Some people visit internists, neurologists, orthopedists, osteopaths, or physical therapists.
That recommendation increases the likelihood that physicians will refer more people to chiropractors, who already provide most of the manipulative therapy delivered in the United States. For that reason, a RAND research team, led by Paul Shekelle and Ian Coulter, set out to determine the appropriateness of decisions by chiropractors to use spinal manipulation to treat low back pain. Based on a review of chiropractic office records from six sites across the United States and Canada, combined with ratings from a panel of back experts and reinforced with a literature review, the research produced somewhat encouraging results. Chiropractic decisions to use spinal manipulation were deemed appropriate 46 percent of the time, a proportion similar to conventional medical procedures studied previously. Spinal manipulation was judged inappropriate for 29 percent of those who received the treatment, a proportion the researchers say should be reduced.