Research

1. Status and Recognition of Chiropractic Care
2. Posture
3. Headaches
4. Back Pain (Acute, Chronic, and General)
5. Carpal Tunnel Syndrome
6. Fibromyalgia
7. Infantile Colic
8. Childhood Ear Infections
9. Elderly
10. Pregnancy

Status and Recognition of Chiropractic Care

Chiropractic is now firmly rooted in the public consciousness as a primary agent of health care management. According to a 1990 study published in the New England Journal of Medicine, the number of visits to non-medical health care providers in 1990 totaled 425 million, 9.5% more than the total number of visits to all family physicians (Eisenberg et al.1993). A follow-up study determined that, in 1997, total visits to non-medical providers amounted to 629 million, exceeding the total projected visits to all primary care physicians by 63% (Eisenberg et al. 1998). Moreover, a 1998 study published in the New England Journal of Medicine reported chiropractic as the most used non-medical treatment (15.7%) (Astin 1998).

The change in consumer preferences for health care is reflected in health insurance coverage. Specifically, a 1999 study found that coverage of chiropractic care is "offered by nearly two-thirds of all HMOs (65%)" (Landmark 1999, 14). When surveyed concerning their policies toward alternative 1 therapies, 43% of HMO representatives reported that they "do not regard chiropractic as an alternative therapy" but as a form of mainstream health care (11).

RAND , a prestigious nonprofit research organization and "think tank," has conducted several studies of chiropractic. Dr. Paul Shekelle, a medical doctor and a researcher for RAND , stated: "Instead of thinking of chiropractic as an alternative or some kind of therapy separate from other health care, we really should consider it equivalent" (Qtd. in Brin 1998).

Widespread consumer use of chiropractic care and its documented effectiveness have flagged the profession for major studies by governments and other organizations throughout the United States , Canada , Europe , and other areas of the world. Some of the significant studies and other inquiries are reported herein.

1 In consideration of these data and because chiropractors represent the third largest primary health care profession (surpassed in numbers only by medical and dental practitioners), the chiropractic community and those served by the profession do not generally apply the terms "alternative" or "unconventional" as descriptors of chiropractic care. Where these terms do appear in this brochure, they are utilized by authors of a particular study.

• Astin, John A. 1998. "Why Patients Use Alternative Medicine." Journal of the American Medical Association 279, no. 19: 1548-1553.
• Brin, Dinah Wisenberg, July 2 1998 , "Study Credits Chiropractors with Right Procedures," The Scranton Times , 14+.
• Cherkin, Daniel C., and Frederick A. MacCornack. 1989. "Patient Evaluations of Low Back Pain Care from Family Physicians and Chiropractors." Western Journal of Medicine 150 (March): 351-355.
• "Chiropractors File Supreme Court Response to AMA's Requests for Review." 1990. Press Release. November 5. Chicago , Illinois .
• DiFabio, R.P. 1992. "Efficacy of Manual Therapy." Physical Therapy 72, no. 12: 853-864.
• Eisenberg, David M., Roger B. Davis, Susan L. Ettner, Scott Appel, Sonja Wilkey, Maria Van Rompay, and Ronald C. Kessler. 1998. "Trends in Alternative Medicine Use in the United States, 1990-1997: Results of a Follow-up National Survey." Journal of the American Medical Association 280, no. 18: 1569-1575.
• Eisenberg, David M., Ronald C. Kessler, Cindy Foster, Francis E. Norlock, Dav R. Calkins, and Thomas L. Delbanco. 1993. "Unconventional Medicine in the United States ." New England Journal of Medicine 328, no. 4: 246-252.
• Landmark Healthcare, Inc. 1998. The Landmark Report on Public Perceptions of Alternative Care. Sacramento , CA : Landmark Healthcare, Inc.
• Landmark Healthcare, Inc. 1999. The Landmark Report II on HMOs and Alternative Care. Sacramento , CA :Landmark Healthcare, Inc.
• Ottenbacher et al. 1985. "Efficacy of Spinal Manipulation/Mobilization Therapy: A Meta-analysis. Spine 10, no. 9: 833-837.

