Cover of the guidelines for care of LBP patients produced by the AHCPR in 1994

1990s — This decade saw a substantive increase in scientific investigations and the first political dividends from the emerging science of chiropractic. Chiropractic colleges received a few million dollars for research from the National Institutes of Health and the federal Office of Alternative Medicine was established.

At a 1993 meeting of chiropractic clinicians, scientists and politicians at the Mercy Center in California, the first formal consensus guidelines for chiropractic practice were established. The following year, the federal Agency for Health Care Policy & Research (AHCPR) issued its multi-disciplinary guidelines for the treatment of patients with acute low back pain (LBP). Spinal manipulative therapy (SMT) was listed among several conservative methods recommended for this disorder. Chiropractors, it was observed, are estimated to provide 94 percent of all SMT services rendered in the United States.

Randomized, controlled clinical trials (RCTs) of conservative healing methods, conducted and authored by chiropractors, increased in number dramatically and meta-analyses of the dozens of RCTs of SMT proliferated. These achievements had considerable political import for the profession. However, with success came new concerns.

Many chiropractors feared that the validation of SMT for lower back pain would “pigeon hold” chiropractors into a limited, exclusively musculoskeletal scope of practice. Leaders in the chiropractic research community grew alarmed at the over-interpretation of research findings and unsubstantiated claims offered by chiropractic politicians and field doctors.