribed pain medication, codeine.

        Lumbar Spinal Manipulation on Trial: Part 1 - Clinical Assessment. Evans DP et al. Rheumatology and Rehabilitation - 1978;17:46-53.

        Chiropractic Treatment vs. Back School + Corset + Traction

        Researchers found a statistically significant benefit with spinal manipulation at 4 weeks.

        Multicentre Trial of Physiotherapy in the Management of Sciatic Symptoms. Coxhead CE et al. Lancet - 1981;1:1065-1068.

         

        Chiropractic Treatment vs. Deep Heat Applications

        Patients receiving spinal manipulation experienced a significantly shorter time to pain relief than those receiving deep heat applications.

        Distinct benefit for spinal manipulation vs diathermy (deep heat application used by P.T.'s) in return to light work at one month.

        Another study found spinal manipulation provided better pain relief for those with less than 1 week of pain and in patients with their first attack of back pain.

        Relative Therapeutic Efficacy of Vertebral Manipulation and Conventional Treatment in Back Pain Management. Nwuga VC. American Journal of Physical Medicine - 1982;61:273-278.

        Manipulation in the Treatment of Low-back Pain - A Randomized Clinical Trial. Rasmussen GG. Manuelle Medizin - 1979;1:8-10.

        Back Pain: A Randomized Clinical Trial of Rotational Manipulation of the Trunk. Glover JL et al. British Journal of Industrial Medicine - 1974;31:59-64.

         

         

         

        Cost-Effectiveness Studies
         
        It was estimated that 1992 low back pain costs in the US were a staggering $60 billion when production lost was taken into consideration. Research has indicated that low back pain disability is growing 14 times faster than the population. It's the leading cause of disability and morbidity in middle-aged persons, and is the most expensive source of workers' compensation costs in North America. In the 30-50 age group, low back pain is the single most expensive health care problem.

        The escalating costs associated with low back pain have prompted legislators, policy makers and insurance companies to investigate cost-containment strategies. As you will see in the following studies, chiropractic care has been consistently identified as one of the most effective and cost effective treatments for the management of many low back conditions, in addition to a number of other neuromusculoskeletal disorders. Moreover, the volume of scientific evidence now being compiled makes a compelling case for the use of chiropractic as a means of controlling the escalating costs of our overburdened health care system.

          Prevalence of Selected Impairments. United States - 1971. National Center for Health Statistics, Hyattsville, Maryland - 1975, DHHS Publication No. (PHS)75-1526 (Series 10, No. 9) and 1981 DHHS Publication No. (PHS) 87-1587 (Series 10, No. 159)

          Back Injuries in Industry: A Retrospective Study Part I Overview and Cost Analysis. Spengler et al. Spine, 1986 - 11(3):241-245.

         
         
        THE MANGA REPORT

        The following excerpts from the Canadian government commissioned study clearly indicates the cost effectiveness of chiropractic treatment over standard medical treatment:

        • "The overwhelming body of evidence shows that chiropractic management of low-back pain is more cost effective than medical management, and that many medical therapies are of questionable validity or are clearly inadequate ... Chiropractic manipulation is safer than medical management of low-back pain."
        • "There would be highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors... Users of chiropractic care have substantially lower health care costs, especially inpatient costs, than those who use medical care only."

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

         

        THE UTAH STUDY

        In 1988 a Utah Workers' Compensation Board study found the total treatment costs for back-related injuries cost an average of $775.30 per case when treated by a doctor of chiropractic. When injured workers received standard medical treatment as opposed to chiropractic treatment, the average cost per case was $1,665.43.

        They also found the mean compensation cost paid out by the Utah Worker's Compensation Board for patients treated by medical doctors was
        $668.39, while the mean compensation cost paid for patients treated by chiropractic doctors was only $68.38.

        Cost per Case Analysis of Utah Industrial Back Injury Claims: Chiropractic Management vs. Medical Management for Diagnostically Equivalent Conditions. D.C. Tracts - 1989.

        Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-852.




