Frequently Asked Questions

IN BRIEF, WHAT IS CHIROPRACTIC?

Chiropractic is the second largest primary health care profession in the United States today. The following is the American Chiropractic Association's official definition of chiropractic:

"Chiropractic is based on the premise the relationship between structure and function in the human body is a significant health factor and that such relationship between the spinal column and nervous system is the most significant, since the normal transmission and the expression of nerve energy are essential to the restoration and maintenance of good health.

"Chiropractic is that science and art which utilized the inherent recuperative powers of the body and the relationship between the musculoskeletal structures and the functions of the body, particularly of the spinal column and the nervous system, in the restoration and maintenance of health."

Chiropractic is one of the three major schools of health, the other two being allopathy (traditional medicine) and osteopathy. Chiropractic is based on the understanding that good health depends, in part, on a normally functioning nervous system. Body structures such as cells and organs function by the impulses carried through nerves. When these nerve impulses travel uninterrupted, the organs and cells are able to function normally. When there is interference, the tissues and organs cannot function properly and a state of malfunction may begin, predisposing the body to a disease state and less than optimum health.


WHAT DO CHIROPRACTORS DO?

The American Chiropractic Association’s description of the scope of chiropractic practice is "The practices and procedures which may be employed by doctors of chiropractic are based on the academic and clinical training achieved in and through, but not limited to, the use of diagnostics and therapeutics, specifically including the adjustment and manipulation of the articulations and adjacent tissues of the human body, particularly of the spinal column; included is the treatment of intersegmental disorders for alleviation of related neurological aberrations.

"Patient care is conducted with due regard for environmental, nutritional and psychotherapeutic factors, as well as first aid, hygiene, sanitation, rehabilitation and physiological therapeutic procedures designed to assist in the restoration and maintenance of neurological integrity and homeostatic balance."

The adjustment, which is the correction of the misaligned vertebrae, is usually done by hand. It consists of placing the patient on a specially designed adjusting table and applying pressure, using specialized techniques, to the areas of the spine that are out of proper alignment or that do not move properly within their normal range of motion.

What is an Adjustment / Manipulation?

Adjustment / Manipulation is treatment using the doctor's hands to apply body leverage and a physical thrust to one joint or a group of related joints to restore joint and related tissue function. Through the use of manipulation, the doctor seeks to provide relief from symptoms, improve joint and muscle function, and speed recovery. Spinal manipulation is the most common form of manipulation. Manipulation should not be confused with other forms of manual therapy such as mobilization and massage.

Is Spinal Adjustment / Manipulation Effective?

Yes! As more of the benefits and safety of spinal manipulation are made public, it is becoming more universally recognized as a safe and effective choice for the care of back problems.

The most recent evidence of spinal manipulation's effectiveness comes from a landmark study conducted by the Agency for Health Care Policy and Research, a federal government research organization. In this study, a panel of health care experts analyzed the scientific evidence available on all methods of examination and treatment used for acute adult low back problems and formed conclusions regarding their appropriateness and effectiveness. Among their most significant conclusions, they confirmed that spinal manipulation is a safe and effective initial form of treatment for this problem. This panel also strongly recommended that both doctors and patients consider using the most conservative treatment approach first for this common problem. Spinal manipulation is a drugless, nonsurgical (conservative) approach to the treatment of back pain and its related disorders.

Is Spinal Manipulation Safe?

Yes! When administered by a qualified doctor who is well trained and experienced in the use of spinal manipulation, it is one of the safest drugless, nonsurgical procedures available.

Clinical surveys show that complications from manipulation are rare. So low, in fact, that doctors who perform manipulation have the lowest malpractice insurance costs of all practicing doctors. This means that when manipulation is performed by a Doctor of Chiropractic, the potential risk of complications from manipulation is at its lowest.

A word of caution. Spinal manipulation is as much an art as it is a clinical science. It should not be used by unskilled persons. As more people become aware of manipulation's effectiveness, unlicensed or untrained persons might believe they too can use it safely and effectively. For your own safety, when selecting a doctor to provide manipulation for your back problem, be sure you choose a chiropractic doctor who is well trained and experienced in this form of care.

Which Doctors are Most Skilled at Manipulation?

