Work Injuries

Work Injuries (3)

Work Related Injuries, Recurring Low Back Pain, Chronic Care and Chiropractic Treatment:

A Proven Solution to Save Federal, State and Private Insurers $2,871,485,223


A report on the scientific literature 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Published in Dynamic Chiropractic 8/26/2011 


Low back pain and its treatment are a worldwide epidemic in human suffering and as a result, an economic burden to federal, state, public and self-insured risk takers who insure the injured. In 2009, Russo, Weir and Elixhauser reported that hospital stays for low back pain were 3.9 out of every 1000 people aged 55-64 years. That was rated as the #8 reason for hospital stays and fell closely behind cardiac conditions and degenerative arthritis. While low back pain has been well chronicled, recurring low back pain and the necessity for chronic care is now beginning to realize results that necessitate the proper approach to mitigate its frequency, duration and economic impact as sequella.

A very significant component of low back patient is its recurrence after initial care has been rendered as well as complications that ensue. Wasiak, Kim and Pransky reported in 2006 that, "Recent studies suggest that acute low back pain evolves into a chronic or recurrent condition more often than previously suspected" (p. 220). They went on to report that 40% of individuals with recurring low back pain sought additional care when the pain recurred and 42.9% of those had continued care and work disability lasting more than 201 days, underscoring the significance of the problem.

According to Dagenais, Caro and Haldeman in 2007, "The economic burden of a disease is the sum of all costs associated with that condition which would not otherwise be incurred if that disease did not exist. Given the many categories of costs that must be considered, it can be challenging to fully estimate the economic burden of an illness as data are often unavailable. The term 'cost' in health economics refers to the value of the consequences of using a particular good or service rather than its price...Despite this example, it should be made clear that estimating the economic burden of a disease is not simply a matter of tabulating the amount reimbursed for all clinician services related to a particular diagnosis. The total cost of illness—or economic burden—has three components: (1) direct (medical and nonmedical) costs; (2) indirect costs; and (3) intangible costs" (p. 9). Although indirect and intangible costs are significant burdens, this paper will focus solely on direct costs.

When considering direct costs for work related claims, studies indicate that non-work related indemnity plans should be included for work related low back injuries. Lipscomb, Dement, Silverstein, Cameron, and Glazner reported in 2009 that, "The private health insurance payment rates for workers with one work-related injury were 40% higher than for those with no history of work injury..." (p. 1188). The reasons are simple; indemnity carriers are victims of many workers' compensation carrier tactics created by the indemnity carriers, as reported by Griffin (2007), to deny, delay and defend. Patients need care and will access any system at their disposal so they can get necessary care and return to a normal, pain free lifestyle, leaving the indemnity carriers to absorb those financial costs. Although this is a significant factor, it is difficult to assign numbers and amounts that are directly tied to work related injuries, although those statistics undoubtedly tally in the billions.

Utilizing the Joint Report to the Governor by New York State Workers’ Compensation Board in 2009 as a reference, in 2004 the total number of claims in New York was 143,667 and out of those claims, 19.3% were low back related. The total costs for treating low back was $579,675,476.96, calculated for inflation to 2011 (Tom's Inflation Calculator, 1997-2011, This equates to $29.88 per resident to treat work related low back pain. Nationally, this equates to $9,262,855,559 based upon US Census statistics.

Cifuentes, Willets and Wasiak (2011) compared the treatment of recurrent or chronic low back pain. They considered any condition recurrent or chronic if there was a recurrent disability after a 15 day absence and return to disability. Anyone with less than a 15 day absence was excluded from the study.

The study concluded that chiropractic care during the health maintenance care period resulted in:

16% Decrease in disability duration of first episode compared to physical therapy

240% Decrease in disability duration of first episode compared to medical physician's care

6.6% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care

17.2% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care

32% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care

21% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care

The study concluded that chiropractic care during the disability episode resulted in:

24% Decrease in disability duration of first episode compared to physical therapy

250% Decrease in disability duration of first episode compared to medical physician's care

5.9% Decrease in opioid (narcotic) use during maintenance care compared to physical therapy care

30.3% Decrease in opioid (narcotic) use during maintenance care compared medical physician's care

19% Decrease in average weekly cost of medical expenses during disability episode compared to physical therapy care

43% Decrease in average weekly cost of medical expenses during disability episode compared to medical physician's care

Based upon the Joint Report to the Governor (2009) and the statistics rendered by Cifuentes et al. (2011), the savings with chiropractic care utilized exclusive from medicine and physical therapy ranges from $1,759,942,556 with physical therapy to $3,983,027,890 with medicine. Understanding that most medical physicians utilize physical therapy as a primary tool for back related pain, we will average the savings to $2,871,485,223 by utilizing chiropractic care.

Cifuentes et. al (2011) started by stating, "Given chiropractors are proponents of health maintenance care...patients with work related Low back pain who are treated by chiropractors would have a lower risk of recurrent disability because that specific approach would be used (p. 396). They concluded by stating, " After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type (Cifuentes et. al, 2011, p. 404).


1. Russo, A., Wier, L. M., & Elixhauser, A. (2009, September). Hospital utilization among near-elderly adults, ages 55 to 64 years, 2007. Agency for Healthcare Research and Quality, Retrieved from

2. Wasiak, R., Kim, J., & Pransky, G. (2006). Work disability and costs caused by recurrence of low back pain: Longer and more costly than in first episodes. Spine, 31(2), 219-225.

3. Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. Spine, 8(1), 8-20.

4. Lipscomb, H., Dement, J., Silverstein, B., Cameron, W., & Glazner J. (2009). Who is paying the bills? Health care costs for musculoskeletal back disorders, Washington State Union Carpenters, 1989-2003. Journal of Occupational and Environmental Medicine, 51(10), 1185-1192.

5. Griffin, D. (2007, February 7). Insurance companies fight paying billions in claims. Anderson Cooper Blog 360°, Retrieved from insurance-companies-fight-paying.html

6. New York State Workers’ Compensation Board (2009, March). Joint report to the Governor, From the Superintendant of Insurance and Chair, Workers' Compensation Board, summarizing and benchmarking workers' compensation data and examining progress on prior recommendations for improvement in data collection, Retrieved from 2009DataCollectionReport.pdf

7. Halfhill, T. R. (1997-2011). Tom's Inflation Calculator. Retrieved from

8. U.S. Census Bureau (2010, December 22). U.S. POPClock Projection, Retrieved from

9. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.



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Published in the 9-9-2010 Dynamic Chiropractic Journal

Work Injuries, Workers Compensation and Chiropractic:

