Chiropractic Research

Chiropractic Research-Based Health Care

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The history and development of chiropractic, in many ways, mirrors the advance of medical understanding over the past century. During the late 1800’s, the concept of “spinal irritation” was popular in medical circles and the practice of chiropractic was consistent with many aspects of scientific thought at the time. These theories seem quaint today, but at the time, the sophisticated workings of the human nervous system and the spinal cord, which the bones of the spine protect, were barely known and many branches of medicine were searching for theories to explain how the human body worked. As science advanced, so did understanding of the neurological principles, which underlie the effectiveness of chiropractic treatment. Today, these principles form the foundation of chiropractic education.

Evidence-based Health Care

Chiropractic has undergone considerable scrutiny from individuals and organizations within the health care and scientific communities, as well as from chiropractors themselves. This scrutiny has been welcomed and embraced by the profession and has resulted in a significant body of evidence around the efficacy of chiropractic care. For example, in the area of neck pain and low back pain alone, more than 44 studies have been conducted assessing the efficacy and safety of spinal adjustment. [1]

A Leader In Chiropractic Research

The Canadian Memorial Chiropractic College (CMCC) has been a leader in chiropractic research for more than five decades. The College has dedicated itself to the development of an ongoing, productive research program. Faculty have been successful in obtaining research grants from funding agencies and have published extensively in peer-reviewed and referred chiropractic journals, as well as in multi-disciplinary journals such as the British Medical Journal, Spine, Annals of Internal Medicine, Pain, the Lancet, and The New England Journal of Medicine. Over the years, CMCC has developed relationships with faculty in other academic institutions in North America. Research collaborations have taken place with faculty from the University of Toronto, University of Waterloo, McMaster University, University of Western Ontario, Institute for Work and Health, St. Michaels Hospital, Sunnybrook and Women’s College Health Sciences Centre, University of Calgary, University of Saskatchewan, The Texas Back Institute, and St. Joseph’s Hospital, Hamilton. In 1996, CMCC partnered with the University of Waterloo to establish Canada’s first chiropractic research clinic within a university.

Headache Study

In 1999, CMCC received a three-year, $1 million grant from the Ontario Ministry of Health and Long-Term Care to study chiropractic and medical treatments for tension headaches. This is a multi-disciplinary project with collaborators from St. Michaels Hospital and McMaster University.

Colic And Asthma Research

Most recently, a research report published in 1999 in the Journal of Manipulative and Physiological Therapeutics concluded that “spinal adjustment is effective in relieving infantile colic”. [2] The study was a randomized, controlled clinical trial with a blinded observer and compared the effect of chiropractic treatment with a commonly prescribed medication used to relieve infantile colic. Another study, published in The New England Journal of Medicine in 1998, looked at chiropractic as complementary therapy for children with medically managed asthma. It revealed a trend toward improved quality of life for patients receiving chiropractic treatment based on reduced need for medication and reduced severity of attacks. [3] This is another example of how research continues to inform chiropractic treatment.

Canadian Institutes For Health Research Partnership

In 1998, the then Medical Research Council of Canada (MRC) (now the Canadian Institutes for Health Research or CIHR) and the Canadian Chiropractic Association (CCA) established two Research Fellowships and two Doctoral Research Awards in chiropractic research. The CIHR matches the CCA’s contributions dollar for dollar with the mutual goal of improving the health of Canadians through new knowledge generated by research. In the same year, the CIHR partnered with the Canadian Memorial Chiropractic College to offer two Doctoral Research Awards for faculty. In 1999, this partnership was renewed to offer two Research Fellowships and one Doctoral Award to pursue research in specific chiropractic-related areas. In 2000, two Postdoctoral Research Fellowships were awarded. Ongoing research will no doubt further expand knowledge of how the spine, and the neural pathways which it protects, affects health.

November 2001

For more research in Chiropractic you can go to:
http://www.chiropracticresearch.org/

[1] See appendix of research references.
[2] The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic, Wiber JMM et al, Journal of Manipulative and Physiological Therapeutics, Vol. 22, No. 8, October 1999.
[3] A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma, Balon J et al, The New England Journal of Medicine, Vol. 339, No. 15, October 1998.

Research References

The following is a small sampling of the large volume of research conducted into the practice of chiropractic, its effectiveness, and its safety. The Appropriateness of Spinal Manipulation for Low Back Pain, Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brooke RH. Commissioned by the RAND research corporation, Document No. R-4025/1-CCR/FCER, 1991. Conclusion: Support is consistent for the use of spinal adjustment as a treatment for patients with acute low-back pain and an absence of other signs of lower-limb, nerve-root involvement.

