Compared to Other Treatments — Base Camp Chiropractic

There is moderate evidence that spinal manipulative therapy/mobilization is superior to general practitioner management for short-term pain reduction and superior to physical therapy in long-term pain reduction of neck and low back pain. Recommendations can be made with some confidence regarding the use of spinal manipulative technique and/or mobilization as a viable option for the treatment of both low back pain and neck pain.

This study demonstrated that manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain, compared with usual medical care. 94% of the manual-thrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care.

In this randomized controlled trial, the effectiveness of manual therapy (use of manipulation or adjustments), physical therapy, and continued care by a general practitioner were compared in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group as for the continued care group. Manual therapy scored better than physical therapy on all outcome measures. Patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care, and manual therapy and physical therapy each resulted in statistically significant less analgesic use than continued care.

In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy from a doctor of chiropractic, pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with chiropractors and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication.

In this study, patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56% vs. 13%) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.

The results of this trial suggest that chiropractic manipulative technique in conjunction with standard medical care offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care.

This study demonstrates a very strong association between surgery and first provider seen for an injury even after adjustment for other important variables. Reduced odds of surgery were observed for those patients whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.

This study demonstrates the high incidence of intra- and postoperative complications of major spinal surgery. 87% of patients had at least one documented complication with 39% of these adversely affecting hospital length of stay. The rate of intraoperative surgical complication was 10.5%. The incidence of postoperative complication was 73.5% with wound complications including delirium, pneumonia, neuropathic pain, dysphagia, and neurological deterioration. There were 14 mortalities during the study period.

This 2006 study by Stockard et al found that 82% of medical graduates "failed to demonstrate basic competency in musculoskeletal medicine."

This 2002 study by Freedman et al concluded that medical school preparation in musculoskeletal medicine is inadequate.

This 2010 study by Williams et al. found that the "usual care provided by general practitioners (e.g. medical doctors) for low back pain does not match the care endorsed in international evidence-based guidelines and may not provide the best outcomes for patients. This situation has not improved over time. The unendorsed care may contribute to the high costs of managing LBP, and some aspects of the care provided carry a higher risk of adverse effects."

In this 2005 study, Matzkin et al found that training in musculoskeletal medicine is inadequate in both medical school and nonorthopaedic residency training programs. (Chiropractors focus the majority of their graduate and post-graduate studies in musculoskeletal care and rehabilitation.)