A growing list of research studies and reviews demonstrate that the services provided by chiropractic physicians 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.
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
A review article of over 1000 ramdomized controlled trials of all treatments for low back pain. Recommends spinal manipulation for both acute and chronic low back pain.
--Koes B W , van Tulder MW, Thomas S (2006) 'Diagnosis and Treatment of Low Back Pain'. British Medical Journal (BMJ).
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 1996,the authors performed a systematic review of randomized trials. Their objective was to access the effectiveness of the most conservative types of treatment for patients with acute and chronic non-specific low back pain. They found strong evidence for the effectiveness of manipulation, back schools and exercise therapy for chronic low back pain, especially for short-term effects.
– Maurits, W., et al. (1997). Conservative Treatment Of Acute And Chronic Non-Specific Low Back Pain, Spine
The Royal College of General Practitioners, in consultation with the Chartered Society of Physiotherapy, Osteopathic Association of Great Britain, British Chiropractic Association and the National Back Pain Association constructed clinical guielines on low back pain management, based on extensive international scientific evidence. One of the principal recommendations of the guidelines is to “consider manipulative treatment within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities” based on high level evidence that within the first 6 weeks of onset of acute or recurrent low back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which is has been compared.
– Royal College of General Practitioners (1996)
In Comparison to Other Treatment Alternatives
"Manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain compared with usual medical care. 94% of the manual-thrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care."
– Schneider et al (2015), Spine
"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
“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
The Quebec Task Force consisted of an 18-member expert multidisciplinary panel whose mandate was to undertake a comprehensive review and study of whiplash-associated disorders (WAD). One of the sections of the report dealt with clinical guidelines for the diagnosis, treatment and prognosis of WAD. It was the Task Force consensus that the use of non-steroidal anti-inflammatory agents and analgesics, short-term manipulation and mobilization by trained persons and active exercises are useful in Grade II and III WAD, and that manipulative treatments by trained persons for the relief of pain and facilitating early mobility can be used in WAD.
-- Spitzer, W.O., et al. (1995) Whiplash Associated Disorder (WAD): Redefining Whiplash and its Management: Quebec Task Force on Whiplash-Associated Disorder
Chiropractic may offer the best opportunity for relief from the pain of whiplash, according to a study published in the Journal of Orthopaedic Medicine. Ninety-three patients with chronic whiplash symptoms were divided into three groups based upon the nature and severity of their symptoms. All 93 patients received an average of 19.3 chiropractic adjustments over the study period (about four months).
Results showed that two of the three groups (patients with neck pain, restricted neck range of motion and/or neurological symptoms) improved under chiropractic care, with 85.5% reporting "some benefit," 33.5% improving by two symptom grades, and 31% being relieved of all symptoms. As the authors of this study conclude, when it comes to treating whiplash,"chiropractic is the only proven effective treatment."
-- Khan S, Cook J, Gargan M, et al. (1999). Asymptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine.
A report into the effectiveness of manual therapy, as practiced by chiropractors, manipulative physiotherapists and osteopaths for various common musculoskeletal disorders such as back pain and other health problems Effectiveness of Manual Therapies: the UK Evidence Report was published in February 2010. This found evidence that spinal manipulation/mobilisation is an effective treatment for acute, subacture and chronic low back pain; migraine and cerviocogenic headache; cervicogenic dizziness; manipulation/mobilisation is effective for several extremity joint conditions; and thoracic manipulation/mobilisation is effective for acute/subacute neck pain. The conclusions were based on the results of systematic reviews of randomised clinical trials, widely accepted and primarily UK and US evidenced-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories.
-- Bronfort et al. (2010), Effectiveness of Manual Therapies: the UK Evidence Report
In May 2009, The National Institute for Health and Clinical Excellence (NICE) published new guidelines to improve the early management of persistent non-specific low back pain. The guidelines recommend what care and advice the NHS should offer to people affected by low back pain. NICE assessed the effectiveness, safety and cost-effectiveness of available treatments and one recommendation is to offer a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. This treatment may be provided by a range of health professionals, including chiropractors as spinal manipulation is part of the package of care that chiropractors can offer.
-- Nice Guidelines (2009)
This MRC-funded study estimated the effect of; adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise in comparison to “best care” in general practice for patients consulting with back pain. The study summerised that spinal manipulation with and without exercise showed additional improvement at 3 and 6 months compared to ‘best care’. Manipulation was found to be a cost effective addition to ‘best care’ for back pain in general practise and manipulation alone is better value for money than manipulation followed by exercise
-- UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 329:1377
This large UK trial funded by the Medical Research Council (MRC) compared chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. Outcome: chiropractic treatment was 30% more effective than hospital outpatient management, mainly for patients with chronic or severe back pain.
-- Meade et al (1990), Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 300; 1431-1437
This follow up trial conducted in 1995 funded by the MRC, confirmed the findings of the earlier report – patients with low back pain treated by chiropractors derive more benefit and long term satisfaction than those treated by hospitals.
