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Chiropractic Care and Spinal Surgery for Workplace Back Injuries

This is a new research article published in the December 2012 issue of the Spine Journal which looked at workplace back injuries and the early predictors of spine surgery.

The article reveals that following a workplace back injury those whose first provider was a Chiropractor had a reduced rate of spine surgery, and

42.7% of injured workers who saw a surgeon first, under went back surgery. While only 1.5% of injured workers who saw a Chiropractor first under went back surgery.

There is a very strong association between back surgery and the first provider seen for an injury.

Benjamin J Keeney, Deborah Fulton-Kehoe, Judith A Turner, Thomas M Wickizer, Kwun Chuen Gary Chan, Gary M Franklin

Cost Effective

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)

List of research papers

  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 I ntern Med 164:1985-1992.


The medication alternative may increase risk.

In a study published in the March 2010 issue of The American Journal of Medicine, researchers determined that regular use of aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk of hearing loss in men, particularly in younger men, below age 60.



Research – Cost effective.

Chiropractic care is more effective and economical and also gives longer lasting results for disorders of the spine than other forms of health care.1 2 3

List of research papers

  1. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. (1990) Low Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Treatment. The British Medical Journal 300:1431-7
  2. 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, Canada.
  3. Shekelle PG, Adams AH, Chassin MR et al. (1991) AHThe Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Panel. Santa Monida, Calif: RAND Copr, 1991


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 therefore 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.

List of research papers

  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


Chiropractic Effective for Headache

There is now a clear anatomical basis for headache arising from dysfunction in the cervical spine (cervicogenic headache). This is 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 reviewed the evidence. They specifically recommended cervical manipulation (adjustment) for many patients with head and neck pain. This would include patients with whiplash associated disorder from motor vehicle accidents.

List of research papers

  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