        THE OAKLAND UNIVERSITY STUDY

        After reviewing the health insurance claims for 395,641 chiropractic and medical care patients, Miron Stano, Ph.D., lead researcher, concluded:

        Those patients who receive chiropractic care, either solely or in conjunction with medical care, experienced "
        significantly lower health care costs... on the order of $1,000 each over the two-year period" compared with those who received only medical care. Specifically, total insurance payments were $1,138 (30% higher) for those who elected medical care only. The lower costs for chiropractic patients were attributable both to lower inpatient and outpatient costs and indicated that "chiropractic treatment substitutes for other forms of outpatient care."

        Stano/Medstat Research. Miron Stano, Ph.D. Oakland University.




        THE VIRGINIA RESEARCH STUDY

        An economic analysis conducted in Richmond, Virginia in 1992 found chiropractic care to be a lower cost option for back-related ailments. The researchers concluded that if chiropractic care was insured to the extent of other medical specialties, it would likely emerge as a first option for many patients with certain medical conditions. They also believed this could result in a decrease in the overall treatment costs for these conditions.

        Additional research conducted by The College of William and Mary and the Medical College of Virginia in 1992 on mandated health insurance coverage and the economic impact of chiropractic coverage revealed:

        • The low cost of chiropractic is due not to its low rate of use, but to its apparently offsetting impacts on costs in the face of high rates of utilization. Chiropractic is a growing component of the health care sector, and it is widely used by the population.
        • Formal studies of the cost, effectiveness, or both of chiropractic, usually measured against other forms of treatment, show it to compare favorably with them.
        • By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.
        • The conclusion of this analysis is that chiropractic mandates help make available health care that is widely used by the American public and has proven to be cost-effective.

          A Comparison of the Costs of Chiropractors versus Alternative Medical Practitioners. Dean DH, Schmidt RM. University of Richmond, Richmond, Virginia - January 13, 1992.

          Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with Implications for the Commonwealth of Virginia. Schifrin LG. The College of William and Mary, Williamsburg, Virginia, and Medical College of Virginia, Richmond, Virginia - January 1992.




        THE FLORIDA STUDY

        This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job. Their findings revealed that individuals who received chiropractic care compared with standard medical care for similar diagnoses experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

        An Analysis of Florida Workers' Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation for Chiropractic Education and Research, Arlington, VA. - 1988.




        THE AV-MED STUDY

        In this study, 80 patients who previously received medical treatment were subsequently referred to the Silverman Chiropractic Center. Of the 80 patients, 21 percent had just been diagnosed with spinal disc problems, 12 percent had been diagnosed as requiring surgery and 5 percent had received emergency room treatment. Following chiropractic treatment, none of the patients were required to have surgery, 86 percent of the patients needed no further care, and the estimated health care savings in the group of 80 was estimated to be $250,000.

          The Av-Med Study - 1993.




        THE AUSTRALIAN STUDY

        In this Australian study, 1,996 workers' compensation cases were evaluated in patients who experienced work-related mechanical low back pain. It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.

        Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.

         

         

        Patient Satisfaction Studies

        Patient satisfaction studies have consistently shown that patients are extremely satisfied with the care they receive from chiropractors and far less satisfied with the care they receive from medical practitioners.

        THE GALLUP STUDY

        In 1991 the Gallup Organization performed a nationwide demographic study to determine the attitudes, opinions, and behaviors of both users and nonusers of chiropractic services.

        Their findings?

        Overall, 90% felt that chiropractic health care was effective: more than 80% were satisfied with the treatment they received; nearly 75% felt that most of their expectations were met during the last visit or series of visits; 68% said they would likely see a doctor of chiropractic again for treatment of a similar condition, and 50% would likely be willing to see a doctor of chiropractic for some other problem chiropractors treat. Nearly 80% of the chiropractic users felt that the cost of chiropractic treatment was reasonable.

        Demographic Characteristics of Users of Chiropractic Services. The Gallup Organization, Princeton, New Jersey - 1991.


        THE HARRIS POLL

        According to this 1994 Harris Poll, patients were more satisfied with chiropractic care than care from medical doctors and other health care professionals.

        Those who sought care from a chiropractor were more likely to be very satisfied with their care than those who visited any other practitioner. (Choices were between Chiropractic Doctors, Medical Doctors, Physical Therapists, or Osteopathic Doctors) Of those who have seen both types of practitioner, the majority were more likely to be satisfied with the care of the chiropractor than with that of the medical doctor.

