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Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey

Abstract (provisional)


Background

Clinical practice guidelines on the management of neck pain make recommendations to help practitioners optimize patient care. By examining the practice patterns of practitioners, adherence to CPGs or lack thereof, is demonstrated. Understanding utilization of various treatments by practitioners and comparing these patterns to that of recommended guidelines is important to identify gaps for knowledge translation and improve treatment regimens. Aim To describe the utilization of interventions in patients with neck pain by clinicians.

Methods

A cross-sectional international survey was conducted from February 2012 to March 2013 to determine physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain.

Results

The survey was international (19 countries) with Canada having the largest response (38%). Results were analyzed by usage amongst physical therapists (38%) and chiropractors (31%) as they were the predominant respondents. Within these professions, respondents were male (41-66%) working in private practice (69-95%). Exercise and manual therapies were consistently (98-99%) used by both professions but tests of subgroup differences determined that physical therapists used exercise, orthoses and `other? interventions more, while chiropractors used phototherapeutics more. However, phototherapeutics (65%), Orthoses/supportive devices (57%), mechanical traction (55%) and sonic therapies (54%) were not used by the majority of respondents. Thermal applications (73%) and acupuncture (46%) were the modalities used most commonly. Analysis of differences across the subtypes of neck pain indicated that respondents utilize treatments more often for chronic neck pain and whiplash conditions, followed by radiculopathy, acute neck pain and whiplash conditions, and facet joint dysfunction by diagnostic block. The higher rates of usage of some interventions were consistent with supporting evidence (e.g. manual therapy). However, there was moderate usage of a number of interventions that have limited support or conflicting evidence (e.g. ergonomics).

Conclusions

This survey indicates that exercise and manual therapy are core treatments provided by chiropractors and physical therapists. Future research should address gaps in evidence associated with variable practice patterns and knowledge translation to reduce usage of some interventions that have been shown to be ineffective.

 

Source

The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain

Abstract


Background

Several tests have been suggested to assess the isometric endurance of the cervical flexor (NFME) and extensors (NEE) muscles. This study proposes to determine whether neck flexors endurance is related to extensor endurance, and whether cervical muscle endurance is related to disability, pain amount and pain stage in subjects with neck pain.

Methods

Thirty subjects (18 women, 12 men, mean ± SD age: 43 ± 12 years) complaining of neck pain filled out the Visual Analogue Scale (VAS) and the Neck Pain and Disability Scale-Italian version (NPDS-I). They also completed the timed endurance tests for the cervical muscles.

Results

The mean endurance was 246.7 ± 150 seconds for the NEE test, and 44.9 ± 25.3 seconds for the NMFE test. A significant correlation was found between the results of these two tests (r = 0.52, p = 0.003). A positive relationship was also found between VAS and NPDS-I (r = 0.549, p = 0.002). The endurance rates were similar for acute/subacute and chronic subjects, whereas males demonstrated significantly higher values compared to females in NFME test.

Conclusions

These findings suggest that neck flexors and extensors endurance are correlated and that the cervical endurance is not significantly altered by the duration of symptoms in subjects with neck pain.

 

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VBA Stroke: Resources for Doctors of Chiropractic

There is growing interest in the association between cervical manipulation and vertebrobasilar artery (VBA) stroke. Unfortunately, opinion rather than fact has often dominated discussions on this topic, even though there has been no definitive evidence that cervical adjustments can cause a stroke. ACA is sensitive to the public‘s concerns surrounding this complex issue, and is offering the following resources to help state associations and doctors of chiropractic disseminate accurate information about the risks of serious injury following cervical manipulation.

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ACA Honors Exceptional Service with 2014 Annual Awards

 

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American Chiropractic Association Adopts Summit's "Drug-Free Approach" to Health Care

Washington, D.C.--The American Chiropractic Association's (ACA) House of Delegates (HOD) today adopted language describing the profession's approach to health care and the use of drugs by chiropractic physicians during it's annual meeting Feb. 28- March 1 in Washington, D.C.

The statement was originally written and approved by the Chiropractic Summit, an umbrella leadership group of more than 40 prominent chiropractic organizations, during a meeting in Seattle in November.

