Research on Clinical Outcomes of Modern Chiropractic Care
I will be adding more research to this page as I and
my staff have time to summarize and transfer from the sources where we obtain
Dr Sheely comments: I personally find taking care of babies with colic symptoms extremely rewarding. Of course, babies do not have to believe in the doctor, or have faith in the doctor for the treatment to work. It is quite simply a matter of examining the patient whether it is a baby or an adult and determining if the spine is functioning appropriately or not. I know, you are thinking, "How can you tell if the spine is painful for the baby,....he or she can not talk" You are right...most colicky babies do not point to their spine and say "It hurts here Doc"! But you know what? Chiropractors are experts in an examination procedure called "motion palpation of the spine." Just like a surgeon can sew up a laceration in the skin with needles and surgical clips with speed and skills that will amaze you ... Chiropractic Doctors have developed the skill of determining normal and abnormal function of the spinal column and other joints of the body. It is a learned skill just like determining if a tire is balanced or not.....the Chiropractic Doctor can determine if the the spine of an infant or an adult is functioning properly. The other reason that I enjoy taking care of babies so much is that they tend to respond so much faster than adults! In fact, children, on the average, get results in about 1/3 of the time it takes adults! One reason is that their bodies are still growing with a higher metabolism and probably because they have not yet developed all of the bad habits that adults have.
Klougart, Nilsson, and Jacobsen (1989) reported a prospective study of 316 cases of infantile colic. The authors found that 94% of the infants appeared to be helped by chiropractic treatment “within 14 days from the start of treatment” (287). The infants included in the study had moderate to severe infantile colic and were otherwise healthy, they averaged two weeks of age at the outset of colic, and averaged 5.7 weeks of age at the beginning of treatment.
The authors found that chiropractic treatment resulted in two major outcomes; “both a reduction of the daily length of the colic periods and a reduction of the number of colic periods per day” (287). Because recovery began between 5.7 and 7.7 weeks of age, the authors maintained that this provided substantial evidence that the improvement could not be attributed strictly to “natural cessation of colic symptoms” (286). The facts in this study would indicate that some infants began to show relief almost immediately after the first few treatments.
In a 1999 study similar to the 1989 colic study noted above, Wilberg, Nordsteen, and Nilsson found that “spinal manipulation has a positive short-term effect on infantile colic” (520). Researchers randomly placed otherwise healthy, colicky infants into one of two treatment groups: chiropractic treatment and dimethicone medication. Parents kept a diary of symptoms during the trial. Both groups received two weeks of treatment. The infants in the chiropractic group exhibited “a reduction of 67% on day 12” of daily hours with colic, which was nearly identical to the results of the first study. The “dimethicone group only had a reduction in daily hours with colic of 38% by day 12” (520). This would indicate that the dimethicone group had a results percentage of approximately half of what the chiropractic care infants group did.
The dimethicone group had several subjects drop out of the study because their symptoms worsened. These subjects and their corresponding data were excluded from the results, creating better overall improvement statistics for the dimethicone group than actually occurred. Yet, the chiropractic subjects still exhibited twice as much improvement at the end of the trials when compared to the dimethicone group.
The authors noted that “spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open 2 possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral” (520). (In either case, the results for these babies and their parents were significant enough to show that chiropractic works for this condition. The determination as to whether colic is a visceral (internal organ) or a musculoskeletal disorder may still be undecided in the scientific circles....but clinical science shows that it gets results .....simply put....Chiropractic works....period. Dr Sheely)
Klougart, Niels, Niels Nilsson, and Jens Jacobsen. 1989. “Infantile Colic Treated by Chiropractors: A prospective Study of 316 cases.” Journal of Manipulative and Physiological Therapeutics 12, no. 4: 281-288.
Wiberg, Jesper M. M., Jan Nordsteen, and Niels Nilsson. 1999. “The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer.” Journal of Manipulative and Physiological Therapeutics 22, no. 1: 13-16.
