It is probably no exaggeration to say that the chiropractic profession exists today, and has grown to such strength in numbers, because of its very successful management of patients with back pain.
There is now good evidence of the effectiveness and cost-effectiveness of chiropractic treatment.1
Dr. Gordon Waddell, a leading orthopaedic surgeon from Scotland writes:
Failure to restore function means any pain relief will be temporary and reinforces chronic pain. In the management of occupational back pain, the chiropractic profession is leading the way. The problem is weakness, and loss of function, not disease.2
A few facts about back pain
- Back pain is very common. Eighty-five percent of people will be disabled by an episode of back pain during their lives, and at any given time 7% of the adult population is suffering from back pain lasting 2 weeks or longer.3 Back pain is the second most common reason, after respiratory disorders, that patients seek medical attention.4 It is now known that back pain is common from early adolescence – a new Danish study reports a large increase during the ages 12-14, and that 50% of young women have had their first episode of back pain by age 18, 50% of young men by 20.5
- Most back pain is caused by mechanical problems in joints and muscles. Over 90% of back pain is caused by functional pathology (e.g. restricted joint movements; stiffness; weakness or trigger points in muscle; nerve entrapment) rather than structural pathology (e.g. disease, tumours, fractures, disc herniation).6
- Back pain is very disabling and costly. Back pain is the most frequent and expensive health care problem in the 30-50 age group, and it is the most common cause of work loss and disability.7
- Disability and cost caused by back pain have been growing far more quickly than the population for decades and now represent an epidemic. Between 1971 and 1981 the U.S. population rose by 12.5% but the population disabled by back pain grew by 168% – 14 times faster than the population.
- Back pain has not been well understood and managed under traditional medical care. For example:
- “Low back pain treatment has represented the least cost-effective expenditure of health care dollars that the author is aware of.” Charles Burton, MD, neurosurgeon, Minneapolis.8
- “We have not been honest with ourselves in the past when we have supported months of passive modality care that can offer no long-term benefit. We have not been fair to our patients when we have focused on pain rather than function. We, as medical clinicians, have relied only on the science available to us for the care of structural deficits… the time has come to develop rational principles of care.” Vert Mooney, MD, orthopaedic surgeon, San Diego.9
- “Modern medicine can successfully treat many serious spinal diseases and persisting nerve compression but has completely failed to cure the vast majority of patients with simple low back pain.” Gordon Waddell, MD, orthopaedic surgeon, Glasgow.10
- “The conventional wisdom is that herniated discs are responsible for low back pain, and that sacroiliac joints do not move significantly and do not cause low back pain or dysfunction. The ironic reality may well be that sacroiliac joint dysfunctions are the major cause of low back dysfunction, as well as the primary factor causing disc space degeneration and ultimate herniation of disc material.” Joseph Shaw, MD, orthopaedic surgeon, Topeka.11
- Chapman-Smith, D. (2000) The Chiropractic Profession. NCMIC Group. West Des Moines, Iowa.
- Chapman-Smith, D. (1993) The Chiropractic Report. July: 1-6
- Deyo, R.A. (1987) Descriptive epidemiology of low back pain and its related medical care in the United States. Spine 12: 264-268.
- Deyo, R.A., Cherkin, D.C., Conrad, D., Volinn, E. (1991) Cost controversy crisis: low back pain and the health of the public. Ann. Rev. of Pub. Health 12: 141-156.
- Leboeuf-Yde, C. & Kyvik, K.O. (1998) At what age does low back pain become a common problem? A study of 29,424 individuals aged 12-41 years. Spine 23: 228-234.
- Kirkaldy-Willis, W.H. & Bernard, T.N. (1999) eds. Managing low back pain. 4th edition. New York: Churchill Livingstone.
- Spengler et al. (1986) Back injuries in industry: a retrospective study. Part I: Overview and cost analysis. Spine 11: 241-245.
- Burton, C. (1981) Conservative management of low back pain. Postgrad. Med. 70: 168-185.
- Mooney, V. (1988) Foreword. In: Mayer, T.G., Gatchel, R.J. Functional restoration for spinal disorders: the sports medicine approach. Philadelphia, Pennsylvania: Lea & Febiger.
- Waddell, G. (1987) A new clinical model for the treatment of low back pain. Spine 12: 632-644.
- Shaw, J.L. (1992) The role of the sacroiliac joint as a cause of low back pain and dysfunction in low back pain and its relation to the sacroiliac joint. Vleeming, A., Mooney, V., Snijders, C., Dorman, T. eds. Proceedings of the First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. San Diego, California: University of California, November 5-6.