It has been just over a year since many in the chiropractic profession first learned that the American Chiropractic Association (ACA) joined more than 80 medical specialty society partners to participate in an initiative that is sponsored by the American Board of Internal Medicine Foundation. This initiative’s mission is to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” It is called the Choosing Wisely campaign¹ and it has generated more spirited discussion among doctors of chiropractic than I can recall since release of the Mercy Conference Proceedings in 1993.

While a chiropractic student, I traveled with a group of medical providers to a community in Ghana to provide supplies, assist with health screens in remote villages, and work in a local hospital within a variety of departments. During my time there, I interviewed different community members employed by the hospital or by non-governmental organizations working with the hospital about their perceived health burdens and openness to chiropractic. Unexpectedly, interviewees expressed that while they practiced a Western medicine model, there was some uncertainty on how much that body of knowledge applied to them since they felt so underrepresented in the studies that contributed to that knowledge. The patients and study participants described were rarely people that came from similar geography, cultures, and lifestyles or had physical characteristics they identified with. 

The objective of this study was to compare the associations between primary care physician and chiropractic care in relation to acute lumbar disc herniation (LDH) with early surgery. The clinical picture of LDH in the early stages (i.e. the prodromal phase), in which low back pain progresses to radicular leg pain and possible neurologic signs, is often uncertain and can be a confusing time for both patients and clinicians. Thus, making a diagnosis of LDH during the early course of symptoms is often very difficult. The study's hypothesis was that chiropractic care could only be thought to increase the risk for acute LDH if the measured association between chiropractic visits and acute LDH exceeded the association between PCP visits and acute LDH.

It’s been one year since the American Chiropractic Association released its Choosing Wisely list, which features recommendations designed to help patients start conversations with their chiropractors about appropriate care. In an era of evidence-based care and shared decision making, patients need this type of information to have meaningful discussions with their doctors that lead to better care and, ultimately, better outcomes.

Spinal manipulation and mobilization for the treatment of back and neck pain have been the topic of several systematic reviews, with some suggesting that the evidence in support of the view that spinal manipulative therapy is superior to other standard treatments for chronic low back pain is sparse. On the other hand, more recent systematic reviews have reported that spinal manipulation and mobilization are “viable” options for treating pain. Despite this degree of variability among studies, manipulation and mobilization are still considered to be effective treatments when compared with other therapies. The purpose of this systematic review was to unravel these differences and inconsistent findings.