Chronic Spinal Pain Syndromes: A Clinical Pilot Trial Comparing Acupuncture, a Nonsteroidal Anti-Inflammatory Drug and Spinal Manipulation, Lynton GF, Muller, R, Journal of Manipulative and Physiological Therapeutics, 22:376-81, 1999. Conclusion: Spinal adjustment, if not contraindicated, results in greater improvement than acupuncture and medicine.

Randomised Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow-up, Meade TW, Dyer S, Browne W, Frank AO, The British Medical Journal, Vol 311, August 5, 1995. Conclusion: Those treated by chiropractic derive more benefit and long-term satisfaction than those treated by hospitals.

The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, Manga P, Angus D, Papadopoulos C, Swan W. Commissioned by the OCA. Funded by the Ontario Ministry of Health, 1993. Conclusion: On the evidence, particularly the most scientifically valid clinical studies, spinal adjustment applied by chiropractors is shown to be more effective than alternative treatments for LBP [lower back pain]. Many medical therapies are of questionable validity or are clearly inadequate. There is an overwhelming body of evidence indicating that chiropractic management of LBP is more cost-effective than medical management.

Chiropractic Services Review, An Internal Review, Wells et al, Commissioned by the Ontario Ministry of Health, 1994. Conclusion: On the grounds of effectiveness, safety, patient satisfaction and public acceptance of chiropractic services, particularly in the treatment of musculoskeletal disorders, chiropractic services should continue to be funded by the Ontario Health Insurance Plan.

Trunk Exercise Combined with Spinal Manipulative or NSAID Therapy for Chronic Low Back Pain: A Randomized, Observer-Blinded Clinical Trial, Bronfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV, Journal of Manipulative and Physiological Therapeutics, Vol 19, No 9, Nov/Dec 1996. Conclusion: Each of the three therapeutic regimes was associated with similar and clinically important improvement over time, however, there was an increase in adverse reactions with NSAIDs.

Manipulative Therapy Versus Education Programs in Chronic Low Back Pain, Triano JJ, McGregor M, Hondras MA, Brennan PC, Spine, Vol 20, No 8, 948-955, 1995. Conclusion: Greater improvement was noted in pain and activity tolerance in the adjustment group. Immediate benefit from pain relief continued to accrue after adjustment, even for the last encounter at the end of the 2-week treatment interval.

Multicenter Trial of Physiotherapy in the Management of Sciatic Symptoms, Coxhead CE et al, Lancet, 1:1065-1068, 1981. Conclusion: Greater reductions in perceived pain were reported by those in the spinal manipulative therapy (SMT) group. Combinations of SMT and exercise produced the optimal results.

Efficacy of Various Forms of Conservative Treatment in Low Back Pain, Postacchini F, et al, Neuro-Orthop, 6:28-35, 1988. Conclusion: Spinal manipulative therapy was found to be the superior treatment in acute cases.

Spinal Manipulation in the Treatment of Low Back Pain, Kirkaldy-Willis WH, Cassidy JD, Canadian Family Physician, 31:535-540, 1985. Conclusion: Strong support for the value of adjustment in the treatment of chronic lumbar facet and sacroiliac syndrome.

Spinal Manipulation for Chronic Low Back Pain: A Review of the Evidence, Vernon, H, Journal of the Canadian Chiropractic Association, 40(3), 1996.

Chiropractic in the United States: Training, Practice and Research, U.S. Department of Health and Human Services, AHCPR Research Report, Dec.1997.

Chiropractic in New Zealand, Report of the Commission of Inquiry, Hasselberg PD, Government Printer, Wellington, 1979.

Medicare Benefits Review Committee, Thompson CJ, Commonwealth Government Printer, Australia 1986.

The conclusions from the following references are summarized in the Fact File document titled Chiropractic and Safety.

The Appropriateness of Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature, Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG, Spine, 21(15); 1746-1760, 1996.

Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation, Haldeman S, Kohlbeck FJ, McGregor M. Spine, 24(8); 785-794, 1999.

Arterial dissections following cervical manipulation: the chiropractic experience, Haldeman S, Carey P, Townsend M, Papadopoulos C, Canadian Medical Association Journal, Vol 165, No 7, 905-906, 2001.

