The Science of Chiropractic – Something to Get Excited About

By Beth Clay

Looking back at the history of chiropractic and the history of the International Chiropractors Association (ICA), one realizes that too often we have allowed others to define who we are and what we are about. This past week, two stories came out sharing the good news of the benefits of chiropractic care.

Fox News broadcast a story in which our own ICA Council on Pediatrics President, Dr. Lora Tanis was quoted regarding chiropractic care for babies. The story, Ohio baby ‘smiling again’ after chiropractic adjustments, parents say — but is it safe?” shared the amazing but – as our Pediatrics Diplomate doctors know – all too common story of a child who benefited from chiropractic care. The second story “How a ‘chiropractic adjustment’ finally helped Max Muncy return to the Dodgers” shares the story the integral role of chiropractic in the combined health professions efforts to return a star professional athlete to the lineup.

Both stories detail how chiropractic was not the first line of care, but the care of last resort – and in the pediatrics story, as we always see, a medical doctor with no training in the science, art, or philosophy of chiropractic is quoted with an attempt to plant doubt in the public’s mindset about the safety and benefit of chiropractic care across the lifespan.

It is times like these that I am reminded that we – the ICA and the chiropractic profession – need to constantly be responsible for defining ourselves and not allow others to take that power and responsibility from us.

Don’t let others define you. Don’t let the past confine you. Take charge of your life with confidence and determination and there are no limits on what you can do or be.

Michael Josephson, Founder of Josephson Institute of Ethics

The International Chiropractors Association has been and remains the moderate voice in the chiropractic profession. We stand stalwart in our protection and promotion of the chiropractic profession as a separate and distinct profession with its own science, art, and philosophy. We unapologetically respect and protect this system of healing and the underlying premise that it is founded on – that identification and correction of the vertebral subluxation removes the barriers of communication from the brain to every cell in the body so that the body’s own innate is freed up to focus on recovery and optimal health and life expression.

You, as a doctor of chiropractic or chiropractor, hold within your hands the ability to facilitate health through the chiropractic adjustment. It is time to recognize and give voice to the fact that chiropractic care is both patient-centered and evidence-based.

History shows us that assumptions made about chiropractic care have been wrong. An example of that is the long-standing presumption within states that providing coverage of chiropractic care for lower back pain-related injuries in Worker’s Compensation Programs would increase costs. In the 1990s, many states, faced with dramatically increasing medicals costs in Workman’s Comp claims, restricted reimbursement of chiropractic care because they believed the assumption of increased costs without evidence. Fast forward a quarter century and the Workman’s Compensation Research Institute (WCRI) conducted a study to determine if this the assumption was true. The findings were published in 2022 and reported that the average medical cost-per-claim for injured workers with lower back pain who were treated exclusively by a chiropractor was 61% less than for those who received no chiropractic treatment. Another finding of this study was that the utilization of chiropractic – and the resulting cost savings – was higher in states where the individual was able to choose their course of care rather than the employer or the state.

Research is Something to Get Excited About: The growing research record on the clinical- and cost-effectiveness of chiropractic validates the call from the chiropractic community and the public to improve and increase access to chiropractic care more equitably in federally managed or funded health systems and programs, particularly Medicare. While regular chiropractic care has a whole person effect, it is most widely known as a first line of care for back and neck pain and that is where most of the research evidence exists so far. As you know, chiropractic care falls into the category of “conservative care” from chronic and acute pain issues and is considered preferable as a first line of care over pharmacological and more invasive medical interventions.

While chiropractors use the term “chiropractic adjustment,” many researchers use “spinal manipulation therapy” or SMT. Data show that those who seek chiropractic care first are more than 50% less likely to fill an opioid prescription. In 2004, back pain accounted for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations.[1] By 2014, the costs for back pain annual were in excess of $200 billion.[2] The costs continue to increase.

Below is a small snapshot of some of the important studies pointing to the value of chiropractic and its cost-savings.

