Recent data suggests that expanding insurance coverage of alternative therapies like chiropractic could drive down overall health-care costs. A new study, published in the January 2013 issue of Health Affairs, provides further information into expenditure patterns and utilization of complementary alternative medicine (CAM). Since chiropractic is the predominant source of CAM utilization, the study sheds light on how chiropractic can contribute to patient savings.
According to the study, between 2002 and 2008 the use and spending on CAM services, which had previously been rising, largely plateaued. This suggests that “Any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best." According to the authors, cutting coverage for CAM and chiropractic services could even have the opposite effect, since excluding services currently covered by private and public insurance could “trigger increased spending.”
The analysis of the Medical Expenditure Panel Survey revealed a trend towards increased usage of CAM services, up 6% from 2002 to 2008. In 2002, there were an estimated 15.2 million adult users; this increased to 16.1 million in 2008. The number of chiropractic patients increased from 11.5 million in 2002 to 11.9 million in 2008, while acupuncture saw a 16% increase in adult visits.
Despite the increasing number of patients, total visits to chiropractors and other CAM providers decreased. Chiropractic visits decreased by 3%, from 98.6 million visits in 2002 to 96.1 million in 2008. Acupuncture visits decreased 16% over the same time period, from 6.4 million to 5.4 million. According to the study authors, “The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth.”
The study also investigated the costs associated with chiropractic and other CAM services. Expenditures on chiropractic care increased from $6.2 billion in 2002 to $6.9 billion in 2008. Meanwhile, expenditures on acupuncture, massage, and other CAM treatments remained stable.
This data has important implications for national health-care policy. In their attempt to reduce waste, health-care policy makers often target complementary and alternative medicine services for exclusion. However, this tactic would, at best, result in only a small cost savings. Since CAM appears to be relatively inexpensive when compared with allopathic treatments, if medical providers are able to collaborate with local CAM providers, offering alternative and complementary medicine services could help health-care policy makers achieve their goals of cost savings.
The researchers conclude that health-care policy makers should consider the potential offset effect, in which patients substitute the excluded services with other services, which are covered by their health insurance, at an increased cost.
This study comes at the heels of another recent study suggesting that chiropractic patients have lower annual medical costs than patients in traditional care.
Davis MA, et al. U.S. spending on complementary and alternative medicine during 2002-2008 plateaued, suggesting role in reformed health system. Health Affairs 2013;32(1):45-52.
An estimated 300 million people worldwide suffer from asthma. With 180,000 deaths attributed to the disease, asthma treatment has a significant financial burden. In the United States alone, asthma medication is estimated to cost between $1 billion and $6 billion per year. While often treated with medication, there are other natural treatments available, such as chiropractic care.
In recent years, manipulative therapy has been used in addition to medication for managing respiratory diseases in adults and children. While many chiropractors report success with such treatments, few studies have examined the overall effectiveness of using manual therapies for respiratory disease treatment.
A recent literature review sought to examine the efficacy of chiropractic care for patients with asthma. The study involved randomized controlled trials, case reports, case series, cohort studies, survey studies, commentaries, and systematic reviews. The researchers concluded that chiropractic care may offer an alternative care approach for patients with asthma. However, the authors concluded further randomized controlled clinical trials should be conducted for future investigation of this approach.
Another new literature review focused on the use of manual therapy to treat childhood respiratory disease. That study involved eight clinical trials on the effects of manual therapy on children and teens with respiratory diseases. Five of the studies involved children with asthma, while the others focused on the treatment of children with other respiratory conditions, including recurrent respiratory infections, cystic fibrosis, and bronchiolitis.
Six of the eight studies identified positive results of manual therapy, including reduced anxiety, better lung function, and improved levels of salivary cortisol. The use of manual techniques such as chiropractic, osteopathic medicine, and massage appear to be beneficial for children with respiratory disease.While more research is needed to confirm the results of these initial studies, the findings offer promise for families searching for natural relief of asthma.
A recent case study highlights the impact that chiropractic can have for children with asthma. The case study involved a ten-year old boy who found relief from headache and respiratory symptoms under the care of chiropractor.
Alcantara J, et al. The chiropractic care of patients with asthma: a systematic review of the literature to inform clinical practice. Clinical Chiropractic 2012; 15: 23-30.
Pepinoa VC, et al. Manual therapy for childhood respiratory disease: A systematic review. Journal of Manipulative and Physiological Therapeutics 2013; 36(1): 57-65.
