What We Know

Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative effectiveness study

A 2 arm randomized controlled trial comparing standard medical care alone to standard medical care with chiropractic manual therapy for acute low back pain demonstrated that over a 4 week trial of treatment, Roland-Morris disability scores dropped significantly more in the standard medical care plus chiropractic manual therapy group at the 2 week and 4 week interval. Numeric pain scales decreased significantly more in in the standard medical care plus chiropractic care as well.

  • Goertz, C. M., Long, C. R., Hondras, M. A., Petri, R., Delgado, R., Lawrence, D. J., … Meeker, W. C. (2013). Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain. Spine, 38(8), 627–634. https://doi.org/10.1097/BRS.0b013e31827733e7

Where the United States spends its spine dollars: expenditures on different ambulatory services for the management of back and neck conditions

The purpose of this study was to examine expenditures on common ambulatory health services for the management of back and neck conditions. Approximately 13.6 million people in 2008 reported ambulatory visit for a primary diagnosis of back or neck pain in the United States. Between 1999 and 2008 there was a mean inflation of 95% on expenditures for medical care.

  • Davis, M. A., Onega, T., Weeks, W. B., & Lurie, J. D. (2012). Where the United States Spends Its Spine Dollars. Spine, 37(19), 1693–1701. https://doi.org/10.1097/BRS.0b013e3182541f45

Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.

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, B. J., Fulton-Kehoe, D., Turner, J. A., Wickizer, T. M., Chan, K. C. G., & Franklin, G. M. (2013). Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. Spine, 38(11), 953–964. https://doi.org/10.1097/BRS.0b013e3182814ed5

A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial

Manual-thrust manipulation provides greater short-term reductions in self-reported disability & 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, M., Haas, M., Glick, R., Stevans, J., & Landsittel, D. (2015). Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain. Spine, 40(4), 209–217. https://doi.org/10.1097/BRS.0000000000000724

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial.

The objective of this study was to determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone. At the 6 week mark, they found a statistically significant difference in scores in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity, disability, and satisfaction. Odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement and self reported pain medication use.

  • Goertz, C. M., Long, C. R., Vining, R. D., Pohlman, K. A., Walter, J., & Coulter, I. (2018). Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain. JAMA Network Open, 1(1), e180105. https://doi.org/10.1001/jamanetworkopen.2018.0105

Manual therapy with or without physical medicine modalities for neck pain: a systematic review.

A systematic review assessed the efficacy of manipulation, mobilization, and soft tissue work on neck pain, function, disability, patient satisfaction, quality of life, and global perceived effect. Mobilization, manipulation, and soft tissue work demonstrated benefit in short-term pain relief and satisfaction. The combination of manual therapy and exercise appears to produce longer-term benefits across multiple outcomes. Mobilization, manipulation, and soft tissue techniques produced greater improvements in GPE, patient satisfaction, and QoL.

  • D’Sylva, J., Miller, J., Gross, A., Burnie, S. J., Goldsmith, C. H., Graham, N., … Hoving, J. L. (2010). Manual therapy with or without physical medicine modalities for neck pain: a systematic review. Manual Therapy, 15(5), 415–433. https://doi.org/10.1016/j.math.2010.04.003

Spinal Manipulative Therapy and other conservative treatments for Low Back Pain: A Guideline from the Canadian Chiropractic Guideline Initiative.

The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain in adults to provide best practice recommendations. For patients with acute back pain, suggestions of postural advice and staying active, reassurance, education, and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or combination of SMT and usual medical care to improve pain and disability. For patients with chronic back pain, suggestions of advice and education, SMT or SMT as part of multimodal therapy (exercise, myofascial therapy, or usual medical care when deemed beneficial) were deemed best practice following a review of the patient outcomes. Similarly, for patients with chronic back related leg pain, suggestions of offering advice and education along with SMT and home exercises were considered best practice.

  • Bussières, A. E., Stewart, G., Al-Zoubi, F., Decina, P., Descarreaux, M., Haskett, D., … Ornelas, J. (2018). Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative. Journal of Manipulative and Physiological Therapeutics, 41(4), 265–293. https://doi.org/10.1016/j.jmpt.2017.12.00