The November 1992 issue of the Journal of Family Practice presented three of the most positive papers on chiropractic ever to appear in a medical journal. All three addressed the topic of family practitioners understanding and referring to chiropractors. All three encourage their readers to "re-evaluate chiropractic" and "reconsider referrals to chiropractors for musculoskeletal problems."
The first paper, "Family Physicians, Chiropractors and Back Pain," was authored by:
Peter Curtis, MD, with the Department of Family Medicine at the University of North Carolina, Chapel Hill. Dr. Curtis was also one of the members of the RAND multidisciplinary panel on low back pain.The other two papers were editorials supporting the paper by Drs. Curtis and Bove: one by well known researcher Daniel Cherkin, PhD, who has done a great deal of survey work reviewing the attitudes of patients to chiropractors and family physicians; the other by three Israeli MDs who supported the conclusions of Drs. Curtis and Bove.Geoffrey Bove, DC, a PhD candidate in the Department of Cell Biology and Anatomy at the University of North Carolina. Dr. Bove is also a fellow of the Foundation for Chiropractic Education and Research (FCER).
Most DCs will be very surprised at the tone of the first paper. The last part of the introduction says it all:
"In this country, low back pain, dysfunction, and work disability are moving toward epidemic proportions, and the context in which back problems occur most often results in presentation to primary care physicians, particularly family physicians. However, another discipline, chiropractic, is playing an increasing role in the primary care of musculoskeletal problems. Family physicians should therefore re-evaluate their relationship with these health care providers."The paper continues:
"Back pain is the second leading reason reported by patients for visiting physicians.1,2 Every year nearly 13 million visits are made to physicians for chronic low back pain, and it is the second leading cause of work days lost.2,3 From 1971 to 1981, the number of disabled people and the cost of care for low back pain increased at a rate 14 times that of the population growth.2 In medical settings, family physicians care for 38.6% of the patients with acute and chronic back pain, compared with 36.9% seen by orthopedists, 16.9% by osteopaths, and 7.6% by internists.4 Back symptoms are the third most common reason for visiting a family physician."5The authors discussed the ignorance that most family physicians have regarding chiropractic: "Fifty percent of family physicians surveyed believed they were only slightly or not at all informed about the clinical scope and skills of chiropractors, although 26 percent saw them as an excellent source of care for certain musculoskeletal problems." Greater patient satisfaction of chiropractic patients versus those of family physicians was also discussed.6
The discussion led to why family physicians were reluctant to refer to DCs, with an open admission that it took a lawsuit, Wilk et al., to solve the problem. Ultimately, there appears to be three reasons why family physicians don't refer to chiropractors:
Suspicion regarding the extent, depth, and validity of manipulative training:Manipulative therapy (the term the authors use when speaking of chiropractic adjustment) is discussed at length. The paper is very educational to the uninformed family practitioner.The authors gave a very solid description of chiropractic education, ending with this statement: "Doctors of chiropractic are highly trained practitioners, qualified and licensed to diagnose disease entities and to refer patients when the treatment necessary is out of their scope of practice."
Perceived lack of basic scientific evidence:
The authors admitted that: "Basic scientific evidence and clinical trials dealing with this topic are scarce, as they are for other modalities used in the treatment of musculoskeletal ailments."
Manipulation is a dangerous intervention:
This argument is addressed in a straight forward manner with the authors providing actual reports of the incidence of vascular accident: "between 1:400,000 and 1:1 million procedures."
"Guidelines for Identifying a Competent Chiropractor" are also included:
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
