In 1992 the Province of Ontario, Canada found itself with a staggering public deficit of 12 billion dollars. The government-paid health care system was one of the obvious culprits as it accounted for more than one-third of the budget. As a result the government began examining the various components of the health care system in an effort to determine what worked, and what didn't. The Manga Report was commissioned as a comprehensive study of treatment modalities for Low Back Pain because there was a significant body of research to indicate that this was an area of increasing need and vast waste of health care dollars. Low Back Pain (LBP) is most likely the leading cause of disability and morbidity in middle-aged persons, and by far the most expensive source of workers' compensation costs in most area. This report consisted of an unbiased appraisal of the statistics of existing research and literature.

Lead author Dr. Pran Manga, a University of Ottawa health economy professor, reported in The Manga Report that chiropractic care is: cost-effective, safe, has a higher rate of patient satisfaction, and is more effective than medical treatment for low back pain. The findings are as follows:

Spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.

There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of LBP. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (physician-induced) complications for LBP sufferers.

While further study of chiropractic efficacy of chiropractic management of LBP would be prudent, the existing literature reveals that there is a much greater need for clinical evidence of the validity of medical management of LBP. What currently exists indicates that medical therapies for LBP are generally contraindicated. There is also some evidence to suggest that spinal manipulations are less safe and less effective when performed by non-chiropractic professionals.

There is an overwhelming body of evidence to substantiate that the chiropractic management of LBP is more cost-effective than medical management and there is a definite lack of any convincing arguments or evidence to the contrary. Studies show lower chiropractic costs for the same diagnosis and episodic need for care.

There would be a highly significant cost savings if more management of LBP was transferred from medical doctors to chiropractic doctors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually. In addition, workers' compensation studies report that injured workers with the same specific diagnosis of LBP returned to work much sooner when treated by chiropractors rather than by physicians.

There is good empirical evidence indicating that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of low back pain.
Despite the unofficial medical disapproval and economic disincentive to patients (possibly higher private, out-of-pocket cost), the use of chiropractic has grown steadily over the years.

Chiropractic, when compared with these 21 other treatments for low back pain, came out on top—by a lot!
Bed rest
Prescription drugs
Exercise, education and functional restoration
Surgical intervention
Chemonucleolysis (enzyme injection)
Spinal fusion
Lumbar laminectomy
Discectomy (removal of spinal disc)
Denervation (destruction of nerves)
Traction
Electroanalgesia (TENS units)
Heating pads
Diathermy
Ultrasound
Infrared rays
Ice
Soft tissue massage
Back braces
Needle acupuncture
Biofeedback
Psychotherapy