Doctors of Chiropractic (DCs) are the public's first choice of doctors for treatment using manipulation. A summer, 1994 study by the respected health care research organization Louis Harris & Associates confirms this as a fact. This nation-wide survey reveals that nearly one-half of the general public and six in ten of those who sought professional care for a back problem in the recent past regard DCs as most skilled in the use of spinal manipulation. And the majority of those who visited other doctors for a back problem also consider DCs more skilled in the use of manipulation than their medical or osteopathic doctor.

The DC's clinical expertise is derived from his/her training and the clinical experience gained from spending over 85% of his/her daily practice in the differential diagnosis of the patient's complaint and the management of neuromusculoskeletal (NMS) disorders. The DC's training and experience enable him/her to identify those health problems that are most likely to be responsive to chiropractic management and to administer the appropriate treatment personally, safely

What if Chiropractic is Not Covered in My Insurance Plan?

Ask your insurance plan administrator to add full, direct access chiropractic services coverage to your plan for both you and your dependents. And be sure to specify that you want these chiropractic services to be provided only by a Doctor of Chiropractic.

Federal Guidelines On Low Back Pain Treatment

On December 8, 1994, The Agency for Health Care Policy and Research (AHCPR) of the U.S. Department of Health and Human Services, released an extensive study of diagnostic and treatment methods for acute low back pain. This condition is the most common health complaint experienced by working Americans today, and a condition which costs the economy at least $50 billion a year in lost wages and productivity.

The AHCPR panel -- a 23-member committee of 11 medical doctors, nurses, experts in spine research, physical therapists, a psychologist, an occupational therapist, 2 chiropractic doctors and a consumer representative -- concluded, among other things, that:

  • spinal manipulation was the only recommended treatment that relieved symptoms, increased function and hastened recovery for acute low back problems in adults;
  • conservative treatments such as spinal manipulation should be pursued -- in most cases -- before surgical interventions are considered;
  • prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems. 

Evidence for the Effectiveness of Chiropractic

Research conducted throughout the world shows that chiropractic treatment for lower back pain is both safe and effective. The following are excerpts from a few of the more recent studies:
Quality of Results

· "...for the management of low-back pain, chiropractic care is the most effective treatment, and it should be fully integrated into the government's health care system."
The Manga Report, 1993.
Versus Alternative Treatments

· "Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain."
British Medical Journal, 1990.
British Medical Research Council Study.

· "...spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low-back pain."
The Manga Report, 1993.

· "...injured workers ... diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."
The Manga Report, 1993.
Long-Term Effectiveness

· "Two and three years after patients with back pain were treated by chiropractors, they experienced far less pain than those who were treated by medical doctors."
British Medical Journal, 1990.
"Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment."

· "...one of the unexpected findings ...looks as though the treatment that the chiropractors give does something that results in a very long-term benefit."
T. W. Meade, M.D., CBC Radio.

HOW ARE CHIROPRACTORS LICENSED?

Most states, including New York, have independent state chiropractic examining boards responsible for issuing and renewing licenses to practice. Doctors of chiropractic in New York must first pass a clinical board examination, include Parts I, II, III, Physiotherapy, and the Part IV Practical. The National Board of Chiropractic Examiners (NBCE) administers the comprehensive clinical competency examination.

HOW DO YOU KNOW WHEN TO USE A DOCTOR OF CHIROPRACTIC?

Doctors of chiropractic are primary health care providers according to both Federal and State regulations. This means chiropractors can serve as portals of entry into the health care delivery system. Under chiropractic care, a patient is either treated or referred after a comprehensive differential diagnosis is performed utilizing an orthopedic and neurological examination, an X-ray examination if necessary, as well as laboratory procedures if deemed appropriate for the patient's complaint. By consultation and examination, the doctor of chiropractic will arrive at a prognosis under chiropractic care or will refer the patient to an appropriate health care professional specialist.

CAN MEDICAL DOCTORS REFER TO CHIROPRACTORS?

The American Medical Association permits medical physicians to refer patients to doctors of chiropractic and to similarly accept patient referrals from chiropractors. Many individual physicians have had close professional relationships with doctors of chiropractic for years. The chiropractic profession continues to work towards strengthening interprofessional referrals so that the people of New York State will benefit from the best care offered by both types of practitioners.

