Do patients with nonmusculoskeletal disorders benefit from chiropractic?
Editorial Staff
Patients with nonmusculoskeletal (non-MSK) symptoms often report improvement of symptoms when receiving care from practitioners of spinal manipulative therapy. This is not unique to chiropractic, but is reported by patients of osteopathic physicians as well as other manual therapy providers. For centuries, millions of people have reported these responses.
What Existing Research Suggests
A number of independent studies have confirmed that patients with non-MSK symptoms report symptom improvement following chiropractic care. In interviews with chiropractic patients, Leboeuf-Yde, et al., found that 21-25 percent of patients reported at least one improvement of non-MSK symptoms after chiropractic spinal manipulation. Of these improvements, 26 percent related to airway passages, 25 percent related to digestion, 14 percent related to eyes/vision and 14 percent related to heart/circulation.1 A follow-up study, six years later, found these results "were largely reproduced," with improved breathing (27 percent), digestion (26 percent) and circulation (21 percent) being the most common responses.2
Non-MSK Disorders and Spine Pain
Non-MSK disorders also have been shown to have a high comorbid association with spine pain. De Luca, et al., looked at spine pain and comorbidities among 579 Australian women. They studied the association of comorbid chronic diseases that appear to be "significantly related to spine pain" including diabetes, cardiovascular disease, pulmonary disease, cancer and mental disorders.3 They found that:
84.5 percent of women with spine pain had at least one comorbidity
60 percent had either one (30.9 percent) or two (29.3 percent) comorbidities
Almost a fourth (24.3 percent) had three or more comorbidities.
A third (33.2 percent) of women with spine pain had cardiovascular disease
A fifth (20.3 percent) had some form of mental disorder
Connecting the Dots
Chiropractic is widely accepted for relief of pain and disability. Pain relief and disability have, in turn, been shown to have significant multiorgan physical and psychological health benefits. Green, et al., "found that a number of health behaviors and modifiable risk factors, such as smoking and obesity, were associated with several spinal disorders and across age and sex groups. This suggests that some spinal disorders may be an expression of overall health. In this review, the smallest measures of association were related to various spinal pains and the largest measures of association were those pertaining to congenital anomalies of the spine. There is also sufficient evidence to suggest that in many people with a spinal disorder, substantial and often severe co-morbidities exist."4
New Research in the Works
The NCMIC Foundation has funded three initial studies to be conducted by the Global Spine Care Initiative:
Systematic literature review: non-musculoskeletal comorbidities of spine pain and related disability
Original research using national databases (USA): which non-MSK disorders are associated with spine pain and how strong are the associations?
Original research using national databases (USA): are the associations of non-MSK disorders and spine pain related to pain alone or spine pain plus disability, and are such associations related to severity or chronicity of the spine pain?
These studies will be published in open-access journals and represent significant steps toward understanding how chiropractic can benefit non-MSK disorders. Co-investigator Scott Haldeman, MD, DC, PhD, noted:
"Care provided by chiropractors commonly includes spinal manipulation, exercise, psychosocial and lifestyle education. These interventions have been included in most guidelines as first-line interventions for the management of spine pain and related disability. If this project confirms and defines the nature of comorbid associations of general health conditions with spine pain and related disability, it would guide future research to investigate whether reduction in spine pain and disability positively impacts specific non-MSK symptoms or diseases. If such future research proves that reducing spine pain and disability also improves non-MSK conditions, then chiropractors logically would be part of the management team whenever such a comorbid association exists."
Speaking for the NCMIC Foundation, President Louis Sportelli, DC, added: "NCMIC Foundation is excited to fund these ground-breaking studies. The understanding of the value of spinal manipulation on the broad range of co-morbidities will only be enhanced by carefully constructed research. The literature to date appears to suggest a strong correlation between SMT and a variety of co-morbidities among patients. Anecdotal evidence has been available for more than a century suggesting some connection. It is now time to truly investigate the connections with the same rigor other aspects of spinal manipulation have been researched."
References
Leboeuf-Yde C, Axen I, Ahlefeldt G, et al. The types and frequencies of improved nonmusculoskeletal symptoms reported after chiropractic spinal manipulative therapy. J Manipulative Physiol Ther, 1999;22 (9):559-564.
Leboeuf-Yde C, Pedersen EN, Bryner P, et al. Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey. J Manipulative Physiol Ther, 2005;28(5):294-302; discussion 365-366.
de Luca KE, Parkinson L, Haldeman S, et al. The relationship between spinal pain and comorbidity: a cross-sectional analysis of 579 community-dwelling, older Australian women. J Manipulative Physiol Ther, 2017;40(7):459-466.
Green BN, Johnson CD, Haldeman S, et al. A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLOS One, 2018;13(6):e0197987.
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