A solution to lowering health care costs in America


A report on the scientific literature 

by Mark Studin DC, FASBE(C), DAAPM, DAAMLP

The cost of healthcare has been such a burden on the economy that it now accounts for 16.2% of the national gross domestic product (GDP) in 20081. Congress, along with President Obama, has recently enacted a health care reform bill that addresses many issues in the health care reform arena that will ensure every American has health care coverage. Leaving politics aside, there is a potential that the percentage of health care costs in the GDP will rise.
With mushrooming annual budgets that include multi-billion dollar shortfalls, most individual states are now pressured to cut costs and prevent unnecessary spending. One of the largest areas of expenditure in every state’s budget is health care through workers compensation and Medicaid. If those governments put politics aside and look at the hard numbers, they will see chiropractic as a solution. It appears that chiropractic care has continued to be a political football and has been seen as a scapegoat to many of our states’ health care financial problems.
One political argument in California during the quest to remove chiropractic from the workers compensation system was that chiropractors pander to lawyers who want higher fees to win their cases. This detractor, an MD with a long anti-chiropractic history should realize, as should the California legislature, that there will always be a certain number of unscrupulous people in any system and that number is equal among medical doctors and chiropractors alike. The problem is that this should not be a political argument. It should be guided by the statistics alone and the metrics of health care outcomes and the financial savings should be solely judged.
As to the health care metric, that argument is long over, as chiropractic has been proven effective and a topic long laid to rest. The cost metric has to go beyond the simple office visit to the orthopedist or medical back care provider. The real costs accrue cover the medical office visits and the drugs which are often used over a lifetime and consequently, one must often deal with the addiction to the narcotics. The metric covers durable medical equipment, physical therapy and all of the associated ancillary requirements followed by the surgeries and high cost of hospital stays. Then we need to account for the lifetime of disabilities that could have been avoided. Every one of those costs needs to be accounted for.
With that being said, there are many times medical intervention and all of its wonderful tools are needed because no one doctor can care for every ailment. However, the progression of treatment should be drugless first, drug administration used second and surgery as a last resort. In states like California, the less expensive, largest, most effective drugless option is no longer available to its residents. In other states like New York, the reimbursement is so low that chiropractors are emigrating from the state in alarming numbers, leaving a void for injured people to seek appropriate care and lower the cost of health care reducing the financial burden to the NYS workers compensation system.
An obvious pragmatic strategy would be utilizing services for injured workers that have been proven to be more effective at lower costs. Past history would suggest that if such a method was identified, tax credits or other incentives could be offered to ensure workers received this care, thereby reducing costs to the system and creating a more competitive business environment.
Chiropractic care has been shown repeatedly in government and private studies conducted around the world to be more effective at helping injured workers return to work faster at significantly lower costs. (See Table 1.)
Samples of research showing the effectiveness and reduced costs of chiropractic care for spinal-related injuries and conditions.


UtahWorkers  Compensation Board
Total treatment costs for back-related injuries averaged $775.30 per case when treated by a chiropractor; $1,665.43 when injured workers
received standard medical treatment.
North Carolina Workers Compensation Patients3  
Average medical care cost for lumbosacral sprain was $3,425, but only $634 when treated with chiropractic.
Ministry of Health,
“Inured workers…diagnosed with low-back pain returned to work much sooner when treated by chiropractors than by physicians."
The American Journal
of Managed Care5
The cost of healthcare for back and neck pain was substantially lower for chiropractic patients than medical care ($539 versus $774).
Medical Care Journal6  

  1. The mean total payments were lower for chiropractic care ($518) versus medical care ($1020).
  2. Favorable satisfaction and quality indicators suggest that chiropractic deserves careful consideration in gate keeper strategies adopted by employers and third-party payers to control health care spending.
Universityof Ottawa7  

  1. Chiropractic treatment was significantly more effective than hospital outpatient treatment, especially in patients with chronic and severe back pain. Significantly fewer patients needed to return for further treatments at the end of the first and second years in those who received chiropractic care (17% compared with 24%).
  2. Highly significant cost savings if more management of low-back pain was transferred from physicians to chiropractors.
OaklandUniversityStudy8 Health insurance claims for 395,641 chiropractic and medical care patients concluded patients who receive chiropractic care, solely or in conjunction with medical care, experienced significantly lower health care costs compared with those who received only medical care. Total insurance payments were 30% higher for those who elected medical care only.
of Virginia9
By every test of cost and effectiveness, the general weight of evidence shows chiropractic to provide important therapeutic benefits, at economical costs. Additionally, these benefits are achieved with apparently minimal, even negligible, impacts on the costs of health insurance.
FloridaWorkers Compensation Board10  
Of 10,652 back-related injuries on the job, individuals who received chiropractic care compared with standard medical care experienced had a (i) 51.3 percent shorter temporary total disability duration (ii) lower treatment cost by 58.8 percent ($558 vs. $1,100 per case) (iii) 20.3 percent hospitalization rate in the chiropractic care group vs. 52.2 percent rate in the medical care group.
Australian Workers Compensation Study11  
Individuals who received chiropractic care for their back pain returned to work 4 times faster (6.26 days vs. 25.56 days) and had treatment that cost 4 times less ($392 vs. $1,569) than those who received treatments from medical doctors.
VU Medical Center Extramural Medicine12  
Total costs of manual therapy (447 Euro) were around one third of the costs of physiotherapy (1297 Euro) and general practitioner care (1379 Euro) for neck pain.
Journal of Manipulative Physiological Therapy13  
For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.
As a result of these studies and many more nationally and globally, governments, both federal and state, should be offering tax incentives for our brightest young minds entering the health care educational arena to become chiropractors and urging every injured citizen of the United States to be under chiropractic care because it works and saves the system money. The hard part is getting the legislators to see through the special interests to the facts. Fair and equitable access and reimbursement to chiropractors serves the needs of the millions of chiropractic patients nationally as well as affording fiscal savings for the government.  It is also in the best interest of all to keep the existing chiropractors and encourage new chiropractic practices in the business place.
It’s not the chiropractors who want to be treated different; it’s the people who are being denied the care they need and the government who is epitomizing the adage of being “penny wise and billions of dollars foolish.” These studies and more indicate that chiropractic saves every system in the world money by having a prominent place and if governments put rhetoric aside and opened their eyes, they would fight to lower the GDP by offering incentives to any injured person who sought chiropractic care.