When treating persistent back pain, it can be difficult to accurately predict how well a patient will recover from symptoms resulting from non-specific pain. Will the patient be plagued with a lifetime of back pain or can the symptoms be resolved in a matter of months? Although several factors influence the prognosis of back pain, studies suggest that prognosis may differ depending on which treatments patients receive. The identification of which patients are more likely to respond to specific treatments would have valuable clinical implications, yet little research has been done in this area.
A team of researchers recently sought to identify predictors of response to three conservative treatments for low back pain: spinal manipulation (SM), individual physiotherapy (IP), or back school (BS). The research involved 210 patients with chronic, non-specific low back pain. Each was randomly assigned to one of the treatment groups.
Significant improvement was found following all three intervention types. However spinal manipulation provided more functional recovery and pain relief than either of the other interventions studied. Overall 34% of the patients did not respond to treatment but spinal manipulation showed the lowest rate of non-responders.
The researchers then sought to identify specific patterns of response to treatment in order to identify predictors of outcome. They found that age, quality of life, work status, pain duration, patients' beliefs, and other variables studied did not predict response to treatment. Patients were more likely to benefit from spinal manipulation than from back school or physiotherapy, regardless of their baseline disability score and other clinical characteristics.
A lower initial disability score predicted poor outcome for back school and for individual physiotherapy, but not for patients treated with spinal manipulation. The researchers concluded that patients with chronic lower back pain and related disability should first consider spinal manipulation before other conservative treatments.
Other research has shown that combining chiropractic adjustments with exercise therapies can enhance back-pain treatment.
Cecchi F, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine 2012; 48: 371-8.
Many parents of children with chronic-health conditions struggle to help their child manage ongoing pain and symptoms. They also worry about the potential effects certain medical treatments and drugs can have on their child's health. That could be why more parents are now seeking natural treatment options like chiropractic.
In a recent study, chiropractic was one of the most commonly-used alternative therapies for children with chronic-health problems.
The study included more than 900 parents of children being treated at cardiology, gastroenterology, neurology, oncology, and respiratory clinics in Canada. Parents were asked about their child's use of alternative therapies and products.
Nearly half of parents said their child used an alternative therapy in addition to receiving conventional treatments. Almost 10% of parents said they'd pursue complementary and alternative medicine (CAM) prior to conventional treatments, and 5% said they used alternative medicine in place of traditional care.
Of the two hospitals included in the survey, at one hospital, 71% of children had received CAM therapies, while 42% had used CAM therapies at the other. The most common CAM therapies were massage, chiropractic, relaxation, and aromatherapy.
Several parents also said their child took multivitamins and minerals and had used herbal supplements and homeopathic remedies in the past. However, parents did not always communicate with primary-care physicians about their child's use of herbal supplements and minerals, which had some observers worried.
Herbal and dietary supplements can change how the body reacts to certain drugs, warned Dr. Josephine Briggs, director of the National Center for Complementary and Alternative Medicine, who commented on the issue in recent article from The Huffington Post. She encouraged patients to talk with physicians about their herbal and dietary supplement use, and reminded physicians to take the time to ask.
The study suggests that the use of CAM therapies like chiropractic among children is on the rise. Studies show that chiropractic care is a safe, effective treatment for children with musculoskeletal complaints, headache, and more.
Adams D, et al. Complementary and alternative medicine use by pediatric specialty outpatients. Pediatrics 2013; doi: 10.1542/peds.2012-1220.
Many patients rely on pain medications to manage migraines but did you know those medications may actually be causing you more headaches? A recent study found that medication overuse causes daily headaches in 1 in 50 people. Fortunately, there are natural treatment options that don't put you at risk for worsening head pain.
Cases studies have suggested that chiropractic is beneficial for migraine treatment in pregnant women and children but a 2000 study was one of the the first randomized, controlled trials assessing the efficacy of chiropractic for migraine.
The study involved 127 participants between the ages of 10 and 70. All had been diagnosed with migraines, and had a minimum of at least one migraine per month. Half of the patients received chiropractic treatments, while the other half served as a control group. Treatment consisted of two months of chiropractic spinal manipulations, with a maximum of 16 treatments. Over the course of the study, participants completed headache diaries noting the frequency, intensity, duration, disability, associated symptoms, and medication use for each migraine.
The treatment group showed statistically significant improvements in average responses for migraine frequency, duration, disability, and medication use when compared to the control group. Twenty-two percent of participants reported more than a 90% reduction of migraines after the 2 months of treatment. The results of this study support previous information that some people report significant improvement in their migraines after chiropractic spinal manipulation.
Given that a high percentage of people with migraines report stress as a major migraine factor, it appears likely that chiropractic care affects physical conditions related to stress, thereby reducing the effects of the migraine.
