Chiropractic Research & Literature

Examining The Evidence

Chiropractic is a modern science, philosophy, and art concerned with the relationship of body structure (primarily of the spine) to function (as co-ordinated by the nervous system). It is the only profession dedicated to the analysis, correction and prevention of the vertebral subluxation complex.

There is a growing body of evidence confirming the basic concepts of chiropractic. This research comes from within and outside the chiropractic profession. As with all science, it is a continual ongoing process of discovery and refinement using the best available models and evidence (click here for specific literature pertaining to the vertebral subluxation complex).

The safety and effectiveness of chiropractic care in terms of enhancing sports performance, economic benefits, patient satisfaction, increasing immune system function, pain and symptom relief, restoring the body’s optimum balance and speeding up its natural recovery, has been documented in various case reports, clinical studies and trials, and a number of government inquiries.

While chiropractic care has positive outcomes for many diverse health problems it is not in itself a treatment for any specific condition. Rather, chiropractors specialise in the detection and correction of subluxations to enhance the expression of life, health, and proper function of an individual regardless of disease or condition, or the presence or absence of symptoms.

Despite popular misconception, chiropractic and spinal manipulation or adjustments in particular, are one of the most studied health interventions in the world. While all studies have their strengths and limitations the majority of studies about chiropractic have been positive, and the remainder equivocal at worst.

Below is a selection of peer-reviewed scientific papers and other articles discussing aspects of chiropractic and its delivery. For comprehensive frequently-updated links to articles on chiropractic care and related topics visit the Chiropractic Resource Organisation, ICPA website, or search for topics on ChiroIndex.

Back Pain, Neck Pain, Headaches and Other Neuro-musculo-skeletal Symptoms
Because of its primary focus on the spine, chiropractic is traditionally associated with low back pain and other musculo-skeletal syndromes (eg. neck pain, headaches, whiplash, disc injuries, scoliosis and other postural syndromes). It is now well accepted that chiropractic care and its hallmark the spinal adjustment (aka manipulation or manual therapy) is often an effective intervention in these cases. Various chiropractic techniques have also shown to benefit non-spinal joint problems such as carpal tunnel and thoracic outlet syndrome, epicondylitis, foot, ankle and knee dysfunction among others. While the bulk of clinical trials and other studies have focused on a limited musculo-skeletal approach, the research scope is now widening to other areas of health and wellness.

