As we celebrate our 25th anniversary as the definitive news and information source for the chiropractic profession, we look back at the important events as reported in DC since 1983, while also looking forward to the future. Throughout 2008, we will feature a review of the top headlines in chiropractic for a given year, along with an article on the future of chiropractic authored by an influential member of the profession.
January 2005: Manipulation-Exercise Combo Effective for Back Pain
A recent study conducted by the Medical Research Council, a research organization based in the United Kingdom, has found that patients given a combination of spinal manipulation and exercise experienced greater improvements in back function and greater reductions in pain compared to those treated with spinal manipulation or exercise only. These improvements also lasted longer in patients receiving both manipulation and exercise compared to those who received only one type of intervention.
The study, published in the British Medical Journal, was conducted at 14 health centers across the United Kingdom and included more than 1,300 patients who had consulted a general practitioner about low back pain, but whose pain had not improved. Patients were randomized into four groups; all of the groups received "best care," based on the national acute back pain guidelines. One group was used as a control and did not receive any other intervention. The remaining groups received one of three forms of care: spinal manipulation, exercise or both interventions.
Participants completed a series of questionnaires on general health, back pain, disability (the Roland Morris Disability Questionnaire and the Modified Von Korff Scales), fear-avoidance beliefs and psychological well-being before being randomized, and at 1-, 3- and 12-month intervals. The researchers also monitored instances of adverse events.
Analysis of the disability questionnaire showed just how much the combination of manipulation and exercise could help patients regain their ability to perform certain activities of daily living. The questionnaire contained 24 items (valued at one point each) that were designed to measure functional disability due to back pain, including a variety of daily activities such as walking, dressing and self-care. When comparing the results of each group, exercise helped the participants perform an average of 1.4 additional personal functions three months after the start of the study; manipulation helped patients perform 1.6 additional functions; and combined treatment resulted in patients being able to perform 1.9 additional personal functions.
As the researchers noted: "We believe that this is the first study of physical therapy for low back pain to show convincingly that both manipulation alone and manipulation followed by exercise provide cost-effective additions to care in general practice. The detailed clinical outcomes reported in the accompanying paper reinforce these findings by showing that the improvements in health status reported here reflect statistically significant improvements in function, pain, disability, physical and mental aspects of quality of life and beliefs about back pain."
January 2005: Unity in New Jersey
The chiropractic situation in New Jersey was similar to most other states, but even more so. Seven chiropractic state associations - the Central New Jersey Chiropractic Society, the Council of New Jersey Chiropractors, the Garden State Chiropractic Society, the New Jersey Chiropractic Society, the Northern New Jersey Chiropractic Society, the Ocean-Monmouth Chiropractic Society and the Southern New Jersey Chiropractic Society - were competing for less than 3,000 licensed doctors of chiropractic. Almost every time one of the associations tried to accomplish something for its members, at least one other association was ready to block its efforts. The chiropractic profession in New Jersey was routinely embarrassed in front of state politicians, in legal arenas and with the public. Unity was the obvious solution. The tasks required to achieve that solution were daunting.
Dr. Michael Spadafino, former president of the New Jersey Chiropractic Society, recalls: "The past history that we all experienced was a major barrier to unifying the profession in New Jersey. Our organization's board of directors had to accept our complete dissolution in the formation of the new organization. In order for us to overcome this concern, we needed to discuss some of the past problems and address what was fact and what was fiction. Once we were able to overcome the past concerns, we were able to begin open dialogue on topics that for years were not approached. Additionally, once we established a format for unity talks, we were able to stay on track and accomplish many tasks."
According to Dr. Allan Vargas, representative for the Council of New Jersey Chiropractors: "The barriers facing the N.J. chiropractic unity effort were to develop a workable organizational model that would allow differing chiropractic factions to openly express and support widely disparate chiropractic viewpoints within the constraints of a single board of directors. The primary breakthrough in the unity process was the recognition and acknowledgement of all organizations that 'unity' was not synonymous with 'merger.'"
Six of the seven chiropractic state associations agreed to meet in an effort to unify. (While the door is still open to them, the Garden State Chiropractic Society chose not to be involved in the meetings.) Ultimately, the Central New Jersey Chiropractic Society, New Jersey Chiropractic Society, Ocean Mammoth Chiropractic Society, and Southern New Jersey Society agreed to merge into the Association of New Jersey Chiropractors (ANJC). The Council of New Jersey Chiropractors and Northern New Jersey Chiropractic Society agreed to function as part of the new association while remaining independent.
The objective of the new association was that each of the six organizations, whether merged or independent, would be equally represented. In order to make unity a reality, each organization had to make sacrifices. All of the organizations gave up their ability to independently pursue legislative and regulatory goals, their ability to independently generate income for political purposes, and their ability to independently set their own political agenda. Those organizations that merged gave up corporate names, bank accounts, officers, board members, lobbyists, staff and more. Individually, the leaders making the decision to merge their organization had to be willing to step down from their positions.