What Medical Doctors Say About Chiropractic

Chiropractic treatment for a variety of neuromusculoskeletal conditions is gaining wider acceptance among the medical profession. Because students of chiropractic spend significantly more time studying the spine than do medical students, many medical doctors recognize the value of chiropractors as the appropriate source for diagnosis of and first line of treatment for functional disorders of the entire musculoskeletal system.

· M.D.s now categorize chiropractic manipulation with the highest rating: "Generally accepted, well-established and widely used."
Spine, 1991.
North American Spine Society.

· "A majority of family physicians (in Washington) admitted having encouraged patients to see a chiropractor, and two-thirds indicated a desire to learn more about what chiropractors do."
The Journal of Family Practice, 1992.
"Family Physicians and Chiropractors: What's Best for the Patient?"

· "Our trial showed that chiropractic is a very effective treatment, more effective than conventional hospital outpatient treatment for low-back pain ... particularly in patients ... who have severe problems."
T. W. Meade, M.D.

· "The only difference that I can see is that the patients at John F. Kennedy get chiropractic manipulations. And in my experience, the patients at J.F.K. almost without fail get out of the hospital in a week. At Lutheran, it usually takes, oh, not uncommonly, 14 days."
Per Frietag, M.D., an orthopedic surgeon, on why he prefers to admit his patients with back pain to John F. Kennedy Hospital, which has staff chiropractors, rather than Lutheran General, which does not have staff chiropractors.

· "Manipulative medicine is no longer a taboo topic."
Norton Hadler, M.D., self-described "cantankerous doctor who would have never dealt with manipulation in the past," professor of rheumatology, University of North Carolina Medical School at Chapel Hill, Time Magazine, 1991.

· "Ten years ago if you practiced manipulation ... you couldn't get published and were never invited to meetings. Now I can't keep up with the invitations."
Neurologist Scott Haldeman. M.D.. D.C..
New York Times. 1991.

WHAT ARE NYS RESIDENTS LIKELY TO GO TO A CHIROPRACTOR FOR?

According to the Gallup survey, New Yorkers utilize chiropractic care for back and spinal problems (75%), relief of aches, pains and tension (14%), problems with neck (14%), and muscle pain, spasm or headaches (9%). Chiropractors not only have great success in caring for a wide variety of health problems but also in contributing to an individual's total health and well-being.

DO CHIROPRACTORS PRESCRIBE OR USE DRUGS OR SURGERY?

The chiropractor does not utilize drugs or surgery. If these methods of treatment are indicated by the patient's condition, the chiropractor will recommend another type of practitioner in order to serve the patient's best interests.

ARE CHIROPRACTIC COLLEGES ACCREDITED NATIONALLY?

Go to Institutional Recognition Under (CAREER IN CHIROPRACTIC Buttons)

DO CHIROPRACTORS TREAT INFANTS AND CHILDREN?

Yes, of course. The chiropractic profession places considerable emphasis on structural balance and integrity. The strains to which children and infants are subjected can easily be a contributing factor in creating spinal subluxations and nerve interference. Thousands upon thousands of children are cared for annually by doctors of chiropractic and chiropractic care is especially important and useful in the early detection and treatment of scoliosis in children.

ARE CHIROPRACTIC PATIENTS IN NEW YORK SATISFIED WITH THE CARE THEY RECEIVE?

According to the Gallup Survey, people who have had a recent experience with chiropractic report a high level of satisfaction - 94% and found the treatment effective. More than 70% of the patients who have seen a chiropractor in the past year said they would return because they were satisfied with the care received. Those who were satisfied but unlikely to return cited problems in obtaining insurance reimbursement for treatment as the main reason.

Chiropractic’s Increase in Popularity

Because chiropractic treatment of lower back pain is often more successful than medical treatment, patient satisfaction with chiropractic care is generally higher. As these successes mount, positive word-of-mouth spreads. Today, the popularity of chiropractic is at an all-time high.

  • Nearly 30% of the U.S. population, aged 18 and older, have used chiropractic.
    The Gallup Organization, 1991.

  • Nine of ten chiropractic users felt their treatment was effective.
    The Gallup Organization, 1991.

  • 58% of those using chiropractic considered it an essential part of their Heath insurance package.
    The Gallup Organization, 1991.

  • "Chiropractic patients were three times more satisfied with their care than patients of family practice physicians."

  • Western Journal of Medicine, 1989.
    "Patient Evaluations of Low-Back Pain Care."

