This major study examined 10, 652 closed cases of patients with back-related injuries who were covered by Florida workers' compensation law to compare chiropractic case management with standard medical case management. The results indicated that the duration of temporary total disability was 51.3 percent shorter for chiropractic patients; the cost of chiropractic service was 58.8 percent lower, and 52.2 percent of medical patient claimants were hospitalized compared to only 20.3 percent of chiropractic patients.

• "There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain."

• Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals.

• "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."

The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report) Pran Manga and Associates (1993) - University of Ottawa, Canada.

On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

The 23 member AHCPR panel was multidisciplinary and consisted of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

Their findings included:

• The risk of serious complications form lumbar spinal manipulation is rare;

• Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention;

• Prescription drugs such as oral steroids; antidepressant medications and colchicines are not recommended for acute low back problems.

Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S., et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) –U.S. Department of Health and Human Services

The government of New Zealand published a 377 page report which assessed the efficacy and safety of chiropractic care. The report was a result of almost 2 years of conducted hearings form recognized health care experts.

Their main findings included:

• "Chiropractors are the only health practitioners who are necessarily equipped their education and training to carry out spinal manual therapy (spinal adjustments)."

• "Chiropractors carry out spinal diagnosis and therapy at a sophisticated and refined level."

• "Spinal manual therapy in the hands of a registered chiropractor is safe."

• "The duration and training of a registered chiropractor are sufficient to enable him/her to determine whether there are contraindications to spinal manual therapy in a particular case, and whether that patient should have medical care instead of, or as well as, chiropractic."

New Zealand Report. Hasselberg PD. Government Printer, Wellington - 1979.