Chiropractic Confirmed More Effective than PT for Acute LBP

Reviewed by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists
Diplomate, International Academy of Neuromusculoskeletal Medicine

Chiropractic: The First Choice

In the recent paper published by Bise et al. in the Physical Therapy and Rehabilitation Journal [1], the authors performed a retrospective analysis focusing on 29,806 patients seeking care for a new episode of lower back pain.

The authors concluded that the initial utilization of chiropractic care and physical therapy in the treatment of acute lower back pain appears to decrease in immediate and long-term utilization of healthcare resources.

Chiropractic Benefits?

The authors did not provide due credit to the overall benefit of chiropractic care when compared to PT. Their abstract and conclusions do not reflect this important distinction.

The Results

Substantial benefits are realized when chiropractic is the initial point of care. [1]:

Episode Length (Days/Median):

  • Chiropractic: 35
  • Physical Therapy: 37

Low Back Costs (Median):

  • Chiropractic: $431.70
  • Physical Therapy: $851.83

Total Cost of Care (Median):

  • Chiropractic: $3,334.08
  • Physical Therapy: $5,716.24

CT/MRI (Frequency):

  • Chiropractic: 3%
  • Physical Therapy: 9%
  • PCPs or Surgeons: 49%

Injections (Associated Frequency):

  • Chiropractic: <5%
  • Physical Therapy: 15%
  • Medical Specialists: 55%

Opioids (Prescription Rates):

  • Chiropractic: <5%
  • Physical Therapy: 11%
  • Specialty Care: 39%
  • Emergency Department: 55%

Surgery (Progressed to Surgery):

  • Chiropractic: <1%
  • Physical Therapy: >1%
  • Emergency Department: 4%
  • Specialty Care: 7%


Bize et al. provide, “compelling evidence that the first provider seen for an acute episode of LBP influences the trajectory of a specific patient episode and future health care utilization.” [1]

Their evidence indicates that chiropractic care alleviates symptoms and reduces cost in the treatment of acute LBP, reducing opiate utilization with associated morbidity/mortality, and surgical rates better than PT.

Chiropractic physicians should be the initial point of contact prior to PT and other providers for neuromusculoskeletal complaints.


  1. Christopher G Bise, PT, MS, DPT, and others, First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization, Physical Therapy, 2023;, pzad067,


The views and opinions expressed in this presentation are solely those of the author. The information is not offered as a standard of care as research and care evolve. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.

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