The statement reads, in part--
Summit Promotes Drug-Free Approach:

"The drug issue is a non-issue because no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care."
As you can imagine, this statement was crafted very carefully and after long discussions by all participants of the Summit, which includes organizations and individuals from all corners of the profession and with widely varying viewpoints. When the group first approached the task, it realized that the profession could not legitimately use the word "drugless" to describe itself. Surprised? It makes sense when you consider the FDA classifies the use of certain vitamins and supplements to treat a condition a form of drug use. With so many doctors of chiropractic using nutritional therapy to help their patients, it was obvious to even the most conservative among us that "drug-free approach" more accurately describes what we all do.

Granted, there are wide variations in the scope of practice for chiropractic based on the state in which DCs practice. Some states are quite expansive in what they allow doctors of chiropractic to do; others are rather restrictive. The Summit's role is not to define scope (that is the function of the states themselves), so any statement on chiropractic practice drafted-to be accurate-needed to keep into account those who may have more tools in their toolbox.

Nevertheless, the approach that all doctors of chiropractic take, regardless of their available tools for patient care, is first and foremost drug-free. This is what unites us; we as a profession can be proud that the organizations representing the Chiropractic Summit came together and unanimously agreed on this very positive and powerful statement.

"ACA is proud to adopt the Chiropractic Summit's statement, which succinctly describes the intention behind our profession's conservative approach to health care," said ACA President Keith Overland, DC.

The HOD met in conjunction with the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium. Be sure to visit ACA's Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

 

Hundreds of Chiropractic Supporters Advocate for Patients, Expanded Access at NCLC 2014

Washington, D.C.—Hundreds of chiropractic physicians, students and supporters joined the American Chiropractic Association (ACA) in Washington, D.C. today to visit with lawmakers on Capitol Hill as part of the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium.

Doctors from all walks of the profession came to Washington to tell their stories and advocate on behalf of the patients they serve. Attendees urged lawmakers to support bills that would benefit patients, expand access to chiropractic services for veterans and active-duty military personnel, and help chiropractic graduates qualify for federal programs that would enable them to practice in underserved areas in exchange for student loan debt relief.

Keynote speaker, Sen. Jerry Moran (R-Kan.)—a member of the Senate Appropriations Committee, the Banking, Housing and Urban Affairs Committee, and the Veterans’ Affairs Committee—discussed how his commitment to improving the health and quality of life of our nation’s veterans ties into his support for chiropractic.

“When we advocate for chiropractic, we are really advocating for patients, including veterans,” said Sen. Moran. “We must honor our commitment to provide for the military, including providing for their health care. Chiropractic is a way to provide for veterans and their communities.”

NCLC Plenary Speaker, Fabrizio Mancini, DC, an internationally acclaimed educator, philanthropist and president emeritus of Parker University, shared his experiences promoting whole-person wellness, and how that focus will be essential in the formed health care landscape.

“Just because our health care system has a hard time fitting us in its box doesn’t mean we can’t serve that system,” said Dr. Mancini. “Chiropractic has what the new health care system is looking for. We get more results than most, we just have to share them with the public.”

Attendees also heard from the prime sponsor of the Chiropractic Care Available to All Veterans Act, Sen. Richard Blumenthal (D-Conn.), who was part of a bipartisan coalition of senators responsible for including major portions of the bill in larger legislation that was recently sent to the full Senate for consideration; Rep. Bill Enyart (D-Ill.), a cosponsor of the Chiropractic Health Parity for Military Beneficiaries Act designed to further integrate the services provided by doctors of chiropractic in the U.S. Department of Defense (DoD) health delivery system; and Rep. Cory Gardner (R-Colo.), a member of the influential House Energy and Commerce Committee.

ACA President Keith Overland, DC, in his opening address to attendees, focused on the importance of creating a level playing field for chiropractic physicians in order to improve the health and wellness of the American people and U.S. veterans. “Doctors of chiropractic offer safe approaches for helping veterans in pain, so your message to lawmakers is so important,” he said.

To complete the day, ACA will host a “Green-tie Gala” event to honor retiring Sen. Tom Harkin (D-Iowa), a long-time chiropractic champion on the Hill who is known for his penchant for wearing green ties.

Visit ACA’s website for video excerpts of the conference, and be sure to visit ACA’s Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

 

Source

ACA Legislative Alert Bulletin 2: Further Integrate the Services Provided by Doctors of Chiropractic in the Veterans Affairs Health System

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th. Please read carefully and take the specific action requested below.

