Research summary of CHIROPRACTIC CARE for injured workers

Posted on 18. Jul, 2013 by in Read, Research


Compiled by Joseph J. Ierano. BSc DC



The following is a collection of the growing body of evidence that will form the basis of chiropractic scientific principles. Chiropractic was discovered in 1895 and has grown into one of the largest non-medical professions in the western world.





What is Chiropractic? 

Chiropractic is that clinical science based upon a law of biology that states that inborn into all living things is the ability to be well.


Chiropractic draws on the theory of physiology stating that the nervous system (consisting of the brain, spinal cord, peripheral nerves and special sensory organs) controls and coordinates all other organs and structures in the body and relates it to its environment.


Chiropractic clinical science further hypothesises an association between this governing system, the nervous system, and the existence of health in the body.


Chiropractic was originally conjectured, by its founder DD Palmer, as that science that primarily investigates interference to the nervous system’s control of all other organs and structures by the human frame (ie: the spine, skeleton and joints).


Today this conjecture has been elevated to hypothesis by a growing volume of research supporting it.


[Definition of chiropractic by Virgil V Strang, DC PhC (former president Palmer College of Chiropractic, USA)]



Government and Research Studies on Chiropractic and back pain

In recent years, numerous independent researchers and various overseas and Australian government agencies have conducted studies which focus on the efficacy, appropriateness and cost-effectiveness of chiropractic care. Several of these important studies are listed below.



Dr Phillip Ebrall of RMIT Australia published a study in the Chiropractic Journal of Australia (1992; 22(2):47-53). Only one third of the cost of medical care was incurred by those under chiropractic management for back injury. Chiropractic patients were also six times less likely to become chronic. See Appendix one.



A 1994 study published by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services endorses spinal manipulation for acute low back pain in adults in its Clinical Practice Guideline # 14. An independent multidisciplinary panel of private-sector clinicians and other experts convened and developed specific statements on appropriate health care of acute low back problems in adults. One statement cited, relief of discomfort (low back pain) can be accomplished most safely with spinal manipulation, and/or non-prescription medication.



A major study to assess the most appropriate use of available health care resources was reported in 1993. This was an outcomes study funded by the Ontario Ministry of Health and conducted in hopes of sharing information about ways to reduce the incidence of work-related injuries and to address cost-effective ways to rehabilitate disabled and injured workers. The study was conducted by three health economists led by University of Ottawa Professor Pran Manga, Ph.D. The report of the study is commonly called the Manga Report. The Manga Report overwhelmingly supported the efficacy, safety, scientific validity, and cost effectiveness of chiropractic for low-back pain. Additionally, it found that higher patient satisfaction levels were associated with chiropractic care than with medical treatment alternatives.


“Evidence from Canada and other countries suggests potential savings of hundreds of millions annually,” the Manga Report states. “The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability.”



A four-phase study conducted in the early 1990s by RAND, one of America’s most prestigious centers for research in public policy, science and technology, explored many indications of low-back pain. In the RAND studies, an expert panel of researchers, including medical doctors and doctors of chiropractic,

found that:


Chiropractors deliver a substantial amount of health care to the U.S. population.


Spinal manipulation is of benefit to some patients with acute low-back pain.


The RAND reports marked the first time that representatives of the medical community went on record stating that spinal manipulation is an appropriate treatment for certain low-back pain conditions.



A particularly significant study of chiropractic was conducted between 1978-1980 by the New Zealand Commission of Inquiry. In its 377-page report to the House of Representatives, the Commission called its study “probably the most comprehensive and detailed independent examination of chiropractic ever undertaken in any country.”


The Commission entered the inquiry with “the general impression … shared by many in the community: that chiropractic was an unscientific cult, not to be compared with orthodox medical or paramedical services.”


By the end of the inquiry, the commission reported itself “irresistibly and with complete unanimity drawn to the conclusion that modern chiropractic is a soundly-based and valuable branch of health care in a specialized area…”


Conclusions of the Commission’s report, based on investigations in New Zealand, the U.S., Canada, theUnited Kingdom, and Australia, stated:


Spinal manual therapy in the hands of a registered chiropractor is safe.


Spinal manual therapy can be effective in relieving musculo-skeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine.


Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy.