  • "Chiropractors are now accepted as a legitimate healing profession by the public and by an increasing number of physicians."

  • The Manga Report, 1993.

  • "Chiropractic is a growing component of the health care sector, and it is widely used by the population."

  • The College of William and Mary, Williamsburg, Virginia, and Medical College of Virginia, Richmond, Virginia, January 1992.
    "Mandated Health Insurance Coverage for Chiropractic Treatment: An Economic Assessment, With Implications for the Commonwealth of Virginia." 

CHIROPRACTIC IS SAFER

"Chiropractic manipulation is safer than medical management of low-back pain."
--The Manga Report

The Manga Report, commissioned by the Ministry of Health in Ontario, Canada and carried out by leading, independent health economists at the University of Ottawa and headed by Pran Manga, PhD, reviewed all of the international evidence on the management of low-back pain. It concluded:

  • There would be highly significant cost savings if more management of low-back pain was transferred from medical physicians to doctors of chiropractic.

  • There should be a "shift in policy to encourage and prefer chiropractic services for most patients with low-back pain," and chiropractic should "be fully insured (and) fully integrated" into the Ontario health-care system.

  • "The overwhelming body of evidence" shows that chiropractic management of low-back pain is more cost-effective than medical management, and that "many medical therapies are of questionable validity or are clearly inadequate..." It also stated, "Chiropractic manipulation is safer than medical management of low-back pain."

  • "Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction." 

ARE CHIROPRACTORS WELL EDUCATED IN THE USE OF DIAGNOSTIC X-RAYS?

Chiropractic education assigns more hours of study to diagnostic X-ray than does medical education. Following a period of study in the safe use and effects of X-ray, the candidate for chiropractic licensure is given a separate examination by the State of New York in the use and effects of X-ray. The Chiropractic profession is the only profession in New York that is subjected to a separate examination on X-ray as a prerequisite to licensure. In 1983, Governor Mario Cuomo signed legislation that expanded the chiropractor's use of X-ray as a diagnostic tool.

HAS CHIROPRACTIC CARE EVER BEEN DEMONSTRATED TO BE OF BENEFIT IN STATISTICS?

Yes. Workers` Compensation studies in several states provide objective evidence of the efficacy of chiropractic care when compared to medical care for similar injuries and conditions. Many comparisons between chiropractic and medical care showed that cases under chiropractic management resulted in reduction treatment costs, lower salary losses by employers through a reduction in the number of lost workdays, lower workers' compensation insurance costs to the employer, and less work time losses and disability claimed by employees. Also, the Rand Study was conducted by a multidisciplinary panel to assess the appropriateness of spinal manipulation for low back pain.

Cost Effectiveness of Chiropractic

Chiropractic treatment of back pain is a perfect example of how health care expenditures can be reduced while in fact increasing the quality of care. Not only is chiropractic treatment significantly less costly than treatment managed by a medical doctor, but because chiropractic care can get workers back on the job more quickly, it can save business millions of dollars in lost productivity.
Cost/Quality Analysis

· "The overwhelming body of evidence shows that chiropractic management of low-back pain is more cost effective than medical management, and that many medical therapies are of questionable validity or are clearly inadequate ... Chiropractic manipulation is safer than medical management of low-back pain."
The Manga Report, 1993.

· "There would be highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors... Users of chiropractic care have substantially lower health care costs, especially inpatient costs, than those who use medical care only."
The Manga Report, 1993.
Mean Compensation Costs

· "The mean compensation cost (not treatment costs) paid out by the Utah Worker's Compensation Board for patients treated by medical doctors was $668.39; the mean compensation cost paid for patients treated by chiropractic was only $68.38."
Journal of Occupational Medicine, 1991.
"Cost per Case Comparison of Back Injury Claims for Chiropractic vs. Medical Management for Conditions with Identical Diagnostic Code."
Medical Payments

· Total medical costs for back-related injuries cost the Utah Worker's Compensation Board an average of $1,665.43 per case; chiropractic costs for similar diagnoses cost only $775.30.
D.C. Tracts, 1989.
"Cost per Case Analysis of Utah Industrial Back Injury Claims: Chiropractic Management vs. Medical Management for Diagnostically Equivalent Conditions."

