Chiropractic and Treating Low-Back Pain

Table of Contents (click to jump to sections)

Key Points
What is chiropractic?
Who uses chiropractic and for what health problems?
What kind of training do chiropractors receive?
What do chiropractors do in treating patients?
Have side effects or problems been reported from using chiropractic to treat back pain?
Do health insurance plans pay for chiropractic treatment?

Key Points

• Chiropractic is most often used to treat musculoskeletal conditions--problems with the muscles, joints, bones, and connective tissue such as cartilage, ligaments, and tendons.
  
  
• Research studies of chiropractic treatment for low-back pain have been of uneven quality and insufficient to allow firm conclusions. Nonetheless, the overall sense of the data is that for low-back pain, chiropractic treatment and conventional medical treatments are about equally helpful. It is harder to draw conclusions about the relative value of chiropractic for other clinical conditions.
  
  
• The risk of experiencing complications from chiropractic adjustment of the low back appears to be very low. However, the risk appears to be higher for adjustment of the neck.
  
  
• It is important to inform all of your health care providers about any treatment that you are using or considering, including chiropractic. This will help each provider make sure that all aspects of your health care are working together.

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1. What is chiropractic?

The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand." Chiropractic is an alternative medical treatment and takes a different approach from conventional medicine in diagnosing, classifying, and treating medical problems.

Chiropractic is a form of health care that focuses on the relationship between the body's structure, primarily of the spine, and function. Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation (or adjustment) as their core clinical procedure. While there are some differences in beliefs and approaches within the chiropractic profession, this Research Report will give you a general overview of chiropractic, discuss scientific research findings on chiropractic treatment for low-back pain, and suggest other sources of information.

The basic concepts of chiropractic can be described as follows:

• The body has a powerful self-healing ability.
  
  
• The body's structure (primarily that of the spine) and its function are closely related, and this relationship affects health.
  
  
• Chiropractic therapy is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals.

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2. Who uses chiropractic and for what health problems?

In 1997, it was estimated that Americans made nearly 192 million visits a year to chiropractors. Over 88 million of those visits were to treat back or neck pain. In one recent analysis, over 40% of patients receiving chiropractic care were being treated for back or low-back problems. over half of those survayed said that their symptoms were chronic. Conditions commonly treated by chiropractors include back pain, neck pain, headaches, sports injuries, and repetitive strains. Patients also seek treatment of pain associated with other conditions, such as arthritis.

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3. What kind of training do chiropractors receive?

Chiropractic training is a 4-year academic program consisting of both classroom and clinical instruction. At least 3 years of preparatory college work are required for admission to chiropractic schools. Students who graduate receive the degree of Doctor of Chiropractic (D.C.) and are eligible to take state licensure board examinations in order to practice.

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4. What do chiropractors do in treating patients?

If you become a chiropractic patient, during your initial visit the chiropractor will take your health history. He will perform a physical examination, with special emphasis on the spine, and possibly other examinations or tests such as x-rays. If he determines that you are an appropriate candidate for chiropractic therapy, he will develop a treatment plan.

When the chiropractor treats you, he may perform one or more adjustments. An adjustment (also called a manipulation treatment) is a manual therapy, or therapy delivered by the hands. Given mainly to the spine, chiropractic adjustments involve applying a controlled, sudden force to a joint. They are done to increase the range and quality of motion in the area being treated. Other health care professionals--including physical therapists, sports medicine doctors, orthopedists, physical medicine specialists, doctors of osteopathic medicine, doctors of naturopathic medicine, and massage therapists--perform various types of manipulation. In the USA, chiropractors perform over 90% of manipulative treatments.

Most chiropractors use other treatments in addition to adjustment, such as mobilization, massage, and nonmanual treatments.

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5. Have side effects or problems been reported from using chiropractic to treat back pain?

Patients may or may not experience side effects from chiropractic treatment. Effects may include temporary discomfort in parts of the body that were treated, headache, or tiredness. These effects tend to be minor and to resolve within 1 to 2 days.

The rate of serious complications from chiropractic has been debated. There have been no organized prospective studies on the number of serious complications. From what is now known, the risk appears to be very low.

For your safety, it is important to inform all of your health care providers about any care or treatments that you are using or considering, including chiropractic.

6. Do health insurance plans pay for chiropractic treatment?

Compared with alternative therapies as a whole (few of which are reimbursed), coverage of chiropractic by insurance plans is extensive. As of 2002, over 50% of health maintenance organizations (HMOs), over 75% of private health care plans, and all state workers' compensation systems covered chiropractic treatment. Chiropractors can bill Medicare, and over two dozen states cover chiropractic treatment under Medicaid.

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