Dynamic Chiropractic – April 22, 1996, Vol. 14, Issue 09

I.Q. -- Interesting Quotes

By Editorial Staff
JAMA Admits Effectiveness of "Spinal Manipulation"

There was a time not long ago when the chances of finding a positive spinal manipulation paper in the Journal of the American Medical Association (JAMA) was nil.

But times do change, and JAMA with it.

There are currently 51 reviews in the scientific literature examining the many studies on the efficacy of spinal manipulation. A paper in JAMA1 rates the methodological quality of these studies: "Objective. -- To study the relationship between the methodological quality and other characteristics of reviews of spinal manipulation for low back pain on the one hand and the reviewers' conclusions on the effectiveness of manipulation on the other hand.

"Data Extraction. -- Methodological quality was assessed using a standardized criteria list applied independently by two assessors (range, 0% to 100%). Other extracted characteristics were the comprehensiveness of the search, selective citation of studies, language, inclusion of non-RCTs, type of publication, reviewers' professional backgrounds, and publication in a spinal manipulation journal or book. The reviewers' conclusions were classified as negative, neutral, or positive.

"Data Synthesis. -- A total of 51 reviews were assessed, 17 of which were neutral and 34 positive. The methodological quality was low, with a median score of 23%. Nine of the 10 methodologically best reviews were positive. Other factors associated with a positive reviewers' conclusion were review of spinal manipulation only, inclusion of a spinal manipulator in the review team, and a comprehensive literature search.

"Conclusions. -- The majority of the reviews concluded that spinal manipulation is an effective treatment for low back pain. Although, in particular, the reviews with a relatively high methodological quality had a positive conclusion, strong conclusions were precluded by the overall low quality of the reviews. More empirical research on the review methods applied to other therapies in other professional fields is needed to further explore our findings about the factors related to a positive reviewers' conclusion."


1. Assendelft WJJ, Koes BW, Knipschild PG, Bouter LM. The relationship between methodological quality and conclusions in reviews of spinal manipulation. JAMA 1995;274: 1942-1948.


Lobbyist's Major Victory = Professional Status for Chiropractors

John Mangum, lobbyist for the Arizona Association of Chiropractic, was recognized recently as the #2 lobbyist in the state of Arizona for 1995 by one of the state's major newspapers.1

"Major Victory: Scored a major win for chiropractors by pushing through a bill to require continuing education among the field's practitioners. In doing so, the chiropractors took a major leap toward professional status."

1. "Top lobbyists have distinctive styles," The Arizona Republic, January 21, 1996.


Learning to Speak Chiropractic?

Consider the following quote:

"Manipulation provides dramatic relief in cases of subluxation."1

While this may not appear to be news, consider the fact that this statement is part of an abstract published by two MDs, a nurse practitioner PhD, and a research assistant (no DCs). But there is more:

"Sacroiliac dysfunction, often termed subluxation, occurs when the ilium slips on the sacrum. An irregular prominence of one articular surface becomes wedged upon the prominence of an opposed articular surface. The ligaments are taut, and the reflex muscle spasm and pain are intense, severe, and continuous. The condition is differentiated from sacroiliac strain in that the pain is more intense and is not relieved by sitting, recumbency, or a tight encircling bandage. The overlap can be so slight that it cannot be recognized on radiographs. CT images are more reliable in the detection of joint space abnormalities and associated soft tissue.(18) The pain of subluxation is often relieved suddenly and dramatically by reduction of the subluxation by manipulation."(2)
Our research and networking with other providers is beginning to have positive effects on our relationships with other health professions. The health care professions are beginning to understand what chiropractors mean when they speak of subluxations.
It is this knowledge, and the acknowledgment of the efficacy of spinal manipulation, that is prompting more health care providers to refer patients to chiropractors.


1. Hendler N, Kozikowski JG, Morrison C, Sethuraman G. Diagnosis and management of sacroiliac joint disease. JNMS 3:169-174, 1995.

2. Turek SL. Orthopaedics: Principles and Their Application. 3rd ed. Philadelphia: JB Lippincott, 1977.

18. Fishman EK, Magid D, Brooker AF. Fractures of the sacrum and sacroiliac joint: evaluation by computed tomography with multiplaner reconstruction. South Med 1988:81: 171-177.



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