NCHM Key Facts and Figures

Active & Adaptive: Key Messages and Facts

During NCHM 2020, use the following key messages and facts when talking to patients, preparing presentations, or creating content for your website and social media.

COVID-19: Impact on Musculoskeletal Health and Fitness

The coronavirus pandemic has changed the way we work and live. Many Americans have shifted to remote work and online learning and are avoiding indoor spaces such as gyms and health clubs. As a result, people are moving less and some are experiencing back pain and other musculoskeletal conditions.

  • A poll conducted by the American Chiropractic Association found that more than 90 percent of respondents said their patients or people they knew were experiencing more musculoskeletal issues since having to shelter in place at the beginning of the pandemic.1
  • Even before the coronavirus pandemic, there has been a trend toward inactivity caused in part by sedentary occupations, motorized transportation and increased use of technology.2
  • According to the National Center for Health Statistics, more than 4 in 10 Americans are obese.3
  • According to CDC, obesity increases the risk of serious illness from COVID-19. Obesity is defined as a body mass index (BMI) of 30 or above.4
  • Physical activity can improve symptoms, decrease disability and improve function and well-being in a range of chronic musculoskeletal conditions.5
  • Physical activity also reduces risks of cardiovascular disease and diabetes beyond that produced by weight reduction alone.6

The coronavirus pandemic may limit where we can go, but it’s important to remain mindful of our health and try to get enough physical activity daily.

  • The CDC recommends adults get 150 minutes of moderate-intensity aerobic activity each week (or 75 minutes of vigorous-intensity aerobic activity each week).6
  • The CDC recommends children and teenagers to be physically active for at least 60 minutes each day, or almost every day.7
  • Along with physical activity, a healthy lifestyle includes balancing what you eat and drink, getting adequate sleep and managing stress.7  
  • Even before the pandemic, more than half of all U.S. adults failed to meet the surgeon general’s physical activity recommendations.8

Many people are experiencing increased stress and anxiety because of the coronavirus pandemic. Physical activity can improve our mental health as well as our physical health.

  • The number of Americans suffering from anxiety and depression has more than tripled during the COVID-19 pandemic.9
  • Physical Activity can reduce stress and anxiety and enhance sleep and quality of life.10

Musculoskeletal Health is Important to Overall Health

Many seniors, who have a higher risk of serious illness from COVID-19, are spending more time indoors. It’s important to remove fall risks in the home and take steps to strengthen muscles, bones and joints.

  • Deaths from falls among seniors age 75 and over have increased three-fold in recent years and total about 25,000 annually.14
  • Experts say improving muscle strength and balance can help reduce the risk of falls in the elderly.15
  • An active lifestyle, leading to a higher level of physical fitness, is related to better spinal control in middle-aged men and women.16
  • Bone mass usually peaks in the third decade of life, but physical activity can improve the strength of your bones at any age.17

The Impact of Back Pain

Of all musculoskeletal conditions, low back pain is one of the most disabling, leading to chronic pain, lost productivity and other problems.

  • Low back pain is the single leading cause of disability worldwide.18
  • Back pain is one of the most common reasons for missed work. One-half of all working Americans admit to having back pain symptoms each year.19
  • Back pain alone accounts for more than 264 million lost U.S. work days in one year.20
  • Experts estimate that as much as 80% of the population will experience back pain at some time in their lives.21
  • Low back pain costs Americans at least $50 billion in health care costs each year22—factor in lost wages and decreased productivity and that figure easily rises to more than $100 billion.23

Chiropractic is a Part of the Solution to the Opioid Epidemic

Back pain has played a significant role in the opioid epidemic, which has worsened in some communities since the beginning of the COVID-19 pandemic. Nondrug approaches to pain relief such as chiropractic care remain an important option for people looking for relief.

  • Almost half of all U.S. opioid overdose deaths involve a prescription opioid.24
  • Back pain is one of the leading reasons why people are prescribed opioids.25
  • Research shows that opioids do not provide clinically meaningful pain relief for people with chronic back pain.26
  • As many as one in four people who receive prescription opioids long term for non-cancer pain struggle with addiction.27
  • Almost 80 percent of Americans prefer to first use options other than prescription drugs for their pain.28
  • Patients who saw a chiropractor as their initial provider for low back pain (LBP) had 90% decreased odds of both early and long-term opioid use.29

Chiropractic Care Is Essential, Effective and Safe

Chiropractic services are essential to communities. Chiropractors offer a safe nondrug, noninvasive approach to managing back pain and other musculoskeletal conditions that helps take pressure off front-line medical providers during the COVID-19 pandemic.

