A primary health-care profession with statutory regulation
Chiropractic is a health profession that specialises in the diagnosis, treatment, and management of musculoskeletal conditions, particularly those of the spine and their effects on the nervous system. Chiropractors may treat all the joints of the body, but more commonly the muscles, joints and ligaments of the spine often with manual therapy using their hands to perform a wide range of skilled, precise manipulation, mobilization or soft tissue techniques.
Numerous studies throughout the world have shown that chiropractic treatment, including manipulative therapy and spinal adjustment, is both safe and effective.
Manual Therapies Back and Neck Service, NHS North East Essex – Department of Health Case Study - published 19 July 2011; NHS North East Essex wanted to provide greater choice, easier access and shorter waiting times for patients suffering back and neck pain and at the same time address the unsustainably high demand on local spinal services.In 2008, all existing providers were contacted and invited to bid to offer patients these services.Patients can now choose from 20 different providers of chiropractic, osteopathy and physiotherapy based throughout the Colchester and Tendering area. There are four chiropractic, five osteopathy and 11 physiotherapy providers to choose from and they all meet NHS standards and agreed prices. Patients are given an appointment within two weeks and receive up to four treatments.During 2009/10, 2,810 patients used these services and 97% of patients were seen within two weeks of referral.Providers are working to locally agreed common referral and clinical protocols and whilst there is competition, there is also cooperation between individual providers and disciplines to ensure service integration for patients.Evaluation after the first 12 months of offering patients a choice of any qualified provider has identified improved patient access and choice meaning early treatment and improved outcomes; and reduced primary care consultations, imaging, medication costs and inappropriate referrals to secondary care. Referrals to spinal surgeons have reduced by more than 25%.To date this service has seen over 7000 patients.In 2009, this approach to offering chiropractic, osteopathy and physiotherapy services to treat back and neck conditions was awarded the NHS Alliance ‘Acorn Award’ for alternative therapy.The full case study can be read here http://healthandcare.dh.gov.uk/back-and-neck-pain-services/
Bronfort; A report into the effectiveness of manual therapy, as practiced by chiropractors, manipulative physiotherapists and osteopaths for various common musculoskeletal disorders such as back pain and other health problems Effectiveness of Manual Therapies: the UK Evidence Report was published in February 2010. This found evidence that spinal manipulation/mobilisation is an effective treatment for acute,
subacture and chronic low back pain; migraine and cerviocogenic
headache; cervicogenic dizziness; manipulation/mobilisation is effective
for several extremity joint conditions; and thoracic
manipulation/mobilisation is effective for acute/subacute neck pain.
The conclusions were based on the results of systematic reviews of
randomised clinical trials, widely accepted and primarily UK and US
evidenced-based clinical guidelines, plus the results of all RCTs not
yet included in the first three categories.
NICE Guidelines; In May 2009, The National Institute for Health and Clinical Excellence (NICE) published new guidelines to improve the early management of persistent non-specific low back pain. The guidelines recommend what care and advice the NHS should offer to people affected by low back pain. NICE assessed the effectiveness, safety and cost-effectiveness of available treatments and one recommendation is to offer a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. This treatment may be provided by a range of health professionals, including chiropractors as spinal manipulation is part of the package of care that chiropractors can offer. UK Beam Trial; Back pain, exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. British Medical Journal Nov 2004; 329; 1377 (doi: 10.1136 /bmj. 38282. 669225.AE)
Medical Research Council; 'Low Back pain of mechanical origin: randomised comparison of Chiropractic from hospital outpatient treatment'; Meade et al.
Medical Research Council (Follow-up-study) Trial 'Randomised comparison of Chiropractic and hospital outpatient management for low back pain; results from extended follow up'; Meade et al.
RCGP - Clinical Guidelines for the Management of Acute Low Back Pain (1996, 1999, 2001)
Clinical Standards Advisory Group; Backpain Report 1994.
Acute Back Pain - Primary Care Project; The Wiltshire and Bath Health Commission.
Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work - principal recommendations. Faculty of Occupational Medicine. London. Occupational health guidelines for the management of low back pain at work - leaflet for practitioners. Faculty of Occupational Medicine. London. 2000. Waddell G, Burton AK 2000. Occupational health guidelines for the management of low back pain at work - evidence review. Faculty of Occupational Medicine. London.
Chiropractic Treatment in Workers with Musculoskeletal Complaints; Mark P Blokland DC et al;Journal of the Neuromusculoskeletal System vol 8 No 1, Spring 2000
Musculoskeletal Services Framework – Department of Health July 2006
The main treatment interventions, as recommended by the current evidence review and that of clinical guidelines is a biopsychosocial approach: a) Guidance on activity, lifestyle, prognosis and prevention. b) Physical treatments drawn from all types of manual therapy, spinal manipulation and rehabilitation exercise. c) Advice about pain control, including non-prescription medication. d) Psychosocial interventions aimed at resolving cognitive barriers to recovery.
Non-rigid stabilisation procedures for the treatment of low back pain – National Institute for Health and Clinical Excellence. June 2006
States that chiropractic intervention can be used in the treatment of acute low back pain.
European guidelines for the management of acute nonspecific low back pain in primary care. 2005 Recommends the consideration of spinal manipulation for patients failing to return to normal activities.
The Anglo European College of Chiropractic and Welsh Institute of Chiropractic, two of the colleges of chiropractic education in the UK, have full and varied research interests.
The links to these research institutions can be found here: