Chiropractic Is Failing With Utilization Despite Outcome Validation

Chiropractic utilization has been reported as low as 7% and as high as 14% despite being practiced in over 100 countries. It has become the most-used alternative to drugs and surgery in the United States and Europe. The most feasible study reported utilization at 9.1% globally,¹ with the main reason for seeking chiropractic care related to musculoskeletal conditions and pain.

Recent findings point to a multimodal approach to care, including chiropractic spinal adjustments, patient education, soft-tissue therapy, mechanically assisted manipulation therapy, nutritional supplements, exercise instruction, heat, ice, manual traction, orthopedic supports, electric stimulation, therapeutic ultrasound, and acupuncture.^2-3

When doing a Google Scholar search, there were 59,500 articles when querying “positive chiropractic outcomes.” Since 2024, there have been 6,540 results. The most essential truism to any provider is “do no harm.” To that end, the current literature confirms the safety of chiropractic care. In 2023, data from 960,140 patients revealed an extremely low adverse event rate of 0.00021%, with all reported outcomes being minor in nature.⁴ It was also reported in 2015 that among 6,669,603 chiropractic patients and 24,068,808 visits, there were zero adverse outcomes on patients without comorbidities to the spine.⁵

As discussed in a previous article, use of chiropractic as a first-line treatment to manage anxiety and depression could help, while avoiding long-term side effects. When indicated, medication is useful, but common sense dictates drugless first, drugs second and surgery last.

It has been reported that 61% of low back pain sufferers sought care first with their primary care provider.⁶ Primary care providers and medical specialists cannot identify the cause of the pain 99.1% of the time, labelling the condition as nonspecific back pain. This indicates no fracture, tumor, infection, or disc condition, and the typical referral is physical therapy.

A 2025 study indicates a 398% increase in utilization for low back pain with physical therapists (PTs) compared to chiropractic. Realizing that PTs are predominantly secondary providers and must be referred to by a physician (a process critical to maintain, as PTs are not trained in diagnosing comorbidities), medical providers are uneducated in thinking that manipulation by a PT is the same as a chiropractic spinal adjustment. It is not.

One cannot interchange a chiropractic spinal adjustment (CSA) with a physical therapy manipulation or mobilization, as the mechanism and neurobiochemical processes are different and render different results. The arbiter and ultimate test between the CSA and spinal manipulation is the central segmental motor control (CSMC) changes that occur as sequela to that treatment.

The CSMC changes have been evidenced (a topic for another discussion) and are easily defined as central nervous system changes that affect the motor and other functions of the brain afferently. The core of the difference is where the thrust is directed.

Haavik, et al. (2021), reported, “It is possible to direct a thrust at any spinal segment, regardless of whether it is dysfunctional or not. Therefore, for the purposes of this review, if a thrust is directed at a spinal segment that has not been examined and identified as having clinical indicators of dysfunction, it will be referred to as spinal manipulation. In contrast, a thrust directed at a dysfunctional vertebral motion segment will be referred to as a spinal adjustment. This distinction is important, as adjustments are likely to have different physiological consequences compared to thrusting at or manipulating a vertebral segment that has no signs of motor control dysfunction.”⁷

The key is determining the dysfunctional segments that make neuroplastic changes based on outcomes. In those dysfunctional segments, the high-velocity, low-amplitude thrust, or chiropractic spinal adjustment (CSA/HVLA), must be directed or you will be manipulating and not realize the best outcomes. In determining outcomes, a CSA/HVLA thrust in deep abdominal muscular activation was 38.4% better than manipulation. Six months later, 19% of that additional muscular activation was retained.

A CSA/HVLA thrust increased the H-reflex and V-wave (neurological feed to the central nervous system) by 16% without muscular fatigue. That control and manipulation group had no changes in amplitude, and the muscle fatigued much earlier. Maximum voluntary contractions of the jaw increased by 55% to 60% with CSA/HVLA thrusts only after one adjustment. Maximum voluntary contractions increased by 64.2% in chronic stroke survivors, with/HVLA only after one adjustment. A CSA/HVLA spinal adjustment increases motor-evoked potentials by 54.5% in the upper limb and 44.6% in the lower limb muscles. A CSA/HVLA realized a 16.76% change in the neurophysiological change in the 30N SEP (brain impulses). It changed brain functioning.^8-11

The literature validates the effectiveness of chiropractic care independently and vs. PT, medicine, and osteopathic care. In 2018, it was reported that 95% of sacroiliac joint pain improved with a CSA.¹² In 2014, 95% of chronic pain patients with no fracture, tumor infection, or disc issue reported improvement.¹³ In 2025, there was a 300% increase in drug-related overdose hospitalizations compared to chiropractic care.¹⁴

In 2020, chiropractic outcomes exceeded osteopathy by 46% with similar diagnoses.¹⁵ In 2023, with a cohort of 4,827 patients, with PTs, opioids increased by 80% in 90% of the patients if two or more modalities were used, and a 0% reduction of opioids with any combination of therapy.¹⁶ Conversely, there was a 55% reduction in opioid use with chiropractic care for similar diagnoses.¹⁷

This is a small sampling of outcome studies showing the efficacy of chiropractic care vs. all other mechanical low back pain therapies. Yet the profession lags in utilization by 398% despite overwhelming statistical outcomes in direct care and drugs. We must close the awareness gap by educating the public, primary care physicians, and specialists about the proven efficacy of chiropractic care through outcome studies, patient success stories, and evidence-based data. Through statistical and financial outcomes, we also must seek mandatory integration into care paths.

Chiropractic should not be treated as an alternative but as a frontline, non-pharmacological solution. Hospitals, insurers, and care networks must integrate chiropractic referrals early in treatment protocols, reducing unnecessary drugs, imaging, and surgeries. Our political entities should leave the realm of self-centered guidelines and join forces to accomplish what research has given us: evidence-based outcomes.

References

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2. Bussieres A, Stewart G, Al Zoubi F, et al. The treatment of whiplash and neck pain associated disorders: Canadian Chiropractic Guideline Initiative clinical practice guidelines. J Manip Physiol Ther, 2016;39:523-604.
3. Wong J, Cote P, Sutton D, et al. Clinical practice guidelines for the noninvasive management of low back pain: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain, 2017;20:201-16.
4. Chu, EC-H, et al. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep, 2023;13(1):1-9.
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11. Haavik H, et al., Euro J Applied Physiol, Op Cit.
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13. Leeman S, Peterson C, Schmid C, et al. Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: a prospective observational cohort study with one-year follow-up. J Manipulative Physiol Ther, 2014;(3):155-163.
14. Dow PM, et al. Association of pharmacologic and nonpharmacologic management of cute low back pain with overdose hospitalizations: a nested case-control study. J Integr Complement Med, 2025 Jul;31(7):664-673.
15. Ndetan H, et al. Chiropractic care for spine conditions: analysis of National Health Interview Survey. J Health Care Res, 2020(2):105.
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17. Whedon JM, Toler AW, Goehl JM, Kazal LA. Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. J Alt Compl Med, 2018;24(6):552-556.