BACKGROUND: The Department of Veterans Affairs (DVA) health care system continues to discriminate against doctors of chiropractic and America’s veterans who need and deserve the essential services DCs provide. We have long argued that the DVA needs to “fully integrate” doctors of chiropractic into their healthcare system, however, chiropractic services continue to remain unavailable in nearly half of the nation’s major DVA treatment facilities. This lack of care is not only unfair to America’s veterans, but sends a very damaging signal to the consumer public, private employers, and other hospitals and healthcare systems, that the DVA does not consider the services provided by doctors of chiropractic to be important or valued enough to be made routinely available to all consumers and patients in need of our care. Gaining “full inclusion” in the DVA would send a strong signal not only to our veterans, but to all insurers, employers, medical doctors and hospitals on a nationwide basis.

There is legislation currently pending in the U.S. House of Representatives that would greatly expand our profession’s presence within the DVA health care system, HR 921, the Chiropractic Care Available to All Veterans Act. We urgently need to gain additional cosponsors and support for this bill. We simply need to generate a strong grassroots response on HR 921, in order to increase the likelihood that the legislation will be enacted into law this year.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.

 

ACA Legislative Alert Bulletin 1: Important Medicare Payment Issue

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th.

This is the first in a series of three Legislative Alert Bulletins that requires your immediate grassroots response. Please read carefully and take the specific action requested below.

BACKGROUND: In the near future all Part B Medicare providers, including doctors of chiropractic, will face draconian reductions (over 27%) in their Medicare payment rates unless Congress takes legislative action to “fix” a flaw in the Sustainable Growth Rate (SGR) payment formula that exists under current law.

Specifically, Congress needs to enact new legislation to prevent the imposition of these prior to March 31 of this year. As a “solution” to this problem, the American Chiropractic Association favors the enactment of legislation, which would provide a long-term “fix” to the SGR problem. While the legislation currently under consideration does not address all problems and limitations that DCs have with the Medicare program, it does include a new Merit-Based Incentive Payment System (MIPS) and DCs are specifically made eligible to qualify for this component.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond to this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.

 

NBCE begins practice analysis survey

The National Board of Chiropractic Examiners (NBCE) has just begun mailing surveys to more than 10,000 randomly selected chiropractic practitioners throughout the United States. The survey procedures have been reviewed and approved by the Institutional Review Board of Palmer College of Chiropractic. Results from the survey will be used to produce the Practice Analysis of Chiropractic 2015. This reference volume is the fifth edition of a document that was first published in 1993 and called the Job Analysis of Chiropractic.

The Practice Analysis is the only publication of its kind to focus on the role of a typical full-time doctor of chiropractic, presenting reliable statistics about demographics and practice patterns, as well as a review of recent research about chiropractic. Results of the completed project will be shared with educators, insurance companies, legislators, libraries, state licensing boards and others who need a reference concerning the profession.

Within the NBCE, the Practice Analysis is the foundation of the Part III and Part IV clinical and practical skills assessments administered by the NBCE. Its use ensures that the content of these examinations directly pertains to the practice of chiropractic. In short, the new edition will benefit every aspect of the profession, including the general public.

The accuracy of the Practice Analysis is largely dependent upon the response of a large number of practitioners. It is critical that those who receive the survey complete and return it as quickly as possible, either by mail or online. The submitted data will be compiled and analyzed, with the results being added to the chapters that are already in progress.


Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

 

Recent Important Victories for the Chiropractic Profession

 

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Federal Panel Recommends Full, Three-Year Federal Recognition for CCE

 

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Chiropractic Physicians Appointed to New AMA Quality, Safety Committees

 

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National Chiropractic Health Month: Discover Chiropractic ... Get Vertical

 

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ACA and NYCC Interview Opportunities

 

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ACA Represents Chiropractic at Nation’s Largest Gathering of State Legislators

Participation Educates Lawmakers on Value of Including Profession in State-level Health Reform Efforts

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Hey Desk Jockeys: Get Vertical!

American Chiropractic Association Launches 2013 Public Health Awareness Campaign

Arlington, Va.—During National Chiropractic Health Month this fall, the American Chiropractic Association (ACA) and chiropractic physicians nationwide will promote the importance of joint health and the vital role physical activity plays in keeping joints healthy and pain free. This year’s theme—“Get Vertical”—focuses on getting off the couch or out of the office chair, and standing or moving more each day.

