Safety of Treatments

Chiropractic Safety And Research Studies

Chiropractic treatments are extremely safe for people of all ages. Unfortunately, some critics of chiropractic care have attempted to pressure the public into thinking chiropractic treatments are dangerous. Nothing could be further from the truth. Chiropractic treatments are among some of the safest treatments used in the health care field.

Read what Canadian researchers stated after performing the largest analysis of scientific literature on the most effective and cost effective treatments for low back pain: "Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

Research Studies:

1. The Manga Report
The Ontario Ministry of Health commissioned Manga Report represents the largest analysis of scientific literature on the most effective and cost effective treatments for low back pain. After reviewing all of the international evidence on the management of low back pain, lead investigator Pran Manga, Ph.D., found the treatments provided by Doctors of Chiropractic were exceptionally safe - much safer than for standard medical treatments of similar conditions. "There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain." "Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals."

"Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."

Reference: The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.

2. The Agency on Health Care Policy and Research Study
On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain. The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic physicians, nurses, and experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

Their findings included:

  • The risk of serious complications from lumbar spinal manipulation is rare.
  • Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention.
  • Prescription drugs such as oral steroids, antidepressant medications and colchicines are not recommended for acute low back problems.

Reference: Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.

3. The New Zealand Commission Report
The government of New Zealand published a 377-page report, which assessed the efficacy and safety of chiropractic care. The report was a result of almost 2 years of conducted hearings from recognized health care experts.

Principal findings:

  • "Chiropractors are the only health practitioners who are necessarily equipped by their education and training to carry out spinal manual therapy (spinal adjustments)."
  • "Chiropractors carry out spinal diagnosis and therapy at a sophisticated and refined level."
  • "Spinal manual therapy in the hands of a registered chiropractor is safe."
  • "The duration and training of a registered chiropractor is sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether that patient should have medical care instead of, or as well as, chiropractic care."

4. The U.S. Agency for Health Care Policy and Research
In 1994, The United States Agency for Health Care Policy and Research reviewed the many different care options for acute low-back pain. The research panel was looking at what would produce functional improvements as well as symptomatic improvements. They looked at over 100 studies that related to spinal manipulation, which is the non-specific, medical term used for Chiropractic adjustments. The Agency concluded Chiropractic Care was very helpful for people suffering from acute low-back pain. Chiropractic was the only option studied found to provide both symptomatic improvement and restoration of functional stability. The research panel included medical doctors, osteopaths, nurses and physical therapists. There were no chiropractors included on the panel.

5. Low Back Pain
In 1997 The British Journal of Bone and Joint Surgery found that a single chiropractic adjustment caused immediate significant changes in the reflexes of patients with disk herniation. The authors reported "It may be concluded that spinal [adjustments] may promote relief from [abnormal nerve function] by the offending disk herniation."

The May 15, 1997 issue of Spine reports on a study that shows nearly 1 in 5 fourteen-sixteen year-olds have back pain and many of them report that the pain is chronic. 18 percent of the 14-16 year olds reported back pain that interfered with school work or leisure activities during the previous 12 months. 26 percent of the boys and 33 percent of the girls reported that the pain was recurrent or chronic. It should be noted that as the children got older, the incidents of pain increased. The authors concluded that a significant part of the low back pain children report is recurrent or chronic by the time they are 14. Chiropractic Physicians have always encouraged early detection and correction of spinal problems before they become chronic. This study shows that spinal problems do indeed start early in life and if they go uncorrected, get worse.

6. Fibromyalgia (Chronic Pain)
The May 2000 issue of the Journal of Manipulative and Physiological Therapeutics reports that 60 percent of a group of patients with Fibromyalgia responded very well to chiropractic care. The patients in the study had Fibromyalgia for more than 3 months and were adult members of a regional Fibromyalgia association. Each participant was adjusted during 30 visits with self-administered assessments taken at the beginning of the study, after 15 visits, 30 visits and 30 days after completion of the study. Researchers were looking for improvement in three areas: Pain Intensity, Fatigue Level, and Sleep Quality. 15 women completed the trial. 9 of them (60%) were classified as "respondents". Respondents were those participants who experienced at least a 50 percent improvement in pain intensity over the course of the study. After 30 visits, the respondents showed an average lessening of 77.2 percent in pain intensity and an improvement of 63.5 percent in sleep quality and 74.8 percent in fatigue level. The improvement in all three areas continued after 1 month without chiropractic care.

A similar study in 1986 and reported in the American Journal of Medicine found that 45.9 percent of people who had Fibromyalgia and went to a chiropractor experienced moderate to great improvement. In the same study, anti-depressant medication benefited only 36.3 percent of those studied and exercise was limited to a 31.8 percent rate of improvement.

7. Whiplash
In 1996, a retrospective Study on 28 chronic whiplash patients was reported in the journal Injury; 27(9). Their initial treatments included anti-inflammatories, soft collars, and physiotherapy. These patients were referred for Chiropractic adjustments at an average of 15.5 months (range 3-44 months) after their initial injury. Chiropractic treatment included "specific spinal manipulation, proprioceptive neuromuscular facilitation and cryrotherapy. Spinal manipulation is a high-velocity low-amplitude thrust to a specific vertebral segment aimed at increasing the range of movement in the individual facet joint, breaking down adhesions and stimulating production of synovial fluid. "Following Chiropractic treatment, 93 percent of the patients had improved." The results of this retrospective study would suggest that benefits can occur in over 90 percent of patients undergoing chiropractic treatment for chronic 'whiplash' injury."

