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Chiropractic Research

There is a large volume of published research and national guidelines available relating to Chiropractic treatment, its effectiveness and of course safety. The nature of medical research is that it is usually published in medical journals not directly accessible to the general public, and it tends to be written in 'doctor' speak! We thought you might like to know what it says,....in English.... and so we have done all the boring legwork for you.

The title for each research or government paper is an active web link, so if you are seized by a fit of insanity you can click it and be presented with the full paper in all its glory. For the more 'normal' among you, simply hover over the titles for a summary of the objectives and conclusions for each. Happy reading!

Which treatments work best for back pain? Effectiveness of physical treatments for back pain in primary care: United Kingdom back pain exercise and manipulation randomised trial: (UK BEAM Trial Team 2004)

Objective: Randomised controlled test to estimate the effect of adding exercise classes, spinal manipulation delivered in NHS or private premises, or manipulation followed by exercise to "best care" in general practice for patients consulting with back pain.

Conclusions: Relative to "best care" in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months.

Chiropractic compared to hospital outpatient treating for low back pain Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment: (Meade TW, Dyer S et al 1990)

Objective: Randomised controlled test to compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin

Conclusions: For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Further comparisons between Chiropractic and hospital outpatient care for low back pain Randomised comparison of chiropractic and hospital outpatient management for low back pain: Results from extended follow up (Meade TW, Dyer S et al 1995)

Objective: Randomised controlled test To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain

Conclusions: At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals. (According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors compared with those treated by the hospitals.)

Low back pain: which is the best way forward? (Clinical Standards Advisory Group; Backpain Report 1994.)

Objective: In 1994, a British Clinical Standards Advisory Group was asked by the UK Health Ministers to develop guidelines for patients with back pain. They were asked To find which of the treatments available locally showed the best evidence of limiting acute attacks of low back pain in a patient.

Conclusions: The group found that there is considerable evidence that manipulation can provide short-term symptomatic benefit in some patients with acute back pain and recommended that manipulation should be available as a therapeutic option for the treatment of National Health Service (NHS) patients with back pain, and should be carried out by appropriately trained therapists or practitioners.

What is the best, and cheepest treatment for low back pain The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project.

Objective:The group performed a prospective observational study to determine whether the outcomes of and costs of care differ among primary care practitioners, chiropractors, and orthopedic surgeons.

Conclusions:Among patients with acute low back pain, the outcomes were similar whether they receive care from primary care practitioners (GPs), chiropractors, or orthopedic surgeons. The costs of treatment were highest for the patients seen by orthopedic surgeons and were lowest for the patients seen by primary care providers. Satisfaction was greatest among the patients who went to the chiropractors.

Comparing chiropractic managment and pain clinic managment for low back pain A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. Wilkey A, Gregory M, Byfield D, McCarthy PW

Objective:To compare outcomes in perception of pain and disability for a group of patients suffering with chronic low-back pain (CLBP) when managed in a hospital by either a regional pain clinic or a chiropractor.

Conclusions:This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a subpopulation of patients with CLBP.

Comparing spinal manipulation to conservative medical care for chronic low back pain. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. Hondras MA, Long CR, Cao Y, Rowell RM, Meeker WC:

Objective:A bit of a technical one here, but basically they set out to find out which spinal manipulation technique was more effective, either high-velocity, low-amplitude (HVLA)-SM or low-velocity, variable-amplitude (LVVA)-SM

Conclusions:There was no significant difference between either form of spinal manipulation. However patients who received either form of spinal manipulation showed significant improvements in function over those who received mainstream minimal conservative medical care.

Comparison of different treatments for neck pain. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P, Hogg-Johnson S, Cassidy JD, Haldeman S; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Objective:This was a research paper review looking at the different types of 'non-invasive' (non surgical) treatments for neck pain and whiplash.

Conclusions:They found that treatments involving manual therapy and excercise were the most effective, and specifically for whiplash they found that patient education and joint mobilisation appeared more beneficial than usual outpatient medical care.

Comparing GPs and Chiropractors and the relative instances of asociated strokes Risk of vertebrobasilar stroke and chiropractic care: Results of a population-based case-control and case-crossover study. Cassidy JD, Boyle E, Côté P, et al 2008.

