A substantial number of systematic reviews of literature and meta-analyses have been conducted recently concerning efficacy, patient satisfaction, and cost-effectiveness of chiropractic care. The literature is consistent in reporting substantial evidence that chiropractic treatment is effective for both acute and chronic low-back and neck conditions (Bronfort 1999; Van Tulder, Koes, and Bouter 1997; Aker et al. 1996; Hurwitz et al. 1996; Shekelle et al. 1992; Anderson et al. 1992; DiFabio 1992; Ottenbacher et al. 1985).

Many other studies reported findings indicating the effectiveness of chiropractic care for conditions other than low-back and neck pain.

Acute Low-Back Pain

U.S. Government Agency Report In 1994, the Agency for Health Care Policy and Research published Clinical Practice Guideline 14-Acute Low Back Problems in Adults (Bigos et at. 1994). The guideline defined acute low-back pain, evaluated various treatments, and made recommendations concerning the efficacy of those treatments. According to the Guideline, spinal manipulation is one of the most safe and effective treatments for most cases of acute low-back pain.

Regarding the guideline, the following editorial comments appeared in the Annals of internal Medicine:

"The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that ... spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidal anti-inflammatory drugs... Perhaps most significantly, the guidelines state that... spinal manipulation offers both pain relief and functional improvement" (Micozzi 1998, 65).

Shekelle et al. (1992): doctors of medicine and doctors of chiropractic from RAND, UCLA Schools of Medicine and Public Health, and other research organizations, conducted a literature review of 25 controlled trials and a meta-analysis of nine studies addressing chiropractic treatment of low-back pain. The literature review was published in the Annals of Internal Medicine and concluded, "spinal manipulation hastens recovery from acute uncomplicated low-back pain" (594).

Chronic Low-Back Pain

Van Tulder, Koes, and Bouter (1997), researchers in the Netherlands funded by the Dutch Health Insurance Board, retrieved and evaluated evidence from 48 randomized controlled trials conducted worldwide that addressed the treatment of acute and chronic low-back pain. Researchers found "strong evidence" for the effectiveness of spinal manipulation in the treatment of chronic low-back pain.

General Low-Back Pain

• Bronfort (1999) conducted a systematic review of literature concerning the efficacy of chiropractic treatment of low-back pain. The author found evidence "of short-term efficacy for SMT [spinal manipulative therapy] in the treatment of acute LBP [low-back pain]" (107). Additionally, the author found a combination of spinal manipulation and mobilization to be effective for chronic low-back pain "compared with placebo and commonly used therapies such as general medical practitioner management" (98).
  
  
• In a study reported in 1992, Anderson et al. conducted a meta-analysis of twenty-three randomized controlled clinical trials of the effectiveness of spinal manipulation in the treatment of back pain. The researchers stated, "the trend for spinal manipulation to produce better results than any form of treatment to which it was compared was consistent and strong" (193). For 86% of the outcomes, spinal manipulation was more effective than any other treatment.
  
  
• In a study conducted for the Ontario Ministry of Health, Manga et al. (1993) reported that spinal manipulation is the most effective treatment for low-back pain and that spinal manipulation is "safer than medical management of low-back pain" (11).
  
  
• Following a 1993 study, researchers Cassidy, Thiel, and Kirkaldy- Willis of the Back Pain Clinic at the Royal University Hospital in Saskatchewan concluded that "the treatment of lumbar intervertebral disk herniation by side posture manipulation is both safe and effective" (102).
  
  
• A study conducted by T.W. Meade, a medical doctor, and reported in the British Medical Journal concluded, after two years of patient monitoring, that "for patients with low-back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management" (Meade 1990, 1431).
  
  
• A 1988 study of 10,652 Florida workers' compensation cases was conducted by Wolk and reported by the Foundation for Chiropractic Education and Research. According to Wolk, back injury patients treated by chiropractors versus medical doctors or osteopaths were less likely to develop compensable injuries (injuries resulting in time lost from work and therefore requiring compensation) and less likely to require hospitalization. The author explained that chiropractors are more effective in treating low-back injuries because "chiropractic treatment, in providing more services to the patient at the outset of injury, may produce more immediate therapeutic results and may reduce the amount of time lost from work" (56).

Neck Pain

• Hurwitz et al. (1996), a doctor of medicine and doctors of chiropractic from RAND and several academic institutions, conducted a review of literature on treatments for neck pain. The authors found manipulation to be more effective than mobilization or physical therapy in treating some subacute or chronic neck pain and noted that "all 3 treatments are probably superior to usual medical care" (1755).
  
  
• Doctors of medicine and other professionals from the Netherlands conducted two randomized clinical trials comparing the outcomes of various treatments of chronic back and neck complaints. Spinal manipulative therapy was compared to physiotherapy, treatment by a general practitioner, and a placebo. The authors found faster and greater improvement in the spinal manipulation groups (Koes et al. 1992; Koes et al. 1992).
  
  
• Several studies (Howe, Newcombe, and Wade 1983; Verhoef, Page, & Waddell 1997) have found spinal manipulation to improve neck mobility and decrease neck pain. As Verhoef, Page, and Waddell (1997) concluded, "patients suffering from back and! or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments" (240).

What does chiropractic care have to do with Wellness?

Most people initially consult a doctor of chiropractic to relieve pain in their backs, legs, necks, arms or heads. However, when a chiropractor applies his or her philosophy and techniques to correct the pain problem, there may be an unexpected but welcome secondary gain.

At the core of chiropractic philosophy is the fact that the brain and nervous system control and mediate the functions of the human body. The influence of the nervous system on the rest of the body is altered when the nerves that exit the spine at the vertebrae are crowded, stretched or otherwise irritated by spinal misalignments and fixations. These conditions result in pain at the primary site, but can also affect other areas where the injured nerves travel. For instance, nerves that exit the spine between the shoulder blades travel to the stomach. This is how the brain mediates and controls stomach function. If these nerves are irritated at the level of the spine where they exit, they can cause interference with stomach function. A person may enter the chiropractic office with middle back pain, but through the course of treatment, stomach symptoms - which the individual may have thought were unrelated - improve. Not all stomach problems are caused by this type of nerve interference, but it is an extremely common contributing factor, and in many cases a primary factor.

Through the course of chiropractic treatment for various pain problems involving the spine and its related muscles and nerves, other conditions which affect a person's overall wellness improve. This type of phenomenon is experienced routinely in chiropractic offices. Doctors of chiropractic know that when the nervous system is allowed to function normally and the spine and its related muscles and ligaments are normalized, people experience greater well being.

Chiropractors treat the human body as a whole, which means that nutrition and exercise are usually integrated into the treatment plan, enabling people to achieve their wellness potential.

If you have any questions, please do not hesitate to contact us.

 

Copyright © 1993 by the Foundation for Chiropractic Education and Research. Alt Rights Reserved. For more information on availabte pamphlets and the STAYING WELL newsletter, write or phone FCER/STAYING WELL, #66 Washington Ave., Des Moines, IA 50314, 800-622-6309