IN BRIEF, WHAT
Chiropractic is the second largest
primary health care profession in the United States
today. The following is the American Chiropractic
Association's official definition of chiropractic:
"Chiropractic is based on the
premise the relationship between structure and function
in the human body is a significant health factor
and that such relationship between the spinal column
and nervous system is the most significant, since
the normal transmission and the expression of nerve
energy are essential to the restoration and maintenance
of good health.
"Chiropractic is that science
and art which utilized the inherent recuperative
powers of the body and the relationship between
the musculoskeletal structures and the functions
of the body, particularly of the spinal column and
the nervous system, in the restoration and maintenance
Chiropractic is one of the three
major schools of health, the other two being allopathy
(traditional medicine) and osteopathy. Chiropractic
is based on the understanding that good health depends,
in part, on a normally functioning nervous system.
Body structures such as cells and organs function
by the impulses carried through nerves. When these
nerve impulses travel uninterrupted, the organs
and cells are able to function normally. When there
is interference, the tissues and organs cannot function
properly and a state of malfunction may begin, predisposing
the body to a disease state and less than optimum
WHAT DO CHIROPRACTORS DO?
The American Chiropractic Associations
description of the scope of chiropractic practice
is "The practices and procedures which may
be employed by doctors of chiropractic are based
on the academic and clinical training achieved in
and through, but not limited to, the use of diagnostics
and therapeutics, specifically including the adjustment
and manipulation of the articulations and adjacent
tissues of the human body, particularly of the spinal
column; included is the treatment of intersegmental
disorders for alleviation of related neurological
"Patient care is conducted
with due regard for environmental, nutritional and
psychotherapeutic factors, as well as first aid,
hygiene, sanitation, rehabilitation and physiological
therapeutic procedures designed to assist in the
restoration and maintenance of neurological integrity
and homeostatic balance."
The adjustment, which is the correction
of the misaligned vertebrae, is usually done by
hand. It consists of placing the patient on a specially
designed adjusting table and applying pressure,
using specialized techniques, to the areas of the
spine that are out of proper alignment or that do
not move properly within their normal range of motion.
What is an Adjustment
Adjustment / Manipulation is treatment
using the doctor's hands to apply body leverage
and a physical thrust to one joint or a group of
related joints to restore joint and related tissue
function. Through the use of manipulation, the doctor
seeks to provide relief from symptoms, improve joint
and muscle function, and speed recovery. Spinal
manipulation is the most common form of manipulation.
Manipulation should not be confused with other forms
of manual therapy such as mobilization and massage.
Spinal Adjustment / Manipulation Effective?
Yes! As more of the benefits and
safety of spinal manipulation are made public, it
is becoming more universally recognized as a safe
and effective choice for the care of back problems.
The most recent evidence of spinal
manipulation's effectiveness comes from a landmark
study conducted by the Agency for Health Care Policy
and Research, a federal government research organization.
In this study, a panel of health care experts analyzed
the scientific evidence available on all methods
of examination and treatment used for acute adult
low back problems and formed conclusions regarding
their appropriateness and effectiveness. Among their
most significant conclusions, they confirmed that
spinal manipulation is a safe and effective initial
form of treatment for this problem. This panel also
strongly recommended that both doctors and patients
consider using the most conservative treatment approach
first for this common problem. Spinal manipulation
is a drugless, nonsurgical (conservative) approach
to the treatment of back pain and its related disorders.
Is Spinal Manipulation
Yes! When administered by a qualified
doctor who is well trained and experienced in the
use of spinal manipulation, it is one of the safest
drugless, nonsurgical procedures available.
Clinical surveys show that complications
from manipulation are rare. So low, in fact, that
doctors who perform manipulation have the lowest
malpractice insurance costs of all practicing doctors.
This means that when manipulation is performed by
a Doctor of Chiropractic, the potential risk of
complications from manipulation is at its lowest.