Cervical manipulation and risk of stroke, Kapral MK, Bondy SJ, Canadian Medical Association Journal, Vol 165, No 7, 907-908, 2001.

Chiropractic Manipulation and Stroke: A Population-Based Case-Control Study, Rothwell DM, Bondy SJ, Williams JI, Stroke, May 2001.

Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents, Rome PL, Chiropractic Journal of Australia, Vol. 29, No. 3, September 1999.

Carotid Artery Dissection Due to Elongated Styloid Process, Zuber M, Mos JI, Neurology, November 1999.

Beauty Parlour Stroke Syndrome: Report of Five Cases, Weintraub MI, Journal of the American Medical Association, 269:2085-86, 1993.

Abrupt Change in Head Position and Cerebral Infarction, Sherman DG, Hart RG, Easton JD, Stroke, 12:2-6, 1981.

Paediatric Chiropractic

Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head, Okawara S, Nibbelink D, Stroke, 5:640-42, 1974.

Cervical Manipulation and Stroke, Eastman JD, Sherman DG, Stroke, 8:594-97, 1977.

A Risk Assessment of Cervical Manipulation v. NSAIDs for the Treatment of Neck Pain, Dabbs V, Lauretti WJ, Journal of Manipulative and Physiological Therapeutics, 18:530-6, 1995.

Redefining Whiplash and Its Management: Scientific monograph of the Quebec task force on whiplash-associated disorders, Spitzer WO, Skovron ML et al. Spine, 20:85, 1995.

Conservative Management of Mechanical Neck Pain: A Systematic Overview and Meta-Analysis, Aker PD, Gross AR, et al. The British Medical Journal, 313: 1291-96, 1996.

The Short-Term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized, Controlled, Clinical Trial with a Blinded Observer, Wiberg JMM, Nordsteen J, Nilsson N, Journal of Manipulative and Physiological Therapeutics, Vol 22, No 8, October 1999.

Conclusion: Spinal adjustment is effective in relieving infantile colic. A Comparison of Active and Simulated Chiropractic Manipulation as Adjunctive Treatment for Childhood Asthma, Balon J et al, The New England Journal of Medicine, Vol. 339, No. 15, October 1998.

Conclusion: Spinal manipulative therapy may contribute to improved quality of life in terms of reduced need for medication and reduced severity of attacks. Musculoskeletal Pain in Primary Paediatric Care: Analysis of 1000 Consecutive General Paediatric Clinic Visits, de Inocenio J, Paediatrics, Vol. 102 No. 6, Dec. 1998.

Conclusion: MSP [musculo-skeletal pain] represents a frequent presenting complaint in general paediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing paediatrics continuing medical education and training programs.

Back Pain in School Children: A Study Among 1178 Pupils, Troussier B, Davoine P, de Gaudemaris R, Fauconnier J, Phelip X, Scandinavian Journal of Rehabilitative Medicine, 26:143-46, 1994

The Epidemiology of Low Back Pain in an Adolescent Population, Olsen TL, Anderson RL, Dearwater MS, et al, American Journal of Public Health, 82(4):606-608, 1992

Use of Chiropractic Services from 1985 through 1991 in the United States and Canada, Hurwitz EL, Coulter ID, Adams AH, Genovese B, Shekelle PG. American Journal of Public Health, Vol. 88, No 5, 771-776, May 1998.

Job Analysis of Chiropractic in Canada, Published by the National Board of Chiropractic Examiners, 1993.

Chiropractors: Do They Help?, Kelner M, Hall O, Coulter I, Fitzhenry & Whiteside, Toronto, 1980.

Demographic and Clinical Characteristics of Chiropractic Patients: A five year study of patients treated at the Canadian Memorial Chiropractic College, Waalen DP, White TP, Waalen JK, Journal of the Canadian Chiropractic Association, 38(2): 75-82, 1994.

Canadian Chiropractic Resources Databank: A Profile of Canadian Chiropractors, Kopansky-Giles D, Papadopoulos C, Journal of the Canadian Chiropractic Association, 41(3): 155-191, 1997.

Trends in Alternative Medicine Use in the United States. 1990-1997. Results of a Follow-up National Survey, Eisenberg DM, Davis RB, Ettner SL, et al. The Journal of the American Medical Association, 280: 1569-1575, 1998.

Use of Alternative Health Care Practitioners by Canadians, Millar WJ, Canadian Journal of Public Health, May-June 1997.