By Dr. Aaron Puhl BSc, MSc, DC
The following is not a exhaustive list of all Chiropractic-related Research, however, it does represent a concise summary of recent peer-reviewed literature that supports the use of spinal manipulation (the most notable therapy used by chiropractors) for common musculoskeletal conditions. While this discussion emphasizes spinal manipulation, it should be noted that at Able Body, patients are usually treated with multimodal therapy (e.g., education, soft-tissue therapy, exercise rehabilitation, laser and electrotherapy, lifestyle and ergonomic advice, nutritional recommendation, etc). Also included here is information on ways the contemporary chiropractic profession is improving on its evidence-base.
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Mechanical Low Back Pain
Few other health care interventions have been assessed as extensively as spinal manipulation for low back pain, both in terms of safety and effectiveness. The most recent Cochrane Collaboration analysis concluded that spine manipulation is as effective as other common therapies prescribed for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy (See reference 1). A systematic review concluded that spine manipulation achieves equal or superior improvement in pain and function than all other commonly used treatments for acute low back pain (See reference 2). In fact, even the American College of Physicians and the American Pain Society have recently recommended that spine manipulation be considered for people who do not improve on their own (See reference 3). Indeed, a recent, hospital-based study found that a combination of medication, progressive exercise, and spine manipulation offered patients significantly greater improvement than ‘usual-care’ (See reference 4). Moreover, a high-quality medical study found that spinal manipulation was significantly better than the NSAID medication Diclofenac and also clinically superior to placebo (See reference 5).
The public appears to agree with the scientific literature, as the Consumer Reports Health Ratings Center survey found that chiropractic was the most satisfying treatment available for back pain.
Neck Pain
Many studies have been published that examine manual therapies for the treatment of neck pain. The most recent high-quality study published found that for acute and subacute neck pain, spinal manipulation and exercise are more effective than medication in both the short and long term (See reference 6). Indeed, most studies that have examined spinal treatments for neck pain have reached similar conclusions, and a high-quality systematic review concluded that spine manipulation or mobilization can provide immediate or short-term improvement in pain and function (See reference 7).
As it was for back pain treatment, the public appears to agree with the scientific literature regarding chiropractic neck pain treatment; the Consumer Reports Overview of Alternative Therapies revealed that chiropractic was considered more effective than all other neck-pain treatments.
Headaches
A systematic review concluded that chiropractic therapies might be as effective as some commonly used medications for the prevention of migraine headaches (See reference 8). In addition, a unique subgroup of headaches caused by joint irritation in the neck (cervicogenic headache), also appear to respond well to manual therapies like chiropractic (See reference 9). The Consumer Reports Overview of Alternative Therapies indicated that the public considers chiropractic one of the top three most effective treatments for headaches and the highest rated drug-free approach to headache treatment.
Interestingly, high-quality research has confirmed that acupuncture can also offer significant relief of both tension headaches (See reference 10) and migraine headaches (See reference 11).
Lumbar Disc Herniations and Sciatica
Research currently suggests that spinal manipulation is safe for the treatment of disc-related pain (See reference 12). A systematic review and meta-analysis found a significant improvement in overall recovery from sciatica following spinal manipulation, when compared to usual medical care (See reference 13). Similarly, another systematic review suggested that spinal manipulation is effective for the treatment of lumbar disk herniation and sciatica (See reference 14). For example, a prospective cohort comparative effectiveness study found spine manipulation to offer relief equal to that from nerve root injections (See reference 15). Another prospective study found that up to 60% of patients with chronic sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention (See reference 16).
‘Maintenance’ Care?
Combined with an active self-care program, many chronic pain patients find great benefit from ‘maintenance’ (or more accurately, ‘supportive’) care. A medical doctor/researcher has recently published the results of a high-quality study that examines long-term spinal manipulation in patients with chronic low back pain. The study found that “maintenance spinal manipulation” every 2 weeks obtains improved long-term benefits (See reference 17).
Ongoing Research in Public Universities
The Canadian Institutes for Health Research (CIHR) is partnered with the Canadian Chiropractic Research Foundation (CCRF) to provide grants to chiropractors and other scientists for high quality, chiropractic research. This partnership has now placed fully-funded chiropractors, doing high-quality research, in 12 public universities across Canada – click here for info!
References:
1) Rubinstein SM, van Middelkoop M, Assendelft WJ, et al., Spinal manipulative therapy for chronic low-back pain.Cochrane Database Syst Rev. 2011 Feb 16;(2):CD008112.
2) Dagenais S, Gay RE, Tricco AC, Freeman MD, et al., NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain. Spine J. 2010 Oct;10(10):918-40.
3) Chou R, Qaseem A, Snow V, Casey D, et al., Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
4) Bishop PB, Quon JA, Fisher CG, Dvorak MF. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J. 2010 Dec;10(12):1055-64.
5) von Heymann WJ, Schloemer P, Timm J, Muehlbauer B.Spinal HVLA-Manipulation in Acute Nonspecific LBP: A Double Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo. Spine (Phila Pa 1976). 2013 Apr;38(7):540-8.
6) Bronfort G, Evans R, Anderson AV, Svendsen KH, et al., Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10.
7) Gross A, Miller J, D’Sylva J, Burnie SJ, et al., Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249.
8) Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011 Apr;12(2):127-33.
9) Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012 Mar 30. [Epub ahead of print]
10) Linde K, Allais G, Brinkhaus B, Manheimer E, et al., Acupuncture for tension-type headache. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007587.
11) Linde K, Allais G, Brinkhaus B, Manheimer E, et al., Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218.
12) Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210.
13) Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2013 Oct 4. pii: S1529-9430(13)01497-6.
14) Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am. 2011 Feb;22(1):105-25.
15) Peterson CK, Leemann S, Lechmann M, et al. Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. J Manipulative Physiol Ther. 2013 May;36(4):218-25.
16) McMorland G, Suter E, Casha S, du Plessis SJ, et al., Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010 Oct;33(8):576-84.
17) Senna MK, Machaly SA. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976). 2011 Aug 15;36(18):1427-37.
Chiropractic Research by Dr. Aaron Puhl is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.