A word of caution. Spinal manipulation
is as much an art as it is a clinical science. It
should not be used by unskilled persons. As more
people become aware of manipulation's effectiveness,
unlicensed or untrained persons might believe they
too can use it safely and effectively. For your
own safety, when selecting a doctor to provide manipulation
for your back problem, be sure you choose a chiropractic
doctor who is well trained and experienced in this
form of care.
Doctors are Most Skilled at Manipulation?
Doctors of Chiropractic (DCs) are
the public's first choice of doctors for treatment
using manipulation. A summer, 1994 study by the
respected health care research organization Louis
Harris & Associates confirms this as a fact.
This nation-wide survey reveals that nearly one-half
of the general public and six in ten of those who
sought professional care for a back problem in the
recent past regard DCs as most skilled in the use
of spinal manipulation. And the majority of those
who visited other doctors for a back problem also
consider DCs more skilled in the use of manipulation
than their medical or osteopathic doctor.
The DC's clinical expertise is derived
from his/her training and the clinical experience
gained from spending over 85% of his/her daily practice
in the differential diagnosis of the patient's complaint
and the management of neuromusculoskeletal (NMS)
disorders. The DC's training and experience enable
him/her to identify those health problems that are
most likely to be responsive to chiropractic management
and to administer the appropriate treatment personally,
if Chiropractic is Not Covered in My Insurance Plan?
Ask your insurance plan administrator
to add full, direct access chiropractic services
coverage to your plan for both you and your dependents.
And be sure to specify that you want these chiropractic
services to be provided only by a Doctor of Chiropractic.
Federal Guidelines On Low Back Pain
On December 8, 1994, The Agency
for Health Care Policy and Research (AHCPR) of the
U.S. Department of Health and Human Services, released
an extensive study of diagnostic and treatment methods
for acute low back pain. This condition is the most
common health complaint experienced by working Americans
today, and a condition which costs the economy at
least $50 billion a year in lost wages and productivity.
The AHCPR panel -- a 23-member committee
of 11 medical doctors, nurses, experts in spine
research, physical therapists, a psychologist, an
occupational therapist, 2 chiropractic doctors and
a consumer representative -- concluded, among other
- spinal manipulation was the only
recommended treatment that relieved symptoms,
increased function and hastened recovery for acute
low back problems in adults;
- conservative treatments such
as spinal manipulation should be pursued -- in
most cases -- before surgical interventions are
- prescription drugs such as oral
steroids, antidepressant medications and colchicine
are not recommended for acute low back problems.
for the Effectiveness of Chiropractic
Research conducted throughout the
world shows that chiropractic treatment for lower
back pain is both safe and effective. The following
are excerpts from a few of the more recent studies:
Quality of Results
· "...for the management
of low-back pain, chiropractic care is the most
effective treatment, and it should be fully integrated
into the government's health care system."
The Manga Report, 1993.
Versus Alternative Treatments
· "Chiropractic treatment
was more effective than hospital outpatient management,
mainly for patients with chronic or severe back
British Medical Journal, 1990.
British Medical Research Council Study.
· "...spinal manipulation
applied by chiropractors is shown to be more effective
than alternative treatments for low-back pain."
The Manga Report, 1993.
· "...injured workers
... diagnosed with low-back pain returned to work
much sooner when treated by chiropractors than by
The Manga Report, 1993.
· "Two and three years
after patients with back pain were treated by chiropractors,
they experienced far less pain than those who were
treated by medical doctors."
British Medical Journal, 1990.
"Low Back Pain of Mechanical Origin: Randomized
Comparison of Chiropractic and Hospital Outpatient
· "...one of the unexpected
findings ...looks as though the treatment that the
chiropractors give does something that results in
a very long-term benefit."
T. W. Meade, M.D., CBC Radio.
HOW ARE CHIROPRACTORS LICENSED?
