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How Safe Are Spinal Adjustments?

After intensive study and evaluation, government researchers have concluded what millions of chiropractic patients have known for years: Spinal manipulation is a safe and effective form of initial treatment for one of the most common health complaints -- acute low back problems. For over a century, spinal manipulation has been what chiropractors do best. It provides relief from pain without drugs or surgery.

The Agency for Health Care Policy and Research (AHCPR), in a milestone study involving a multidisciplinary panel of health care experts, concluded that spinal manipulation is the safest drugless initial form of treatment for acute low back problems in adults. The study also recommended that -- for most cases -- conservative treatment such as manipulation should be pursued before surgical interventions are considered. This study included the participation of (and its conclusions were supported by) the American College of Orthopedic Surgeons.

A recent Harris Poll survey found that patients with back problems were more satisfied with chiropractic treatment than other types of care, and 70 percent of Americans surveyed believe that chiropractic should be included as a basic benefit in their health plans.

In another study, the prestigious Rand Corporation concluded that spinal manipulation was an appropriate treatment for acute low back pain, and reported from its analysis that 94 percent of all manipulations are performed by doctors of chiropractic.

Factors which define the effectiveness and success of chiropractic care include patient satisfaction, and drugless, non-surgical, lower cost treatment for low back pain and related musculoskeletal problems.

A recent study compared traditional medical intervention (NSAIDs, such as aspirin or ibuprofen) to chiropractic adjustments for neck pain. The best evidence indicates that cervical manipulation for neck pain is much safer than NSAIDs by as much as a factor of several hundred times. Further, there was no evidence that NSAIDs were any more effective than manipulation (adjustment) for pain.

Recent argument suggests that chiropractic adjustments are a dangerous intervention, especially adjustments to the cervical spine (neck), but dangerous complications, such as vascular or neurologic accident, occur in very small numbers. The most widely accepted statistics for vascular accidents following neck adjustments is one in 1 million procedures. Complications following low-back adjustments are even more rare.

Another study compared the drug amitriptyline to cervical manipulation for tension headaches, and found that chiropractic patients had a much longer relief and far fewer side effects. Some promising research has been published for manipulation and primary dysmennorhea (menstrual cramps), headache, and many other conditions. The future of research looks very bright, indeed.

Boline PD, et al. Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension Headache: A Randomized Clinical Trial. Jour Manip Phys Ther (JMPT) 1995 18:3


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