The Evidence Supports Chiropractic Care

The Evidence Supports Chiropractic Care

Myth #3: There is no evidence to support that chiropractic works.

I don’t even know where to start with this one. The fact is that there is are so many studies done on spinal manipulation that a Medline search would be overwhelming. Instead of going through the many systematic reviews and meta-analyses that exist, I think the evidence is well summed up by an review exploring international low back pain guidelines. The review can be accessed here.

Over the last 10 years, 12 countries have done critical reviews of the scientific literature concerning low back pain. The international consensus is that the balance of the evidence shows that chiropractic spinal manipulation is effective in managing low back pain, and therefore is included in the recommendations. Here is a summary of their findings:

Clinical practice guidelines for the treatment of acute lower back pain

  • Reassurance of the favourable natural history
  • Advice to stay active
  • Discourage bed rest
  • Acetaminophen, p.r.n.
  • Chiropractic spinal manipulative therapy
  • Advice against passive physiotherapy modalities, prolonged bed rest or specific back exercises.

Essentially the investigators found that following these treatment guidelines (including chiropractic spinal manipulation) led to better outcomes than usual medical care. It is important to note that the guidelines don’t recommend chiropractic as a stand alone treatment, but as one component of a continuum of care.

One of the authors of the study then went on to launch the 2-part C.H.I.R.O study (Chiropractic Hospital-Based Interventions Research Outcome study). The first part pitted chiropractic care (along with the above guideline recommendations) versus usual medical care. The people who received chiropractic care showed better functional and quality of life improvements. The results of this study have been presented at Canadian Spine Society Meeting, the International Society for the Study of the Lumbar Spine, and the North American Spine Society and will be published in an upcoming edition of Spine. A summary of the results can be found here.

In the opinion of this Comox Valley Chiropractor, we are so far past establishing that there is evidence supporting chiropractic care. We are now heading in the direction of trying to establish how to best use this tool in the management of patients, or whether certain subsets of patients will respond more favourably. In the past 5 years, Chiropractic Research Chairs have been established at many universities across Canada in order to further chiropractic research.

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

2 thoughts on “The Evidence Supports Chiropractic Care”

  1. Hi!

    I know this is an old post, but I have to ask:

    The evidence seems pretty clear that Chiropractic treatment works well for lower back pain. How are the evidence on treating other problems? I’m thinking specificaly of the Simon Singh case, when he in an article wrote:

    “The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence.”

    Can you link to some studies supporting chiropractic treatment of asthma, colic, ear infections and so on?

    /Arne

    1. Hi Arne,

      Thanks for your comment. I can’t speak for the British Chiropractic Association, and am not familiar with their position on current research or practice patterns. I do remember reading the Singh article, but dismissed a lot of it as one-sided and inflammatory (as articles on chiropractic tend to be).

      What I can comment on is how I practice, and how the chiropractors I associate with practice. I am an evidence-based chiropractor, which means I treat neuro-musculoskeletal conditions. This is what I advertise, and this is what I do in my practice. This is also what the evidence supports.

      Chiropractic research is mainly self-funded. That means each year I pay dues into the Canadian Chiropractic Research Fund in order to fund Canadian chiropractic researchers. Most research that has been done is for back pain, neck pain and headaches – our bread and butter and something we treat very well. There just isn’t a lot of research that has been done on the conditions you speak of. Maybe in the future if the research is promising I’ll change my tune, but for now I stick with NMS conditions.

      I do want to make a few comments though on colic and asthma. We are starting to see some research coming from Denmark and the Netherlands concerning kids with colic. I can’t find the full text articles online, but the results of this research are promising enough to warrant more structured research (randomised controlled trials etc.). As for asthma, in my opinion chiropractic cannot change the anatomy of the lungs (and therefore change forced expiratory volume) but we can help with the musculo-skeletal ramification of this including thoracic spine and rib function, and quality of life. The big article that came out in 1998 concerning chiro and asthma in the NEJM was quick to slam chiropractic for not changing lung function. What the conclusion didn’t bother to mention (which was obvious if your read the results section) was that those patients who received chiropractic care took less medication and reported a higher quality of life. That study can be found here:
      http://www.ncbi.nlm.nih.gov/pubmed/9761802?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

      So, maybe chiropractic does have a role to play in some conditions such as colic or asthma, but as of yet we haven’t figured out what that role is. Until we do, I won’t be saying that I treat it in my clinic.

      Hope this answers your questions.

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