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Posture

 "Posture affects every physiologic function from breathing to hormonal production.  Spinal pain, headaches, mood, blood pressure, pulse and lung capacity are among the functions most easily influenced by posture."A.J.P.M. 1994; 4(1):36

• Good posture is a life-long habit worth developing. It is simple and do-able, something that's good for you and easy to do whether you're working at your desk, driving your car, shopping for groceries, or lying in your bed.
  
  The benefits of good posture are numerous - for example, it can prevent injury, aid in breathing, save your energy, lessen your stress level, and improve digestion. Plus, it simply makes you feel and look better.

  Why it's important What causes poor posture
  
  • Accidents, injuries, falls
  • Careless sitting, standing, sleeping habits
  • Poorly designed work space
  • Foot problems or improper shoes
  • Inadequate mattress support
  • Muscle weakness
  • Muscle imbalance
  • Excess weight
  • Respiratory difficulties
  • Visual difficulties
  • Emotional difficulties (e.g., low self-esteem)
  • Occupational stress

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Headache Pain

• A randomized controlled trial reported by medical doctors and doctors of chiropractic in Denmark found manipulation to have "a significant positive effect" on intensity and duration of cervicogenic headaches compared to "soft-tissue" therapy (Nilsson, Christensen, and Hartrigsen 1997).

Nilsson, Niels, Henrik Wulff Christensen, and Jan Hartvigsen. 1997. "The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache." Journal of Manipulative and Physiological Therapeutics 20, no. 5: 326-330.

• Boline et al. (1995) conducted a study comparing manipulation to pain medication (amitriptyline) in the treatment of tension headaches. The authors found that pain medication had short-term effectiveness--although with side effects--while "four weeks after the end of intervention, the spinal manipulation group showed a 32% reduction in headache intensity, 42% [reduction] in headache frequency, 30% [reduction] in over-the-counter medication usage, and a 16% improvement in functional health status... The amitriptyline therapy group showed no improvement or slight worsening" (150).

Boline, Patrick D., Kassem Kassak, Gert Bronfort, Craig Nelson, and Alfred V. Anderson. 1995. "Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-Type Headaches: A Randomized Clinical Trial." Journal of Manipulative and Physiological Therapeutics 18, no. 3: 148-154.

• In 1998, Hack et al. reported a new anatomical discovery: bridges of connective tissue establish a direct connection between neck muscles and the protective covering of the brain and spinal cord. This is a probable cause-and-effect connection between headaches and cervical spine dysfunction. The authors hypothesized that chiropractic treatment of muscle tension headaches is effective because it can "decrease muscle tension and thereby reduce or eliminate pain by reducing the potential forces exerted on the dura via the muscle-dura connection" (22).

Hack, D.G., G. Dunn et al. 1998. "The Anatomist's New Tools." 1998 Medical and Health Annual. Chicago : Encyclopaedia Brittanica, Inc.

• In 1998, Mitchell, Humphreys, and O'Sullivan described previously unreported ligaments of the neck attached to the base of the skull. This discovery has implications for manual therapy and the treatment of cervicogenic headaches caused by damaged ligaments, mainly in cases of moderate to severe whiplash.

Mitchell, Barry S., B. Kim Humphreys, and Elizabeth O'Sullivan. 1998. "Attachments of the Ligamentum Nuchae to Cervical Posterior Spinal Dura and the Lateral Part of the Occipital Bone." Journal of Manipulative and Physiological Therapeutics 21, no. 3: 145-48.

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Back 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 al. 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 antiinflammatory drugs... Perhaps most significantly, the guidelines state that... spinal manipulation offers both pain relief and functional improvement" (Micozzi 1998, 65).

Bigos, Stanley J., O. Richard Bowyer, G. Richard Braen, et a1. 1994. Acute Low Back Problems in Adults: Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville , MD : Agency for Health Care Policy and Research, Public Health Service , U.S. Department of Health and Human Services.

Micozzi, Mark. 1998. "Complementary Care: When is it Appropriate? Who Will Provide It?" Annals of Internal Medicine 129: 65-66.

• 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).

Shekelle, Paul. G., Alan H. Adams, Mark R. Chassin, Eric L. Hurwitz, and Robot H. Brook. 1992. "Spinal Manipulation for Low-Back Pain." Annals of Internal Medicine 117, no. 7: 590-598.