  1. The Henry J. Kaiser Family Foundation. U.S. Health Care Costs. Retrieved from
  2. Jarvis, K. B., Phillips, R. B., Morris, E. K. (1991, August). Cost per case comparison of back injury claims of chiropractic versus medical management for conditions with identical diagnostic codes. Journal of Occupational Medicine, 33(8), 847-852.
  3. Devitt, M. (2004, November 18) Work comp study: chiropractic less expensive, more effective than medical care.Dynamic Chiropractic,22(24). Retrieved from
  4. Meade, T. W., Dyer, S., Browne, W., Townsend, J., & Frank, A. O. (1990, June 2). Low back pain of mechanical origin: randomized comparison of chiropractic and hospital outpatient treatment.British Medical Journal, 300(6737),1431-1437.  
  5. Mosley, C. D., Cohen, I. G., & Arnold, R. M. (1996, March).Cost-effectiveness of chiropractic care in a managed care setting.The American Journal of Managed Care, 2, 280-282.
  6. Stano, M. & Smith, M. (1996, March). Chiropractic and medical costs of low back pain. Medical Care, 34(3), 191-204. 
  7. Manga, P., Angus, D. E., Papadopoulos, C. & Swan, W.R. (1993, August). The effectiveness and cost effectiveness of chiropractic management of low-back pain. Retrieved from 0/Manga_report_summary%5B1%5D.pdf
  8. Stano, M. Stano/Medstat Research. Retrieved from pages/rightpages_allaboutchiro/research/research_costeffectiveness.html
  9. Dean, D. H., Schmidt, R. M. (1992, January 13). A comparison of the costs of chiropractors versus alternative medical practitioners.Retrieved from costeffectiveness.html
  10.  Wolk, S. (1988). An analysis of florida workers’ compensation medical claims for back related injuries. Retrieved from rightpages_allaboutchiro/research/research_costeffectiveness.html
  11. Ebrall, P.S. (1992). Mechanical low-back pain: a comparison of medical and chiropractic management within the victorian work care scheme.Chiropractic Journal of Australia 22, 47-53.
  12. Korthals-de Bos I. B. C., Hoving J. L., van Tulder, M. W., Rutten-van Molken M. P. M. H., Adèr, H.J., de Vet, H. C. W., Koes, B. W., Vondeling, H., & Bouter L. M. (2003, April 26). Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.British Medical Journal, 326(7395), 911.
  13. Nelson, C.F., Metz, R.D. & LaBrot, T. (2005, October). Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain.Journal of Manipulative Physiological Therapeutics,28(8), 564-569.

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Work Injuries, Full Recovery and Chiropractic Care