Numerous studies throughout the world have shown that chiropractic
treatment, including manipulative therapy and spinal adjustments, is both safe
and effective. Many other studies have shown that chiropractic care can be a
cost-effective remedy that brings healing in less time than other treatments.
The following are excerpts from just a few of these studies:
The Practice of Chiropractic
Sandefur R, Febbo T, Rupert R. “Assessment Of Knowledge Of Primary Care Activities In A Sample Of Medical And Chiropractic Students.” Journal of Manipulative and Physiological Therapeutics 2005;28:336-344
This study evaluated the primary care knowledge of a group of final-term chiropractic students versus a sample of medical students just entering their residency program. A team composed of MDs and DCs created a 100-item exam to test the students’ training in 52 primary care tasks. The chiropractic students performed almost as well as the medical students, except in the musculoskeletal portion of the examination, in which the chiropractic students scored higher. A 2000 World Health Organization ranked the United States 37th among nations by measures of quality, relevance and cost-effectiveness. Perhaps chiropractors should be given a greater role as primary health care providers.
Anthony J, Lisi A, Holmes E, Ammendolia C. “High-Velocity Low-Amplitude Spinal Manipulation for Symptomatic Lumbar Disk Disease: A Systematic Review of the Literature.” Journal of Manipulative and Physiological Therapeutics 2005;28:429-442
A search of the published English literature resulted in 16 scientific studies that evaluated the effectiveness of high-velocity low-multitude spinal manipulation (HVLASM) for symptomatic lumbar disc disease (SLDD). In light of previous studies that conclude 20 to 76 percent of asymptomatic adults exhibit structural abnormalities upon MRI of the lumbar spine, the term SLDD has been coined to characterize those patients where the disc is thought to be responsible for back pain. Utilization studies conclude that chiropractors commonly manage intervertebral disc syndrome and 6 percent of their low back cases may represent SLDD. This review concluded that the published literature supports that spinal manipulation may be effective for symptomatic lumbar disc disease. There is no published evidence that HVLASM is inherently unsafe for SLDD, and these studies did not report any cases of acute adverse effects with spinal manipulation. Various authors have demonstrated that HVLASM results in increased range of joint mobility, hypoalgesia, normalization of muscle tone and altered kinematics. These effects could be responsible for the clinical benefits of spinal manipulation in SLDD.
Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. “Efficacy of Preventive Spinal Manipulation for Chronic Low-Back Pain and Related Disabilities: A Preliminary Study.” Journal of Manipulative and Physiological Therapeutics 2004 Oct;27(8):509-14.
This 10-month study compared two groups of patients who both initially received a one- month phase of intensive chiropractic treatment (12 visits) for low back pain. One group received one further treatment in the subsequent nine months, while the other group of patients continued to receive “maintenance” spinal manipulation every three weeks for the 9-month follow-up period. At 10 months, levels of pain were similar for both groups, however disability scores returned to pretreatment levels for the “no maintenance” group, while they stayed level for those patients who continued to receive “maintenance” care. Most chiropractors believe that ongoing follow-up care after an initial treatment course can be used to minimize recurrence of symptoms and disability. This study appears to confirm that paradigm.
Muller R, Giles L. “Long-Term Follow-Up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes.” Journal of Manipulative and Physiological Therapeutics 2005;28:3-11
Patients with chronic back pain (>13weeks) were treated for nine weeks wither with medication, acupuncture or spinal manipulation. The medication patients were either given Celbrex, Vioxx or Acetaminophen. Acupuncture was administered by sterile needles twice per week, and manipulation patients were treated twice per week with high-velocity low-amplitude spinal manipulation. The results at nine weeks, previously published by Muller and Giles in Spine 2003, provided evidence that in patients with chronic spinal pain, manipulation results in greater short-term improvement than acupuncture or medication. This study assessed the long-term benefits of the three treatment types at a 1-year follow up. The researchers concluded that only the spinal manipulation group achieved broad-based long-term benefit from their treatment with significant improvement in five of seven outcome measures. The group treated with medication did not achieve any improvement in chronic spinal pain. The acupuncture group had improvement in only one of seven outcome measures. The researchers also found noteworthy that the manipulation group had “by far” the lowest percentage of patients that had to change treatment modality because of side effects of unsatisfactory results. Chronic spinal pain places an immense financial strain on public health resources by affecting lost working time through illness. This study concludes that spinal manipulation may be the only treatment regime to provide long-term benefit to the chronic back pain patient.