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.

Van Tulder, Maurits W., Bart W. Koes, and Lex M. Boater. 1997. "Conservative Treatment of Acute and Chronic Nonspecific Low Back Pain: A Systematic Review of Randomized Controlled Trials of the Most Common Interventions." Spine 22, no. 18: 2128-2156.

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).

Bronfort, Gert. 1999. "Spinal Manipulation: Current State of Research and Its Indications." Neurologic Clinics of North America 17, no. 1: 91-111.

• 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.

Anderson, Robert, William C. Meeker, Brian E. Wirick, Robert D. Mootz, Diana H. Kirk, and Alan Adams. 1992. "A Meta-Analysis of Clinical Trials of Spinal Manipulation." Journal of Manipulative and Physiological Therapeutics 15, no. 3: 181-194.

• 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).

Manga, Pran, Doug Angus, Costa Papadopoulos, and William Swan. 1993. The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Ottawa : University of Ottawa .

• 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).

Cassidy, J. David, Haymo W. Thiel, and William H. Kirkaldy-Willis. 1993. "Side Posture Manipulation for Lumbar Intervertebral Disk Herniation." Journal of Manipulative and Physiological Therapeutics 16, no. 2: 96-103.

• 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).

Meade, T. W., S. Dyer, W. Browne, J. Townsend, and A. O. Frank. 1990. "Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment." British Medical Journal 300, no. 6737: 1431-1437.

• 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).

Wolk, Steve. 1988. "An Analysis of Workers' Compensation Medical Claims for Back-Related Injuries." ACA Journal of Chiropractic (July): 50-59.

• "Of 1,996 low-back pain cases studied, patients receiving chiropractic treatment averaged 6.26 compensation days compared to th25.56 compensation days for medical patients."

Ebrall, P. Mechanical Low-Back Pain: A comparison of Medical and Chiropractic Management Within Victorian WorkCare Scheme. Chiropractic Journal of Australia 1992; 22(2): 47-53.

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Carpal Tunnel Syndrome

• Davis et al. (1998) compared chiropractic treatment of carpal tunnel syndrome ( CTS ) to nonsurgical medical treatment. The chiropractic group used manipulation, ultrasound, and wrist supports while the medical group used wrist supports and ibuprofen. While both treatment groups improved significantly, the authors noted that chiropractic represents an alternative conservative treatment for CTS , especially for patients "who are unable to tolerate ibuprofen" (322).

Davis, P. Thomas, James R. Hulbert, Kassem M. Kassak, and John J. Meyer. 1998. "Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial." Journal of Manipulative and Physiological Therapeutics 21, no. 5: 317-326.

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Fibromyalgia

• Blunt, Rajwani, and Guerriero (1997) concluded that chiropractic treatment of fibromyalgia resulted in clinically significant improvement in flexibility and pain levels. The authors recommended that chiropractic treatment be included in a multidisciplinary treatment regimen for fibromyalgia.

Blunt, Kelli L., Moez H. Rajwani, and Rocco C. Guerriero. 1997. "The Effectiveness of Chiropractic Management of Fibromyalgia Patients: A Pilot Study." Journal of Manipulative and Physiological Therapeutics 20, no. 6: 389-399.

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Infantile Colic

• Klougart, Nilsson, and Jacobsen (1989) reported a prospective study of 316 cases of infantile colic. The authors found that 94% of the infants appeared to be helped by chiropractic treatment "within 14 days from the start of treatment" (287). The infants included in the study had moderate to severe infantile colic and were otherwise healthy, averaged two weeks of age at the outset of colic, and averaged 5.7 weeks of age at the start of treatment.

The authors found that chiropractic treatment resulted in "both a reduction of the daily length of the colic periods and a reduction of the number of colic periods per day" (287). Because recovery began between 5.7 and 7.7 weeks of age, the authors maintained that this provided substantial evidence that the improvement could not be attributed strictly to "natural cessation of colic symptoms" (286).

Klougart, Niels, Niels Nilsson, and Jens Jacobsen. 1989. "Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases." Journal of Manipulative and Physiological Therapeutics 12, no. 4: 281-288.