Most states, including New York,
have independent state chiropractic examining boards
responsible for issuing and renewing licenses to
practice. Doctors of chiropractic in New York must
first pass a clinical board examination, include
Parts I, II, III, Physiotherapy, and the Part IV
Practical. The National Board of Chiropractic Examiners
(NBCE) administers the comprehensive clinical competency
HOW DO YOU KNOW
WHEN TO USE A DOCTOR OF CHIROPRACTIC?
Doctors of chiropractic are primary
health care providers according to both Federal
and State regulations. This means chiropractors
can serve as portals of entry into the health care
delivery system. Under chiropractic care, a patient
is either treated or referred after a comprehensive
differential diagnosis is performed utilizing an
orthopedic and neurological examination, an X-ray
examination if necessary, as well as laboratory
procedures if deemed appropriate for the patient's
complaint. By consultation and examination, the
doctor of chiropractic will arrive at a prognosis
under chiropractic care or will refer the patient
to an appropriate health care professional specialist.
CAN MEDICAL DOCTORS
REFER TO CHIROPRACTORS?
The American Medical Association
permits medical physicians to refer patients to
doctors of chiropractic and to similarly accept
patient referrals from chiropractors. Many individual
physicians have had close professional relationships
with doctors of chiropractic for years. The chiropractic
profession continues to work towards strengthening
interprofessional referrals so that the people of
New York State will benefit from the best care offered
by both types of practitioners.
Medical Doctors Say About Chiropractic
Chiropractic treatment for a variety
of neuromusculoskeletal conditions is gaining wider
acceptance among the medical profession. Because
students of chiropractic spend significantly more
time studying the spine than do medical students,
many medical doctors recognize the value of chiropractors
as the appropriate source for diagnosis of and first
line of treatment for functional disorders of the
entire musculoskeletal system.
· M.D.s now categorize chiropractic
manipulation with the highest rating: "Generally
accepted, well-established and widely used."
North American Spine Society.
· "A majority of family
physicians (in Washington) admitted having encouraged
patients to see a chiropractor, and two-thirds indicated
a desire to learn more about what chiropractors
The Journal of Family Practice, 1992.
"Family Physicians and Chiropractors: What's
Best for the Patient?"
· "Our trial showed
that chiropractic is a very effective treatment,
more effective than conventional hospital outpatient
treatment for low-back pain ... particularly in
patients ... who have severe problems."
T. W. Meade, M.D.
· "The only difference
that I can see is that the patients at John F. Kennedy
get chiropractic manipulations. And in my experience,
the patients at J.F.K. almost without fail get out
of the hospital in a week. At Lutheran, it usually
takes, oh, not uncommonly, 14 days."
Per Frietag, M.D., an orthopedic surgeon, on why
he prefers to admit his patients with back pain
to John F. Kennedy Hospital, which has staff chiropractors,
rather than Lutheran General, which does not have
· "Manipulative medicine
is no longer a taboo topic."
Norton Hadler, M.D., self-described "cantankerous
doctor who would have never dealt with manipulation
in the past," professor of rheumatology, University
of North Carolina Medical School at Chapel Hill,
Time Magazine, 1991.
· "Ten years ago if
you practiced manipulation ... you couldn't get
published and were never invited to meetings. Now
I can't keep up with the invitations."
Neurologist Scott Haldeman. M.D.. D.C..
New York Times. 1991.
WHAT ARE NYS RESIDENTS LIKELY
TO GO TO A CHIROPRACTOR FOR?
According to the Gallup survey,
New Yorkers utilize chiropractic care for back and
spinal problems (75%), relief of aches, pains and
tension (14%), problems with neck (14%), and muscle
pain, spasm or headaches (9%). Chiropractors not
only have great success in caring for a wide variety
of health problems but also in contributing to an
individual's total health and well-being.
PRESCRIBE OR USE DRUGS OR SURGERY?
The chiropractor does not utilize
drugs or surgery. If these methods of treatment
are indicated by the patient's condition, the chiropractor
will recommend another type of practitioner in order
to serve the patient's best interests.