March 2005: Chiropractor Ranked #4 on Fast Company's List of Top Jobs for 2005
What are the best jobs to pursue for the next five years? Fast Company, a magazine that chronicles how the business world is changing, has published its list of "The 25 Top Jobs for 2005." Coming in at number four on the magazine's list of top jobs for 2005 is a familiar occupation: chiropractor.
According to the article, chiropractors "diagnose and treat problems related to a person's muscular, nervous and skeletal systems, with special emphasis on the spine." The article cited advanced education, the trend toward alternative health and insurance reimbursement as the reasons why "the job is hot." As a career, chiropractor had the highest score in the education index - a whopping 98.48. This score beat out a wide variety of other jobs included in the top 25 such as medical scientist (98.28), biochemist/biophysicist (96.48); epidemiologist (98.28) and lawyer (98.37).
Chiropractor also did well on the salary range index with a score of 84.93. This fell below personal athlete (100), security sales agent (89.36) and financial advisor (87.95), but bested the remaining 21 jobs. The job growth index for chiropractors was not particularly high at 39.53; however, that was still better than eight other jobs. Chiropractor was given a zero on the innovation index, but this was true for nine other jobs as well.
September 2005: NMS Patients Improve With Chiropractic
A study involving 5,607 chiropractic patients, cared for by nearly 400 DCs in seven different countries, investigated whether a relationship exists concerning "spinal adjustments and changes in nonmusculoskeletal conditions." A total of 385 doctors of chiropractic collected data. The number of patient questionnaires per country ranged from 276 in Hong Kong to 1,855 in Australia. Ultimately, a total of 5,607 questionnaires were analyzed.
According to the investigators, "75 percent of the participating chiropractors believed it was always or often more important to correct a subluxation than to relieve a patient's symptomatic complaint, and 74 percent of chiropractors claimed to have - in the past 3 months - told all or most of their patients that chiropractic adjustments might have nonmusculoskeletal effects on their bodies."
The two most common reasons patients sought chiropractic care were not nonmusculoskeletal complaints, but low back pain (60 percent) and neck problems (51 percent). According to the chiropractors participating in the study, the three most common nonmusculoskeletal complaints were problems with digestion (19 percent of respondents), circulation (12 percent of respondents) and allergies (11 percent of respondents). A reported 69 percent of patients took medically prescribed drugs.
Fifty-six percent of the patients experienced one to six treatment visits. Four spinal areas were treated in at least half of the patients (listed in the order of frequency): occiput to C3; T1 to T6 (including ribs); T7 to T12; and L1 to L5. Most commonly, the total number of spinal areas treated was three (in 26 percent of patients). While patients without nonmusculoskeletal complaints also reported changes, the most significant changes were seen in patients with nonmusculoskeletal complaints. In relation to their specific nonmusculoskeletal complaint, 9 percent to 56 percent reported some degree of improvement.
While the study suggests some exciting relationships, it does have obvious limitations, including but not limited to the "absence of a control group to compare the results against, which would be necessary to investigate treatment effects. It is therefore not possible to establish whether patients improved (or worsened) because of the treatment, despite the treatment or regardless of the treatment." Certainly a fair amount of additional research is required before chiropractic can stake a scientific claim on being effective for nonmusculoskeletal ailments, but this may be a start.
December 2005: WHO Releases New Guidelines
In early November, the World Health Organization (WHO) released Guidelines on Basic Training and Safety in Chiropractic, which provides recommendations to governments worldwide on chiropractic and minimum standards of education. The guidelines, developed in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges, and various chiropractic, medical, osteopathic and other groups, recognize that the one full and acceptable level of education is that established by chiropractic accrediting agencies.
The guidelines recognize that in some countries and circumstances, there may need to be an interim program when chiropractic is first introduced, with slightly reduced hours for a short period. However, courses must still be close to the full level for reasons of competency and safety.
Much credit for the guidelines also must go to Dr. John Sweaney, a former WFC president, who was selected by WHO as its consultant to prepare the first draft of the guidelines. The guidelines are currently only in English, but versions in French and Spanish are being prepared and will be available early next year.
December 2005: ICA Billboard Promotes Chiropractic
In the July 16 issue, we reported on the appearance of an anti-chiropractic billboard in New Haven, Conn., created by an allegedly "international" group of individuals concerned about the dangers of neck manipulation. Almost immediately, various elements of the profession banded together, contacted the billboard display's owner, and were successful in having the negative billboard removed within 72 hours.
As we go to press, DC has learned that the International Chiropractors Association (ICA) has installed a new pro-chiropractic billboard in the exact same location as the original negative billboard. The new billboard touts a simple message: "Chiropractic Is Safe," and directs readers to a Web site of the same name.
"ICA members worldwide are determined to share with the public an accurate, ethical and responsible message about chiropractic," said Dr. John Maltby, ICA president. "ICA's positive message stands in sharp contrast to the ugly and deliberate deception fueled by anti-competitive motives that characterized the first billboard."
