American Chiropractic Association Releases Choosing Wisely® List of Tests, Procedures to Question

Arlington, VA – The American Chiropractic Association (ACA) today released a list of five tests and procedures commonly ordered but not always necessary in chiropractic care. The list is part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation and Consumer Reports®, which encourages conversations between patients and their clinicians about what care is really necessary and appropriate.

To date, nearly 100 health care groups have participated in the Choosing Wisely® campaign to create lists identifying specific tests and procedures that evidence indicates may not always be necessary. ACA is the first chiropractic group to join the campaign.

“The American Chiropractic Association (ACA) and its members support evidence-informed care as well as shared decision-making between patients and their doctors. For this reason, we are proud to partner with Choosing Wisely® in this effort to encourage important conversations between patients and chiropractors that may reduce unneeded or overused services, yielding the best possible patient care,” said ACA President David Herd, DC.

ACA’s list features the following five recommendations:

  • In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain.
  • Do not perform repeat spinal imaging to monitor patients’ progress.
  • Avoid prolonged or ongoing use of passive or palliative physical therapy treatments (such as heat, cold, electrical stimulation and ultrasound) for low-back pain unless they support the goal(s) of an active treatment plan.
  • Do not provide long-term pain management without psychosocial screening or assessment for possible related psychological disorders, most notably depression and anxiety.
  • Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.

ACA’s Choosing Wisely® recommendations were developed by the association’s Committee on Quality Assurance and Accountability, and approved by the ACA Board of Governors, after an extensive search of the most current scientific evidence on management and treatment options and months of careful review and consideration.

“Conversations about what care patients truly need is a shared responsibility among all members of the health care team,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The American Chiropractic Association’s Choosing Wisely® list will help chiropractors across the country engage their patients in a dialogue about what care is best for them, and what we can do to reduce waste and overuse in our health care system.”

Using a non-drug approach, chiropractors focus on disorders of the musculoskeletal system, most often treating complaints such as back pain, neck pain, pain in the joints of the arms or legs and headaches. Widely known for their expertise in spinal manipulation, chiropractors are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling. According to a recent Gallup survey, about 35 million Americans visit a chiropractor each year.

To view details about ACA’s list of recommendations, visit To learn more about the Choosing Wisely campaign and to view all lists, visit


About the American Chiropractic Association
The American Chiropractic Association (ACA) is the largest professional association in the United States representing doctors of chiropractic. On behalf of its members, ACA educates the public about the benefits of chiropractic services, supports research, and provides professional and educational opportunities for chiropractors, with the goal of advancing high-quality health care. ACA promotes the highest standards of ethics and evidence-informed patient care. To learn more, visit, and connect with us on Facebook and Twitter.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit, connect with us on Facebook or follow us on Twitter.

About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at