Objective:To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (GP/Hospital) visits and VBA stroke.

Conclusions:There was found to be no difference between patients receiving chiropractic treatment and patients receiving PCP (GP) treatment In terms of the relative risk of VBA stroke. A small association was found for both forms of treatment in persons under the age of 45, but was thought likely to be explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.

Does more Chiropractic corelate to more strokes or not? Examining vertebrobasilar artery stroke in two Canadian provinces. Boyle E, Côté P, Grier AR, Cassidy JD.

Objective:To determine the ammount of people hospitalized by vertebrobasilar artery (VBA) stroke in Saskatchewan and Ontario between 1993 and 2004, and then to determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic treatments. Basically to find out if more chiropractic treatments within a population means more strokes.

Conclusions:At the ecological level, they found no correlation between the rate of chiropractic treatments, and the rate of VBA stroke. In a nutshell, the amount of strokes was not linked to the amount of chiropractic treatments.

Comparing the risks of Chiropractic neck treatment to other treatments. What are the Risk of Chiropractic Neck Treatments? William J. Lauretti, DC

Objective:A research paper review to establish what the 'actual' risks of cervical manipulation are, and then compare them to the other forms of treatment available.

Conclusions:The author puts the risk at between 1 in 4 million to 1 in 500 thousand, and states that there is up to a 100 times greater risk of dying from an ulcer due to taking a prescription NSAID like Motrin than from a cervical neck manipulation. He states that chiropractors' malpractice insurance rates remain among the lowest in the health professions, due to their being statistically amongst the safest, and that if you live 8 miles away from your chiropractor you are more likley to die in a car crash on the way than from the cervical manipulation.

Neck Manipulation and its corelation to cerebrovascular events. Safety in chiropractic practice, Part I; The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988. Klougart N, Leboeuf-Yde C, Rasmussen L (1996).

Objective:To estimate the occurrence of cerebrovascular accidents (including strokes) after chiropractic treatment to the cervical spine

Conclusions:They confirmed that the risk was low, finding 1 potential occurrence of a cerebrovascular incident per 1.3 million chiropractic neck manipulations, and one event per 0.9 million upper cervical neck manipulation.

A comparison between Chiropractic treatment and just using heat for low back pain. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA

Objective:To evaluate the efficacy of chiropractic spinal manipulation, manual flexion/distraction, and hot pack application for the treatment of low back pain from osteoarthritis (OA) compared with moist heat alone.

Conclusions:Chiropractic care combined with heat is more effective than heat alone for treating OA-based lower back pain. Pain reduction occurs more rapidly and to a greater degree, and ROM increases more rapidly and to a greater degree.

A omparison between Chiropractic treatment and ultrasound for chronic low back pain. A prospective randomised controlled trial of spinal manipulation and ultrasound in the treatment of chronic low back pain. Mohseni-Bandpei MA, Critchley J, Staunton T, et al.:

Objective:To assess the short and long term effectiveness of spinal manipulation therapy, and to identify the effect of manipulation on lumbar muscle endurance in patients with chronic low back pain.

Conclusions:Patients receiving manipulation & exercise consistently showed a greater improvement compared with those receiving ultrasound & exercise over the whole study period.

A comparison between spinal manipulation and excercise for chronic back pain. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: A randomized trial. Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, et al.

Objective:To compare effects of general exercise, motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain.

Conclusions:Motor control exercise and spinal manipulative therapy produce slightly better results over the short term than general exercise, but not better medium or long-term effects, in patients with chronic non-specific back pain.

What makes the 'cracking' noise? 'Cracking joints'. A bioengineering study of cavitation in the metacarpophalangeal joint." Unsworth A, Dowson D, Wright V. (1971).

Objective:This is probably the most recognised study into the mechanics of joint manipulation, assesing amongst other things what makes the 'cracking noise'!

Conclusions:When you 'crack' a joint, you are basically increacing the space within that joint very rapidly. This results in a low pressure area in the joint into which a small portion of the joint fluid evapourates forming bubbles. This state change releases energy in the form of the cracking sound. The joint gap then settles a little, the gas being resorbed over the next 20 - 30 seconds. The joint fluid having been moved, the joint ultimatley settles to a new, more open, more mobile possition.

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