Resolving the myth that doing nothing is better

A report on the scientific literature 

William J. Owens DC, DAAMLP


Thousands of people have realized the benefits of receiving chiropractic after a traumatic injury at work.  Many of the things we are employed to do often cause injuries to the neck or the lower back.  This can include repetitive lifting, bending, twisting and sitting at a desk or computer for a prolonged period of time.  It is incorrect to assume that because your are lifting car engines or leaning over a desk for 8 continuous hours that you can’t hurt your back.  There is a term called “creep” that is used to describe a profound effect on the health of your spine and joints.  In this case, "creep" refers to the change in shape one experiences as a result of constant stress, and is similar to pulling slowly and steadily on a bar of salt water taffy.  If you were to do this for a while, the taffy would stretch and be reluctant to return to its original position.  That is why postural trauma, such as sedentary work or driving for long distances, can have negative consequences over time. 
A doctor of chiropractic is trained to evaluate this type of condition as well as injuries to the spine that result quickly from a single incident.  Both can have profound negative effects on your body and can cause pain and loss of function. Proper treatment for work related injuries is critical to returning to work in a timely manner and preventing recurrence.  Although pain is an important part of the evaluation process of work related injuries, functional status (the ability to carry out one's activities)2 is equally important; you need to be out of pain and be able to do what you want and need to get done without any limitations.  Your chiropractor wants you to get you back to your normal routine as quickly as possible and should then work with you to stay that way.
In a recent research paper published in 2009, the authors stated, “Over the last 15 years, the percentage of pre-retirement disabled US workers has increased from 5% to 9% such that more people receive disability income than are unemployed.” (Aspegren et al., 2009, p. 765).  This has tremendous implications on the workforce, productivity of businesses and your ability to earn a living.  The data for the study was listed by the authors as records containing 249 patients ranging from the age of 18 to 65 years (mean = 38.3 years, SD = 10.7 years, 84 women) with dates of service ranging from January 1, 2003 to December 31, 2006.  These were retrospectively analyzed (
100 records were used).  Based on date of injury to first date of chiropractic care, the cases were subdivided into acute (0-21days), subacute (22-90 days), and chronic (>90 days) injured workers.3
One powerful conclusion of the research was that workers in the acute or subacute groups had better treatment scores than patients with a chronic condition.  This indicates that the sooner the patient received chiropractic treatment, the better the outcomes.  Access and treatment is the key to long term success in the workforce.

MYTH: Problems resolve themselves
The idea that lower back pain has a “natural history” and will resolve on its own has been recently challenged in the scientific literature.  Several papers have reported actual statistics. “Hestbaek et al, Carey et al, and later Nicholson and Jonsson who describe how acute low back pain becomes chronic or recurrent more frequently than previously suspected. Jayson expanded on these concerns, noting at 3 months that the natural history prognosis [allowing it to get better on its own] for patients having experienced an acute episode of low back pain was as follows: 27% were completely better, 28% improved, 30% had no change, and 14% were actually worse”
(Aspegren et al., 2009, p. 768).  The idea that pain in your lower back gets better is actually a myth; the results show that 75% of participants actually had pain that continued and 44% had no change or got worse.  Thinking it will go away is just not a good idea.3
The conclusion of this study was, “Patients recorded improvement in functional scores and subjective response involving work-related spinal injuries.  Improvement was noted in all 3 time-based phases of patient status (acute, subacute, and chronic)"
(Aspegren et al., 2009, p. 770).  Therefore, when you have a work related injury, although care is most effective when you see a doctor of chiropractic as soon after the injury as possible, patients seeking care 90 days or greater after the injury will still receive tremendous benefit from chiropractic care. In other words, the sooner you see a doctor, the better chance you have of recovery, but better later than never.

Being cared for by a doctor of chiropractic is an essential and effective way to decrease pain and increase function.  Full recovery from a work related injury and the assurance that you will be able to continue your job, with no limitations, is everyone’s goal. The doctor of chiropractic works with both you, the patient, and your employer to ensure that you do recover and are able to return to work, with as little disability time as possible, functioning in your full capacity with no limitations.


1.  LoveToKnow, Corp. (n.d.). Creep definition, Retrieved from

2.  Clauser, S. B., & Bierman, A. S. (2003, Spring). Significance of funcational status data for payment and quality. Health Care Financing Review. Retrieved from
3.  Aspegren, D., Enebo, B. A. , Miller, M., White, L., Akuthota, V., Hyde, T. E. , & Cox, J. M. (2009). Functional scores and subjective responses of injured workers with back or neck pain treated with chriopractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics, 32(9), 765-771.

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