“Recent studies of low back pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients.”
-Hurwitz EL, Morgenstern H, Yu F. “Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA low back pain study.” Spine (Phila Pa 1976). 2005 Oct 1;30(19):2121-8.
“Chiropractic physicians handle more back pain visits than do medical doctors and are playing an increasing role in the management of neuromusculoskeletal problems in general. Furthermore, chiropractic patients are more satisfied with their care than are patients of family physicians.”
-Horwitz, Alan D et al. “A New Gatekeeper for Back Pain.” The American Journal of Managed Care. 1998 Apr Vol 4(4): 576-579.
“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks.”
-Hertzman-Miller et al. “Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.” Am J Public Health. 2002 Oct;92(10):1628-33.
“Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high. There is steadily increasing patient use of chiropractic in the United States, which has tripled in the past two decades.”
-Meeker WC, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med. 2002 Feb 5;136(3):216-27.
“This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary healthcare for low back pain, as currently recommended in existing guidelines.”
-Goertz, CM et al. “Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone” JAMA Network Open. 2018;1(1):e180105.
“For acute and subacute low back pain (LBP), strong evidence supports the use of spinal manipulation to reduce symptoms and improve function.”
“For chronic LBP, strong evidence supports the use of spinal manipulation/ mobilization to reduce symptoms and improve function.”
-The Agency for Healthcare Research and Quality (a division of the United States Department of Health and Human Services) has the above guidelines on www.guideline.gov.
“Our data synthesis suggests that recommendations can be made with some confidence regarding the use of spinal manipulation and/or mobilization as a viable option for the treatment of both low back pain and neck pain.”
-Bronfort G, Haas M, Evans RL, Bouter LM. “Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.” Spine J. 2004 May-Jun;4(3):335-56.
“Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.”
-Cecchi, Francesca et al. “Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: A randomized trial with one-year follow-up.” Clinical Rehabilitation January 2010; Vol. 24, No. 1; pp.26-36.
“Spinal manipulative therapy is an effective treatment for tension headaches… Four weeks after the cessation of treatment, however, the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values. The sustained therapeutic benefit associated with spinal manipulation seemed to result in a decreased need for over-the-counter medication.”
-Boline PD et al. “Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial.” J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):148-54.
“Participants with all 4 factors (current not smoking, not physically inactive, moderate alcohol use, and plasma vitamin C level greater than 0.88 mg/dL as a surrogate for fruit and vegetable consumption) had an advantage of approximately 14 years in chronological age over those without 1 of the 4 factors.”
-Khaw et al. “Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med. 2008 Jan 8;5(1):e12.
“Maternal obesity can result in unfavorable outcomes for the woman and fetus. Maternal risks during pregnancy include gestational diabetes and chronic hypertension leading to preeclampsia. The fetus is at risk for stillbirth and congenital anomalies…Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes…”
-Begum KS et al. “Maternal obesity and pregnancy outcome” Clin Exp Obstet Gynecol. 2011;38(1):14-20.
“Life expectancy increases track more closely with economic prosperity and sanitary engineering than with strictly medical advances. Notable achievements in the past century–the decreased incidences of epidemic infections, dental caries, and stomach cancer–are owed to virologists, dentists, and (probably) refrigeration more than to physicians.”
-Eaton SB et al. “Evolutionary health promotion” Prev Med. 2002 Feb;34(2):109-18.
“The health and well-being of children are inextricably linked to their parents’ physical, emotional and social health, social circumstances, and child-rearing practices. The rising incidence of behavior problems among children attests to some families’ inability to cope with the increasing stresses they are experiencing…”
-Schor EL; American Academy of Pediatrics Task Force on the Family. “Family pediatrics: report of the Task Force on the Family” Pediatrics. 2003 Jun;111(6 Pt 2):1541-71.
