The importance of musculoskeletal
health problems
Up to 30% of all GP consultations relate to
musculoskeletal problems, and this area
accounts for a £230m yearly burden on the
health economy. This is dwarfed, however, by
the impact on the wider economy – each year
neck and back pain lead to nearly 11 million sick
days off for workers in England.
(http://healthandcare.dh.gov.uk/back-and-neck-pain-services)
NICE low back pain guidance outline
Guidance
for early treatment and
management of persistent or recurrent low
back pain, defined as non-specific low back
pain that has lasted for more than 6 weeks,
but for less than 12 months
NICE low back pain guidance principles of management
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Keep diagnosis under review at all times
Promote self-management
Offer drug treatments as appropriate
Offer one of the following treatment
options ….
Treatment options
• Exercise programme
• Course of manual therapy
• Course of acupuncture
Manual therapy
• To include spinal manipulation
• Up to 9 sessions over up to 12 weeks
• Care can be delivered by:
• Chiropractors
• Osteopaths
• Physiotherapists with postgraduate training in
manipulation
What is chiropractic?
• Chiropractic is a profession, not a treatment
• Chiropractors provide a package of care including
biopsychosocial assessment
• Chiropractors take a detailed case history and perform a
thorough diagnostic examination, which considers all aspects of
the presenting complaint
• Package of care may include physical treatments drawn from all
types of manual therapy as well as spinal manipulation,
exercise, muscular therapies and a range of advice on activity,
lifestyle and prevention
The chiropractic profession
• Chiropractors Act (1994)
• Statutory regulation (GCC) with mandatory CPD
• The Royal College of Chiropractors (2012)
Case Study: Manual Therapies Back and
Neck Service - NHS North East Essex
(http://healthandcare.dh.gov.uk/back-and-neck-pain-services)
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NHS North East Essex wanted to provide greater choice, easier access
and shorter waiting times for patients suffering back and neck pain
and at the same time address the unsustainably high demand on local
spinal services
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In 2008, all existing providers were contacted and invited to bid to
offer patients these services
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Patients chose from 20 different providers of chiropractic, osteopathy
and physiotherapy based throughout the Colchester and Tendering
area. There were four chiropractic, five osteopathy and 11
physiotherapy providers to choose from and they all meet NHS
standards and agreed prices. Patients were given an appointment
within two weeks and received up to four treatments
NHS North East Essex: Outcomes
• During 2009/10, 2,810 patients used these
services and 97% of patients were seen within
two weeks of referral
• Providers work to locally agreed common
referral and clinical protocols and whilst there
is competition, there is also cooperation
between individual providers and disciplines
to ensure service integration for patients
NHS North East Essex: Outcomes
• Evaluation after the first 12 months of offering patients a choice
of any qualified provider has identified improved patient access
and choice meaning early treatment and improved outcomes;
and reduced primary care consultations, imaging, medication
costs and inappropriate referrals to secondary care. Referrals
to spinal surgeons have reduced by more than 25%.
• In 2009, this approach to offering chiropractic, osteopathy and
physiotherapy services to treat back and neck conditions was
awarded the NHS Alliance ‘Acorn Award’ for alternative therapy
• A similar service continues under the Any Qualified Provide
(AQP) model
Chiropractors don’t only treat back pain
Although the evidence for back pain is the most compelling, the following are conditions that
chiropractors routinely encounter and treat, and for which RCT evidence indicates effectiveness
of chiropractic care:
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Cervicogenic dizziness
Cervicogenic headache
Frozen shoulder (adhesive capsulitis
Hip osteoarthritis
Knee osteoarthritis
Migraine headache
Patellofemoral pain syndrome
Plantar fasciitis
Sciatica / radiating leg pain
Shoulder girdle pain / dysfunction
Tennis elbow
(Bronfort et al, 2010: http://www.biomedcentral.com/content/pdf/1746-1340-18-3.pdf)