A more recent study published in 2012 demonstrated that chiropractic care reduced pain severity in migraine patients by an average of 68%. In other words, chiropractic patients had their pain levels drop from an average of 5 to 0.5 on scale of 1 to 10.
Jahangiri JN, Vatankhah N, and Baradaran HR. Reduction of Current Migraine Headache Pain Following Neck Massage and Spinal Manipulation. Journal of Therapeutic Massage and Bodywork. 2012; 5(1): 5–13.
Tuchin P, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 2000; 23 (2)
Some physical therapists and other health-care providers are firm believers in the efficacy of patient education as a means to reduce symptoms for various musculoskeletal diseases. Ongoing research has been conducted to investigate the actual effects that patient education has on symptoms.
In one such study, Danish researchers compared the effectiveness of patient education with chiropractic and patient education without chiropractic. The participants included patients with hip osteoarthritis. One group of patients were educated by a specially trained physical therapist; another group received the same education sessions in addition to manual therapy delivered by a chiropractor, including trigger point release therapy, muscular stretching, and joint manipulation. These two groups were also compared to a group receiving minimal control intervention, who performed simple home-based stretching exercises only.
Participants were treated for six weeks and rated their pain intensity following their specified interventions. Researchers also assessed participants for hip disability, pain outcomes, perceptions about their interventions, and whether or not hip replacement surgery was needed within a year.
The patient education group did not experience outcomes any better than the control group. But the patients who were educated in addition to being treated with chiropractic manual therapy had significant improvements compared to the other two groups. At six weeks, more than 76% of the chiropractic patients reported improvement compared to just 22% of the patient education group and 12% of the home-based stretching group. The chiropractic group was also significantly less likely to have hip replacement surgery within 12 months of the study. Only four in the chiropractic group needed an operation, in contrast with 12 patients in the patient education group and seven in the control group who needed surgery within the year.
Other research about hip osteoarthritis showed that chiropractic manual therapy alone provides effective treatment, and a follow-up study investigated the reason that chiropractic is so effective at easing hip pain.
Poulsen E, Hartvigsen J, et al. Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip- A proof of principle three-arm parallel group randomized clinical trial. Osteoarthritis and Cartilage 2013; 21:145.
Attention-deficit/hyperactivity disorder (ADHD) is a common childhood condition with symptoms such as impulsivity, hyperactivity, inattentiveness, and distractibility. Treatment options are varied, including medication and complementary and alternative medicine (CAM) options. Chiropractic care has been suggested as one potential treatment for ADHD.
There is some preliminary evidence to suggest that chiropractic care could have some positive effect on learning disabilities and ADHD. A recent case study adds this body of evidence by detailing the chiropractic care of a 5-year-old boy diagnosed with ADHD. His parents hoped that chiropractic care could help address signs of ADHD such as acting out, inability to follow instructions, and poor performance at school.
An initial examination revealed trigger points and hypertonicity in the paraspinal muscles, along with cervical and thoracolumbar facet joint irritation. Treatment included stretching, soft tissue therapy, and spinal manipulation conducted three times per week initially, declining to twice per week and continuing for one year.
Following one year of treatment, subjective improvements were noted in the patient's ability to follow instructions, episodes of acting out, and general performance at school and home. This suggests that chiropractic care could have a potential role in the management of patients with ADHD. However, the researchers pointed out that these improvements may have resulted from the psychological benefit of having an increased support system during treatment. Additionally, since physical touch has been shown to alter mood and behavior, the hands-on approach of the treatment could have also played a role in its success.
While this case study provides us with an example of the potential impact of chiropractic on kids with ADHD, the overall evidence on chiropractic for ADHD is sparse. No large-scale trials evaluating chiropractic treatments for ADHD have been conducted, and more research must be done to confirm any effects.
Muir JM. Chiropractic management of a patient with symptoms of attention-deficit/hyperactivity disorder. Journal Chiropractic Medicine 2012l 11(3): 221–224.
Most people think of chiropractic as effective way to treat back pain. While this is true, dozens of medical studies show that chiropractic can alleviate a number of other health conditions, while promoting general health and wellness.