“It is projected that raising the minimum year-around serum 25(OH)D (Vitamin D) level to 40 to 60 ng/mL (100–150 nmol/L) would prevent approximately 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer each year, and three fourths of deaths from these diseases in the US and Canada…”
-Garland CF et al. “Vitamin D for cancer prevention: global perspective” Annals of Epidemiology. 2009 July;19(7):468-483.
“They found a large body of evidence suggesting that chiropractic management of low back pain is safer, more efficacious, more cost-effective, and more satisfying to patients than allopathic medical management. They concluded that a good case could be made for making chiropractic physicians the gatekeepers for the management of low back pain.”
-Horowitz, Alan D et al. “A New Gatekeeper for Back Pain.” Am J Man Care. Apr 1998;4:576 -579. (Referring to Manga et al. study commissioned by the Canadian government)
“When considering effectiveness and cost together, chiropractic physician care for low back pain and neck pain is highly cost effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds.”
-Choudhry, Niteesh and Arnold Milstein. “Do Chiropractic Physician Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefit Plans?” A report prepared for the Foundation for Chiropractic Progress. Oct 12, 2009. (Niteesh Choudhry, MD, PhD is out of Harvard Medical School, Boston, MA)
“Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs.”
-Antonio P. Legorreta et al. “Comparative Analysis of Individuals With and Without Chiropractic Coverage.” Arch Intern Med. 2004;164:1985-1992.
“Clinical and cost utilization based on 70,274 member-months over a 7-year period demonstrated decreases of 60.2% in- hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when (chiropractic primary care was) compared with conventional medicine IPA (independent physician association) performance for the same health maintenance organization product in the same geography and time frame…the CAM-oriented PCPs (chiropractors) using a nonsurgical/ nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.”
-Sarnat RL, Winterstein J, Cambron JA. “Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update.” J Manipulative Physiol Ther. 2007 May;30(4):263-9.
“This study suggests that cervical spine manipulation may alter cortical somatosensory processing and sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment.”
-Haavik-Taylor H, Murphy B. “Cervical spine manipulation…” Clin Neurophysiol. 2007 Feb;118(2):391-402. Epub 2006 Nov 29.
“Spinal manipulation appears to prevent fatigue developed during maximal contractions. Spinal manipulation appears to alter the net excitability of the low-threshold motor units, increase cortical drive, and prevent fatigue.” “The improvements in MVC following spinal manipulation are likely attributed to increased descending drive and/or modulation in afferents.”
-Niazi, IK et al. “Changes in H-reflex…” Exp Brain Res. 2015 Jan 13.
“These results suggest that asymptomatic (no pain) people with a history of SCNP (subclinical neck pain) have reduced elbow JPS (joint position sense) accuracy compared to those with no history of any neck complaints. Furthermore, the results suggest that adjusting dysfunctional cervical segments in people with SCNP can improve their upper limb JPS accuracy.”
-Haavik H, Murphy B. “Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense.” J Manipulative Physiol Ther. 2011 Feb;34(2):88-97.
“The results of this preliminary clinical trial demonstrated that MFMA SMT (mechanical force, manually assisted spinal manipulative therapy) results in a significant increase in sEMG erector spinae isometric MVC muscle output (trunk muscle strength).”
-Keller TS, Colloca CJ. “Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial.” J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):585-95.
“Several clinical studies indicate that spinal manipulation alters central processing of mechanical stimuli evidenced by increased pressure pain thresholds and decreased pain sensitivity in asymptomatic and symptomatic subjects following manipulation.
-Reed, WR et al. J Manipulative Physiol Ther 2014;37:277-286.
“The prevalence and impact of back pain have led to an expanding array of tests and treatments, including injections, surgical procedures, implantable devices, and medications. Each is valuable for some patients, but use may be expanding beyond scientifically validated indications, driven by professional concern, patient advocacy, marketing, and the media.”
-Deyo, RA et al. “Overtreating Chronic Back Pain: Time to Back Off?” The Journal of the American Board of Family Medicine Volume 22 Number 1, January 2009, pp. 62-68.
