Low back pain is a serious problem in society, and is very common. About 80% of the population will suffer from a bad to severe case of it at least once in their lives.1
It is estimated to cost over $90 billion each year in the USA. Leaders in orthopaedic medicine now acknowledge that medical management of patients with back pain was “a 20th century medical disaster” and that “the legacy reverberates into the new millennium”.2 The Chiropractic approach to low back pain is to correct/realign mechanical problems in the spine involving the joints, muscles, discs and nerves. The term for a mechanical problem in the spine that irritates/affects the nerves is a subluxation. A subluxation free spine is one that move, bends, twists and works freely, painlessly and effortlessly. This can also potentially minimise the rate the spine degenerates with age.3 Following the new wealth of research since the 1980s, the Manga Report from Canada in 1993 4, the thorough evidence-based national guidelines in Denmark 5, the UK 6 and the USA 7 during 1990s and 2000s, there is compelling evidence for the cost-effectiveness and appropriateness of a chiropractic approach to the management of back pain patients.
The New Zealand Royal Commission of enquiry into Chiropractic found, beyond any reasonable degree of doubt, to have a more thorough training in spinal mechanics and spinal manual therapy than any other health professional.8
A large study of 1334 patients in the UK concluded that Chiropractic was “Cost-effective”, “effective” and with no “serious adverse effects”.6
Another large UK study, and its follow up study 5 yrs later, showed that the chiropractic treatment was significantly more cost effective, safe and effective than hospital outpatient care, comprising of physiotherapy and medical care.9,10
A Medstat study, from the US, looked at chiropractic and medical use and costs and found total medical costs were 61% higher than chiropractic costs.11
In a study of 627 patients; 51% of patients were very satisfied with chiropractic care compared to 16% for physiotherapists and 8% for medical doctors. At the other end of the scale only 12% were not at all satisfied with chiropractic compared with 40% with physiotherapists and 44% for medical doctors.12
1. Deyo R, Cherkin D, Conrad A, Voinn E. Cost, controversy, crisis: Low Back pain and the health of the public. Annurev.pu;12:141-156.
2. Waddell G (2004) The Back pain revolution, Churchill Livingstone, Edinburgh, 2nd edition.
3. Cramer H, Fournier J, Wolcott C, Henderson C. Degenerative changes following spinal fixation in a small animal model. JMPT 27(3) 141-154.
4. 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.
5. Manniche C et al. Low-back pain: Frequency, Management and Prevention form a HDA perspective. Danish Health Technology assessment. 1999;1(1).
6. United Kingdom back pain exercise and manipulation randomised trial: Cost-effectiveness of physical treatments for back pain in primary care, BMJ online first, Nov19,2004:1-6.
7.Bigo S, Bowyer O, Braen G et al (1994) Acute low –back problems in adults. Clinical practice guideline no.14. AHCPR publication no.95-0642. Rockville, MD; agency for health care policy and research, Public health service, US department of health and human services.
8. Royal Commission of Inquiry on Chiropractic in New Zealand, 1979.
9.Meade T, Dyer S et al (1990) Low-back pai of mechanical origin: Randomised comparision of chiropractic and hospital outpatient treatment, Br Med J 300:1431-37.
10.Meade T, Dyer S et al (1995) Randomised comparison of chiropractic and hospital outpatient management for low-back pain: Results from extended follow up, Br Med J 311:349-351.
11. Smith M, Stano M (1997) Cost and recurrences of Chiropractic and medical episodes of low-back care, JMPT 20(1),5-12.
12.Boven (1977)Appendix to report of the committee of inquiry into chiropractic, osteopathy, homeopathy and naturopathy (Webb committee), Australian government publishing service, Canberra.