The New Zealand Commission

In 1978-1979 the New Zealand Government conducted a commission of inquiry into the chiropractic profession which is the most thorough independent study on the profession ever published. In its Report at the conclusion of its investigations the Commission found itself “irresistibly ….. drawn to the conclusion that chiropractic is a soundly based and valuable branch of health care” that should be accepted by the medical profession in the public interest, and strongly disapproved of organised medicine which had portrayed chiropractic as a cult.

Hassellberg PD (1979) Chiropractic in New Zealand, Report of the Commission of Inquiry into Chiropractic, Government Printer, Wellington New Zealand

Non-Musculoskeletal Responses to Chiropractic Care

The majority of patients first consult chiropractors for back pain, neck pain or headache. Effectiveness in these areas of chiropractic care are well supported by research. Chiropractors and their patients also report anecdotally on a daily basis, and in case studies, improvement in other systems of the body. Such conditions as asthma, ear problems like otitis media, constipation, dysmenorrhea (severe period pain), dizziness and many others have been reported to respond to chiropractic care.

A comprehensive Swedish study of non-musculoskeletal benefits following chiropractic care was published in 1999. 1504 patients and 87 chiropractors were involved. 23% of patients who were consulting a chiropractor for a musculoskeletal condition (such as back or neck pain) experienced non-musculoskeletal benefits after adjustment. The most common improvements were in respiratory disorders (26%), digestive disorders (25%), cardiac/circulatory problems (14%) and visual disturbances (14%).

Leboeuf-Yde C, Axen I et al. (1999) The Types and Frequency of Improved Nonmusculoskeletal Symptoms Reported After Chiropractic Spinal Manipulative Therapy, J Manipulative Physiol Ther, 22(9):559-564

The World Federation of Chiropractic commissioned the same author to conduct a similar larger multi-nation study which was published in 2005. Questionnaires were received from 6,156 patients of 385 chiropractors in 7 countries. This study had very similar results with the most common conditions of improvement being disorders of digestive, respiratory, circulatory/cardiac and tinnitus. These results call for specific studies into chiropractic care and each individual condition.

LeBoeuf-Yde C, Pedersen EV, Bryner P et al. (2005) Self-Reported Nonmusculoskeletal Responses to Chiropractic Intervention: A Multination Survey, J Manipulative Physiol Ther, 28:294-302.

Chiropractic Effective for Headache

There is now a clear anatomical basis for headache arising from dysfunction in the cervical spine (cervicogenic headache), this being direct connective tissue bridges between the dura and muscles and ligaments in the upper cervical spine (1), and clear random controlled trial evidence of the effectiveness of chiropractic management. (2) Multidiscipline expert panels in Canada (3) and the US (4) have upon review of the evidence, specifically recommended cervical manipulation (adjustment) for many patients with head and neck pain, including patients with whiplash associated disorder from motor vehicle accidents.

1. Hack GD, Koritzer RT et al (1995) Anatomic Relation Between the Rectus Capitus Posterior Minor Muscle and the Dura Mater, Spine 20(23):2484-2486
2. McCrory DC, Penzien DB et al (2001) Evidence Report: Behavioural and Physical Treatments for Tension-Type and Cervicogenic Headache, Des Moines, Iowa, Foundation for Chiropractic Education and Research. Product No. 2085
3. Spitzer WO, Skovron MLet al (1995) Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining Whiplash and its Management, Spine 20:8S
4. Coulter ID, Hurwitz EL et al (1996)The Appropriateness of Manipulation and Mobilisation of the Cervical Spine, RAND Santa Monica, California, document No. MR-781-CR

Chiropractic Management for Lumbar Disc Herniation Proven Safe and Effective

There is now broad based agreement in medical practice that surgery should not generally be considered for lumbar disc herniation patients until there has been a trial of conservative care (1, 2, 3)

A recent large multi-centre interdisciplinary US study (4) compared the effectiveness of “usual medical care” (prescription drugs, exercise plan, self care advice and physical therapies) and “usual chiropractic care” (spinal adjustments, physical therapies, exercise plan and self care education for a group of back pain patients with leg pain extending below the knee. The study utilised 2,870 patients, 51 chiropractic clinics (60 treating chiropractors), 14 medical clinics (111 treating medical doctors).