• In a 1999 study similar to the 1989 colic study noted above, Wiberg, Nordsteen, and Nilsson found that "spinal manipulation has a positive short-term effect on infantile colic" (520). Researchers randomly placed otherwise healthy, colicky infants into one of two treatment groups: chiropractic treatment and dimethicone medication. Parents kept a diary of symptoms and behaviors before the trial to establish baseline data and continued to keep a diary of symptoms during the trial. Both groups received two weeks of treatment. The infants in the chiropractic group exhibited "a reduction of 67% on day 12" of daily hours with colic, which was nearly identical to the results of the first study. The "dimethicone group only had a reduction in daily hours with colic of 38% by day 12" (520).

The dimethicone group had several subjects drop out of the study because their symptoms worsened. These subjects and their corresponding data were excluded from the results, creating better overall improvement statistics for the dimethicone group than actually occurred. Yet, the chiropractic subjects still exhibited twice as much improvement at the end of the trials when compared to the dimethicone group.

The authors noted that "spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open 2 possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral" (520).

Wiberg, Jesper M. M., Jan Nordsteen, and Niels Nilsson. 1999. "The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer." Journal of Manipulative and Physiological Therapeutics 22, no. 1: 13-16.

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Childhood Ear Infections

• Children age 5 or younger with reoccurring middle ear infections were treated with chiropractic adjustments to the upper cervical (neck) region. The results were favorable with 93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. …This study's data indicates that limitation of medical intervention (antibiotics) and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

Froehle RM. Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther. 1996 Mar-Apr;19(3):169-77.

• Otitis media is a common disorder that results in numerous visits to the physician each year. This article suggests that by using some forms of manipulation, the eustachian tube is made to open and close in a "pumping action" that allows the ear to drain accumulated fluid more effectively.

Pratt-Harrington D. Galbreath technique: a manipulative treatment for otitis media revisited. J Am Osteopath Assoc . 2000 Oct;100(10):635-9.

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Elderly

• Coulter, et al. demonstrated that "[Elderly] chiropractic users were less likely to have been hospitalized, less likely to have used a nursing home, more likely to report a better health status, more likely to exercise vigorously, and more likely to be mobile in the community. In addition, they were less likely to us prescription drugs."

Coulter I, Hurwitz E, Aronow H, Cassata D, Beck J. Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion. Topics in Clinic Chiropractic 1996; 3(2): 46-55.

• Several studies indicate that elderly persons who utilize chiropractic care spend less money on health care those who do not. Data compiled from the Centers for Medicare and Medicaid Services ( CMS ) in 1999 demonstrated that health care payments for beneficiaries receiving chiropractic care was on average $3,677 less per year than those payments made on beneficiaries not receiving chiropractic care. Other studies have found that this monetary discrepancy may be even more.

Muse & Associates. Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs. July 2001.

• According to a recent study reported in Fundamentals of Chiropractic, patients over the age of 65 who received maintenance care (minimum of four visits per year for five years averaged halth care expenditures of $3,106 per year. This compared to $10,041 per year for patients over the age of 65 who were not receiving chiropractic care, a difference of $6,935.

Redwood, D. Fundamentals of Chiropractic. Mosby. August 1, 2003 .

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Pregnancy

• A study done jointly by a chiropractor and a medial doctor revealed that 75% of pregnant women who received adjustments during their pregnancies stated they found relief from pain symptoms.

Mantero E, Crispini L. Static Alterations of the Pelvic, Sacral, and Lumbar Area due to Pregnancy. Chiropractic Interprofessional Research. Torino : Edizioni Minerva Medica, 1982: 59-68.

• Structural adaptations…place excessive demands on the musculoskeletal system…resulting directly from postural changes, hormonal secretions and increased abdominal girth (that allows for the) development of back pain during pregnancy and labor. Non-invasive chiropractic adjustments can play an important role in treating back pain in both the pregnant and postpartum patients.

Benizzi-DiMarco, D. The Female Patient: Enhancing and Broadening the Chiropractic Encounter with Pregnant and Postpartum Patients. Journal of the American Chiropractic Association. November 2003; 18-24.

• Researchers found that a reduction of labor time is associated with chiropractic care.

Fallon JM. Chiropractic and Pregnancy. Int. Rev. Chiro. 1990; 46(6): 39-42.

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