COLLEGES ACCREDITED NATIONALLY?
Go to Institutional Recognition Under (CAREER IN
TREAT INFANTS AND CHILDREN?
Yes, of course. The chiropractic
profession places considerable emphasis on structural
balance and integrity. The strains to which children
and infants are subjected can easily be a contributing
factor in creating spinal subluxations and nerve
interference. Thousands upon thousands of children
are cared for annually by doctors of chiropractic
and chiropractic care is especially important and
useful in the early detection and treatment of scoliosis
PATIENTS IN NEW YORK SATISFIED WITH THE CARE THEY
According to the Gallup Survey,
people who have had a recent experience with chiropractic
report a high level of satisfaction - 94% and found
the treatment effective. More than 70% of the patients
who have seen a chiropractor in the past year said
they would return because they were satisfied with
the care received. Those who were satisfied but
unlikely to return cited problems in obtaining insurance
reimbursement for treatment as the main reason.
Increase in Popularity
Because chiropractic treatment of
lower back pain is often more successful than medical
treatment, patient satisfaction with chiropractic
care is generally higher. As these successes mount,
positive word-of-mouth spreads. Today, the popularity
of chiropractic is at an all-time high.
- Nearly 30% of the U.S. population,
aged 18 and older, have used chiropractic.
The Gallup Organization, 1991.
- Nine of ten chiropractic users
felt their treatment was effective.
The Gallup Organization, 1991.
- 58% of those using chiropractic
considered it an essential part of their Heath
The Gallup Organization, 1991.
- "Chiropractic patients were
three times more satisfied with their care than
patients of family practice physicians."
Western Journal of Medicine, 1989.
"Patient Evaluations of Low-Back Pain Care."
- "Chiropractors are now accepted
as a legitimate healing profession by the public
and by an increasing number of physicians."
The Manga Report, 1993.
- "Chiropractic is a growing
component of the health care sector, and it is
widely used by the population."
The College of William and Mary, Williamsburg,
Virginia, and Medical College of Virginia, Richmond,
Virginia, January 1992.
"Mandated Health Insurance Coverage for Chiropractic
Treatment: An Economic Assessment, With Implications
for the Commonwealth of Virginia."
is safer than medical management of low-back pain."
--The Manga Report
The Manga Report, commissioned by
the Ministry of Health in Ontario, Canada and carried
out by leading, independent health economists at
the University of Ottawa and headed by Pran Manga,
PhD, reviewed all of the international evidence
on the management of low-back pain. It concluded:
- There would be highly significant
cost savings if more management of low-back pain
was transferred from medical physicians to doctors
- There should be a "shift
in policy to encourage and prefer chiropractic
services for most patients with low-back pain,"
and chiropractic should "be fully insured
(and) fully integrated" into the Ontario
- "The overwhelming body of
evidence" shows that chiropractic management
of low-back pain is more cost-effective than medical
management, and that "many medical therapies
are of questionable validity or are clearly inadequate..."
It also stated, "Chiropractic manipulation
is safer than medical management of low-back pain."
- "Chiropractic management
is greatly superior to medical management in terms
of scientific validity, safety, cost-effectiveness
and patient satisfaction."
WELL EDUCATED IN THE USE OF DIAGNOSTIC X-RAYS?
Chiropractic education assigns more
hours of study to diagnostic X-ray than does medical
education. Following a period of study in the safe
use and effects of X-ray, the candidate for chiropractic
licensure is given a separate examination by the
State of New York in the use and effects of X-ray.
The Chiropractic profession is the only profession
in New York that is subjected to a separate examination
on X-ray as a prerequisite to licensure. In 1983,
Governor Mario Cuomo signed legislation that expanded
the chiropractor's use of X-ray as a diagnostic
CARE EVER BEEN DEMONSTRATED TO BE OF BENEFIT IN
Yes. Workers` Compensation studies
in several states provide objective evidence of
the efficacy of chiropractic care when compared
to medical care for similar injuries and conditions.