· Medical payments for back-related injuries cost the Florida Worker's Compensation Board $1,100 per case; chiropractic treatment for similar diagnoses cost only $558.
ACA Journal of Chiropractic, 1988.
"An Analysis of Florida Worker's Compensation Medical Claims for Back-Related Injuries."
Comparison of Compensation Days

· Of 1,996 low-back pain cases studied, patients receiving chiropractic treatment averaged 6.26 compensation days compared to 25.56 compensation days for medical patients.
Chiropractic Journal of Australia, 1992.
"Mechanical Low-Back Pain: A Comparison of Medical and Chiropractic Management."
The Av-Med Study

This study included 80 patients, each of whom was previously treated by a medical doctor and subsequently referred to the Silverman Chiropractic Center. Of these 80 patients, 21 % had been diagnosed with disc problems, 5% received emergency room treatment and 12% had been diagnosed as requiring surgery.

Following chiropractic treatment, no surgery was required. 86% needed no further treatment at all. And the projected savings on the patient study group was approximately $250,000.
The Av-Med Study, 1993.

CHIROPRACTIC IS LESS COSTLY

"Patients that receive chiropractic care, either solely or in conjunction with medical care experience significantly lower health-care costs."
--Stano/Medstat Research

Miron Stano, PhD, Oakland University, conducted a study comparing the health-care costs for chiropractic and medical patients. The database he used came from the records of MEDSTAT Systems, Inc., a health benefits management-consulting firm which processes insurance claims for many of the country's largest corporations. The database was comprised of 395,641 patients, 42,215 of which were Michigan patients.

After reviewing claims paid over a two-year period, he concluded:

  • Patients, who receive chiropractic care, either solely or in conjunction with medical care, experienced "significantly lower health-care costs... on the order of $1,000 each over the two-year period" than those who received only medical care. Specifically, total insurance payments were $1,138 (30% higher) for those who elected medical care only.

  • The lower costs for chiropractic patients were attributal both to lower in-patient and out-patient costs, and indicated that "chiropractic treatment substitutes for other forms of out-patient care." 

CHIROPRACTIC OFFERS RELIEF

"More than 80% of patients found their expectations for chiropractic care to be met..."
--Gallup Study

A study by the Gallup Organization, reported in March 1991, was conducted to determine the attitudes, opinions, and behaviors of both users and non-users of chiropractic services. Overall, 90% felt that chiropractic health care was effective: more than 80% were satisfied with the treatment they received; nearly 75% felt that most of their expectations were met during the last visit or series of visits; 68% said they would likely see a doctor of chiropractic again for treatment of a similar condition, and 50% would likely be willing to see a doctor of chiropractic for some other problem chiropractors treat.

Nearly 80% of the chiropractic users felt that the cost of chiropractic treatment was reasonable.

Duke University Researchers Determine
Spinal Manipulation is Effective for Headaches (March 2001)

Spinal manipulation may be an effective treatment option for tension headaches and headaches that originate in the neck, according to a new report released by researchers at the Duke University Evidence-Based Practice Center in Durham, NC.

Based on a literature review of several headache treatment options, a panel of 25 multidisciplinary experts concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headaches, or those that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly-prescribed medication.

The report, titled “Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache,” brings to fruition work begun six years ago by an Agency for Health Care Policy and Research (AHCPR) panel. In 1995, that panel was charged with the responsibility of developing evidence-based guidelines on treatment options for headache, but its work was halted before a report was actually printed and disseminated. The new report was authored by Douglas C. McCrory, M.D., MI-ISc; Donald B. Penzien, Ph.D., and Rebecca N. Gray, D.Phil.

It is estimated that 20 to 30 percent of adults have more than one episode of tension-type headache a month. Over 17 percent of those with frequent headache meet diagnostic criteria for cervicogenic headache. Headaches result in a significant number of missed workdays each year and can have an untold negative impact on the personal lives of headaches sufferers.

Spinal manipulation or adjustment is the primary treatment option performed by doctors of chiropractic. In addition, according to the Rand Corp., doctors of chiropractic perform 94 percent of all spinal manipulation in the country.

The researchers at Duke examined the quality research for physical methods, such as acupuncture, cervical spinal manipulation, and physiotherapy, and behavioral methods, such as relaxation, biofeedback, and stress management training, of treating the two types of headache — tension and cervicogenic.

Researchers concluded the following:

“Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity.”