The Journal of Orthopaedic Medicine 21(1) in 1999 investigated if patients with chronic whiplash would benefit from chiropractic treatment. The 93 patients all underwent spinal manipulation performed by a chiropractic physician. Referral for chiropractic treatment was a mean of 1.2-7 months (0-82 months) after injury. Patients were in 3 groups according to severity of injury, and underwent a mean of 19.3 treatments (range 1-53) over a period of 4.1 months. Results: Group 1, (50 patients), 36 patients (72%) gained benefit from chiropractic spinal adjustments, 12 (24%) became asymptomatic, and 12 (24%) improved by 2 grades. Group 2, (32 patients), 30 patients (94%) responded positively to chiropractic manipulation with 12 (38%) becoming asymptomatic and 13 (43%) improving by two grades. [This is a remarkable response considering these patients had neurological involvement.] Group 3, (11 patients), with severe symptomatology, 3 (27%) improved following chiropractic treatment and 1 improved by two grades. The authors concluded that Chiropractic is the only proven effective treatment in chronic cases.

8. Immune Function
Research highlighted in the Journal of Physiological and Manipulative Therapeutics; 1989; 12(4), shows that the immune system may well be under direct control of the nervous system. The white blood cells, known as T-lymphocytes, have been found to have receptor sites for chemicals produced by the nerve system on them. These chemicals increase or decrease the activity of the white blood cells. The research also found that the white blood cells also produce these chemicals, which suggests that the white blood cells can also communicate with the nervous system. The authors of the study summarize that spinal misalignments can negatively affect the body's immune response by interfering with the communication link between the nervous system and the immune system. Chiropractic adjustments correct spinal misalignments and help restore this communication link.

A follow up paper in The Lancet, (vol. 357, 2001); a prestigious medical journal confirms the connection of the immune system and the nervous system. "Immunity is divided into two parts determined by the speed and specificity of the reaction. These are named innate and the adaptive responses, although there is much interaction between them." "The immune system is easily accessible through the stem cells in the bone marrow." "It is becoming clear that the immune system does not work in isolation, but has close communications with other tissues. The interaction of the immune cells with the neurological and endocrine systems is now documented."

Further validation is stated in Chapter 5, "Catecholamines, Sympathetic Nerves, and Immunity", p. 198; by Kelley S. Madden, in the text Psychoneuroimmunology, Third edition, Academic Press 2001. "These experiments demonstrate that the SNS [sympathetic nervous system] regulates all aspects of immune function in vivo, including proliferation, cytokine production, antibody production, and lymphocyte migration."

9. Bedwetting
One study involving 171 children was reported in the Journal of Manipulative and Physiological Therapeutics. At the beginning of the study, the average number of bed-wettings per week per child was 7. After a program of chiropractic care was administered the average number of bed-wettings per week per child had dropped to 4. While only 1 percent of the children were considered dry at the beginning of the study, 15.5 percent were considered dry at the end.
Another study was presented at the October 1993 National Conference on Chiropractic & Pediatrics. 46 children between the ages of 5 and 13 were studied over a period of 14 weeks. The control group experienced no change at all while the children receiving adjustments averaged 17.9 percent fewer wet nights.

In another study published in the Journal of Manipulative and Physiological Therapeutics; 1994; 17(9), the children under chiropractic care had similar average reductions as the previous study.25 percent of the treatment group experienced 50 percent or more reductions in wet nights.

10. Migraine Headaches
An Australian study published in the February 2000 issue of the Journal of Manipulative and Physiological Therapeutics found that migraine headache patients experienced significant relief under chiropractic care. Over a six-month period, 83 people with clinically diagnosed migraines kept headache diaries before, during and after undergoing Chiropractic Care. The participants in the study reported a significant decrease in the frequency, duration, disability and amount of medicine they used compared with people in the control group who did not receive chiropractic care. 50% of the participants receiving chiropractic care reported significant improvement in the morbidity (sickness) level of their migraines. 22 percent of the participants reported more than a 90 percent reduction of their migraines as a result of the adjustments.

A March 2, 2000 report from the National Headache Foundation says that 12 percent of the public suffers from migraine headaches. This figure represents approximately 30 million people. Using the numbers from this study, approximately 6.6 million (22%) of these people could reduce the occurrence of their migraines by 90 percent if they got under chiropractic care!!

11. Infantile Colic
The August 1989 issue of the Journal of Manipulative & Physiological Therapeutics reports that 94 percent of a group of 316 children with infantile colic responded very favorably to Chiropractic care. The study involved infants with an average age of 5.7 weeks at the beginning of the study and included reassessments at 1 week, 2 weeks and 4 weeks. The infant's mothers were provided a diary and kept track of the baby's symptoms, intensity and length of the colicky crying as well as how comfortable the infant seemed. 94 percent of the children in the study showed a satisfactory response to Chiropractic care within 14 days from the beginning of care. "The results occur shortly after the treatment has been initiated and show both a reduction of the daily length of the colic periods and a reduction of the number of colic periods per day. "In this study, an average of three treatments was found to be required to obtain a satisfactory result. No side effects were reported." 51 percent of the children in the study had other, unsuccessful treatments for the colic previous to becoming involved in this research project.

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