Chiropractic

How chiropractic works, research and effectiveness

The chiropractor's role is to give people back the tools they need to reach their full health potential. Specifically, he focuses on the relationship between structure (principally the spine) and function as coordinated by the nervous system.

The chiropractor will therefore focus on the biomechanics and proper functioning of the spine and all joints, in order to eliminate irritations to the nervous system. To do this, he or she will mainly use chiropractic adjustments, a special form of joint manipulation.

To this end, chiropractic care is scientifically documented for many ailments, including :

• lower back pain,
• sciatic pain,
• headaches,
• migraines
• and cervical pain (neck).

Some examples of studies

Lower back or neck pain

A meta-analysis reports that spinal manipulation treatments (chiropractic adjustments) are more effective than comparable treatments for low-back pain.

Source: Anderson, R., Meeker, W. C., Wirick, B. E., Mootz, R. D., Kirk, D. H., and Adams, A. A meta-analysis of clinical trials of spinal manipulation. J Manipulative Physiol Ther 1992;15(3):181-194.

In fact, systematic reviews of the literature show that spinal manipulation treatments (chiropractic adjustments) are as, if not more, effective than conventional medical treatments (anti-inflammatories, analgesics), rest, massage therapy or physiotherapy. to relieve lower back pain acute or chronic.

Sources:

• Bronfort, G., Haas, M., Evans, R. L., and Bouter, L. M. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J 2004;4(3):335-356.
• Van Tulder, M. W., Koes, B. W., and Bouter, L. M. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 9-15-1997;22(18):2128-2156.

A randomized, double-blind clinical trial shows that chiropractic adjustments are superior to muscle relaxants in the treatment of relief from lower back pain.

Source: Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., and Verzosa, G. T. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004;27(6):388-398.

Sciatic pain

A recent cohort study reveals that patients suffering from acute low back pain accompanied by pain in the sciatic nerve returned to work more quickly when treated with chiropractic than when receiving conventional medical treatment.

Source: Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. J Manipulative Physiol Ther. 2007 Feb;30(2):135-9.

In addition, a randomized, double-blind clinical trial demonstrates the efficacy of chiropractic adjustments in patients suffering from acute low back pain and sciatic pain caused by a disc protrusion.

Source: Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7.

Headaches

Systematic reviews of the literature report that manipulations of the cervical vertebrae (chiropractic adjustments) are not only effective in the treatment of migraines and headaches of cervical origin in the short and long term, but also that these treatments are safe and associated with few serious side effects:

Sources:

• Cassidy, J.D., Boyle, E., Côté, P., He, Y., Hogg-Johnson, S., Silver, F.L., and Bondy, S.J. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine 2008;33(4S):S-176-S183.
• Bronfort, G., Nilsson, N., Haas, M., Evans, R., Goldsmith, C. H., Assendelft, W. J., and Bouter, L. M. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004;(3).
• Vernon, H., McDermaid, C. S., and Hagino, C. Systematic review of randomized clinical trials of complementary/alternative therapies in the treatment of tension-type and cervicogenic headache. Complement Ther Med 1999;7(3):142-155.
• Shekelle, P. G. and Coulter, I. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord 1997;10(3):223-228.

Lower back or neck pain

Systematic reviews of the literature report that manipulation of the cervical vertebrae (chiropractic adjustments) offers a relief from neck pain and that this type of treatment is superior to conventional medical treatment.

Sources:

• Bronfort, G., Nilsson, N., Haas, M., Evans, R., Goldsmith, C. H., Assendelft, W. J., and Bouter, L. M. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2004;(3).
• Shekelle, P. G. and Coulter, I. Cervical spine manipulation: summary report of a systematic review of the literature and a multidisciplinary expert panel. J Spinal Disord 1997;10(3):223-228.

Also, recent randomized clinical trials favor the use of spinal manipulation (chiropractic adjustments) in the treatment of cervical pain and chronic conditions, reducing both pain and functional disability.

Sources:

• Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. 2007 Apr;87(4):431-40.
• González-Iglesias J, Fernández-de-las-Peñas C, Cleland JA, Gutiérrez-Vega Mdel R. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009 Jan;39 (1):20-7.
• Palmgren PJ, Sandström PJ, Lundqvist FJ, Heikkilä H. Improvement after chiropractic care in cervicocephalic kinesthetic sensibility and subjective pain intensity in patients with nontraumatic chronic neck pain. J Manipulative Physiol Ther. 2006 Feb;29(2):100-6.

Research in chiropractic sciences

The effervescence of basic research in chiropractic sciences is now providing the chiropractic profession with a better understanding of neurophysiological mechanisms. In fact, they may indicate the use of spinal manipulations (chiropractic adjustments) in the treatment of various visceral conditions such as asthma, ear infections, gastrointestinal disorders and so on.

It is from this in-depth knowledge of basic research that the chiropractic scientific community will be able to conduct methodologically sound clinical studies to determine, among other things, which types of patients are most likely to benefit from chiropractic care for these specific conditions.

Numerous chairs and research programs in chiropractic at several Canadian universities stimulate the scientific advancement of our profession. In fact :

• The creation of the Research Chair in Chiropractic at the Université du Québec à Trois-Rivières (UQTR), in 2006,
• The creation of the Research Chair in Pain Neurophysiology at UQTR in 2010
• and the inauguration of McGill University's Chiropractic, Epidemiology and Rehabilitation Research Program in 2012,

These are concrete examples that will further highlight the importance and benefits of chiropractic research for the people of Quebec and the rest of the world.

The Quebec government has recognized the contribution of chiropractic research to the Quebec population, as demonstrated by the 2009 partnership between the Fonds de recherche en santé du Québec (FRSQ), the Ordre des chiropraticiens du Québec and the Fondation de recherche chiropratique du Québec (FRCQ).
You can consult the list of publications of the Research Chair in Chiropractic of the Université de Montréal.UQTR.

Lexical references for a better understanding of the different types of study

• Meta-analysis Meta-analysis: a statistical analysis that combines the results of a series of comparable, independent studies on a given problem. Meta-analysis enables a more in-depth analysis of the data due to the increased number of cases studied, resulting in a stronger overall conclusion than is possible with individual studies. 
• Systematic review A rigorous scientific approach based on a critical review of the literature. This approach consists of several stages:
  The first step is to search for all studies, clinical trials or other relevant studies, published or unpublished, that have answered the same specific clinical question. For example, all clinical trials conducted to evaluate the efficacy of a treatment.
  Next, the quality of each study is assessed, and the results obtained in the selected studies are synthesized. Finally, if the data permit, a statistical analysis, known as a meta-analysis, is carried out (source: Réseau Francophone Cochrane).
• Clinical trial Clinical trial: scientific study designed primarily to evaluate the safety and/or efficacy of a diagnostic method or treatment. The scientific quality of clinical trials depends on a rigorous, proven methodology to avoid bias and errors in collecting or interpreting results.
• Randomized Random allocation between experimental and control groups is carried out in such a way as to give everyone an equal chance of being in either group.
• Double-blind The subject doesn't know whether he's in the control or experimental group, while the experimenter doesn't know which group the subject is in.
• Cohort study Study: an observational study, generally projected into the future, in which two groups (cohorts) of subjects are compared: one group exposed to a particular risk factor or treatment, and another unexposed group.