Many comparisons between chiropractic and medical
care showed that cases under chiropractic management
resulted in reduction treatment costs, lower salary
losses by employers through a reduction in the number
of lost workdays, lower workers' compensation insurance
costs to the employer, and less work time losses
and disability claimed by employees. Also, the Rand
Study was conducted by a multidisciplinary panel
to assess the appropriateness of spinal manipulation
for low back pain.
Effectiveness of Chiropractic
Chiropractic treatment of back pain
is a perfect example of how health care expenditures
can be reduced while in fact increasing the quality
of care. Not only is chiropractic treatment significantly
less costly than treatment managed by a medical
doctor, but because chiropractic care can get workers
back on the job more quickly, it can save business
millions of dollars in lost productivity.
· "The overwhelming
body of evidence shows that chiropractic management
of low-back pain is more cost effective than medical
management, and that many medical therapies are
of questionable validity or are clearly inadequate
... Chiropractic manipulation is safer than medical
management of low-back pain."
The Manga Report, 1993.
· "There would be highly
significant cost savings if more management of low-back
pain was transferred from physicians to chiropractors...
Users of chiropractic care have substantially lower
health care costs, especially inpatient costs, than
those who use medical care only."
The Manga Report, 1993.
Mean Compensation Costs
· "The mean compensation
cost (not treatment costs) paid out by the Utah
Worker's Compensation Board for patients treated
by medical doctors was $668.39; the mean compensation
cost paid for patients treated by chiropractic was
Journal of Occupational Medicine, 1991.
"Cost per Case Comparison of Back Injury Claims
for Chiropractic vs. Medical Management for Conditions
with Identical Diagnostic Code."
· Total medical costs for
back-related injuries cost the Utah Worker's Compensation
Board an average of $1,665.43 per case; chiropractic
costs for similar diagnoses cost only $775.30.
D.C. Tracts, 1989.
"Cost per Case Analysis of Utah Industrial
Back Injury Claims: Chiropractic Management vs.
Medical Management for Diagnostically Equivalent
· Medical payments for back-related
injuries cost the Florida Worker's Compensation
Board $1,100 per case; chiropractic treatment for
similar diagnoses cost only $558.
ACA Journal of Chiropractic, 1988.
"An Analysis of Florida Worker's Compensation
Medical Claims for Back-Related Injuries."
Comparison of Compensation Days
· Of 1,996 low-back pain
cases studied, patients receiving chiropractic treatment
averaged 6.26 compensation days compared to 25.56
compensation days for medical patients.
Chiropractic Journal of Australia, 1992.
"Mechanical Low-Back Pain: A Comparison of
Medical and Chiropractic Management."
The Av-Med Study
This study included 80 patients,
each of whom was previously treated by a medical
doctor and subsequently referred to the Silverman
Chiropractic Center. Of these 80 patients, 21 %
had been diagnosed with disc problems, 5% received
emergency room treatment and 12% had been diagnosed
as requiring surgery.
Following chiropractic treatment,
no surgery was required. 86% needed no further treatment
at all. And the projected savings on the patient
study group was approximately $250,000.
The Av-Med Study, 1993.
IS LESS COSTLY
"Patients that receive chiropractic
care, either solely or in conjunction with medical
care experience significantly lower health-care
Miron Stano, PhD, Oakland University,
conducted a study comparing the health-care costs
for chiropractic and medical patients. The database
he used came from the records of MEDSTAT Systems,
Inc., a health benefits management-consulting firm
which processes insurance claims for many of the
country's largest corporations. The database was
comprised of 395,641 patients, 42,215 of which were
After reviewing claims paid over
a two-year period, he concluded:
- Patients, who receive chiropractic
care, either solely or in conjunction with medical
care, experienced "significantly lower health-care
costs... on the order of $1,000 each over the
two-year period" than those who received
only medical care. Specifically, total insurance
payments were $1,138 (30% higher) for those who
elected medical care only.
