Integrating Chiropractic Care with Other Doctors

In an effort to document emerging standards of chiropractic care, the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) recently polled a panel of leading chiropractors, who reached 80% consensus on some statements regarding chiropractic manipulation.1

While many of these consensus statements have already been detailed in this article, this section reviews some other relevant chiropractic standards that are worth noting.

Chiropractic Standards of Practice

Some generally agreed upon statements about chiropractic include the following:

  1. The ultimate goal of chiropractic care is to improve patient functionality and provide patients with the education to improve their back pain on their own. In other words, chiropractors should focus on reducing the frequency of treatments to a point where patients can independently achieve therapeutic relief of their back pain, specifically via individual strengthening, range of motion and rehabilitation exercises.
  2. It is vital that initial therapeutic trials are reexamined to gauge the effectiveness of chiropractic treatments and determine the next step in chiropractic care.
  1. In order to achieve the preceding point, there needs to be accepted measurements to compare, contrast and determine chiropractic effectiveness. In addition to spinal range of motion assessments, some suggested outcome measurements included:
    • Pain scales (such as the visual analog scale, numeric rating scale)
    • Pain diagrams (allowing the patient to depict lower back pain location and symptoms)
    • Validated activities of daily living measures (like the Oswestry Back Disability Index, Roland Morris Back Disability Index, RAND 36, Bournemouth Disability Questionnaire, etc.)
    • Increases in home and leisure activities, exercise, work capacity
    • Decreases in work restrictions
    • Improvements in lifting capacity, strength, flexibility, endurance, etc.1
  2. Chiropractors should refer patients to other practitioners or emergency care when the following takes place:
    • There is no response to chiropractic treatment, and all other alternative chiropractic avenues have been used
    • The patient’s lower back pain has worsened with treatment
    • The patient has a serious or progressively worsening infection
    • There are increasing neurologic deficits (cauda equina syndrome)
    • The patient experiences a medical emergency.1

Integration of Chiropractic Care

In addition to continually defining its emerging standards, it’s important that chiropractic continues to cooperate with the various health professions that treat low back pain. When appropriate, chiropractors may need to refer patients to other practitioners or work in tandem with these professionals when treating lower back pain.

While most chiropractors work solo or with other chiropractors, some have already begun to integrate with other health care professionals to offer more comprehensive treatment of back pain. This integration can be achieved either through a referral network, or by working together in a multi-disciplinary or multi-specialty spine clinic.


  • 1.Globe G, Morris C, Whalen W et al. Chiropractic Management of Low Back Disorders: Report from a Consensus Process. Journal of Manipulative and Physiological Therapeutics November/December 2008: 651-658.