What Can Chiropractic Treat?

When it comes to health science research, there are two main types:

Applied Research:

Research that explores whether an intervention is safe or effective for patients. These studies usually use a large group of people as test subjects, testing whether an intervention is able to solve a current problem.

Not all studies are created equal due to test group size, sources of bias and study design. Meta-analysis studies and systematic reviews are the most trusted form of applied research, followed by randomised controlled trials.

Basic Research:

Studies that investigate the fundamental science of what is going on. They are often performed in a laboratory by scientists with the goal to answer questions about the core underlying structures and functions.

Chiropractic basic research is usually performed on a small number of people, looking into very specific changes to the body in a highly controlled setting. This inevitably makes the results less applicable to real-world scenarios.

Research into Chiropractic (i.e. spinal manipulation) has found that the treatment can influence numerous aspects of the body.
Below is a list of findings from research investigating the positive effects of spinal manipulation:

Applied Research:

Meta-Analysis & Systematic Review Findings

•  Treatment for acute [1] [2] , sub-acute [2] and chronic [3] [4] lower back pain.

•  Treatment for neck pain. [5]

•  Treatment for cervicogenic headaches and dizziness [6], tension-type headaches [7] and migraines. [8]

•  Treatment for sciatica. [9]

These findings come from research with high strength study designs and are applicable to real-world scenarios

Applied Research:

Randomised Control Trial Findings

•  Back pain prevention. [10]

•  Sacroiliac joint dysfunction. [11]

•  Pain related to a lumbar disc injury. [12]

These findings come from research with moderate strength study designs but are applicable to real-world scenarios

Basic Research:

  • Changed brain function in the pre-frontal cortex. [13]
  • Altered and enhanced muscle function in the general population. [14]
  • Decreased reaction times. [15]
  • Increased muscle strength in the upper and lower limbs. [16]
  • Prevention of muscle fatigue from developing in certain areas. [17]
  • Increased muscle strength and cortical drive in stroke patients who had muscle weakness. [18]
  • Increased neck range of motion. [19]
  • Reduced joint position sense error. [20]
  • Improved feed-forward activation of core stabilising muscles. [21]
  • Improved sensorimotor function related to falls risk of community dwelling older adults. [22]
  • Improved or altered visual acuity and visual field size. [23]
  • Altered spinal cord reflex excitability. [24]
  • Reduced pain thresholds for those suffering from lateral epicondylalgia. [25]
  • Changes in the way the brain processes sensory and motor information. [26]
  • Improved spinal function. [27]

These findings come from research with high strength study designs but are less applicable to real-world scenarios

The basic research shows that Chiropractic can help with specific aspects of nervous system function, mostly related to the musculoskeletal system. We recommend being wary of Chiropractors who use the results of basic research as evidence that Chiropractic can help all aspects of nervous system function.

