Over many years, spinal manipulation, also known as an adjustment, has been evaluated by researchers within the profession itself, and from the legislative, health care and scientific communities. This has resulted in a significant body of evidence regarding the efficacy of spinal manipulation for musculoskeletal disorders such as back pain, neck pain and headache.
Cost Effective Health Care
Many different governments have evaluated the effectiveness of chiropractic care, from both a public funding perspective and also to help establish clinical guidelines for the chiropractic management of back pain.
In 1993, health economists at the University of Ottawa published their findings. This report concluded that spinal adjustment applied by chiropractors is more effective than alternate treatments for lower back pain. They also concluded that there would be significant cost-saving to the health care system if more management of lower back pain was transferred from physicians to chiropractors.
A major four-year study published in the American Medical Association journal, "The Archives of Internal Medicine", concluded that patients with chiropractic health benefit coverage returned to work faster, had lower claim costs, and used fewer interventions such as MRI's compared to patients without chiropractic benefits.
A study published in the British Medical Journal concluded that adding spinal manipulation to current “best care” in general practice was effective and cost-effective for patients with low back pain.
The Clinical Standards Advisory Group (CSAG) published an important report in the UK in 1994. The CSAG guidelines for the management of back pain recommend spinal manipulation along with active exercise and physical activity to modify pain mechanisms and speed recovery.
The 1997 New Zealand Acute Low Back Pain Guide is a government sponsored, evidence-based guideline based on an extensive review of the international literature. It also used wide consultation with professional groups in New Zealand. This guideline reinforced the CSAG recommendations by including adjustment as an appropriate treatment for pain relief and improvement in mobility and function for acute low back pain.
In 1999, The Danish Institute for Higher Technology Assessment (DIHTA) produced a report on the frequency, management and prevention of low back pain. This report states that spinal manipulation is indicated for management of acute pain and helps improve function. The report stated that manipulation should be considered for use in patients who have been experiencing pain for longer than two to three days. DIHTA also recommended that manipulation be considered for recurrent, chronic low back pain and for nerve root/disc conditions.
The U.K. Royal College of General Practitioners (RCGP) 2001 Clinical Guidelines for the Management of Acute Low Back Pain, state that there is strong evidence that spinal manipulation can provide short-term improvement in pain and activity levels. It also stated that spinal manipulation demonstrates higher patient satisfaction than alternate treatments. These guidelines recommend that spinal manipulation be considered for pain relief and for patients who are failing to return to normal activities.
The Ontario Workplace Safety and Insurance Board (WSIB) guidelines for the treatment of chronic pain, published in The Clinical Journal of Pain supplement in December 2001, stated that manipulation is more effective for chronic low back pain than usual care by a general practitioner, bed rest, analgesics or massage in the short to intermediate term.
A 2004 review of the WSIB Program of Care for acute low back injuries found faster return to work and high satisfaction levels with chiropractic care.
Studies in other countries have reached similar conclusions. The international medical literature contains a broad range of published studies affirming the effectiveness and safety of chiropractic care for musculoskeletal complaints including back pain, neck pain and headaches.
Evidence continues to accumulate, as research advances, to support the benefits of chiropractic care for a variety of conditions.