Chiropractors can help benefit workers and their workplace by contributing to improved outcomes, reduced costs and reduced surgeries. 

Here are some key points regarding chiropractic and workers in the workplace:

  • Workers whose first health care visit for the injury was to a doctor of chiropractic had substantially better outcomes (1)
  • Overall, cost comparison studies from private health plans and workers’ compensation plans reported that health care costs were lower with chiropractic care (2)
  • The chiropractic group had the lowest prescription medication rates, least costs per episode of low back pain, and most guideline-consistent use of medications and imaging (3)
  • On-site chiropractic services are associated with lower health care utilization and improved functional status of musculoskeletal conditions (4)
  • On-site chiropractic services are associated with lower health care utilization. These results support the value of chiropractic services offered at on-site health centers (5)
  • Findings suggest strong clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics (6)
  • About 43% of workers who first saw a surgeon had surgery within 3 years, compared to only 1.5% of those who first saw a chiropractor (7)

It is interesting to consider the results from Allen et al (3) that examined low back problems in a major self-insured workforce.  They found the chiropractic group had the lowest prescription rates among all seven classes of medications. The chiropractic group also was the least likely to receive complex medical procedures like surgeries, and to record guideline-incongruent use of imaging, medications and procedures when the latter were delivered. In addition, the chiropractic group averaged significantly lower total costs per episode, even when statistical adjustments were made to improve group comparability. Of note is that the complex medical management approach recorded the highest rates of prescription fills for opioids, other pain medications, SSRI/SNRI/tricyclics, and anxiolytics/sedatives/hypnotics. The physical therapy group had the highest rates for NSAIDs, muscle relaxant, and oral steroids.

These findings are important because, a substantial proportion of US adults utilize chiropractic services and report associated positive outcomes for overall well-being and/or specific health problems for which concurrent conventional care was common. Chiropractors provide a significant amount of care for patients with many health conditions including low back and neck pain (8).

For the general population, the most common reasons for seeking care from a chiropractor included: low back pain (49.7%), neck pain (22.5%), extremity problem (10%), wellness/maintenance (7.5%), hip pain (7%), headache (5.5%).

References:

  1. Turner JA, Franklin G, Fulton-Kehoe D, Sheppard L, Stover B, Wu R, Gluck JV, Wickizer TM. ISSLS prize winner: early predictors of chronic work disability: a prospective, population-based study of workers with back injuries. Spine (Phila Pa 1976). 2008 Dec 1;33(25):2809-18.
  2. Dagenais S, Brady O, Haldeman S, Manga P. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC Health Serv Res. 2015 Oct 19;15:474.
  3. Allen H, Wright M, Craig T, Mardekian J, Cheung R, Sanchez R, et al. Tracking low back problems in a major self-insured workforce: toward improvement in the patient’s journey.  J Occup Environ Med. 2014;56(6):604-20.
  4. Krause CA, Kaspin L, Gorman KM, Miller RM. Value of chiropractic services at an on-site health center. J Occup Environ Med. 2012 Aug;54(8):917-21.
  5. Kindermann SL, Hou Q, Miller RM. Impact of chiropractic services at an on-site health center. J Occup Environ Med. 2014 Sep;56(9):990-2.
  6. Lord DJ, Wright JR, et al. Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost. J Occup Environ Med. 2019 May;61(5):382-390.
  7. Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM. Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976). 2013;38(11):953-64.
  8. Beliveau PJH, Wong JJ, Sutton DA et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017 Nov 22;25:35.

Author: Dean Smith, DC, PhD