The patients’ pain levels were assessed using Visual Analogue Scale which showed a greater improvement in the patients receiving chiropractic care after 2 weeks of treatment. This improvement was also greater on all follow up assessments at 1, 3, 6 and 12 months. The chiropractic patients also showed a much greater improvement in the ability to perform daily activities when assessed using the Revised Oswestry Disability Questionnaire.

Some physicians who are unfamiliar with recent scientific literature may still have concerns about the safety of spinal adjustment in the presence of disc herniation. The safety of spinal adjustment when performed by a skilled practitioner is dealt with in a recent comprehensive review by Oliphant in Canada (5). All published medical experts in manipulation such as Bourdillon and Day (6), Lewit (7) and Maigne (8) agree with the chiropractic profession that skilled manipulation (adjustment) is safe and appropriate for the great majority of patients with lumbar disc herniation.

The relative safety of chiropractic adjustment needs also to be compared to the risks of alternatives such as non-steroidal anti-inflammatory drugs (NSAIDs). A major new study published in the British Medical Journal led by Professor Paul Dieppe concludes that the real risks and harm from NSAIDs which are known to be extensive, are actually under represented in controlled studies.

1. Weber H (1994) The Natural History of Disc Herniation and the Influence of Intervention, Spine 19:2234-2238
2. Saal J (1996) Natural History and Non-operative Treatment of Lumbar Disc Herniation, Spine 21:2S-9S
3. Postacchini F (1996) Results of Surgery Compared with Conservative Management for Lumbar Disc Herniations, Spine 21:1383-1387
4. Haas M, Goldberg B et al. (2004) a practice-Based Study of Patients with Acute and Chronic Low-Back Pain Attending Primary Care and Chiropractic Physicians: Two-week to 48 month follow up, J Manipulative Physiol Ther 27:160-169
5. Oliphant D (2004)Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations: A Systematic Review and Risk Assessment, J Manipulative Physiol Ther 27:197-210
6. Bourdillion JF, Day EA (1987) Spinal Manipulation,4th edition, William Heineman Medical Books, London, 216-217
7. Lewit K (1985) manipulative Therapy and Rehabilitation of the Locomotor system, Butterworths, London and Boston,178
8. Maigne R (1972) Orthopaedic Medicine: A New Approach to Vertebral Manipulations transandedby Liberson WT, 300

Cost Effectiveness

There is a large body of evidence that demonstrates very significant savings in health care and compensation costs when back pain patients receive chiropractic rather than medical management.(1, 2)

In the 1990s health economists Manga and Angus from the University of Ottawa in Canada were funded by their government to review all relevant evidence on the cost effectiveness of chiropractic management of low back pain. They concluded that “there is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost effective than medical management” and that “there would be highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors”.(1)

Ebrall, looking at comparable injured workers in Victoria found that the workers compensation costs were far less than half for chiropractic patients compared to medical patients.(3) He also found that the percentage of patients who developed chronic pain from work place injuries was only 1.9% for those under chiropractic care compared to 11.6% for those under medical care.

A four year study published in 2004 in the Archives of Internal Medicine, was conducted on a managed care fund in California which provided medical care only for 1 million members and the same medical care plus chiropractic care for 700,000 members. The patients with the added chiropractic benefit had significantly lower claims per person than the other 1 million. This was not just for back pain but for total health costs. At the most conservative estimate the saving was $16 million US annually. (4)

1. Manga P, Angus D et al. (1993) The Effectiveness and Cost Effectiveness of Chiropractic Management Of Low-Back Pain, Pran Manga and Associates, University of Ottawa, Ottawa, Ontario.
2. Manga P, Angus D (1998)Enhanced Chiropractic Coverage Under OHIP as a Means of Reducing Health Outcomes and Achieving Equitable Access to Select Health Services, Ontario Chiropractic Asssciation , Toronto.
3. Ebrall PS (1992) Mechanical Low Back Pain: A Comparison of Medical and Chiropractic Management Within the Victorian Workcare scheme, Chiro J Aust 22:47-53
4. Legorreta Ap, Metz RD, Nelson CF et al. (2004) Comparative Analysis of Individuals With and Without Chiropractic Coverage, Patient Characteristics, Utilisation and Costs, Arch Intern Med 164:1985-1992.