Chiropractic Care – What is the Evidence?

CHIROPRACTIC CARE

WHAT IS THE EVIDENCE

A few weeks ago, a Melbourne chiropractor posted a video on Facebook depicting spinal manipulation of a baby.¬† As they say in social media, the video quickly¬†‚Äėwent viral‚Äô, and the television, radio and newsprint media went into a frenzy.¬† The matter is now rightly under investigation by the Chiropractors Registration Board of Australia, who has¬†also advised chiropractors who perform ‚Äėspinal manipulation‚Äô on¬†infants (under 2 years of age) to refrain from doing so, pending the outcome of an expert review.¬† As a practice providing chiropractic care based on the latest evidence (we do not perform spinal manipulation of infants, often known as¬†'cracking'), this review is welcomed. Later in this newsletter we will explore the current evidence for manual therapy of babies, but firstly let us¬†to¬†address some of the recent misleading media regarding chiropractic in general.

For as long as I have studied and practiced chiropractic there has been a section of the population with a poor opinion of my profession.  In some cases, the opinion is based on a personal experience, however some of the strongest and misplaced opinions come from people who have never visited a chiropractor.  There also continues to be a level of negative sentiment towards chiropractic within the medical profession, although in my experience this has reduced significantly in recent years, and we are now seeing a far more collaborative approach to spine care.  In my opinion it is partly the fault of my own profession that Medical Doctors and the broader community have not been better informed about what we do and the evidence behind it.

As chiropractic patients, I’m sure most of you reading this newsletter would have experienced negative opinions regarding your decision to utilise chiropractic care.  How do you respond to these negative opinions?  I know many of you choose to share your experience of how your practitioner helped you, often when other treatments failed.  For those of you who might want to go a step further, we have compiled a short list of current peer reviewed research on the effectiveness of chiropractic care (Please visit our blog for a copy).  Next time a family member, a friend, a work colleague or even a GP challenge your choice of having your back managed by us, why not print this summary (or direct them to our website), and allow them to be better informed about why you choose a chiropractor to be your spine care expert!

CHIROPRACTIC: EVIDENCE BASED SPINAL CARE

CHARACTERISTICS OF CHIROPRACTIC PATIENTS BEING TREATED FOR CHRONIC LOW BACK AND NECK PAIN. J MANIPULATIVE PHYSIOL THERAPEUTICS 2018 AUG 15. JMPT HERMAN PM ET AL

90% of 6342 patients treated with chiropractic for chronic low back and neck pain reported high satisfaction with the care, few used narcotics and avoiding surgery was the most important reason they chose chiropractic care.

ASSOCIATION BETWEEN UTILIZATION OF CHIROPRACTIC SERVICES FOR TREATMENT OF LOW-BACK PAIN AND USE OF PRESCRIPTION OPIOIDS. J ALTERN COMPLEMENT MED. 2018 FEB 22. WEDON ET AL

Among New Hampshire adults with office visits for non-cancer low back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by Doctors of Chiropractic compared with non-recipients.

NON-INVASIVE TREATMENTS FOR ACUTE, SUBACUTE, AND  CHRONIC  LOW  BACK PAIN:  A  CLINICAL  PRACTICE GUIDELINE  FROM  THE  AMERICAN  COLLEGE  OF PHYSICIANS. ANN INTERN MED. PUBLISHED AT ANNALS.ORG ON  14 FEBRUARY  2017 AMIR QASEEM, MD, PHD

A systematic review of randomized, controlled trials  and  systematic  reviews  (through to April 2015)  investigating  non-invasive  pharmacologic  and  non-pharmacologic treatments  for  low  back  pain strongly recommended spinal manipulation for acute, subacute and chronic low back pain.

NON-PHARMACOLOGIC THERAPIES FOR LOW  BACK  PAIN:  A  SYSTEMATIC  REVIEW FOR  AN  AMERICAN  COLLEGE  OF  PHYSICIANS  CLINICAL  PRACTICE  GUIDELINE. ANNALS OF INTERNAL MEDICINE 2017;166(7):493-505. ROGER CHOU ET AL

Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain.
The American College of Physicians (ACP) and American Pain Society (APS) recommended spinal manipulation as a treatment option for acute low back pain and several non-pharmacologic therapies for sub-acute or chronic low back pain. 

COST-EFFECTIVENESS OF GUIDELINE-ENDORSED TREATMENTS FOR LOW BACK PAIN: A SYSTEMATIC REVIEW. EUROPEAN SPINE JOURNAL 20 (7). JUL 2011. 1024-38 LIN CWC ET AL

An interdisciplinary approach including spinal manipulation, exercise, acupuncture and cognitive behavioural therapy was found to be cost-effective in people with subacute, or chronic low back pain. Massage alone was unlikely to be cost effective. 26 studies were reviewed.