Leboeuf-Yde C, Pedersen EN, Bryner P, et al. “Self-Reported Non-Musculoskeletal Responses to Chiropractic Intervention: A Multination Survey.” Journal of Manipulative and Physiological Therapeutics 2005;28:294-302
These researchers surveyed 5,607 chiropractic patients treated by 385 chiropractors in seven different countries to determine if there was a possible link between chiropractic adjustments and unexpected non-musculoskeletal responses, such as improved breathing, digestion and circulation. The patients had initially consulted a chiropractor for conditions such as low and mid-back pain, neck problems and headaches. Most were treated with a short (<6) series of treatment of manual or mechanically assisted adjustments and/or soft tissue therapy. The patients were asked to complete a questionnaire and report whether they experienced definite improvement or definite worsening of various non-musculoskeletal conditions while receiving chiropractic treatment. 10 percent of patients noted improvement in circulation or digestion, while six percent experienced improvement in urination or breathing. The positive pattern of results was similar to those results found in a previous Swedish study and supports a possible link between chiropractic adjustments and improvement in visceral conditions.
Leboeuf-Yde C, Axen I, Jones JJ, et al. “The Nordic Back Pain Subpopulation Program: A One-Year Prospective Multi-Center Study Of Outcomes of Persistent Low-Back Pain in Chiropractic Patients.” Journal of Manipulative and Physiological Therapeutics 2005;28:90-96
875 Norwegian patients who presented persistent lower back pain were treated by Norwegian chiropractors, and their response to treatment was measured by the Oswestry LBP questionnaire at four visits, three months and 12 months. About half the patients reported immediate relief during the first treatment. Most improvement was realized by the fourth treatment, and gradually, the proportion of “improved” patients decreased over the rest of the year. One third of the patients were pain free at three months, but many patients reported recurrent back pain during the one year follow up. The researchers concluded that most improvement occurred early in the course of care. 82 percent of the patients were either very or quite satisfied with treatment while only 4 percent were dissatisfied.
Hoeksma HL, Dekker J, Ronday HK, Heering A, et al. “Comparison of Manual Therapy and Exercise Therapy in Osteoarthritis of the Hip: A Randomized Clinical Trial.” Arthritis Rheum. 2004 Oct 15;51(5):722-9
109 hip pain patients were randomized to either exercise therapy or manual therapy maneuvers to compare the effectiveness of these approaches. The manual therapy group received stretching techniques and traction manipulation applied to shortened hip joint muscles. The exercise group participated in exercise sessions at the clinic, which were followed by home exercise. At the end of nine treatment sessions over five weeks, the manual therapy group achieved 81 percent success while the exercise group realized only a 50 percent success rate, leading the researchers to conclude manual therapy was a more effective treatment than exercise. The superiority of manual therapy persisted at follow up after 17 and 29 weeks. They hypothesized that pain intensity in hip OA is due to restriction of the joint capsule which manual therapy relieves by improving the elasticity of the joint capsule and the surrounding muscles.
Reid SA, Rivett DA. “Manual Therapy Treatment of Cervicogenic Dizziness: A Systematic Review.” Manual Therapy. 2005 Feb;10(1):4-13.
Dizziness is a very common presenting complaint, particularly in patients over 75 years old. Previous studies have linked dizziness with cervicobrachial syndrome, cervical spondylosis and whiplash patients. Two reviewers assessed the validity of nine studies to determine if dizziness can be effectively treated with manual therapy. Their data search led them to conclude that “all the studies had a positive result with significant improvement in symptoms and signs of dizziness after manual therapy treatment.” They proposed that the neuroanatomical and neurophysiological basis for relief is that by increasing range of movement of the neck there is a reduction in muscle spasm and restoration of mechanical gliding of the facets joints, thereby restoring normal afferent input to the cervical spine.