References

  1. Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low‐back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008880. DOI: 10.1002/14651858.CD008880.pub2.
  2. Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low‐back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD005427. DOI: 10.1002/14651858.CD005427.pub2.
  3. Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low‐back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008112. DOI: 10.1002/14651858.CD008112.pub2.
  4. Rubinstein Sidney M, de Zoete Annemarie, van Middelkoop Marienke, Assendelft Willem J J, de Boer Michiel R, van Tulder Maurits W et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials BMJ 2019; 364 :l689
  5. Rubinstein  SM, Terwee  CB, Assendelft  WJJ, de Boer  MR, van Tulder  MW. Spinal manipulative therapy for acute low‐back pain. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008880. DOI: 10.1002/14651858.CD008880.pub2.
  6. G. Bronfort, M. Haas, R. Evans, B. Leininger, and J. Triano, “Effectiveness of manual therapies: the UK evidence report,” Chiropractic and Osteopathy, vol. 18, article 3, 2010.
  7. Lozano López C, Mesa Jiménez J, de la Hoz Aizpurúa JL, Pareja Grande J, Fernández de las Peñas C. Eficacia de la terapia manual en el tratamiento de la cefalea tensional. Una revisión sistemática desde el año 2000 hasta el 2013. Neurología. 2016;31:357–369
  8. Rist, P. M., Hernandez, A. , Bernstein, C. , Kowalski, M. , Osypiuk, K. , Vining, R. , Long, C. R., Goertz, C. , Song, R. and Wayne, P. M. (2019), The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis. Headache: The Journal of Head and Face Pain, 59: 532-542. doi:10.1111/head.13501
  9. Lewis, R, Williams, Nefyn H, Sutton, A., Burton, A. Kim, Din, N, Matar, HE, Hendry, M, Phillips, CJ, Nafees, S, Fitzsimmons, D, Rickard, I and Wilkinson, Clare (2015) Comparative Clinical Effectiveness of Management Strategies for Sciatica: Systematic Review and Network Meta-Analyses. The Spine Journal, 15 (6). pp. 1461-1477. ISSN 15299430
  10. Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, et al. (2018) The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLOS ONE 13(9): e0203029.
  11. Kamali F., Zamanlou M., Ghanbari A., Alipour A., Bervis S.(2019)Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial, Journal of Bodywork and Movement Therapies, 23 (1) , pp. 177-182.
  12. Santilli V., Beghi E., Finucci S. (2006).Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: A randomized double-blind clinical trial of active and simulated spinal manipulations. Spine Journal,  6  (2) , pp. 131-137.
  13. Dina Lelic, Imran Khan Niazi, Kelly Holt, et al., “Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study,” Neural Plasticity, vol. 2016, Article ID 3704964, 9 pages, 2016
  14. Taylor H.H., Murphy B. (2008). Altered Sensorimotor Integration With Cervical Spine Manipulation. Journal of Manipulative and Physiological Therapeutics, 31 (2) , pp. 115-126.
  15. Kelly DD, Murphy BA, Backhouse DP. Use of a mental rotation reaction-time paradigm to measure the effects of upper cervical adjustments on cortical processing: a pilot study. Journal of Manipulative and Physiological Therapeutics. 2000;23:246–51.
  16. Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci. 2016;7(1):2. Published 2016 Dec 23. doi:10.3390/brainsci7010002
  17. Niazi, Imran & Türker, Kemal & Flavel, Stanley & Kinget, Matt & Duehr, Jens & Haavik, Heidi. (2013). Increased cortical drive and altered net excitability of low-threshold motor unit levels to the lower limb following spinal manipulation. Paper presented at: World Federation of Chiropractic’s 12th Biennial Congress April 6-9, 2013; Durban, South Africa.
  18. Holt, K., Niazi, I. K., Nedergaard, R. W., Duehr, J., Amjad, I., Shafique, M., … Haavik, H. (2019). The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients. Scientific reports, 9(1), 2673. doi:10.1038/s41598-019-39577-5
  19. Anderst W, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M. (2018). Intervertebral kinematics in the cervical spine before, during and after high-velocity low-amplitude manipulation. The Spine Journal, Volume 18, Issue 12, 2333 – 2342
  20. Haavik, H and Murphy, B. Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of Manipulative and Physiological Therapeutics. 2011; 34: 88–97
  21. Marshall P., Murphy B. (2006). The Effect of Sacroiliac Joint Manipulation on Feed-Forward Activation Times of the Deep Abdominal Musculature. Journal of Manipulative and Physiological Therapeutics, 29 (3) , pp. 196-202.
  22. Holt K.R., Haavik H., Lee A.C.L., Murphy B., Elley C.R. (2016). Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated with Falls Risk in Older People: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 39 (4) , pp. 267-278.
  23. Wingfield B.R., Gorman R.Frank. (2000). Treatment of severe glaucomatous visual field deficit by chiropractic spinal manipulative therapy: A prospective case study and discussion. Journal of Manipulative and Physiological Therapeutics, 23 (6) , pp. 428-434.
  24. Murphy, B.A., Dawson, N.J., & Slack, J.R. (1995). Sacroiliac joint manipulation decreases the H-reflex. Electromyography and Clinical Neurophysiology, 35 2, 87-94 .
  25. Fernandez-Carnero J., Cleland J.A., Arbizu R.L.T. (2011). Examination of motor and hypoalgesic effects of cervical vs thoracic spine manipulation in patients with lateral epicondylalgia: A clinical trial. Journal of Manipulative and Physiological Therapeutics, 34 (7) , pp. 432-440.
  26. Taylor H.H., Murphy B. (2010). Altered Central Integration of Dual Somatosensory Input After Cervical Spine Manipulation Journal of Manipulative and Physiological Therapeutics,  33  (3) , pp. 178-188.
  27. Martinez-Segura R., Fernandez-de-las-Penas C., Ruiz-Saez M., Lopez-Jimenez C., Rodriguez-Blanco C. (2006). Immediate Effects on Neck Pain and Active Range of Motion After a Single Cervical High-Velocity Low-Amplitude Manipulation in Subjects Presenting with Mechanical Neck Pain: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 29 (7) , pp. 511-517.