Chiropractic

• There are more than 70,000 chiropractors in the United States who are required to pass a series of four national board exams¹  and be state licensed.² Roughly another 3,000 chiropractors work in academic and management roles. 
• There are approximately 10,000 chiropractic students³  in 18 nationally accredited, chiropractic doctoral graduate education programs⁴ across the United States with 2,500 chiropractors entering the workforce every year.⁵ 
• An estimated 40,000 chiropractic assistants (CAs)⁶  are in clinical⁷  and business management roles for chiropractic practices across the United States.
• It is estimated that chiropractors treat more than 35 million Americans (adults and children) annually.⁸  
• Chiropractors are educated in nationally accredited, four-year doctoral graduate school programs⁹  through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship,¹⁰  with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.¹¹ 
• Chiropractors are designated as physician-level providers in the vast majority of states and federal Medicare program. The essential services provided by chiropractors are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs and Defense, Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs.¹² 

A First Line of Defense Against Pain

The essential services provided by chiropractors represent a primary approach for the prevention, diagnosis and conservative management of back pain and spinal disorders that can often enable patients to reduce or avoid the need for riskier treatments, such as prescription opioid pain medications and surgery.

• In 2017, the American College of Physicians released an update to its low back pain treatment guideline that recommends first using non-drug treatments, such as spinal manipulation (a centerpiece of chiropractic care), for acute and chronic low back pain.¹³
• A systematic review/meta-analysis published in the Journal of the American Medical Association in 2017 supports the use of spinal manipulative therapy as a first-line treatment for acute low back pain.¹⁴

Patient Satisfaction/Clinical Effectiveness

• Three in four people who saw a chiropractor in the last year (77%) described chiropractic care as “very effective.”¹⁵
• In a consumer survey, chiropractic outperformed all other back pain treatments, including prescription medication, deep-tissue massage, yoga, pilates, and over-the-counter medication therapies.¹⁶
• Chiropractors are the highest-rated healthcare practitioner for low-back pain treatments above physical therapists (PTs), specialist physician/MD (i.e., neurosurgeons, neurologists, orthopaedic surgeons), and primary care physician/MD (i.e., family or internal medicine).¹⁷  
• Chiropractors’ collaborative, whole person-centered approach reflects the changing realities of health care delivery and fits well into Accountable Care Organization (ACO) and patient-centered, medical home (PCMH) models bringing greater clinical efficiency, patient satisfaction and cost savings.¹⁸

• In 2015, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches by adding chiropractic to its pain management standard.¹⁹

• A clinical comparative trial conducted at three military medical centers found that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone.²⁰
• In another comparative-effectiveness trial, 94% of manual-thrust manipulation (chiropractic) recipients experienced a 30% reduction in their pain, compared with only 54% of medical care recipients.²¹

References

[1]  National Board of Chiropractic Examiners (NBCE) www.NBCE.org. Accessed November 2018.

[2]  Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org Accessed November 2018.

[3]  Association of Chiropractic Colleges, www.chirocolleges.org, Accessed November 2018.

[4]  Council on Chiropractic Education (CCE) www.cce-usa.org is the agency certified by the U.S. Department of Education to accredit doctoral graduate school programs that offer the Doctor of Chiropractic (D.C.) degree; Accessed November 2018.

[5]  Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.

[6]  American Chiropractic Association (ACA) www.ACAtoday.org and Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org 2013.

[7]  Certified Chiropractic Clinical Assistant (CCCA) program.  Federation of Chiropractic Licensing Boards (FCLB), 2013.

[8]  “One in Four Americans Sought Care for Neck and Back Pain Last Year,” Gallup.com, accessed November 2018: http://www.gallup.com/poll/194984/one-four-adults-sought-care-neck-back-pain-last-year.aspx?g_source=Well-Being&g_medium=newsfeed&g_campaign=tiles

[9]  Council on Chiropractic Education (CCE) www.cce-usa.org 2013.

[10] Meeker, DC, MPH; Scott Haldeman, DC, PhD, MD; Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. 2002; 136(3): 216-227. http://annals.org/article.aspx?articleid=474085

[11] Coulter, Adams, Coggan, Wilkes, Gonyea. A Comparative Study of Chiropractic and Medical Education. Alternative Therapy Health Medicine. 1998; 4:64-75.

[12] American Chiropractic Association (ACA), 2013. https://www.acatoday.org/pdf/physicianstatus.pdf

[13] Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & for the Clinical Guidelines Committee of the American College of Physicians. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 166(7), 514. https://doi.org/10.7326/M16-2367 

[14] Paige, N. M., Miake-Lye, I. M., Booth, M. S., Beroes, J. M., Mardian, A. S., Dougherty, P., … Shekelle, P. G. (2017). Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA, 317(14), 1451–1460.https://doi.org/10.1001/jama.2017.3086

[15]  “One in Four Americans Sought Care for Neck and Back Pain Last Year,” Gallup.com, accessed November 2018: http://www.gallup.com/poll/194984/one-four-adults-sought-care-neck-back-pain-last-year.aspx?g_source=Well-Being&g_medium=newsfeed&g_campaign=tiles

[16] Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.

[17] Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013.

    [18] Accountable Care Organizations Optimize Outcomes, Cost Savings and Patient Satisfaction with Chiropractic Care. Foundation for Chiropractic Progress. May 2013.

[19] Clarification of the Pain Management Standard. Joint Commission. https://www.jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf

[20] Goertz CM et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 2018;1(1):e180105.

[21] Schneider M et. al. Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain. Spine 2015; 40(4):209-217.