Chiropractic Outcomes and Patient Satisfaction Have Persistently Outperformed Medicine and Physical Therapy

By: Mark Studin DC, FPSC, FASBE(C), DAAPM

Chiropractic care is often misunderstood within healthcare for several reasons despite its growing recognition and substantial evidence in the scientific arena. Historical stereotypes lead to skepticism due to chiropractic’s origins in the late 19th century when its methods were less grounded in scientific principles. Early chiropractic was seen as alternative or even pseudoscientific, creating a stigma that lingers despite significant advancements. While many chiropractors adhere to evidence-based practices, some may still follow outdated or unscientific methods, reinforcing negative perceptions magnified with complications. The resultant medical intervention to those complications missed or created by those few within chiropractic magnifies the misconception of chiropractic created by the few but assigned to an entire profession.

Chiropractors typically address musculoskeletal issues like back and neck pain, which overlap with treatments offered by physical therapists, orthopedic doctors, and pain management specialists. This competition has historically led to resistance and false information from other medical fields. While a growing body of evidence supports chiropractic interventions, such as spinal adjustments for lower back pain, some critics falsely point to a lack of large-scale, high-quality studies in chiropractic care. This misrepresentation in media and anecdotal experiences often skew public understanding of chiropractic. Negative stories about rare adverse effects or unqualified practitioners too frequently overshadow positive patient outcomes.

The problem in chiropractic is two-fold: too many practitioners work in isolation, limiting opportunities for collaboration and mutual understanding with other healthcare professionals. Secondly, too many chiropractors still “cut corners” in documentation, with many still using paper records, rendering a non-professional perception and hurting the reputation of an entire profession. For an unknown reason, others who use electronic records still avoid vitals and systems reviews. 100% of doctors of chiropractic are taught this in our basic training. Still, when these corners are cut, it renders the perception that we are not “real doctors” trained to protect the public, again rendering a non-professional perception and hurting the reputation of an entire profession. Worse, underlying conditions go unrecognized and could have an adverse health outcome.

Chiropractic is one of the safest treatments currently available in healthcare, and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon et al. (2015) reported that their study was based on 6,669,603 subjects after the unqualified subjects had been removed, accounting for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation or a chiropractic spinal adjustment] induces injury into normal healthy tissues has been identified. Chu et al. (2023), studying 960,140 spinal manipulative therapy (chiropractic spinal adjustments), revealed 39 adverse events, with the majority having underlying osteoporosis. The incidence is 0.21 per 100,000 visits, and none reported severe health incidents. There were no stroke or cauda equina-related incidences.

Newell and Holmes (2024) reported:

“Generally, chiropractic patients are very satisfied with their care with high proportions generating consistently high satisfaction scores. This includes patient groups receiving care in both the independent and public sectors. Studies recruiting patients presenting with conditions commonly seen by chiropractors reported high to very high satisfaction/experience scores with care. This is also true of parental satisfaction with pediatric care where scores range from around 75% to 95% satisfaction.” (pg. 2)

Newell and Holmes (2024) also reported that patient satisfaction for chronic care utilizing chiropractic was 86.4%, medical care for the same conditions was 71%, and acute patients reported 90% satisfaction with chiropractic care vs. 76% for medical care. The common determinant was changes in positive changes in pain outcomes. Upwards of 97% reported very good or excellent on all outcome questions, including the evaluation experience.

In a study exploring the relationship between chiropractors, medical doctors, and their patients, chiropractic scored higher in trust between the patient and their chiropractor. The perceived support and trust in the doctor-patient relationship for their condition was superior with chiropractic care.

Ntedan et al. (2020), with a cohort of 8,023,162, reported that 96% of chiropractic patients were satisfied with chiropractic care. Conversely, Chiarotto and Koes (2022) reported that 99.1% of acute patients did not have serious spinal conditions or non-specific back pain (the title of their published article in the New England Journal of Medicine). In contrast, for those who did not have identifiable causes, they identified the interaction of biological, psychological, and social factors accounting for upwards of 90% of the cases. Statistically, this makes no sense as they first account for 0.9% identified with an anatomical cause (fracture, tumor, infection, herniation) but then assign 90% to psychological or psychosocial issues, leaving a 9.1% gap. Regardless, medicine cannot identify the cause of 99.1% of non-anatomical spinal-related pain. In comparison, chiropractic reports a satisfaction rate of 96% with the above-reported cohort of 8,032,162 participants in a 4-year study.

Farrokhi et al. (2023) reported that opioid use increases in 89.9% of patients with physical therapy, spinal injections increase by 53%, and MD specialty care increases by 50% with two or more modalities, as are typical physical therapy protocols. Conversely, Whedon et al. (2020) reported that opioid use decreased with chiropractic care by 55%, and opioid-related costs decreased by 74% with chiropractic care.

Despite some chiropractors' poor practice and documentation protocols, which hurts the entire profession, the adage “it’s always about the money” seems to overshadow much of the overall issue. According to Farabaugh et al. (2024), the cost of low back pain in the United States alone is $134.5 billion, and they concluded:

“Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.” (pg. 1)

With so much money at stake and most in organized medicine (hospitals, private, local, state, and federal programs) preventing the inclusion of chiropractic, it keeps most of the money inside the medical system despite poorer outcomes. Increased collaboration, when clinically indicated, coupled with advanced chiropractic credentials using medical academia in conjunction with chiropractic academia, has already broken many “glass ceilings,” resulting in additional millions of referrals to chiropractic offices globally.

Integrating evidence into decision-making involves aligning scientific findings with ethical, social, and financial incentives. While the transition might face resistance, persistence in presenting robust data and advocating for change can help evidence prevail over purely financial motivations.

References

1. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.
2. Chu, Eric Chun-Pu, et al. "A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy." Scientific Reports 13.1 (2023): 1-9.
3. Newell, Dave, and Michelle M. Holmes. "Patient Experience and Satisfaction With Chiropractic Care: A Systematic Review." Journal of Patient Experience 11 (2024): 23743735241302992.
4. Ndetan, H., et al. "Chiropractic Care for Spine Conditions: Analysis of National Health Interview Survey." Journal of Health Care and Research 2020.2 (2020): 105
5. Farrokhi, S., Bechard, L., Gorczynski, S., Patterson, C., Kakyomya, J., Hendershot, B.D., Condon, C.R., Perkins, L.M., Rhon, D.I., Delitto, A. and Schneider, M., 2023. The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization. Physical therapy, p.pzad173.
6. Whedon, J. M., Toler, A. W., Goehl, J. M., & Kazal, L. A. (2018). Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. The Journal of Alternative and Complementary Medicine, 24(6), 552-556.
7. Chiarotto, Alessandro, and Bart W. Koes. "Nonspecific low back pain." New England Journal of Medicine 386.18 (2022): 1732-1740.
8. Farabaugh, Ronald, et al. "Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review." Chiropractic & Manual Therapies 32.1 (2024): 8.