- The lower costs for chiropractic
patients were attributal both to lower in-patient
and out-patient costs, and indicated that "chiropractic
treatment substitutes for other forms of out-patient
"More than 80% of patients
found their expectations for chiropractic care to
A study by the Gallup Organization,
reported in March 1991, was conducted to determine
the attitudes, opinions, and behaviors of both users
and non-users of chiropractic services. Overall,
90% felt that chiropractic health care was effective:
more than 80% were satisfied with the treatment
they received; nearly 75% felt that most of their
expectations were met during the last visit or series
of visits; 68% said they would likely see a doctor
of chiropractic again for treatment of a similar
condition, and 50% would likely be willing to see
a doctor of chiropractic for some other problem
Nearly 80% of the chiropractic users
felt that the cost of chiropractic treatment was
Duke University Researchers Determine
Spinal Manipulation is Effective for Headaches (March
Spinal manipulation may be an effective
treatment option for tension headaches and headaches
that originate in the neck, according to a new report
released by researchers at the Duke University Evidence-Based
Practice Center in Durham, NC.
Based on a literature review of
several headache treatment options, a panel of 25
multidisciplinary experts concluded that spinal
manipulation resulted in almost immediate improvement
for cervicogenic headaches, or those that originate
in the neck, and had significantly fewer side effects
and longer-lasting relief of tension-type headache
than a commonly-prescribed medication.
The report, titled Evidence
Report: Behavioral and Physical Treatments for Tension-type
and Cervicogenic Headache, brings to fruition
work begun six years ago by an Agency for Health
Care Policy and Research (AHCPR) panel. In 1995,
that panel was charged with the responsibility of
developing evidence-based guidelines on treatment
options for headache, but its work was halted before
a report was actually printed and disseminated.
The new report was authored by Douglas C. McCrory,
M.D., MI-ISc; Donald B. Penzien, Ph.D., and Rebecca
N. Gray, D.Phil.
It is estimated that 20 to 30 percent
of adults have more than one episode of tension-type
headache a month. Over 17 percent of those with
frequent headache meet diagnostic criteria for cervicogenic
headache. Headaches result in a significant number
of missed workdays each year and can have an untold
negative impact on the personal lives of headaches
Spinal manipulation or adjustment
is the primary treatment option performed by doctors
of chiropractic. In addition, according to the Rand
Corp., doctors of chiropractic perform 94 percent
of all spinal manipulation in the country.
The researchers at Duke examined
the quality research for physical methods, such
as acupuncture, cervical spinal manipulation, and
physiotherapy, and behavioral methods, such as relaxation,
biofeedback, and stress management training, of
treating the two types of headache tension
Researchers concluded the following:
Cervical spinal manipulation
was associated with improvement in headache outcomes
in two trials involving patients with neck pain
and/or neck dysfunction and headache. Manipulation
appeared to result in immediate improvement in headache
severity when used to treat episodes of cervicogenic
headache when compared with an attention-placebo
control. Furthermore, when compared to soft-tissue
therapies (massage), a course of manipulation treatments
resulted in sustained improvement in headache frequency
For tension-type headache,
the researchers point to a study that compared manipulation
to amitriptyline, a drug commonly prescribed for
headache. Said the researchers from Duke, despite
the uniform and relatively low dose of amitriptyline,
however, adverse effects were much more common with
amitriptyline (82 percent of patients) than with
manipulation (4 percent). During the 4-week period
after both treatments ceased, patients who had received
manipulation were significantly better than those
who had taken amitriptyline for both headache frequency
and severity. Although amitriptyline is usually
continued for longer than 6 weeks, the return to
nearbaseline values for headache outcomes in this
group contrasts with a sustained reduction in headache
frequency and severity in those who had received
The authors from Duke have
conscientiously and methodically resurrected and
updated the evidence underlying the behavioral and
physical treatment options for headache, said
Anthony L. Rosner, Ph.D., the director of research
for the Foundation for Chiropractic Education and
Research (FCER). In so doing, they have recognized
the elements of chiropractic management as viable
options for treating cervicogenic and possibly tension
headache as well. We expect that this will publication
gain the appropriate recognition in the healthcare
This new report helps validate
what doctors of chiropractic and their patients
have known for decades that chiropractic adjustments
are an effective treatment option for headache sufferers,
said American Chiropractic Association (ACA) President
James A. Mertz, DC, DACBR. As alarming reports
about the risks of prescription and over-the-counter
drugs continue to surface, the health care community
and patients should consider safe and effective
non-drug treatments such as chiropractic care.