In the public interest and in the interests of patients, there must be no impediment to full professional cooperation between chiropractors and medical practitioners.




A 1988 study of 10,652 Florida workers’ compensation cases was conducted by Steve Wolk, Ph.D., and reported by the Foundation for Chiropractic Education and Research. It was concluded that

“a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors.”



In 1989, a survey administered by Daniel C. Cherkin, Ph.D., and Frederick A. MacCornack, Ph.D., concluded that patients receiving care from health maintenance organizations (HMOs) within the state ofWashington were three times as likely to report satisfaction with care from chiropractors as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.



A workers’ compensation study conducted in Utah by Kelly B. Jarvis, D.C., Reed B. Phillips, D.C., Ph.D., and Elliot K. Morris, JD, MBA, compared the cost of chiropractic care to the costs of medical care for conditions with identical diagnostic codes. Results were reported in the August 1991 Journal of Occupational Medicine.


The study indicated that costs were significantly higher for medical claims than for chiropractic claims; inaddition, the number of work days lost was nearly ten times higher for those who received medical care instead of chiropractic care.



A 1992 article in the Journal of Family Practice reported a study by D.C. Cherkin, Ph.D., which compared patients of family physicians and of chiropractors. The article stated “the number of days of disability for patients seen by family physicians was significantly higher (mean 39.7) than for patients managed by chiropractors (mean 10.8).”


A related editorial in the same issue referred to risks of complications from lumbar manipulation as being “very low.”



A 1991 report on a workers’ compensation study conducted in Oregon by Joanne Nyiendo, Ph.D., concluded that the median time loss days (per case) for comparable injuries was 9.0 for patients receiving treatment by a doctor of chiropractic and 11.5 for treatment by a medical doctor.



A study by Miron Stano, Ph.D., reported in the June 1993 Journal of Manipulative and Physiological Therapeutics involved 395,641 patients with neuromusculoskeletal conditions. Results over a two-year period showed that patients who received chiropractic care incurred significantly lower health care costs than did patients treated solely by medical or osteopathic physicians.



Following a 1993 study, researchers J. David Cassidy, D.C., Haymo Thiel, D.C., M.S., and W. Kirkaldy-Willis, M.D., 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.”



A 1978 study conducted by J.S. Wight, D.C., and reported in the ACA Journal of Chiropractic, indicated that 74.6% of patients with recurring headaches, including migraines, were either cured or experienced reduced headache symptomatology after receiving chiropractic manipulation.


       1991 GALLUP POLL

A 1991 demographic poll conducted by the Gallup Organization revealed that 90% of chiropractic patients felt their treatment was effective; more than 80% were satisfied with that treatment; and nearly 75% felt most of their expectations had been met during their chiropractic visits.



A study conducted by T.W. Meade, a medical doctor, and reported in the June 2, 1990, British Medical Journal concluded after two years of patient monitoring, “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.”



A 1992 study conducted by L.G. Schifrin, Ph.D., provided an economic assessment of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia. As reported by the College of William and Mary, and the Medical College of Virginia, the study indicated that chiropractic provides therapeutic benefits at economical costs. The report also recommended that chiropractic be a widely available form of health care.



A 1992 review of data from over 2,000,000 users of chiropractic care in the U.S., reported in the Journal of American Health Policy, stated that “chiropractic users tend to have substantially lower total health care costs,” and “chiropractic care reduces the use of both physician and hospital care.”



In 1985 the University of Saskatchewan conducted a study of 283 patients “who had not responded to previous conservative or operative treatment” and who were initially classified as totally disabled. The study revealed that “81%… became symptom free or achieved a state of mild intermittent pain with no work restrictions” after daily spinal manipulations were administered.



Further validation of chiropractic care evolved from an antitrust suit which was filed by four members of the chiropractic profession against the American Medical Association (AMA) and a number of other health acare organizations in the U.S. (Wilk et al v. AMA et al, 1990).


Following II years of litigation, a federal appellate court judge upheld a ruling by U.S. District Court Judge Susan Getzendanner that the AMA had engaged in a “lengthy, systematic, successful and unlawful boycott” designed to restrict cooperation between MDs and chiropractors in order to eliminate the profession of chiropractic as a competitor in the U.S. health care system.


