Landmark Study Shows Chiropractic Care Significantly Better than Drugs, Massage and Physiotherapy
A landmark study published in the Spine Journal in 2010 by Bishop et al showed that chiropractic care was significantly better than the more commonly recommended treatments of drugs, massage and physiotherapy (PT).
This is the first study to compare the full clinical practice guideline-based treatment of chiropractic versus medical care in the case of acute low back pain.
The Roland Morris Disability Questionnaire was used to measure outcomes. It provides the patients’ report of measurable data regarding how pain effects daily life.
There were two treatment groups as outlined below:
Clinical Guidelines Chiropractic Group
- Only 4 weeks of treatment
- walk 5-15 minutes per day
- take acetaminophen every 6-8 hours as required
- get lumbar manipulations/adjustments (2-3x/week)
Physician Directed Usual Care Group
- 16 weeks of treatment
- MD’s directed to treat as usual at own discretion
- MD’s prescribed or referred for the following: opioid pain killers, acetaminophen, NSAIDS, referral to physiotherapy (PT), referral to massage, and/or referral to kinesiologist
At 16 weeks, the usual physician directed care group had virtually no improvement (RDQ 0.1). The clinical guidelines based chiropractic group had significant improvements (RDQ of 2.7). The clinical practice guidelines group with chiropractic care showed a 2700% greater improvement at 16 weeks (RDQ 2.7 vs 0.1).
Just 4 weeks of chiropractic care, with a walk, outperformed 16 weeks of usual medical care. Usual medical care included acetaminophen drugs, NSAIDS, opioid pain killers, massage, kinesiologist care, physiotherapy care and passive modalities (heat and cold therapy, ultrasound, laser, traction, electrical muscle stimulation, etc). 80% of patients in the physician directed usual care group received opioid drugs while 78% were still taking them at 16 weeks. 61% of physician directed patients received treatment of passive PT modalities. Ironically opioid drugs and passive modalities are considered guideline discordant or not evidence based. They should not have been recommended due to their documented ineffectiveness.
It is worth noting that the clinical practice guidelines (CPG) were developed on an international scale using independent systematic reviews that are shown to be highly consistent and based on sound scientific evidence rather than on consensus. The American College of Physicians (ACP) has created their own guidelines for use in the United States. The ACP guidelines completely ignore studies such as this and contradict the internationally established evidence-based clinical practice guidelines used in this study.
The study states that there is a poor correlation between what practitioners think it effective care versus what has actually shown itself to be effective. Muscle relaxers, opioid drugs, passive PT modalities, bed rest, special back exercise programs (core stability and extension exercises) are all shown to be guideline discordant meaning they should not be recommended as an effective treatment option.
It is also worth noting that since acetaminophen was used in both groups and the usual physician directed care had virtually no improvement we know that the acetaminophen (tylenol) was not responsible for the significant improvements seen on the clinical guidelines based chiropractic group. That means that 2-3 chiropractic adjustments and a 5-15 walk delivered the significant results. We can also determine that NSAIDS (aspirin, motrin, advil, ubuprofen, naproxen, aleve, celebrex, etc) were ineffective since the group that received them had virtually no improvement after 16 weeks of use.
Not only did 4 weeks of chiropractic care perform better than medical care at 16 weeks, at 6 months after the completion of the study the chiropractic care group reported that function was still significantly better.
The final conclusion of the study, clinical guideline practice based (evidence based) chiropractic care is SIGNIFICANTLY BETTER than family physician directed-usual care for the treatment of low back pain.