Most people nowadays know someone with joint pain, and joint replacement surgery—particularly involving hips and knees—is commonplace. What many do not know is that simple lifestyle changes can in some cases help prevent the need for this type of surgery and keep joints healthier longer.

“Remaining physically active and pain-free is an important measure of the quality of someone’s life, and chiropractic physicians can help by providing exercise and lifestyle recommendations, nutritional advice, and natural approaches to managing aches and pains,” said ACA President Keith Overland, DC. “Just a few healthy lifestyle changes, over time, can potentially mean the difference between being scheduled for joint replacement surgery or remaining active and pain-free well into one’s golden years.”

In honor of National Chiropractic Health Month, ACA offers these tips to help you get vertical and stay pain-free:
  • Stand up: Office dwellers can look into using standing desks or treadmill desks; but if you’re stuck sitting all day, you can still stretch your legs with a short walk about every 20 to 30 minutes.  
  • Take micro-breaks: Frequently stretch your neck, arms and wrists, back, and legs. Simple stretches include neck rotations, fist clenches, arm dangles, and shoulder shrugs.  
  • Get moving: You don’t have to work out like a pro-athlete, just aim for a minimum of 20 to 30 minutes of exercise three to five days a week.  
  • Eat right: A healthy diet—rich in fruits, vegetables and healthy fats—can help reduce inflammation and joint pain. Also limit red meat, refined sugar and white flour. Just a few simple changes can help maintain a healthy weight and have a positive impact on your overall health.
For more tips on healthy, pain-free living, visit www.ChiroHealthy.com.

Sponsored by ACA, National Chiropractic Health Month is a nationwide observance held each October. The event helps raise public awareness of the benefits of chiropractic care and its natural, whole-person, patient-centered approach to health and wellness.  

The American Chiropractic Association (ACA), celebrating its 50th anniversary in 2013, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and professional ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org.

 

VA Prepares to Move Forward with Chiropractic Residency Program

Historic Program Reflects VA’s Dedication to U.S. Veterans, Exciting Opportunities for Integrated Training

Arlington, Va.—The American Chiropractic Association (ACA) today announced that the U.S. Department of Veterans Affairs (VA) has released a request for proposals to establish a chiropractic residency program at VA medical facilities. The program will support up to six residencies for chiropractic physicians at VA medical centers around the country and expand partnerships between VA centers and local chiropractic schools.

VA medical facilities with existing chiropractic clinical programs are eligible to apply for this program. In the months ahead, VA will review proposals and select three to five facilities to participate for three years, beginning in 2014-2015. The application process for individual chiropractic residents will be announced after the participating facilities are identified, likely in early 2014. ACA will keep the chiropractic profession abreast of all program details as they become available.

“I am impressed and grateful that the VA has made a significant enhancement in providing top-notch care to veterans by strengthening its ties to the chiropractic profession. The services provided by doctors of chiropractic can play an important role in improving the health of America’s heroes,” said ACA President Keith Overland, DC. “The program will also offer the highest quality, integrated training for chiropractic physicians.”

All veterans are eligible to receive chiropractic services, and nearly 50 major VA treatment facilities around the United States have on-site chiropractic clinics. This is significant when considering that a 2013 report from the Veterans Health Administration indicated that more than half of all veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report.

In addition to clinical care, VA conducts the nation’s largest education and training program for health professional students and residents, with the goal of educating future health care providers to serve veterans and the US at large. The chiropractic residency program marks the next step in the evolution of the profession’s academic efforts with VA, and will lead to high-quality innovative training that will benefit future patients.

The American Chiropractic Association (ACA), celebrating its 50th anniversary in 2013, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and professional ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org.  

 

Plan to Expand Chiropractic Services to More VA Medical Facilities Clears Senate Committee

Pro-Chiropractic Provisions Included in Legislation Supporting Veterans’ Transition Home

Arlington, Va.—The American Chiropractic Association (ACA) applauds the U.S. Senate Veterans Affairs Committee for including provisions of the Chiropractic Care Available to All Veterans Act (S.422), a bill that would improve veteran health care by expanding the availability of chiropractic services to more VA medical centers, in omnibus veterans’ legislation.