        1994 Harris Poll.




        Patient Evaluations of Care from Family Physicians and Chiropractors

        Findings from this study indicate that patients under chiropractic care had 3 times the satisfaction rate as did patients under the care of Family Physicians. In addition, the patient's perception of the doctor's confidence in diagnosing and treating low back pain was almost 3 times higher in patients receiving chiropractic care compared with those receiving care from family physicians.

        Patient Evaluations of Care from Family Physicians and Chiropractors. Cherkin, D., MacCornack, F.Western Journal of Medicine - 1989;150:351-355.




        THE MANGA REPORT

        As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.

        Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.

        According to lead investigator Pran Manga, Ph.D., "There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management."

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain. Pran Manga and Associates. University of Ottawa, Canada - 1993.

         

         

        Chiropractic Safety Studies

        Chiropractic treatments are extremely safe for people of all ages. Unfortunately, some critics of chiropractic care have attempted to manipulate the public into thinking chiropractic treatments are dangerous. Nothing could be further from the truth. Chiropractic treatments are among some of the safest treatments used in the health care field.

        Read what Canadian researchers stated after performing the largest analysis of scientific literature on the most effective and cost effective treatments for low back pain:

         

        THE MANGA REPORT

          The Ontario Ministry of Health commissioned Manga Report represents the largest analysis of scientific literature on the most effective and cost effective treatments for low back pain. After reviewing all of the international evidence on the management of low back pain, lead investigator Pran Manga, Ph.D., found the treatments provided by Doctors of Chiropractic were exceptionally safe - much safer than for standard medical treatments of similar conditions.

        • "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 (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain."
        • "Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals"
        • "Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

        THE AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY

          On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

          The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

        Their findings included:

        • The risk of serious complications from lumbar spinal manipulation is rare;
        • Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention;
        • Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

        Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.

        THE NEW ZEALAND COMMISSION REPORT

          The government of New Zealand published a 377 page report which assessed the efficacy and safety of chiropractic care. The report was a result of almost 2 years of conducted hearings from recognized health care experts.

          Their principal findings included:

        • "Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy (spinal adjustments)."
        • "Chiropractors carry out spinal diagnosis and therapy at a sophisticated and refined level."
        • "Spinal manual therapy in the hands of a registered chiropractor is safe."
        • "The duration and training of a registered chiropractor are sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether that patient should have medical care instead of, or as well as, chiropractic care."

        New Zealand Report. Hasselberg PD. Government Printer, Wellington - 1979.

         

         

        Government Studies on Chiropractic

        There have been a number of large investigations conducted on chiropractic by the American, Canadian, New Zealand, Swedish and Australian governments over the last few decades. In all cases, their findings have supported the effectiveness and efficacy of Chiropractic.

        Canada's 1993 Manga Report strongly recommended chiropractic care over medical care for the treatment and management of most low-back conditions. The 1994 AHCPR Study from the U.S. Department of Health and Human Services suggested that chiropractic spinal manipulation was a conservative and safe treatment for many low-back conditions and should be utilized prior to any surgical interventions in most cases.

        Doctors of Chiropractic have now become integral to the development of governmental guidelines for the treatment of back conditions in Canada and the U.S. In addition, many hospitals are extending privileges to chiropractors and referrals between medical doctors and chiropractors are becoming increasingly common.

         

        THE AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY

        On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

        The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

        The following conclusions were made in this landmark study:

        • Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention;
        • Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

        Other interesting finds included:

        • The risk of serious complications from lumbar spinal manipulation is rare;
        • There is currently no evidence supporting the use of trigger point, ligamentous and facet injections, needle acupuncture or dry needling as treatment for acute back problems;
        • The panel found no evidence of benefit from the application of physical agents and modalities such as ice, heat, massage, traction, ultrasound, cutaneous laser treatment, transcutaneous electrical nerve stimulation (T.E.N.S.) and biofeedback techniques.

          Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.

        THE MANGA REPORT

        As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.

        Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.

