The Manga Report


A major report on the effectiveness of chiropractic treatment was published in 1993. The titled report, The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain, was funded by the Ministry of Health in Ontario to assess the most appropriate use of health care resources.

The Ministry was particularly interested in reducing the incidence of work-related injuries and in improving the rehabilitation of disabled and injured workers. The report stated that in the past year, “twelve to thirty percent of people in modern industrialized societies reported low back pain.”

In light of these concerns, a massive literature review on the effectiveness and cost effectiveness of chiropractic treatment was undertaken by an independent panel of researchers associated with the University of Ottawa. Their findings, outlined below, overwhelmingly support the efficacy and cost-effectiveness of chiropractic for the treatment of low-back pain:

Scientifically valid clinical studies support the fact that chiropractic spinal manipulation is “more effective than alternative treatments” for LBP (low-back pain). Many medical therapies are of questionable validity or are clearly inadequate.

“There would be a highly significant cost savings if more management of LBP was transferred from physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of hundreds of millions annually. The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, much fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability.”

“There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients … The literature suggests that chiropractic manipulation is safer than medical management of low-back pain.”

“While it is prudent to call for even further clinical evidence of the effectiveness and efficacy of chiropractic management of LBP, what the literature revealed … is the much greater need for clinical evidence of the validity of medical management of LBP. Indeed, several existing medical therapies of LBP are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals.”

“There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management … The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care.”

“There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favouring chiropractic management of LBP.”

The report concluded with various recommendations including fully integrating chiropractic services into the health care system, shifting policy to encourage and prefer chiropractic services for most patients with low-back pain, employing chiropractors in tertiary hospitals, and extending hospital privileges to chiropractors.