“This is the first reported randomized controlled trial comparing full CPG (clinical practice guidelines)-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC (usual care) in the treatment of patients with AM-LBP (acute mechanical low back pain). Compared to family physician-directed UC, full CPG-based treatment including CSMT (chiropractic spinal manipulative therapy) is associated with significantly greater improvement in condition-specific functioning.”
-Bishop, PB et al. “The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial…” Spine J. 2010 Dec;10(12):1055-64.
“For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.”
As a side note, the authors of these guidelines consider acute pain less than 4 weeks duration, and subacute/chronic over 4 weeks duration. Also, note that for acute LBP not resolved with self-care options the ONLY recommendation is spinal manipulation!
-Chou R, et al. “Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline…” Ann Intern Med 2007 Oct 2;147(7):478-91.
“For acute and subacute low back pain (LBP), strong evidence supports the use of spinal manipulation to reduce symptoms and improve function…For chronic LBP, strong evidence supports the use of spinal manipulation/mobilization to reduce symptoms and improve function.”
-Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C, Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther 2008 Nov-Dec;31(9):651-8.
“This study suggests that cervical spine manipulation may alter cortical somatosensory processing and sensorimotor integration. These findings may help to elucidate the mechanisms responsible for the effective relief of pain and restoration of functional ability documented following spinal manipulation treatment.”
-Haavik-Taylor H, Murphy B. “Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study.” Clin Neurophysiol. 2007 Feb;118(2):391-402. Epub 2006 Nov 29.
“Spinal manipulative therapy (SMT) acts on the various components of the vertebral motion segment. SMT distracts the facet joints, with faster separation when a cracking sound is heard. Intradiscal pressure may decrease briefly. Forceful stretching of the paraspinal muscles occurs, which induces relaxation via mechanisms that remain to be fully elucidated. Finally, SMT probably has an inherent analgesic effect independent from effects on the spinal lesion.”
-Maigne JY, Vautravers P. “Mechanism of action of spinal manipulative therapy.” Joint Bone Spine. 2003 Sep;70(5):336-41.
“The evidence suggests that effects of spinal manipulative therapy is primarily neurophysiologic, most likely mediated by intense stimulation of large myelinated fibers in the capsular and/or periarticular tissues. Basic science also demonstrates that large fiber stimulation can modulate dorsal horn excitability by inducing segmental inhibitory mechanisms. The phenomenon of dorsal horn excitability, also referred to as central facilitation or sensitization, is pivotal to the contemporary chiropractic paradigm.”
-Srbely, John. “Chiropractic Science: A Contemporary Neurophysiologic Paradigm.” JCCA 2010;54(3):144-146.
“SMT(spinal manipulative therapy)-treated subjects show a time-dependent attenuation of LPS (lipopolysaccharide)-induced production of the inflammatory cytokines unrelated to systemic levels of SP (substance P). This suggests SMT-related down-regulation of inflammatory-type responses via a central yet unknown mechanism.”
-Teodorczyk-Injeyan JA, Injeyan HS, Ruegg R. “Spinal manipulative therapy reduces inflammatory cytokines but not substance P production in normal subjects.” J Manipulative Physiol Ther. 2006 Jan;29(1):14-21.
As a side note, the above quote states “via a central yet unknown mechanism.” However, read the study at the top left of this page as it explains one of the central mechanisms now identified.
“…the benefits that US health care currently deliver may not outweigh the aggregate health harm it imparts.” “However, higher-intensity care generally does not improve survival, and complications of medical care accounted for 1.1 million hospitalizations in 2006—costing nearly $42 billion.”
-Kilo, CM and Larson, EB. “Exploring the Harmful Effects of Health Care.” J American Medical Assoc (JAMA). 2009;302(1):89-91.
“Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity…”
-Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. “Regional variations in health care intensity and physician perceptions of quality of care.” Ann Intern Med. 2006 May 2;144(9):641-9.