        The researchers also stated that studies on the prevalence and incidence of low back pain suggest that it is the leading cause of disability and morbidity in middle-aged persons, and is by far the most expensive source of workers' compensation costs North America.


        The Canadian Government report concluded with the following findings:

        • 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 low back pain. 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 (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain;
        • Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals;
        • There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management;
        • There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually;
        • Workers' compensation studies report that injured workers with the same specific diagnosis of low back pain returned to work much sooner when treated by chiropractors than by medical physicians;
        • There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management;
        • The use of chiropractic has grown steadily over the years and chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians;
        • In our view, the following offers an overwhelming case in favor of much greater use of chiropractic services in the management of low back pain:
          • the effectiveness and cost effectiveness of chiropractic management of low back pain
          • the untested, questionable or harmful nature of many current medical therapies
          • the economic efficiency of chiropractic care for low back pain compared with medical care
          • the safety of chiropractic care
          • the higher satisfaction levels expressed by patients of chiropractors.


          The following recommendations were also included in the report:

        • There should be a shift in policy to encourage and prefer chiropractic services for most patients with low back pain;
        • Chiropractic services should be fully insured under the Ontario Health Insurance Plan;
        • Chiropractic services should be fully integrated into the health care system;
        • Chiropractors should be employed by tertiary hospitals in Ontario;
        • Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients' needs;
        • Chiropractic should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients;
        • Since low back pain is of such significant concern to workers' compensation, chiropractors should be engaged at a senior level by Workers' Compensation Board to assess policy, procedures and treatment of workers with low back injuries;
        • A very good case can be made for making chiropractors the gatekeepers for management of low back pain in the workers' compensation system in Ontario;
        • The government should make the requisite research funds and resources available for further clinical evaluations of chiropractic management of low back pain, and for further socioeconomic and policy research concerning the management of low back pain generally;
        • Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public finding;
        • Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physiotherapy professions.

          The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

        THE NEW ZEALAND COMMISSION REPORT

        This 377 page report, Chiropractic In New Zealand, was the most comprehensive and detailed independent examination of chiropractic ever undertaken at that time. The report withstood judicial hearings and extensive investigations by the Commission in New Zealand, the United States, Canada, England and Australia.

        According to the researchers,

        "We entered into our inquiry in early 1978. We had no clear idea what might emerge. We knew little about chiropractors. None of us had undergone any personal experience of chiropractic treatment. If we had any general impression of chiropractic it was probably that shared by many in the community: that chiropractic was an unscientific cult, not to be compared with orthodox medical or paramedical services. We might well have thought that chiropractors were people with perhaps a strong urge for healing, who had for some reason not been able to get into a field recognized by orthodox medicine and who had found an outlet outside the fringes of orthodoxy."

        "But as we prepared ourselves for this inquiry it became apparent that much lay beneath the surface of these apparently simple terms of reference. In the first place it transpired that for many years chiropractors had been making strenuous efforts to gain recognition and acceptance as members of the established health care team. Secondly, it was clear that organized medicine in New Zealand was adamantly opposed to this on a variety of grounds which appeared logical and responsible. Thirdly, however, it became only too plain that the argument had been going on ever since chiropractic was developed as an individual discipline in the late 1800's, and that in the years between then and now the debate had generated considerable more heat than light."

        "By the end of the inquiry we found ourselves irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly based and valuable branch of the health care in a specialized area..."

        Their report includes the following findings:

        • Chiropractic is a branch of the healing arts specializing in the correction by spinal manual therapy of what chiropractors identify as biomechanical disorders of the spinal column - they carry out spinal diagnosis and therapy at a sophisticated and refined level;
        • Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy;
        • General medical practitioners and physiotherapists have no adequate training in spinal manual therapy;
        • Spinal manual therapy in the hands of a registered chiropractor is safe;
        • The education and training of a registered chiropractor are sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether the patient should have medical care instead of or as well as chiropractic care;
        • Spinal manual therapy can be effective in relieving musculoskeletal symptoms, such as back pain and other symptoms known to respond to such therapy, such as migraine;
        • In a limited number of cases where there are organic and/or visceral symptoms, chiropractic treatment may provide relief, but this is unpredictable, and in such cases the patient should be under concurrent medical care if that is practicable;
        • In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners;
        • It is wrong that the present law, or any medical ethical rules, should have the effect that a patient can receive spinal manual therapy which is subsidized by a health benefit only from those health professionals least qualified to deliver it;
        • The responsibility for spinal manual therapy training, because of its specialized nature, should lie with the chiropractic profession and part-time or vacation courses in spinal manual therapy for other health professionals should not be encouraged.