Judge Getzendanner rejected the AMA’s patient care defense, and cited scientific studies which implied that “chiropractic care was twice as effective as medical care in relieving many painful conditions of the neck and back as well as related musculo-skeletal problems.”


Since the court’s findings and conclusions were released, an increasing number of medical doctors, hospitals, and health care organizations in the U.S. have begun to include the services of chiropractors.


Appendix One:


Dr. Ebrall: chiropractic Victorian work injury study.


Chiropractic Wins Again

Summary adapted from:


In a research paper published in the June, 1992 issue of the Chiropractic Journal of Australia, Dr. Phillip S. Ebrall demonstrated the cost effectiveness of chiropractic care in the Victoria, Australia WorkCare program. “Mechanical Low Back Pain: A Comparison of Medical and Chiropractic Management within the Victorian WorkCare Scheme” is a retrospective study of “all work-related mechanical low back pain (MLBP) claimants within a 12-month period in Victoria, Australia.”


Dr. Ebrall compared two matched samples of 998 patients each where “management was solely by either a chiropractor or a medical practitioner.” Excerpts from the study are printed below:



“Comparisons of costs and outcomes were made between the two samples with the results being: (i) a significantly lower number of claimants requiring compensation days when chiropractic management was chosen, (ii) fewer compensation days taken by claimants who received chiropractic management, (iii) a greater number of patients progressed to chronic status when medical management was chosen, and (iv) a greater payment per claim with medical management. A further result, namely, a higher average practitioner payment with chiropractic management, suggests a more intense level of practitioner/patient interaction by chiropractors. These results demonstrate a significant benefit to the community by chiropractic participation within the Victorian compensation scheme for work-related low back pain.”




more cost effectiveness studies here


Plus a brand new one just added:


Thanks to Dr Malik Slosberg for this summary from his excellent scientific site:


Richard L. Liliedahl, MD, Michael D. Finch, PhD, David V. Axene, FSA, FCA, MAAA, Christine M. Goertz, DC, PhD. Cost of Care for Common Back Pain Conditions initiated with DC vs MD/DO as First Physician: Experience of one of Tennessee-based General Health Insurer. JMPT 2010;33(9):640-43.

A retrospective claims analysis study (October 2004 thru Sept 2006) on Blue Cross Blue Shield of Tennessee’s intermediate & large group fully insured population to determine if there are differences in the cost of LBP care, including visits & medications (narcotic, analgesic, nonsteroidal, and muscle relaxants), when a Pt can choose Tx w a MD or a DC. Coverage included unrestricted access to primary & specialty providers of their choice & unlimited services, except for a 20-visit/yr year limit on physical therapy. There were no differences in this population for co-pays or deductibles based on provider type. Pts had open access to MDs & DCs thru self-referral w/o any limit to the number of visits or differences in co-pays to these 2 provider types. Analysis is based on episodes of care for LBP: reimbursed care delivered between the 1st & last visit with a health care provider for LBP. A 60 day window w/o Tx is considered a new episode.
Results: Paid costs for episodes of LBP care initiated with a chiropractor were almost 40% less than episodes initiated with an MD. Even after risk adjusting each Pt’s costs (determining the severity of clinical presenting symptoms), episodes of care initiated with a DC were 20% lower than those initiated with an MD.
Conclusions: Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient’s costs, episodes of care initiated w a DC are 20% less expensive than episodes initiated w an MD. Results suggest that insurance companies that restrict access to chiropractic care for LBP may, inadvertently, be paying more for care than they would if they removed these restrictions. Savings to the payer for allowing unrestricted access to chiropractic care would result in a saving of $2.3 million per year.

Commentary: This retrospective claims analysis of some 85,402 patients insured by Blue Cross Blue Shield in Tenessee who sought help for LBP initiated by either a DC or MD demonstrates that treatment for an episode of LBP with a chiropractor results in lower costs for LBP care than episodes initiated by an medical doctor even after controlling for severity of Pts presenting complaints. This is a very large population of Pts insured by one of the major insurers in the USA. The discussion section explains that by restricting access to chiropractic care, insurers may be paying more for management of LBP episodes than if they allowed unrestricted access to chiropractic care. A $2.3 million per year savings is substantial and, clearly, cost-effective. This is a very significant finding which may cause health insurance companies to reappraise their policies concerning restricted access to chiropractic care.