“Spine surgery rates in the UK are about one-fifth of the US rate…and epidemiologic studies suggest that rates of back pain are similar among geographic areas.”
-Deyo RA, Mirza SK. “The case for restraint in spinal surgery: does quality management have a role to play?” Eur Spine J (2009) 18 (Suppl 3):S331–S337.
“…by the year 2043 (if current trends continue) we will be forced to spend every cent of every tax dollar treating chronic illness.”
-Chestnut, JL. The Wellness and Prevention Paradigm. (2011) p173. Source cited: Partnership to Fight Chronic Disease. 2009 Almanac of Chronic Disease.
“Presently, according to the American Heart Association, 1.3 million coronary angioplasty and 448,000 coronary bypass operations are performed annually at a cost of more than $100 billion. Despite these costs, many studies, including one last month in the New England Journal of Medicine, reveal that angioplasties and stents do not prolong life or even prevent heart attacks in stable patients (ie 95 percent of those who receive them).”
-Hyman MA, Ornish D, Roizen M. “Lifestyle medicine: treating the causes of disease.” Alternate Therapies in Health and Medicine. 2009 Nov-Dec;15(6):12-4.
“Pharmacologic therapy is provided for children in almost 70% of ambulatory care encounters. During the 11-year study period the mean annual number of ADE (adverse drug event)-related visits was 585,922… The highest proportion of visits was by children 0 to 4 years old who accounted for 43.2%”
-Bourgeois, FT et al. “Pediatric Adverse Drug Events in the Outpatient Setting: An 11-Year National Analysis.” Pediatrics 2009;124;e744-e750
“78% of our healthcare costs are caused by lifestyle and environmental factors—namely our diet, sedentary lifestyle, smoking, chronic stress, and environmental toxins.”
“There is strong evidence that this approach (lifestyle intervention) works and saves money. Unfortunately, insurance doesn’t usually pay for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. It should be the foundation of our healthcare system.”
-Hyman, MA et al. “Lifestyle medicine: treating the causes of disease.” Altern Ther Health Med. 2009;15(6):12-14.
“Our results support the hypothesis that type 2 diabetes can be prevented or delayed in persons at high risk for the disease. The incidence of diabetes was reduced by 58 percent with the lifestyle intervention…”
-Knowler WC, et al. “Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med. 2002;346(6):393-403.
“A Cochrane review of 32 longitudinal analyses and 17 RCTs showed that intensive counseling strategies incorporating behavioral, dietary, and exercise components resulted in a weight loss of 3 to 4 kg over 1 to 3.3 years. [3] The loss was linked with improved glucose tolerance, improved physical functioning, reduced incidence of diabetes, hypertension and CVD, and reduced bone density.”
“A 6-month lifestyle change intervention in obese, sedentary, postmenopausal women showed that women significantly increased their physical activity (+39.6%) and cardiorespiratory fitness (+13.5%) and reduced their body weight (-6.5%), fat mass (-7.4%), body fat (-2.4%), BP (SBP -6.2%, DBP -9.2%), total cholesterol (-7.4%), triglycerides (-16.5%), and low-density lipoprotein (LDL) cholesterol (9.1%) and improved their diet (p < 0.05). [6]”
-“Lifestyle Medicine – Evidence Review.” American College of Preventive Medicine. June 30, 2009.
“The data from the EPIC-Potsdam study show the unfulfilled potential of preventing chronic diseases. Adhering to recommendations for the 4 lifestyle factors (never smoking, having a body mass index lower than 30, performing 3.5 hrs/wk or more of physical activity, and adhering to healthy dietary principles) considered in our analyses can potentially yield enormous reductions in the onset of major chronic diseases such as CVD, diabetes, and cancer.”
“Our results and those of others emphasize the importance and urgency of continuing vigorous efforts to convince people to adopt healthy lifestyles.”
-Ford, ES et al. “Healthy Living Is the Best Revenge: Findings…” Arch Intern Med. 2009;169(15):1355-1362.
