Would you believe me if I told you that an educational pamphlet is just as effective as chiropractic care or physical therapy in relieving low back pain?
In 1998, a study published in the New England Journal of Medicine looked to compare the effectiveness of chiropractic, physical therapy, or an educational pamphlet for low back pain. The conclusion of the study fueled a lively debate. What the study found was that there was little difference in outcomes between low back pain patients treated with standard chiropractic manipulation, McKenzie exercises, or the educational booklet! Not surprising, chiropractors and physical therapists alike were outraged from the findings.
While many previous studies done prior have shown chiropractic and physical therapy to be effective for helping with low back pain, why did this study show an educational pamphlet was just as effective?
To start, let’s look at the study design. The patients were diagnosed with a regional diagnosis, low back pain, after pathology had been ruled out (herniation, cancer, etc.). This would be no different than saying someone has shoulder pain. Patients were randomly assigned to either chiropractic, physical therapy, or the educational readings. This is where things got interesting.
Patients sent to a chiropractor were diagnosed with a sprain/strain 50% of the time, and another 30% of the chiropractic group was diagnosed with facet syndrome, or misalignments of the spine. The same group of low back pain patients sent to the physical therapist were diagnosed with disc derangement 92% of the time. This should raise some alarm! The same group of randomly assigned patients sent to two different providers had significantly different diagnoses!
While it is entirely possible that the provider’s diagnoses were correct, it is highly unlikely that the difference was that dramatic. It has often been demonstrated that nearly 70 percent of low back pain arises from 3 different sources; disc (39%), facet (15%), and Sacroiliac (SI) joint (13%). This is where the study inherently failed.
While the study was not specific enough to sub classify low back pain patients into their respective groups, the providers themselves seemed to have classified patients based on what they can fix, not what the patient necessarily had. McKenzie exercises have been shown to be effective in treatment of pain arising from the disc. Likewise, chiropractic manipulation would be most effective in treating those struggling with facet and SI joint complications.
While this was not the intent of the study, this ultimately showed where modern day health care has gone wrong! Too often, providers of any profession try to categorize patient’s problems into what they can fix, and not what the patient actually has. It comes without saying that patient outcomes would be much higher if patients were given the treatment they need, and not the treatment the provider is certified to practice. When providers try to fix patients by classifying them into what they can fix and not what the patient actually has, an educational pamphlet has just as much value as chiropractic and physical therapy.
Excerpt modified from [Original DC article] by William Brady, DC. Used with permission. www.integrativediagnosis.com