- Status and Recognition of Chiropractic Care
- Back Pain (Acute, Chronic, and General)
- Carpal Tunnel Syndrome
- Infantile Colic
- Childhood Ear Infections
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
- 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 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.
Why it's important
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.
is essentially the position of the body. "Good posture" means your
bones are aligned in such a way that there is minimal stress or
tension. This proper alignment allows your muscles, joints, and
ligaments to work smoothly. Good posture also enables your vital organs
to be positioned properly so that they can function at peak efficiency.
What causes poor posture
Without good posture, your overall health may be compromised.
Long-term effects of poor posture can include poor digestion, labored
breathing, and stressed muscles, joints, and ligaments. This can
eventually lead to an inability to work efficiently or move properly.
- 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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- 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
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.
- 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"
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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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"
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):
- "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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- 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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- 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:
- 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
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:
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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
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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- 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
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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- 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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