Ben Eliyahu, DJ (1996). Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal of Manipulative and Physiological Therapeutics ; 19, 19.
Burton AK, Tillotson KM, Cleary J (2000). Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. European Spine Journal ; 9: 202-207.
Danbert RJ. (Feb 1989) Scoliosis: biomechanics and rationale for manipulative treatment. Journal of Manipulative and Physiological Therapeutics ; 12 (1): 38-45.
Delauche-Cavallier MC, Budet C, Laredo JD, et.al (1992) Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression. Spine , 17(8): 927-933.
Hoiriis KT, Pfleger B, McDuffie FC, Cotsonis G, Elsangak O, Hinson R, Verzosa GT (2004). A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain. Journal of Manipulative and Physiological Therapeutics ; Jul, 27 (6): 388√398.
Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG.(1996) Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine ; 21 (15): 1746-1759.
Koes BW, van Tulder MW, Ostelo R, Burton AK, Waddell G. (2001) Clinical guidelines for the management of low back pain in primary care. Spine ; 26(22): 2504-2514.
Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y. (1987) Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. British Journal of Rheumatology Dec;26(6):416-23.
Memmo PA, Nadler S, Malanga G. (2000) Lumbar disc herniations: A review of surgical and non-surgical indications and outcomes. Journal of Back and Musculoskeletal Rehabilitation 14(3), pp. 79-88.
Muller, R. and Giles, L. (2005) Long-Term Follow-up of a Randomized Clinical Trial Assessing the Efficacy of Medication, Acupuncture, and Spinal Manipulation for Chronic Mechanical Spinal Pain Syndromes. Journal of Manipulative and Physiological Therapeutics ,Volume 28, Issue 1, Pages 3-11.
Pang-Fu Kuo P, Loh Z. (1987) Treatment of lumbar intervertebral disc protrusions by manipulation. Clinical Orthopaedics and Related Research , 215:47-55.
Postacchini F. (1996) Spine update: Results of surgery compared with conservative management for lumbar disc herniations. Spine 21(11): 1383-1387.
Seaman D, Cleveland C (1999). Spinal Pain Syndromes: Nociceptive, Neuropathic, and Psychologic Mechanisms Journal of Manipulative and Physiological Therapeutics ; 22 (7): 458√472.
Smart LJ, Smith DL. ( 2001) Postural dynamics: Clinical and empirical implications . Journal of Manipulative and Physiological Therapeutics ,24(5), pp. 340-349.
Tarola GA. (1994) Manipulation for the control of back pain and curve progression in patients with skeletally mature idiopathic scoliosis: two cases. Journal of Manipulative and Physiological Therapeutics ; 17 (4): 253-257.
Triano JJ, McGregor M, Hondras MA, Brennan PC. (1995) Manipulative therapy versus education programs in chronic low back pain. Spine 20 (8): 948-955.
Troyanovich SJ, Harrison DD, Harrison DE. (1999) Low back pain and the lumbar intervertebral disk: Clinical consideration for the doctor of chiropractic. Journal of Manipulative and Physiological Therapeutics , vol. 22, no. 2, 96-104.
Vernon HT. (1995) The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. Journal of Manipulative and Physiological Therapeutics ; 18 (9): 611-617.
Winters JC., Sobel JS., Groenier K., Arendzen HJ., Meyboom-de Jong B. (1997) Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomised, single blind study. British Medical Journal , 314:1320-1325.
Yefu et al (1986). Traction and manipulative reduction for the treatment of protrusion of lumbar intervertebral disc: an analysis of 1,455 cases. Journal of Traditional Chinese Medicine ; 6, pp. 31-33.
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Cost Effectiveness, Patient Satisfaction, Outcome Comparisons and Government Inquiries
Chiropractic care has been shown as highly cost effective by governmental and third party payer analyses. Chiropractic ranks very high in patient satisfaction ratings and often outperforms comparative medical care in many aspects. As chiropractic has grown in popularity, many government bodies and health insurers around the world have begun to take notice of its effectiveness, cost effectiveness and potential role in the mainstream health sector. Findings from these inquiries support the utilisation of chiropractic services and make the case for integration of chiropractic into the public system as a safe and effective method of healthcare.
Gemmell HA, Hayes BM. Patient satisfaction with chiropractic physicians in an independent physicians’ association. Journal of Manipulative and Physiological Therapeutics ; 2001 (Nov-Dec); 24 (9): 556-559
Giles, L, Muller, R. (2003) Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation. Spine , 28(14):1490-1502
Haas M, Sharma R, Stano M. (2005) Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain. Journal of Manipulative and Physiological Therapeutics , 28 (8): 555√563.
Inglis BD, Fraser B, Penfold BR. (1979) Chiropractic in New Zealand, Report of a Commission of Inquiry. Wellington, New Zealand: Government Printer.
Jarvis KB; Phillips RB; Morris EK. (1991) Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, 33(8):847-52.
Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. (2003) Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 326(7395):911
Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. (2004) Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs. Archives of Internal Medicine , 164 (18): 1985√1892.
Manga P (2000). Economic case for the integration of chiropractic services into the health care system. Journal of Manipulative and Physiological Therapeutics ; 23(2): 188-122.
Meade TW, Dyer S, Browne W, Townsend J, Frank AO. (1990) Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal ; 300 (6737): 1431-1437
Meade TW, Dyer S, Browne W, Frank AO. (1995) Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. British Medical Journal ; 311 (7001): 349-351
Nwuga, V.C.B. (1982) Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. American Journal of Physical Medicine , 61, pp. 273-278.
Sarnat RL, Winterstein J (2004). Integrated Medical IPA. Journal of Manipulative and Physiological Therapeutics ; 27(5): 336-47.
Stano M. (1993) A comparison of health care costs for chiropractic and medical patients. Journal of Manipulative and Physiological Therapeutics , 16(5):291-9.
Smith M, Stano M (1997). Costs and recurrences of chiropractic and medical episodes of low-back care. Journal of Manipulative and Physiological Therapeutics ; 20(1): 5-12.
Nyiendo J. (1991) Disabling low back Oregon Workers’ Compensation claims. Part II: Time loss. Journal of Manipulative and Physiological Therapeutics , 14(4):231-9.
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Chiropractic and Medical Education
Today’s chiropractors are highly educated professionals who undergo rigorous academic and clinical training. The education to become a chiropractor compares favourably with medical training with similar overall course hours and many of the same basic subjects. In fact, in many areas chiropractors excel in comparison to their medical counterparts (such as neuro-musculo-skeletal anatomy and diagnosis, radiology, and manual spinal correction).

Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M (1998). A comparative study of chiropractic and medical education. Alternative Therapy Health Medicine ; Sep;4(5):64-75.
Freedman KB, Bernstein J (1998). The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery; 80-A(10): 1421-1427.
Freedman KB, Bernstein J (2002). Educational deficiencies in musculoskeletal medicine. Journal of Bone and Joint Surgery ; 84-A(4): 604-608.
Haldeman, S. (2004) Principles and Practices of Chiropractic McGraw-Hill Medical; 3 edition
Taylor JA, Clopton P, Bosch E, Miller KA, Marcelis S. (1995) Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic. Spine , 15;20(10):1147-53; discussion 1154.
World Health Organisation, WHO Guidelines on Basic Training and Safety in Chiropractic (2005) WHO Press Geneva.
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Safety and Relative Risk
Chiropractic has repeatedly been proven as an extremely safe form of healthcare. Unfortunately, political and emotional issues have clouded the true scientific discussion of actual and relative risks. Chiropractic adjustments or manipulations are safer than many everyday activities and are far safer than common over the counter painkillers and other prescribed medications.
Chestnut JL. (2004) The stroke issue: paucity of valid data, plethora of unsubstantiated conjecture. Journal of Manipulative and Physiological Therapeutics , 27(5):368-72.
Coulter, ID. (1998) Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest? Integrative Medicine , 1: 2, 61-66.
Dabbs V, Lauretti WJ. (1996) A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain. Journal of Manipulative and Physiological Therapeutics , 18 (8) 530-6.
Haldeman S, Kohlbeck FJ, McGregor M. (1999) Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine , 24:785-94.
Haldeman, S. (2004) Principles and Practices of Chiropractic McGraw-Hill Medical; 3 edition.
Leboeuf-Yde C, Rasmussen LR, Klougart N. (1996) The risk of over-reporting spinal manipulative therapy-induced injuries; a description of some cases that failed to burden the statistics. Journal of Manipulative and Physiological Therapeutics , 19: 536.
Pistolese RA. (1998) Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient. (Risk of complications in pediatric patients under chiropractic care). Journal of Vertebral Subluxation Research, 2 (2): 73-81
Rome PL. (1999) Perspectives: an overview of comparative considerations of cerebrovascular accidents. Chiropractic Journal of Australia , 29(3), pp87-102.
Terrett A.G.J. (1995) Misuse of the literature by medical authors in discussing spinal manipulative therapy injury. Journal of Manipulative and Physiological Therapeutics ,18(4): 203-10.
Wilk CA. (1996) Medicine, monopolies, and malice. Garden City Park, NY: Avery Publishing Group; (renamed Chiropractic and Medicine: The Need to Work Together for Effectiveness ).
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Athletic Enhancement and Sports Performance
Chiropractic care is often utilised by amateur and professional athletes to help recover from and reduce the chances of injury and also to enhance co-ordination, speed and overall performance. Some chiropractors specialise in this field and help care for some of the worlds top athletes and teams.
Haldeman, S. (1986) Spinal Manipulative Therapy in Sports Medicine. Clinics in Sports Medicine 5: p. 277.
Lauro A. Mouch B. (1991) Chiropractic effects on athletic ability. The Journal of Chiropractic Research and Clinical Investigation , 6: 84-87
Schwartzbauer J., Kolber J., Schwartzbauer D., Hart J., Zhang J. (1997) Athletic performance and physiological measures in baseball players following upper cervical chiropractic care: a pilot study. Paper Presented at the National Subluxation Conference, October 12-13, 1996 Phoenix, Arizona, Sponsored by Sherman College of Straight Chiropractic. Published in the Journal of Vertebral Subluxation Research 1 (4): 7
Smith, D. and Cox R. (1999-2000) Muscular Strength and Chiropractic: Theoretical Mechanisms and Health Implications Journal of Vertebral Subluxation Research , 3(4),
Stump JL, Redwood D. (2002) The use and role of sport chiropractors in the national football league: a short report. Journal of Manipulative and Physiological Therapeutics ; 25 (3): E2
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Wellness and Quality of Life
People under long term and asymptomatic chiropractic care have been shown to enjoy greater overall health and quality of life.
Blanks R., Schuster TL. (1997) A retrospective assessment of network care using a survey of self-rated health, wellness and quality of life. Journal of Vertebral Subluxation Research 1 (4): 1
Blanks R., Dobson M. (1999) A study regarding measures of general health status in patients using the Bio Energetic Synchronization Technique: a follow-up study. Journal of Vertebral Subluxation Research 3 (2): 1-8.
Coulter I., Hurwitz E., Aronow H. (1996) Chiropractic Patients in a Comprehensive Home-based Geriatric Assessment, Follow-up and Health Promotion Program. Journal of topical Clinical Chiropractic : (3:2) pg 46-55
Marino MJ and Langrell, PM. (1999) A longitudinal assessment of chiropractic care using a survey of self-rated health wellness & quality of life: a preliminary study. Journal of Vertebral Subluxation Research 3 (2): 1-9
Morter T, Schuster T. (1998) Changes in salivary pH and General Health Status following the clinical application of bio-energetic synchronization. Journal of Vertebral Subluxation Research 2 (1): 1-7
Owens EF., Hoiriis KT., Burd D. (1998) Changes in general health status during upper cervical chiropractic care: PBR report. Chiropractic Research Journal (Spring); V (1)
For various links and resources including searchable chiropractic research databases click here.