          New Zealand Report. Hasselberg PD. Government Printer, Wellington - 1979.

        THE SWEDEN REPORT

        Up until the late 1980's, Sweden had no legislation regulating the practice of chiropractic, although there were approximately 100 chiropractors in Sweden educated in accredited chiropractic colleges. In 1987, a commission on Alternative Medicine in Sweden conducted a detailed investigation of chiropractic education. They had the scientific literature assessed by university medical faculty and additionally commissioned a demographic survey by Statistics Sweden. Subsequent to the report, the Swedish government passed legislation recognizing and regulating the chiropractic profession in Sweden. Then, together with the governments from Denmark, Finland and Norway, it established a school of chiropractic at the University of Odense in Denmark to provide a regional chiropractic college for students from those countries.

        The reports findings included:

        • Doctors of chiropractic should become registered practitioners and be brought within the national insurance system in Sweden;
        • Training for Doctors of Chiropractic follows a 4-5 year course of university level training and was found to be the equivalent to Swedish medical training - chiropractors have "competence in differential diagnosis" and should be regulated on a primary care basis";
        • "Measures to improve cooperation between chiropractors, registered medical practitioners and physiotherapists are vital" in the public interest.

          Ref 11 Supra.

        THE AUSTRALIAN REPORT

        In July of 1984 the Australian Federal Minister for Health asked their Medicare Benefits Review Committee to "consider requests for extending the scope of Medicare (government-funded health care) arrangements to provide benefits for certain paramedical services" - which included chiropractic services.

        The Committee recommended funding for chiropractic in hospitals and other public institutions, and stated:

        • "We are aware of the very considerable organizational and professional obstacles... orthodox practitioners and, indeed, some chiropractors may initially find the experience an uneasy one, but we consider the differences that currently exist to be unreasonable and efforts should be made to bridge the gap."
        • "... the continuing schism between the two professions does little to help improve the health of the many Australians who might benefit from a joint chiropractic/medical approach to their problems."

          Second Report Medicare Benefits Review Committee. Thompson CJ. Commonwealth Government Printer, Canberra, Australia, Chapter 10 (Chiropractic) - June 1986.

         

         

        Work Comp & Return-to-Work Studies

        A number of workers' compensation studies have shown chiropractic care to be superior to medical care in the treatment of on the job back injuries. Chiropractors have been able to get their patients out of pain and back to work faster and with lower treatment costs.

         

        WORKPLACE SAFETY & INSURANCE BOARD - fewer days lost, higher recovery and satisfaction 

        This June 2004 Program of Care for Acute Low Back Injuries One-Year Evaluation Report compared chiropractic care to physiotherapist care in the treatment of work related injuries. The findings showed chiropractic care to be more effective than physiotherapy in actual work days lost (9 with chiropractic, 20 with physiotherapy) and physical recovery to pre-injury status (88% with chiropractic care, 75% with physiotherapy) as well as other categories specific to employee and employer satisfaction.

        Program of Care for Acute Low Back Injuries One-Year Evaluation Report June 2004. Workplace Safety & Insurance Board of the government of Ontario, Canada with Maitland Consulting.

         

        THE UTAH STUDY- fewer costs and days lost

        This 1988 Utah workers' compensation board study found a tenfold savings for mean compensation costs in back-related injuries treated by chiropractors as compared with medical doctors ($68.38 vs. $668.39). To ensure accurate and true results, only those back-related injuries with the same diagnostic codes were compared between the two treatment groups. Also, the medical treatments assessed were limited to nonsurgical medical treatments only.

        Cost per Case Comparison of Back Injury Claims of Chiropractic versus medical Management for Conditions with Identical Diagnostic Codes. Jarvis KB, et al. Journal of Occupational Medicine - 1991;33:847-52.