-- Meade et al (1995) Randomised comparison of chiropractic and hospital outpatient treatment for low back pain: results from extended follow up. BMJ 311; 349-351
Manipulation can provide short-term improvement in pain and activity levels and higher patient satisfaction. The risks of manipulation are very low in skilled hands Acute Low Back Pain
-- RCGP (1996, 1999, 2001) Clinical Guidelines for the Management of
In 1994 a British Clinical Standards Advisory Group was asked by the United Kingdom Health Ministers to develop guidelines for patients with back pain. The group found that there is considerable evidence that manipulation can provide short-term symptomatic benefit in some patients with acute back pain and recommended that manipulation should be available as a therapeutic option for the treatment of National Health Service (NHS) patients with back pain, and should be carried out by appropriately trained therapists or practitioners.
-- Rosen, M. et al. (1994) Back Pain Report of a CSAG (Clinical Standards Advisory Group), Committee on Back Pain, HMSO, London, England
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
”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 costs, especially inpatient costs, than those who use medical care only.”
– The Manga report (1994)
In The 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 four times faster (6.26 days vs. 25.56 days) and had treatment that cost four 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.
– Ebrall, PS. (1992) Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Work Care Scheme. Chiropractic Journal of Australia.
Summaries of Research
The Meade Study:
A three-year British comparison of Chiropractic care and standard medical care of low-back pain patients found Chiropractic treatment more effective than hospital outpatient management for patients with chronic or severe back pain. The positive effects of Chiropractic care in this1990 study were even more evident during the follow-up period. Funding of this study was provided by the Medical Research Council, the National Back Pain Association, the
European Chiropractors Union, and the King Edward’s Hospital Fund for London.
The RAND Study:
Preliminary reports published in 1991 by one of the most prestigious centres for research in public policy confirms the appropriateness of spinal manipulation for some low-back pain patients. This study is part of a larger, multi-year project designed by the Consortium for Chiropractic Research to help establish standards of care for the Chiropractic profession. The Foundation for Chiropractic Education and Research (FCER) is assisting in the management of this study.
The Florida Study:
The highlights of this 1988 FCER-funded report support the findings of earlier studies of workers’ compensation claims that Chiropractic care is more cost-effective than standard medical care in the management of work-related back injuries. The results of this study indicated Chiropractic patients suffered shorter periods of total disability, and their cost of care was lower, compared to patients of medical doctors, who were likely to be hospitalised.
The Utah Study:
In another study of worker’s compensation claims, this 1991 study found that patients of Chiropractic care returned to work sooner after injury, reporting an average of two lost work days to twenty under standard medical care in compensation payouts. Funding of this study was provided by the Workers’ Compensation Fund of Utah, the Los Angeles College of Chiropractic, and the Greenawalt Fellowship Fund.
The Koes’ Clinical Trial:
A 1991 Dutch project compared Chiropractic and physiotherapy for the treatment of persistent back and neck complaints. After 12 months, the manipulative therapy groups showed greater improvement in the primary complaint as well as in physical function, with fewer visits. Funding for this trial was provided for the Dutch Ministry of Welfare, Health and Cultural Affairs, and by the Dutch Health Insurance Council.
The Manga Study:
This study researched both the effectiveness and cost-effectiveness of the Chiropractic management of low-back pain, and found “on the evidence, particularly the most scientifically valid clinical studies, spinal manipulations applied by Chiropractors is shown to be more effective than alternative treatment for low-back pain. Many medical therapies are of questionable validity or are clearly inadequate. The study was funded by the Ontario Ministry of Health.
“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
Low Back Pain Guidelines
The National Institute for Health and Clinical Excellence (NICE) guidelines for the early management of persistent non-specific low back pain:
Clinical Standards Advisory Group (CSAG) on low back pain: “Back Pain. Report of a CSAG Committee on Back Pain” 1994 HMSO. ISBN 0-11-321887-7.
European low back pain guidelines (acute low back pain)
European low back pain guidelines (chronic low back pain)
European low back pain guidelines (prevention in low back pain)
Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work - principal recommendations. Faculty of Occupational Medicine. London. Occupational health guidelines for the management of low back pain at work - leaflet for practitioners. Faculty of Occupational Medicine. London. 2000. Waddell G, Burton AK 2000. Occupational health guidelines for the management of low back pain at work - evidence review. Faculty of Occupational Medicine. London.
Chiropractic Treatment in Workers with Musculoskeletal Complaints; Mark P Blokland DC et al;Journal of the Neuromusculoskeletal System vol 8 No 1, Spring 2000
Musculoskeletal Services Framework – Department of Health July 2006
The main treatment interventions, as recommended by the current evidence review and that of clinical guidelines is a biopsychosocial approach: a) Guidance on activity, lifestyle, prognosis and prevention. b) Physical treatments drawn from all types of manual therapy, spinal manipulation and rehabilitation exercise. c) Advice about pain control, including non-prescription medication. d) Psychosocial interventions aimed at resolving cognitive barriers to recovery.