This report was produced by the
Duke University Evidence-based Practice Center (EPC)
that is one of 12 institutions to be awarded the
trademark designation EPC by the Agency
for Healthcare Research and Quality.
FCER Study Determines Chiropractic
Offers Long Term Relief For Headache
Chronic tension headache sufferers
should consider chiropractic treatment as a long-term
solution to their ailment without the side effects
of drugs, according to a study funded by the Foundation
for Chiropractic Education and Research (FCER).
The study found that when six weeks of spinal manipulative
treatment by chiropractors was compared to six weeks
of medical treatment with amitriptyline, an antidepressant
used to control severe headache pain, the chiropractic
patients experienced fewer side effects, and the
positive effects of chiropractic proved to be longer
term, with patients reporting continued relief after
the study was completed.
While anecdotal evidence has supported
chiropractic treatment of tension headaches for
years, until now, there have been no clinical trials
that corroborate this reported success. The study
that brings scientific support to these claims,
"Chiropractic Spinal Manipulative Therapy vs.
Amitriptyline for the Treatment of Chronic Tension-type
Headaches: A Randomized Comparative Clinical Trial,"
was conducted by Dr. Patrick D. Boline (principal
investigator) at Northwestern College of Chiropractic
and published in the March/April issue of the Journal
of Manipulative and Physiological Therapeutics.
For the study, a total of 126 patients
between the ages of 18 and 70 were divided into
two groups that were screened and randomly assigned
to receive either chiropractic spinal manipulation
or pharmaceutical treatment consisting of amitriptyline,
a tricyclic antidepressant commonly known by the
brand name Elavil. The spinal manipulation group
received short-lever, low-amplitude, high-velocity
thrust techniques with moist heat and light massage
of the cervicothoracic musculature prior to manipulation.
Patients were palpated to determine the cervical,
thoracic, or lumbar spinal segment to be manipulated
with special attention to the upper three cervical
segments. The patients in the amitriptyline therapy
group received 10 mg daily for the first week, 20
mg daily for the second week, and 30 mg daily thereafter.
This dosage was decreased if adverse side effected
weren't tolerated by the patient.
During the six weeks that both groups
received treatment, both reported similar improvements;
however, four weeks after the end of the clinical
trial, the superiority of chiropractic treatment
was evident. The group receiving spinal manipulation
showed a reduction of 32 percent in headache intensity,
42 percent in headache frequency, 30 percent in
over-the-counter medication usage, and a 16 percent
improvement in functional health status. The group
receiving amitriptyline reverted to the levels recorded
at the beginning of the study. The groups also differed
greatly in their reporting of side effects. While
82.1 percent of the patients who received medical
treatment suffered from drowsiness, dry mouth and
weight gain, only 4.3 percent of the spinal manipulation
group reported side effects consisting of neck soreness
"At last, with the results
of this study, the claims of thousands of chiropractic
patients who have enjoyed relief from pain without
drugs will have to be taken seriously by the medical
community," said Stephen R. Seater, CAE, Executive
Director of FCER. "At last, chiropractic will
be recognized as a viable and scientific alternative
for relief of common tension headaches."