        THE FLORIDA STUDY- shorter disability/lower costs/lower hospitalization rates

        This large State of Florida study examined 10,652 patients who sustained back-related injuries on the job. Their findings revealed that individuals who received chiropractic care compared with standard medical care for similar diagnoses experienced had a (i)51.3 percent shorter temporary total disability duration(ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case)(iii)20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.

        An Analysis of Florida Workers' Compensation Medical Claims for Back Related Injuries. Wolk S. Foundation for Chiropractic Education and Research, Arlington, VA. - 1988.




        THE CALIFORNIA STUDY- chiropractic patients get back to work sooner

        In this study, Richard Wolf, M.D. followed 500 individuals sent for chiropractic treatments and 500 individuals sent to medical doctors for treatment. Those who received chiropractic treatments returned to work in an average of 15.6 days vs. 32 days in those who received treatments from medical doctors.

        Industrial Back Injury. Wolf CR. International Review of Chiropractic - 1974;26:6-7.




        THE OREGON STUDY- chiropractic gets individuals back to work, and fast!

        This Oregon study found that individuals with workers' compensation claims returned to work significantly faster under chiropractic care compared with medical care. In fact, under chiropractic care 82% were able to return to work after one week compared with only 41% in those who received medical care.

        A Study of Time Loss Back Claims. Portland, OR. Workers' Compensation Board, State of Oregon, March 1971.




        THE AUSTRALIAN STUDY- cost & pain-relief effective with a lower chronicity rate

        In this Australian study, 1,996 workers' compensation cases were evaluated in patients who experienced work-related mechanical low back pain. It was found that those individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors. Also, in those patients who received chiropractic care there was a significantly lower incidence of progression to a chronic low back pain status.

        Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Ebrall, PS. Chiropractic Journal of Australia - 1992;22:47-53.


         

        THE MANGA REPORT- back to work... and fast

        According to this Canadian government commissioned study,

        "...injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."

        The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

        "Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

        In a group of patients, those receiving spinal manipulation obtained pain relief in a shorter period of time compared with massage. Also, significantly more subjects were able to return to work 6 months after treatment in the chiropractic treatment group compared with the massage therapy group (60% vs. 36%).

        A Canadian study found spinal manipulation resulted in significantly greater back mobility compared with massage at 2 weeks (30% vs 15%).

        The Efficacy of Manual Treatment in Low-back Pain: A Clinical Trial. Arkuszewski Z. Manual Medicine - 1986;2;68-71.

        A Randomized Trial of Manipulation for Low-back Pain in a Medical Setting. Godfrey CM et al. Spine - 1984;9:301-304.

         

        This June 2004 Program of Care for Acute Low Back Injuries One-Year Evaluation Report compared chiropractic care to physiotherapist care in the treatment of work related injuries. The findings showed chiropractic care to be more effective than physiotherapy in actual work days lost (9 with chiropractic, 20 with physiotherapy) and physical recovery to pre-injury status (88% with chiropractic care, 75% with physiotherapy) as well as other categories specific to employee and employer satisfaction.

        Program of Care for Acute Low Back Injuries One-Year Evaluation Report June 2004. Workplace Safety & Insurance Board of the government of Ontario, Canada with Maitland Consulting.

         


         

        Latest Research Shows Chiropractic Is the "Only" Care Providing "Broad-Based, Long-Term Benefit". 

        In 2003, a randomized clinical trial published in the research journal Spine demonstrated that chiropractic manipulation is superior to needle acupuncture and "medication".  The study focused on chronic spinal pain and found that the "HIGHEST PROPORTION OF EARLY (ASYMPTOMATIC STATUS) RECOVERY WAS FOUND FOR MANIPULATION (27.3%), followed by acupuncture (9.4%) and medication (5%). It summarized that "Overall, patients who have chronic mechanical spinal pain syndromes and received spinal manipulation gained significant broad-based beneficial short-term and long-term outcomes. In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the ONLY treatment modality of the assessed regimens that provides broad and significant long-term benefits."

        Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes. Journal of Manipulative Physiotherapy (JMPT), Muller R., Giles LGF, 2005; 28:3-11.  AND Giles LGF, Muller R. Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine 2003; 28:1490-1503.