Cleland JA, Whitman JM, Fritz JM. “Effectiveness of Manual Physical Therapy to the Cervical Spine in the Management of Lateral Epicondylalgia: A Retrospective Analysis.” J Orthop Sports Phys Ther. 2004 Nov;34(11):713-22
The purpose of this retrospective review of 112 patients with lateral epiconylalgia was to determine if manual therapy to the cervical spine, in addition to directly treating the elbow, would result in a better outcome than local management alone. Both groups achieved successful long-term outcomes; however, the local management plus cervical manual therapy group needed significantly fewer visits to achieve the same positive effects. This study supports the theory that altered biomechanics of the cervicothoracic spine may contribute to the etiology of lateral epicondylalgia.
Browder DA, Erhard RE, Piva SR. “Intermittent Cervical Traction and Thoracic Manipulation for Management of Mild Cervical Compressive Myelopathy Attributed to Cervical Herniated Disc: A Case Series.” J Orthop Sports Phys Ther. 2004 Nov;34(11):701-12
In this case series, 7 patients with mild cervical compressive myelopathy attributed to cervical herniated disc were treated with thoracic spinal manipulation and intermittent cervical traction. Some of the patients had improvement in neurological deficits, including Hoffmann’s reflex, triceps hyporeflexia, hypoesthesia and myotomal weakness. Others symptoms such as headache, dizziness and pain were positively affected. This study supports the theory that biomechanical dysfunction of the thoracic spine may contribute to musculoskeletal disorders of the cervical spine. The researchers conclude that conservative intervention, as opposed to surgical intervention, is indicated in patients with mild cervical compressive myelopathy.
Licciardone J, Brimhall A, King L. “Osteopathic Manipulative Treatment for Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” BMC Musculoskeletal Disorders 2005, 6:43
These British researchers analyzed data from six randomized controlled trials involving 525 subjects and found a statistically significant reduction in pain with osteopathic manipulative treatment (OMT). Patients receiving OMT demonstrated pain reduction twice as great as those receiving no treatment, and the positive effects of treatment persisted for at least three months. They concluded, “OMT may eliminate or reduce the need for drugs that can have serious side effects.”
Nelson CF, Metz RD, LaBrot T. “Effects Of A Managed Chiropractic Benefit On The Use Of Specific Diagnostic And Therapeutic Procedures In The Treatment Of Low Back And Neck Pain.” Journal of Manipulative and Physiological Therapeutics 2005 Oct;28(8):564-9.
Existing guidelines specify that less aggressive diagnostics and treatment of back pain will lead to better clinical outcomes. These researchers studied claims from 1.7 millions patients over four years to the compared rate of use of advanced imaging, surgery, impatient care and plain-film radiographs between employer groups with and without a chiropractic benefit. On a per-episode basis, the use of these procedures was reduced by the following amounts in the chiropractic benefit group: surgery, 32 percent; advanced imaging, 37 percent; inpatient visits, 40 percent; and plain-film radiographs, 23 percent. This study supports the likelihood that substitution of chiropractic care for medical care for the treatment of back and neck pain leads to less use of those costly procedures.
Nelson CF, Metz RD, LaBrot TM, Pelletier KR. “The Selection Effects of the Inclusion of a Chiropractic Benefit on the Patient Population of a Managed Health Care Organization.” Journal of Manipulative and Physiological Therapeutics. 2005 Mar-Apr;28(3):164-9.
Within a particular health care plan, individual employer groups had the option of choosing a health plan with or without a benefit for chiropractic care. This study measured the effect of that choice by studying the patient populations of both groups. The data of 1.7 million subscribers over four years indicated that the employer groups with chiropractic coverage had a younger population and significantly lower rates of common chronic diseases than subscribers who had access only to medical care for neuro-musculoskeletal complaints. The employers who chose the chiropractic rider had a patient population with a more favorable risk profile, thereby decreasing the health care costs of the health plan.