  • In March 2020, the U.S. Department of Homeland Security identified chiropractors as part of the essential healthcare workforce.30
  • A clinical comparative trial found that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone.31
  • Injured workers with similar injuries are 28 times less likely to have spinal surgery if the first point of contact is a doctor of chiropractic (DC) rather than a surgeon (MD).32
  • In 2017, the American College of Physicians (ACP) updated its guideline for the treatment of acute and chronic low back pain to recommend first using noninvasive, nondrug treatments—including spinal manipulation—before resorting to over-the-counter and prescription drugs.33
  • In January 2015, the Joint Commission, the organization that accredits every major hospital in the United States, recognized the value of nondrug approaches by adding chiropractic care to its pain management standard.34
  • Among older adults, access to chiropractic care may reduce medical spending on services for spine conditions.35



  1. ACA Facebook Page,, April 21, 2020.
  2. Guthold et al. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Global Health, Sept. 2018; doi
  3. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief, no 360. Hyattsville, MD: National Center for Health Statistics. 2020.
  4. Center for Disease Control and Prevention, “People with Certain Health Conditions,” Coronavirus Disease 2019 (COVID-19), Obesity, Accessed July 28, 2020.
  5. Booth et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017;15:413–421. doi: 10.1002/msc.1191.
  6. Centers for Disease Control and Prevention, “Physical Activity for a Healthy Weight,” Accessed July 28, 2020.
  7. Centers for Disease Control and Prevention, “Finding a Balance,” Accessed July 28, 2020.
  8. Eijsvogels T. Exercise is medicine. At any dose? JAMA 2015, Nov. 10; 314 (18); 1915-16.
  9. Ginty EE, Presskreischer R, Han H, Barry CL. Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020. JAMA. 2020;324(1):93–94. doi:10.1001/jama.2020.9740.
  10. Department of Health and Human Services, “Physical Activity Guidelines for Americans,” Accessed July 28, 2020.
  11. United State Bone and Joint Initiative, “The Hidden Impact of Musculoskeletal Disorders on Americans,” 2018.
  12. U.S. Department of Health and Human Services, “Top 10 Things to Know About the Second Edition of the Physical Activity Guidelines for Americans,”
  13. Olaya-Contreras et al. The effect of the stay active advice on physical activity and on the course of acute severe low back pain. BMC Sports Science, Medicine, and Rehabilitation, 2015; 7:19.
  14. Hartholt KA, Lee R, Burns ER, van Beeck EF. Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016. JAMA. 2019;321(21):2131–2133. doi:10.1001/jama.2019.4185
  15. Liu-Ambrose T, Davis JC, Best JR, et al. Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial. JAMA. 2019;321(21):2092–2100. doi:10.1001/jama.2019.5795
  16. Aasa U et al. Physical activity might be of greater Importance for good spinal control than if you have had pain or not. Spine 2015; 40:1926–1933.
  17. National Institutes for Health, “Exercise for Your Bone Health,”
  18. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428
  19. Vallfors B. Acute, subacute and chronic low back pain: Clinical symptoms, absenteeism and working environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
  20. The Hidden Impact of Musculoskeletal Disorders on Americans, United State Bone and Joint Initiative, 2018.
  21. Rubin Dl. Epidemiology and risk factors for spine pain. Neurol Clin. 2007; May; 25(2):353-71.
  22. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.
  23. Katz JN. Lumbar disc disorders and low-back pain: Socioeconomic factors and consequences. J Bone Joint Surg Am. 2006; 88(suppl 2): 21-24.
  24. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at
  25. Mojtabai RNational trends in long-term use of prescription opioidsPharmacoepidemiology and Drug Safety, 2017; doi 10.1002/pds.4278.
  26. Abdel Shaheed C et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: A systematic review and meta-analysis. JAMA Intern Med. 2016;176(7):958–968. doi:10.1001/jamainternmed.2016.1251
  27. Boscarino JA et al. Risk factors for drug dependence among out-patients on opioid therapy in a large U.S. health-care system. Addiction 2010;105:1776–82. http://dx.doi. org/10.1111/j.1360-0443.2010.03052.
  28. “Americans Prefer Drug-Free Pain Management Over Opioids,” Gallup-Palmer College of Chiropractic Annual Survey of Americans,
  29. Kazis LE, Ameli O, Rothendler J, et alObservational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid useBMJ Open 2019;9:e028633. doi: 10.1136/bmjopen-2018-028633.
  30. American Chiropractic Association, “Department of Homeland Security Identifies Chiropractors as Essential Service Providers,” March 31, 2020.
  31. Goertz CM et al. Effect of usual medical care plus chiropractic care vs usual medical care alone on pain and disability among US service members with low back pain: A comparative effectiveness clinical trial. JAMA Network Open, 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105.
  32. Keeney BJ et al. Early predictors of lumbar spinal surgery after occupational back injury; Results from a prospective study of workers in Washington State. Spine, May 2013; 38(11):953-64. doi:  10.1097/BRS.0b013e3182814ed5.
  33. Qaseem A et al. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi: 10.7326/M16-2367.
  34. “Clarification of the Pain Management Standard,” The Joint Commission, 2015:
  35. Matthew A. et all. Access to chiropractic care and the cost of spine conditions among older adults. Am J Manag Care. 2019;25(8):e230-e236.