The omnibus bill, the Veterans’ Educational Transition Act of 2013 (S. 944), is designed to assist veterans’ transition to normal life after their service is complete. It was approved by the committee on July 24 and will now go to the Senate floor for a final vote. Details of the chiropractic provisions included in the bill will be available when the committee issues its report in upcoming weeks.

Introduced by Sens. Richard Blumenthal (D-Conn.) and Jerry Moran (R-Kan.), S. 422 aims to increase patient access to the services provided by chiropractic physicians, which are currently available at less than a third of the 160 VA medical centers nationwide.

Further, repeated reports from the Veterans Health Administration indicate that more than half of all veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for these reports. In a statement released after the chiropractic provisions cleared the committee vote, Sens. Blumenthal and Moran noted that veterans suffering from these types of conditions can be successfully and cost-effectively treated by doctors of chiropractic.

“Those who have made sacrifices for our country—especially veterans, active-duty military and their family members—deserve access to the best health care available, which includes the services provided by doctors of chiropractic,” said ACA President Keith Overland, DC. “The Chiropractic Care Available to All Veterans Act is a step in the right direction, and we give special thanks to Sens. Blumenthal and Moran for championing it.”

Prior to collaborative efforts between the chiropractic profession, its congressional allies and VA, eligible veterans were referred to doctors of chiropractic serving in private practice outside the VA health care system.

"When we work together we can accomplish so much,” said R. Jerry DeGrado, DC, chair of the Chiropractic Summit Government Relations Committee. “This is a great success not only for our profession and the patients we serve, but also for our heroes who deserve care for all they have sacrificed."

A companion bill in the U.S. House of Representatives, H.R. 921, was introduced by Rep. Mike Michaud (D-Maine), a ranking member of the House Committee on Veterans Affairs.

Chiropractic physicians, chiropractic students and chiropractic supporters can contact their congressional representatives and urge them to cosponsor H.R. 921 to ensure the initiative passes this Congress.    

The American Chiropractic Association (ACA), celebrating its 50th anniversary in 2013, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and professional ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org



















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BREAKING NEWS: MD-DC Partnership Bill Has Passed the NY Senate!

The New York State Chiropractic Association is pleased to report to you today that the NY MD-DC Partnership Bill (S1940/A5956) has passed the Senate!  This is certainly a welcome and exciting development.  

It is time now, more than ever, to make a concerted effort to reach out to Assemblypersons by sending letters of support of this bill.  This is an important piece of legislation which would amend the limited liability company law, the business corporation law, the partnership law, and the public health law to allow doctors of chiropractic to form LLCs and partnerships with medical doctors.

We earnestly request that you visit NYSCA.com to view and download the sample letters to legislators. Please personalize these letters to make them specific and unique to your office.


We thank you for your continued efforts and support in furthering the interests of Chiropractic in New York.

 

JAMA Suggests Chiropractic for Low Back Pain

Chiropractic Physicians Provide Natural Alternatives for Pain Treatment, Injury Prevention

Arlington,Va.
--An article in the Journal of the American Medical Association (JAMA) suggests patients try chiropractic services for the treatment of low back pain. According to the article, surgery is not usually needed and should only be considered if more conservative therapies fail. The information in JAMA reinforces the American Chiropractic Association's (ACA) position that conservative care options should serve as a first line of defense against pain.

The article, part of JAMA's Patient Page public education series, explains that the back is made up of bones, nerves, muscles and other soft tissues such as ligaments and tendons that support posture and give the body flexibility. Back pain can be caused by problems with any of the structures in the back.

As neuromusculoskeletal experts, chiropractic physicians are particularly well suited to manage and help prevent low back pain.

"We are encouraged to see JAMA suggest patients try chiropractic and other more conservative types of treatment for their back pain. In many cases pain can be alleviated without the use of unnecessary drugs or surgery, so it makes sense to exhaust conservative options first," said ACA President Keith Overland, DC.

"Research confirms that the services provided by chiropractic physicians are not only clinically effective but also cost-effective, so taking a more conservative approach at the onset of low back pain can also potentially save both patients and the health care system money down the line," he added.

For those who are currently pain-free, the exercise tips, posture recommendations and guidance on injury prevention routinely provided by chiropractic physicians can help people maintain a healthy back throughout their lives. To learn more, visit www.acatoday.org/backpain.

The American Chiropractic Association (ACA), celebrating its 50th anniversary in 2013, is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and professional ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit www.acatoday.org.