Research

Testimony to the Department of Veteran's Affairs Chiropractic Advisory Committee

George B. McClelland, D.C., Foundation for Chiropractic Education and Research ~ March 25, 2003

From a number of studies, there is little to contradict the assertion that patient satisfaction with chiropractic care, in a variety of settings, has consistently been high. [1, 2, 3, 4] Indeed, for matched back pain conditions, patient satisfaction with chiropractic treatment has invariably been shown to be significantly greater than that with conventional management [administered by a primary care physician, an orthopedist, or an HMO provider]. [5, 6, 7] Satisfied patients are far more likely to be compliant in their treatment, [8] theoretically bestowing chiropractic patients with yet another advantage over treatment by other providers in terms of outcomes.

Comparing the Satisfaction of Low Back Pain Patients Randomized
to Receive Medical or Chiropractic Care: Results From the
UCLA Low-back Pain Study

Am J Public Health 2002 (Oct); 92 (10): 1628–1633
Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.

Patient Satisfaction With Chiropractic Physicians In An
Independent Physicians' Association

J Manipulative Physiol Ther 2001 (Nov); 24 (9): 556–559
Various aspects of chiropractic care were given a rating of "excellent" by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.

Patient Characteristics, Practice Activities, and One-month Outcomes for Chronic, Recurrent Low-back Pain Treated by Chiropractors and Family Medicine Physicians: A Practice-based Feasibility Study

J Manipulative Phys Therapy 2000 (May); 23 (4): 239–245
Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians. Nonclinical factors may play an important role in patient progress. Findings from the Health Resources and Services Administration-funded project will include a report on the influence of practice activities, including more frequent visits by chiropractic patients, on the clinical course of low-back pain and patient outcomes.

The Chiropractic Outcome Study:
Pain, Functional Ability and Satisfaction With Care

J Manipulative Phys Therapy 1997 (May); 20 (4): 235–240
Based on these results, it seems that patients suffering from back and/or neck complaints experience chiropractic care as an effective means of resolving or ameliorating pain and functional impairments, thus reinforcing previous results showing the benefits of chiropractic treatment for back and neck pain.

The Outcomes and Costs of Care for Acute Low Back Pain Among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons

N Engl J Med 1995 (Oct 5); 333 (14): 913–917
The status at six months was ascertained for 1555 of the 1633 patients enrolled in the study (95 percent). The times to functional recovery, return to work, and complete recovery from low back pain were similar among patients seen by all six groups of practitioners, but there were marked differences in the use of health care services. The mean total estimated outpatient charges were highest for the patients seen by orthopedic surgeons and chiropractors and were lowest for the patients seen by HMO and primary care providers. Satisfaction was greatest among the patients who went to the chiropractors

In the poster on the left, the first sketch (top-left) represents “perfect” head posture. A line dropped from the center of the external auditory meatus (EAM) would land directly in the center of the shoulder (the tip of the acromion process). The graphic on the right demonstrates the progression of forward head posture (occasionally referred to as “anterior head translation”).

According to Kapandji (Physiology of the Joints Vol III), for every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, because they have to work that much harder to keep the head (chin) from dropping onto your chest. This also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves. This nerve compression may cause headaches at the base of the skull. Pressure on the suboccipital nerves can also mimic sinus (frontal) headaches.

Rene Cailliet M.D., famous medical author and former director of the department of physical medicine and rehabilitation at the University of Southern California states:

“Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.”

Persistent forward head posture (a.k.a “hyperkyphotic posture”) puts compressive loads upon the upper thoracic vertebra, and is also associated with the development of Upper Thoracic Hump, which can devolve into Dowager Hump when the vertebra develop compression fractures (anterior wedging). A recent study found this hyperkyphotic posture was associated with a greater than 1.44% mortality.

It's not uncommon to observe 2" of anterior head placement in new patients. Would you be surprised that your neck and shoulders hurt if you had a 20-pound watermelon hanging around your neck? That's what forward head posture can do to you. Left uncorrected, FHP will continue to decline. Chiropractic can be very corrective, especially in the hands of a chiropractic rehabilitationist. Our specialty is in reversing the joint fixations (what we refer to as “subluxations”) and in re-invigorating the muscles that normally retract the head.