Read and respected by more doctors of chiropractic than any other professional publication in the world.

The Chiropractic Journal

A publication of the World Chiropractic Alliance

October 2003

ACA press release distorts research results

The "spin" put on a recent press release by the American Chiropractic Association is raising eyebrows among researchers and chiropractic leaders. Robert Braile, D.C., former president of the International Chiropractors Association and president of Now You Know, brought the embarrassing situation by comparing the press release with the actual research article it referred to.

"Talk about spin and credibility," Dr. Braile noted. "Look at the ACA press release on this study, (check my highlighted areas). Then look at the actual abstract from the Annals of Internal Medicine. This is not even close. This goes way beyond spin and speaks to basic credibility. We all know the amazing benefits of chiropractic. But doing this hurts our professional credibility in the scientific community and in the general press and public."

Note: the areas highlighted by Dr. Braile are indicated are underlined.

ACA Public release date: 2-Jun-2003

Annals' study shows that spinal manipulation is safe alternative to drugs, says ACA

American Chiropractic Association: New study is further support for safe alternatives to drugs

ARLINGTON, VA -- A new study showing that spinal manipulation is just as effective as traditional medical care for treating back pain should come as welcome news to patients looking for safe, drug-free alternatives to medical treatment, according to the American Chiropractic Association (ACA).

The June 3 study in the Annals of Internal Medicine proves what the chiropractic profession has known for decades--that spinal manipulation, or chiropractic adjustment, is an effective alternative to drugs and surgery for back pain, one of the most pervasive conditions afflicting Americans today.

“Our society has become more and more health-conscious in recent years. In keeping with that trend, people are making better food choices, exercising more, and beginning to question the number of potentially harmful drugs they might be taking,” said Daryl D. Wills, DC, President of the American Chiropractic Association. “This study indicates to me that consumers can avoid taking drugs for back pain in favor of a safer form of care, without sacrificing any of the benefit. Nowhere does the study indicate that analgesics or any other treatment is more effective than chiropractic care.”

Because of the increased attention back pain has attracted in recent years, medical doctors have been referring patients to doctors of chiropractic more than ever before. For years, doctors of chiropractic have advised their patients on prevention of back pain through exercise, proper ergonomics and other active solutions.

According to Dr. Wills, however, the study is not without limitations. “A problem with this study is its very narrow evaluation of the available research. For example, it does not mention the Canadian Manga Reports which found that chiropractic care is more effective, safer and less costly than medical care and that many medical treatments for low back pain are untested, questionable or harmful in nature. The study also failed to address the federal government’s guidelines on low back problems which found that spinal manipulation was the only treatment that can relieve symptoms, increase function and hasten recovery.”

Spinal Manipulative Therapy for Low Back Pain

A Meta-Analysis of Effectiveness Relative to Other Therapies
Willem J.J. Assendelft, MD, PhD; Sally C. Morton, PhD; Emily I. Yu, MPH; Marika J. Suttorp, MS; and Paul G. Shekelle, MD, PhD, Pages 871–881

Background: Low back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low back pain.

Purpose: To resolve the discrepancies related to use of spinal manipulative therapy and to update previous estimates of effectiveness by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis.

Data Sources: MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register, and previous systematic reviews.

Study Selection: Randomized, controlled trials of patients with low back pain that evaluated spinal manipulative therapy with at least 1 day of follow-up and at least one clinically relevant outcome measure.

Data Extraction: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage).

Data Synthesis: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results.

Conclusions: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.

Ann Intern Med. 2003;138:871–881.