• For tension-type headache, the researchers point to a study that compared manipulation to amitriptyline, a drug commonly prescribed for headache. Said the researchers from Duke, “despite the uniform and relatively low dose of amitriptyline, however, adverse effects were much more common with amitriptyline (82 percent of patients) than with manipulation (4 percent). During the 4-week period after both treatments ceased, patients who had received manipulation were significantly better than those who had taken amitriptyline for both headache frequency and severity. Although amitriptyline is usually continued for longer than 6 weeks, the return to nearbaseline values for headache outcomes in this group contrasts with a sustained reduction in headache frequency and severity in those who had received manipulation.”

“The authors from Duke have conscientiously and methodically resurrected and updated the evidence underlying the behavioral and physical treatment options for headache,” said Anthony L. Rosner, Ph.D., the director of research for the Foundation for Chiropractic Education and Research (FCER). “In so doing, they have recognized the elements of chiropractic management as viable options for treating cervicogenic and possibly tension headache as well. We expect that this will publication gain the appropriate recognition in the healthcare marketplace.”

“This new report helps validate what doctors of chiropractic and their patients have known for decades —that chiropractic adjustments are an effective treatment option for headache sufferers,” said American Chiropractic Association (ACA) President James A. Mertz, DC, DACBR. “As alarming reports about the risks of prescription and over-the-counter drugs continue to surface, the health care community and patients should consider safe and effective non-drug treatments such as chiropractic care.”

This report was produced by the Duke University Evidence-based Practice Center (EPC) that is one of 12 institutions to be awarded the trademark designation “EPC” by the Agency for Healthcare Research and Quality.

FCER Study Determines Chiropractic Offers Long Term Relief For Headache

Chronic tension headache sufferers should consider chiropractic treatment as a long-term solution to their ailment without the side effects of drugs, according to a study funded by the Foundation for Chiropractic Education and Research (FCER). The study found that when six weeks of spinal manipulative treatment by chiropractors was compared to six weeks of medical treatment with amitriptyline, an antidepressant used to control severe headache pain, the chiropractic patients experienced fewer side effects, and the positive effects of chiropractic proved to be longer term, with patients reporting continued relief after the study was completed.

While anecdotal evidence has supported chiropractic treatment of tension headaches for years, until now, there have been no clinical trials that corroborate this reported success. The study that brings scientific support to these claims, "Chiropractic Spinal Manipulative Therapy vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Comparative Clinical Trial," was conducted by Dr. Patrick D. Boline (principal investigator) at Northwestern College of Chiropractic and published in the March/April issue of the Journal of Manipulative and Physiological Therapeutics.

For the study, a total of 126 patients between the ages of 18 and 70 were divided into two groups that were screened and randomly assigned to receive either chiropractic spinal manipulation or pharmaceutical treatment consisting of amitriptyline, a tricyclic antidepressant commonly known by the brand name Elavil. The spinal manipulation group received short-lever, low-amplitude, high-velocity thrust techniques with moist heat and light massage of the cervicothoracic musculature prior to manipulation. Patients were palpated to determine the cervical, thoracic, or lumbar spinal segment to be manipulated with special attention to the upper three cervical segments. The patients in the amitriptyline therapy group received 10 mg daily for the first week, 20 mg daily for the second week, and 30 mg daily thereafter. This dosage was decreased if adverse side effected weren't tolerated by the patient.

During the six weeks that both groups received treatment, both reported similar improvements; however, four weeks after the end of the clinical trial, the superiority of chiropractic treatment was evident. The group receiving spinal manipulation showed a reduction of 32 percent in headache intensity, 42 percent in headache frequency, 30 percent in over-the-counter medication usage, and a 16 percent improvement in functional health status. The group receiving amitriptyline reverted to the levels recorded at the beginning of the study. The groups also differed greatly in their reporting of side effects. While 82.1 percent of the patients who received medical treatment suffered from drowsiness, dry mouth and weight gain, only 4.3 percent of the spinal manipulation group reported side effects consisting of neck soreness and stiffness.

"At last, with the results of this study, the claims of thousands of chiropractic patients who have enjoyed relief from pain without drugs will have to be taken seriously by the medical community," said Stephen R. Seater, CAE, Executive Director of FCER. "At last, chiropractic will be recognized as a viable and scientific alternative for relief of common tension headaches."