Resources and Strategies

The Evidence-Informed Chiropractor


Benefits of Chiropractic in Managed-Care Settings

The benefits of including chiropractic care in managed care systems has been demonstrated through several studies over the last 5 years.


Consistently, there have been dramatic reductions in the utilization of surgery, hospitalizations, and pharmaceuticals.


Below are some examples from several key studies.


An evidence-based report which evaluates the literature on manual therapies for various conditions was published in Chiropractic and Osteopathy by Bronfort, Haas et al. This review rates the literature and gives the reader a graphic representation of the evidence for various musculoskeletal and non-musculoskeletal disorders. Below is a summary of some of the key findings followed by a link to the article. The categories are listed as Inconclusive, Moderate and High for evidence.

For spinal manipulation/mobilization - Positive; Moderate Evidence for Benefit
  • Spinal- Acute low back pain, chronic low back pain, acute/subacute neck pain, acute whiplash associated disorders (mobilization/exercise), and chronic neck pain
  • Extremities- shoulder girdle pain/dysfunction, adhesive capsulitis, tennis elbow (lateral epicondylitis), knee osteoarthritis (with exercise), patellofemoral pain syndrome (with exercise), and plantar fascitis
  • Headache/Dizziness - migraine headache, cervicogenic headache, cervicogenic dizziness
Effectiveness of Manual Therapies: the UK Evidence Report

Recently, a highly-regarded study has demonstrated that chiropractic care for low back and neck pain is more effective and more cost-effective than other therapies. This report by the highly-respected Mercer group was published in October, 2009. One of the authors, Arnold Milstein, MD is one of President Obama's helath-care advisors.

Do Chiropractic Services for Treatment of Low Back and Neck Pain Improve the Value of Health Benefit Plans?

Significant Reductions in Medical Interventions and Cost


Sarnat RL, Winterstein J, Cambron JA [1, 2]

In two publications, the researchers demonstrated substantial decreases in the utilization of certain services by patients who sought chiropractic care for a wide variety of complaints.

The first publication followed patients over a four-year period and demonstrated the following (when compared to conventional medicine):

  • Hospital admissions reduced 43%
  • Hospital days reduced 58.4%
  • Average length of stay reduced by 23.8%
  • Outpatient surgeries reduced by 43.2%
  • Medication usage reduced by 43.2%

The second of the two studies which followed the patients in the first four-year study through a total of seven years demonstrated even more dramatic results (when compared to conventional medicine):

  • Hospital admissions reduced by 60.2%
  • Hospital days reduced by 59%
  • Outpatient surgeries reduced by 62%
  • Pharmaceutical costs reduced by 85%

Nelson CF, Metz RD, LaBrot T [3]

Data from another managed-care plan over a four year period demonstrated the following for patients with low back pain and those with neck pain (based on numbers per patient versus group; the more conservative of the two approaches with regard to demonstrating success):

Low Back Pain

  • 13.7% fewer surgeries
  • 20.3% fewer use of CT/MRI
  • 24.8% fewer in-patient care episodes (hospitalization)

Neck Pain

  • 31.1% fewer surgeries
  • 25.7% fewer use of CT/MRI
  • 31.1% fewer in-patient care episodes (hospitalization)

1. Sarnat, R.L. and J. Winterstein, Clinical and cost outcomes of an integrative medicine IPA. J Manipulative Physiol Ther, 2004. 27(5): p. 336-47.

2. Sarnat, R.L., J. Winterstein, and J.A. Cambron, Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update. J Manipulative Physiol Ther, 2007. 30(4): p. 263-9.

3. Nelson, C.F., R.D. Metz, and T. LaBrot, Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. J Manipulative Physiol Ther, 2005. 28(8): p. 564-9.

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