The following is a small sampling of the large volume of research conducted into chiropractic effectiveness and safety.
Efficacy of Chiropractic Treatment
The Appropriateness of Spinal Manipulation for Low Back Pain, Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brooke RH. Commissioned by the RAND research corporation, Document No. R-4025/1-CCR/FCER, 1991.
Conclusion: Support is consistent for the use of spinal manipulation as a treatment for patients with acute low-back pain and an absence of other signs of lower-limb, nerve-root involvement.
Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, a Nonsteroidal Anti-Inflammatory Drug and Spinal Manipulation, Lynton GF, Muller, R, Journal of Manipulative and Physiological Therapeutics, 22:376-81, 1999.
Conclusion: Spinal manipulation, if not contraindicated, results in greater improvement than acupuncture and medicine.
Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow-up, Meade TW, Dyer S, Browne W, Frank AO, The British Medical Journal, Vol 311, August 5, 1995.
Conclusion: Those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.
Trunk Exercise Combined with Spinal Manipulative or NSAID therapy for Chronic Low Back Pain: A Randomized, Observer-Blinded Clinical Trial, Bronfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV, Journal of Manipulative and Physiological Therapeutics, Vol 19, No 9 Nov/Dec 1996.
Conclusion: Each of the three therapeutic regimes was associated with similar and clinically important improvement over time, however, there was an increase in adverse reactions with NSAIDS.
Manipulative Therapy Versus Education Programs in Chronic Low Back Pain, Triano JJ, McGregor M, Hondras MA, Brennan PC, Spine, Vol 20, No 8, 948-955, 1995.
Conclusion: Greater improvement was noted in pain and activity tolerance in the manipulation group. Immediate benefit from pain relief continued to accrue after manipulation, even for the last encounter at the end of the 2-week treatment interval.
Multicenter Trial of Physiotherapy in the Management of Sciatic Symptoms, Coxhead CE et al, Lancet, 1:1065-1068, 1981.
Conclusion: Greater reductions in perceived pain were reported by those in the spinal manipulative therapy (SMT) group. Combinations of SMT and exercise produced the optimal results.
Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.
Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979.
Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia 1986.
Legitimization for Vissa Kiropraktorer, Commission on Alternative Medicine, SOU, 1987.
Efficacy of Various Forms of Conservative Treatment in Low Back Pain, Postacchini F, et al, Neuro-Orthop, 6:28-35, 1988.
Conclusion: Spinal manipulative therapy was found to be the superior treatment in acute cases.
Spinal Manipulation in the Treatment of Low Back Pain, Kirkaldy-Willis WH, Cassidy JD, Canadian Family Physician, 31:535-540, 1985.
Conclusion: Strong support for the value of manipulation in the treatment of chronic lumbar facet and sacroiliac syndrome.
Spinal Manipulation for Chronic Low Back Pain: A Review of the Evidence, Vernon H, Journal of the Canadian Chiropractic Association, 40(3), 1996.
The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain. Manga P, Angus D, Papadopoulos C, Swan W. Commissioned by the OCA. Funded by the Ontario Ministry of Health. 1993.
Conclusion: On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP [lower back pain]. Many medical therapies are of questionable validity or are clearly inadequate. There is an overwhelming body of evidence indicating that chiropractic management of LBP is more cost-effective than medical management.
Chiropractic Services Review, An Internal Review, Wells et al. Commissioned by the Ontario Ministry of Health, 1994.
Conclusion: On the grounds of effectiveness, safety, patient satisfaction and public acceptance of chiropractic services, particularly in the treatment of musculoskeletal disorders, chiropractic services should continue to be funded by the Ontario Health Insurance Plan.
Paediatric Chiropractic
The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized, Controlled, Clinical Trial with a Blinded Observer, Wiberg JMM, Nordsteen J, Nilsson N, Journal of Manipulative and Physiological Therapeutics, Vol 22, No 8, October 1999.
Conclusion: Spinal Manipulation is effective in relieving infantile colic.
Musculoskeletal Pain in Primary Paediatric Care: Analysis of 1000 Consecutive General Paediatric Clinic Visits, de Inocenio J, Paediatrics, Vol. 102 No. 6, Dec. 1998.
Conclusion: MSP [musculoskeletal pain] represents a frequent presenting complaint in general paediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing paediatrics continuing medical education and training programs.
A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma, Balon J et al, The New England Journal of Medicine, Vol. 339, No. 15, October 1998.
Conclusion: Spinal manipulative therapy is not effective in relieving childhood asthma.
Conditions Treated
Use of Chiropractic Services from 1985 through 1991 in the United States and Canada. Hurwitz EL, Coulter ID, Adams AH, Genovese B, Shekelle PG, American Journal of Public Health, Vol. 88, No 5, 771-776, May 1998.
Conclusions: Approximately 96 percent of patients seek chiropractic care for conditions mostly related to the neuromusculoskeletal system. These health problems included back disorders, arthritis and rheumatism, headaches and other musculoskeletal disorders.
Job Analysis of Chiropractic in Canada. Published by the National Board of Chiropractic Examiners, 1993.
Chiropractors: Do They Help?, Kelner M, Hall O, Coulter I, Fitzhenry & Whiteside, Toronto, 1980.
Demographic and Clinical Characteristics of Chiropractic Patients: A five year study of patients treated at the Canadian Memorial Chiropractic College, Waalen DP, White TP, Waalen JK, Journal of the Canadian Chiropractic Association, 38(2): 75-82, 1994.
Canadian Chiropractic Resources Databank: A Profile of Canadian Chiropractors, Kopansky-Giles D, Papadopoulos C, Journal of the Canadian Chiropractic Association, 41(3): 155-191, 1997.
Trends in Alternative Medicine Use in the United States. 1990-1997. Results of a Follow-up National Survey. Eisenberg DM, Davis RB, Ettner SL, et al. The Journal of the American Medical Association, 280: 1569-1575, 1998.
Use of Alternative Health Care Practitioners by Canadians. Millar WJ, Canadian Journal of Public Health, May-June 1997.
Chiropractic and Safety
The conclusions from the following references are summarized in the Fact File document titled Chiropractic and Safety.
The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1746-1760, 1996.
Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation. Haldeman S, Kohlbeck FJ, McGregor M, Spine, 24(8); 785-794, 1999.
Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents, Rome PL, Chiropractic Journal of Australia, Vol. 29, No. 3, September 1999.
Carotid Artery Dissection due to Elongated Styloid Process, Zuber M, Mos JI, Neurology, November 1999.
A Risk Assessment of Cervical Manipulation v. NSAIDS for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18:530-6, 1995.
Redefining Whiplash and Its Management: Scientific monograph of the Quebec task force on whiplash-associated disorders. Spitzer WO, Skovron ML et al, Spine, 20:85, 1995.
Conservative Management of Mechanical Neck Pain: A Systematic Overview and Meta-Analysis. Aker PD, Gross AR, et al, The British Medical Journal, 313: 1291-96, 1996.
May, 2000