Studies show that chiropractic care can:
- Ease the pain of aging in adults with scoliosis, spinal degeneration, and osteoarthritis in the knee, hip, and hands
- Heal damaged nerves causing the radiating pain associated with disc herniation, sciatica, carpal tunnel syndrome, and more
- Decrease pregnancy-related pelvic and back pain
- Reduce patient reliance on pain medication to manage migraines and cervicogenic headaches
- Improve recovery from auto injuries like whiplash, neck pain, TMJ disorders, and tinnitus
- Treat and prevent sports injuries like muscle strains and injuries to the shoulders, back, and lower limbs
- Soothe symptoms of fibromyalgia
But chiropractic can do more than provide pain relief, it can improve your overall health and well being. Research suggests that chiropractic care can also:
- Boost immunity
- Reduce stress hormones
- Lower blood pressure
While dozens of scientific studies have examined the many benefits of chiropractic care, the best way to discover the benefits is to try it out yourself. So take the plunge and learn how chiropractic can boost your whole body wellness today.
Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. The Spine Journal 2010; 10: 117-128.
Tuchin P, 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.
Jull G, Trott P, Potter H, et al. A randomized controlled trail of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27(17):1835-1843.
Dizziness Lystad RP, Bell G, et al. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review. Chiropractic and Manual Therapies 2011;19(1):21
Alcantara J, Plaugher G, Klemp DD, Salem C. Chiropractic care of a patient with temporomandibular disorder and atlas subluxation. Journal of Maniuplative and Physiological Therapeutics 2002; 25(1):63-70.
DeVocht JW, Schaeffer W, Lawrence DJ. Chiropractic treatment of temporomandibular disorders using the activator adjusting instrument and protocol. Alternative Therapies in Health and Medicine 2005; 11(6):70-3.
Bronfort G, Evans R, Anderson A, Svendsen K, Bracha Y, and Grimm R. Spinal Manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Annals of Internal Medicine 2012; 156 (1): 1-10.
Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic ‘whiplash’ injuries. Injury: International Journal of the Care of the Injured 1996;27(9):643-645.
Boyles RE, Ritland BM, Miracle BM, Barclay DM, Faul MS, Moore JH, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Manual Therapy 2009;14:375–80
Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.
Cifuentes M, Willetts J, Wasiak R. Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine 2011; 53(4): 396-404.
von Heymann W, Schloemer P, et al. Spinal HVLA-manipulation in acute nonspecific LBP: A double blinded randomized controlled trial in comparison with diclofenac and placebo. Spine 2012; doi: 10.1097/BRS.0b013e318275d09c.
Teodorczyk-Injeyan JA, McGregor M, Ruegg R, Injeyan HS. Interleukin 2-regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropractic & Osteopathy 2010; 18:26.
Bakris G, Dickholtz M, Meyer PM, Kravitz G, et al. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007;21:347-352.
Ogura, Takeshi and Manabu Tashiro, Mehedi,Shoichi Watanuki, Katsuhiko Shibuya, Keiichiro Yamaguchi, Masatoshi Itoh, Hiroshi Fukuda, Kazuhiko Yanai. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Alternative Therapies. 2011; 17 (6): 12-17.
Carpal Tunnel Syndrome/Wrist Pain
De-la-llave-Rincon, A. Response of pain intensity to soft tissue mobilization and neurodynamic technique: a series of 18 patients with chronic carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics 2012; doi:10.1016/j.jmpt.2012.06.002.
Pollard H, Ward G, Hoskins W, and Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. The Journal of the Canadian Chiropractic Association 2008; 52(4):229-42.
Brantingham JW, Globe GA, Cassa TK, et al. A single-group pretest posttest design using full kinetic chain manipulative therapy with rehabilitation in the treatment of 18 patients with hip osteoarthritis. Journal of Manipulative and Physiological Therapy 2012; 33(6): 445-57
Villafañe JH, Silva GB, and Chiarotto A. Effects of passive upper extremity joint mobilization on pain sensitivity and function in participants with secondary carpometacarpal osteoarthritis: a case series. Journal of Manipulative and Physiological Therapeutics 2012; 35(9): 735-42.
Morningstar, Mark W. “Outcomes for adult scoliosis patients receiving chiropractic rehabilitation: a 24-month retrospective analysis.” Journal of Chiropractic Medicine 2011; 10: 179-184.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics 2010; 33(8): 576-584.
Howell ER. Pregnancy-related symphysis pubis dysfunction management and postpartum rehabilitation:two case reports. Journal of Canadian Chiropractic Association 2012; 56 (2):102-111.
Sacroiliac Joint Dysfunction
Kamali, Fahimeh and Esmaeil Shokri. The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork and Movement Therapies 2012; 16: 29-35.
Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. Journal of Chiropractic Medicine 2008; 7 (3): 115-25.
Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. Journal of the Canadian Chiropractic Association 2012;56(1):18-28.
Panton LB, Figueroa A, Kingsley JD, et al. Effects of resistance training and chiropractic treatment in women with fibromyalgia. Journal of Alternative and Complementary Medicine 2009;15(3):321-328.