Thirty years ago, research concluded that if chiropractic care were insured to the extent of other medical specialties, it would likely emerge as a first option for many patients with certain medical conditions. They also believed this could result in a decrease in the overall treatment costs for these conditions. The outcomes from economic assessment conducted at the College of William & Mary and the Medical College of Virginia of mandated health insurance coverage for chiropractic treatment within the Commonwealth of Virginia found chiropractic care to be a lower cost option for back-related ailments. The study reported that:

  • The low cost of chiropractic is due not to its low rate of use, but to its apparently offsetting impacts on costs in the face of high rates of utilization.
  • Formal studies of the cost, effectiveness, or both of chiropractic, usually measured against other forms of treatment, show it to compare favorably with them.
  • By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs.
  • Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.[3]

More recent studies conclude:

2022: Health care utilization and costs for low back pain:

  • Total cost of care was lowest for individuals who first saw a chiropractor ($5093) compared to primary care physicians ($5660) and highest for individuals who saw Orthopedic specialist ($9434) first.
  • Expensive MRIs have been shown to be used more by Orthopedic specialists (Ortho) and physical medicine and rehabilitation doctors (PM&R), with significantly less MRI for chiropractors (Chiro) over the 1-year follow-up.
  • The variances seen in early- and long-term opioid prescriptions rates are concerning given the ongoing opioid crisis. The study demonstrated that patients first seeing Emergency Medicine physicians (EM), PM&R, and advanced practice registered nurse (APRN) initially had higher early and long-term opioids prescription rates than Chiros.[4]

2022: A first of its kind study in France of participants who presented with chronic musculoskeletal pain and depressive symptoms in a hospital setting. Most participants were satisfied with the chiropractic care they received at the hospital and would recommend it for varied reasons. One participant stated, “In terms of efficiency, for me it was quite spectacular, it did me a lot of good, so I highly recommend it.”[5]

2021: An analysis of Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT) (chiropractic). Adults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT.[6]

2021: Chiropractic is a leading conservative management approach to chronic primary back and neck pain. This study notes that SMT as a preferred conservative management approach increasingly recommended by conventional medical organizations.[7-9]

2021: The Journal of the American Medical Association provides the following patient recommendation: “For patients with chronic low back pain, priority should be given to nondrug treatments combined with exercise. According to the ACP, therapies to combine with exercise include multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercises, progressive relaxation, electromyographic biofeedback, low-level laser therapy, cognitive behavior therapy, and spinal manipulation.”[10]

2020: A study analyzing chiropractic care versus physical therapy (PT), found:

  • Higher satisfaction rates in patients visiting chiropractors.
  • In the short term, chiropractic care is a more cost-effective alternative compared to PT for the treatment of acute low back pain. Chiropractic resulted in a lower cost ($48.56).
  • Chiropractic had a higher daily adjusted life years (DALY) than the PT over a one-month treatment period and five months follow-up.[11]

Sources Cited:

  1. Legorreta, A.P., et al., Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Arch Intern Med, 2004. 164(18): p. 1985-92.
  2. Ma, V.Y., L. Chan, and K.J. Carruthers, Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil, 2014. 95(5): p. 986-995 e1.
  3. Schifrin, L.G., Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, with Implications for the Commonwealth of Virginia. 1992, The College of William and Mary: Virginia.
  4. Harwood, K.J., et al., Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res, 2022. 22(1): p. 694.
  5. F, M., et al., Characteristics, expectations, experiences of care, and satisfaction of patients receiving chiropractic care in a French University Hospital in Toulouse (France) over one year: a case study. BMC Musculoskelet Disord, 2022. 23(1): p. 229.
  6. Whedon, J.M., et al., Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults. J Manipulative Physiol Ther, 2021. 44(7): p. 519-526.
  7. Gevers-Montoro, C., et al., Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Front Pain Res (Lausanne), 2021. 2: p. 765921.
  8. Foster, N.E., et al., Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018. 391(10137): p. 2368-2383.
  9. Corp, N., et al., Evidence-based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Eur J Pain, 2021. 25(2): p. 275-295.
  10. Traeger, A.C., A. Qaseem, and J.H. McAuley, Low Back Pain. JAMA, 2021. 326(3): p. 286.
  11. Khodakarami, N., Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation. Healthcare (Basel), 2020. 8(1).
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