The Research

Public Opinion

1.) Two-thirds say that chiropractic care is effective for neck and back pain. More than 33 million U.S. adults saw a chiropractor last year. About half of adults in the U.S. have had some experience as a patient of a chiropractor.

English C, Keating E. Gallup Report. “Majority in U.S. Say Chiropractic Works for Neck, Back Pain.” September 8, 2015.

Reduction in Costs

2.) Clinical and cost utilization based on 70274 member-months over a 7-year period demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame.

Sarnat R, Winterstein J, Cambron J. “Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update”. Journal of Manipulative and Physiological Therapeutics. May 2007. Volume 30, Issue 4, Pages 263–269.

3.) Individuals with similar risk profiles who begin their care pathway with a chiropractor or PCP see fewer total health care providers throughout the overall episode of care than do individuals who initially consult an orthopedic specialist, physical medicine/rehabilitation specialist, or physical/occupational therapist.

Kosloff T, Elton D, et al. “Conservative Spine Care: Opportunities to Improve the Quality and Value of Care” Popul Health Manag. 2013 Dec 1; 16(6): 390–396.

4.) In using chiropractors as a proxy for appropriate non-surgical pathways, there is a potential $219 million risk adjusted impact for non-surgical spinal care (1.4 million episodes in 4 million members over a span of 2.5 years).

Kosloff T, Elton D. “Conservative Care: Ensuring the Right Provider for the Right Treatment for Back Pain. 2012

5.) Paid costs for episodes of care initiated with a DC [Chiropractor] were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient’s costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD.

Liliedahl RL., Finch MD., Axene DV., Goertz CM. Cost of care for common back pain conditions initiated with chiropractic doctor vs. medical doctor/doctor of osteopathy as first physician experience of one Tennessee-based general health insurer. J Manipulative Physiol Ther. 2010;33:640–643

6.) There was a very strong association between surgery and first provider seen for the injury even after adjustment for other important variables. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.

Keeney BJ, Fulton-Kehoe D, et al. “Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.” Spine (Phila Pa 1976). 2013 May 15;38(11):953-64.

7.) 4-year retrospective review of claims from 1.7 million health plan members were analyzed to determine the cost effects of the inclusion of a chiropractic benefit in an HMO insurance plan. Back pain episode-related costs were 25% lower for those with chiropractic coverage ($289 vs. $399).

Legorreta A, Metz D, et al. “Comparative Analysis of Individuals With and Without Chiropractic Coverage.” Archives of Internal Medicine 2004; 164: 1985-1992.

8.) The average cost of [low back injury] claims is $15,884. When a worker with a lower back injury receives at least 75% of his/her care from a chiropractor, that cost decreases to $12,202 and when he/she receives at least 90% of their care from a chiropractor the average cost declines even further to $7,632.”

Texas Workers’ Compensation Report. MGT of America, Inc. Chiropractic Treatment of Workers’ Compensation Claimants in the State of Texas (Austin, Texas: 2003)

9.) Chiropractic care appeared relatively cost-effective for the treatment of chronic lower back pain. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis.

Haas M, Sharma R, Stano M. “Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.” J Manipulative Physiol Ther. 2005 Oct; 28(8):555-63.

10.) Smith, M.; Stano, M. “Costs and recurrences of chiropractic and medical episodes of low-back care.” Journal of Manipulative and Physiological Therapeutics 1997; 20(1): 5-12

11.) The Alternative Medicine Integration Study. Journal of Manipulative and Physiological Therapeutics, May 2007


Outcomes and Efficacy

12.) Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.

McCrory D, Penzien, et al. Duke Evidence Report. “Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache”.   Duke University Evidence-based Practice Center

13.) Many treatments are available for low back pain. Often exercises and physical therapy can help. Some people benefit from chiropractic therapy or acupuncture. Sometimes medications are needed, including analgesics (painkillers) or medications that reduce inflammation. Surgery is not usually needed but may be considered if other therapies have failed.(8)

Goodman D, Burke A, Livingston E. “Low Back Pain”. The Journal of the American Medical Association. 2013;309(16):1738.

14.) Murphy D, Justice B, Paskowski I. et al. “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States” Chiropractic and Manual Therapies (2011); 19(17).

15.) Tuchin PJ, Pollard H, Bonello R. “A Randomized Controlled Trial of Chiropractic Spinal Manipulative Therapy for Migraine” Journal of Manipulative and Physiological Therapeutics (2000); 23 (2) 91-95.

16.) Bronfort G. Evans R., Anderson AV., mSvendsen KH., Bracha Y. Grimm RH. “Spinal Manipulation, Medication or Home Exercise With Advice for Acute and Subacute Neck Pain” Annals of Internal Medicine (2012); 156: 1-10.

17.) McMorland et al. “Manipulation of Microdiskectomy for Sciatica?: A Prospective Randomized Clinical Study” Journal of Manipulative and Physiological Therapeutics (2001); 33 (8): 576-584.

18.) Von Heymann WJ., Schloemer P., mTimm J., Muehlbauer B. “Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo”. Spine (2013); 38 (7): 540-548.


19.) The cost of lost productive time in the U.S. workforce was found to be $61 billion, and 76% of that cost was attributed to health-related reduced performance.

Stewart W, Ricci J, et al. “Lost Productive Time and Cost Due to Common Pain Conditions in the U.S. Workforce. Journal of the American Medical Association 2003. Nov 12; 290(18): 2443-54

20.) Cypress BK. “Characteristics of physicians visits for back symptoms: a national perspective” American Journal of Public Health (1991); 12:141-156.

21.) Wolsko PM, Eisenberg DM, Davis RB, Kessler R, Phillips RS. “Patters and percepttions of care for treatment of back and neck pain: results of a national survey”. Spine (2003); 28(3):292-297, discussion 298.


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“Evidence of Clinical and Cost-Effectiveness of Chiropractic Spinal Manipulation”