Article · HealthSpine Chiropractic
Back Injuries and Who Patients Saw First: A 2013 Study, Published Here With Its Limits
This study is published here with its limitations attached, so you can read it and judge for yourself. It doesn’t describe what happens in this office. It’s one study, one population. Not a claim about your care here.
The links at the bottom go elsewhere on this site, and some of those pages carry prices and a booking button. Read the study and the limits underneath it, then take both to whoever is treating your back.
What the researchers did, and what they counted
of the Washington State workers in this study whose first provider was a surgeon had low back surgery within three years
of the Washington State workers in this study whose first provider was a chiropractor had low back surgery within three years
The researchers recorded which type of provider each injured worker saw first, then followed the cohort for three years to count how many had low back surgery. Across the whole group, 174 of the 1,885 workers, about 9.2%, had one.
Three reasons this isn’t as simple as it looks
- This is an observational study, not a randomized trial. It shows an association between which provider a worker saw first and whether surgery followed. It can’t prove that the choice of provider caused the difference.
- Workers who saw a surgeon first may have had different injuries to begin with, or more severe ones. The study design can’t fully rule that out.
- Everyone studied was a workers’ compensation claimant who missed enough work to receive wage-replacement benefits for a work-related back injury in Washington State. That group may not look like you or your situation.
This is not a prediction about what will happen with your care at this practice.
Three questions worth asking whoever you see
If you are weighing your options, the useful questions aren’t statistical.
- What did the examination actually find?
- What happens if I wait, and how would I know it wasn’t working?
- What would change the plan?
Ask them of anyone you see, this office included.
What an observational study can show, and where it stops
Start with the word observational. Nobody was assigned to a provider. The researchers wrote down what injured workers already did, then came back three years later to see what had happened. That is a legitimate way to study a question you could never ethically randomize. It is also the reason the finding stops where it does.
A randomized trial answers what happens if we change this? An observational study answers what happened in this group? Only the first one earns the word because.
If a worker with a severe injury was more likely to be sent to a surgeon in the first place, then part of the difference between the two figures existed on day one, before any provider treated anyone. Researchers have statistical tools for that problem. None of them close it completely, which is why the second limitation above is written the way it is.
The summary is narrow: in this population, over these three years, the two groups looked very different, and the reason they looked different is not settled by this paper.
What this study is not being used to say here
Four things.
- It is not a claim that care at this practice prevents, avoids, or reduces surgery.
- It is not a criticism of surgeons or of surgery. Spine surgeons operate on people who need operations. Some back problems are surgical problems, and nothing on this page argues otherwise.
- It is not guidance about who you should see first. That answer comes from an examination of you, not from a table describing other people.
- It isn’t a marketing number. It’s a paper. Go read it.
What it can’t tell you: whether you need surgery
No published percentage knows anything about your back. Yours is a specific problem with its own history, and a cohort of injured workers in Washington State does not contain you.
Some back problems need a surgeon. A few need one soon. If your history or your examination points that way, you should be told so plainly and sent, and that is true whichever door you walked in first.
How to read it yourself
Two numbers sit at the top of this page. They are the two the abstract reports by provider type. The study’s overall surgery rate is printed beside them so you can read them against it instead of on their own.
Three things to look at while you have the abstract open:
- The population, before the result. Who was enrolled tells you who the finding might apply to, and it is the part most people skip.
- The outcome that was actually counted. Here it is whether a lumbar spine surgery happened within three years. Not pain, and not how anyone felt.
- The word associated. Authors use it precisely. It is not a quieter way of writing caused.
Full citation. Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM. “Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.” Spine 2013;38(11):953–964.
Common questions about this study
Does this study mean chiropractic care prevents back surgery?
No. It is an observational study, and an observational study can show an association between which provider a worker saw first and whether surgery followed. It cannot show that one caused the other. Workers who saw a surgeon first may have had different injuries to begin with, or more severe ones. This practice does not claim that care here prevents surgery or makes it less likely.
Who was in the Keeney 2013 back injury study?
The study followed 1,885 Washington State workers who filed a new workers’ compensation temporary total disability claim, meaning wage replacement for lost time, after a work-related back injury. The researchers recorded which type of provider each injured worker saw first, then counted how many had low back surgery over the next three years. Across the whole cohort, 174 of the 1,885 workers, about 9.2%, had one. That group may not look like you or your situation.
Should I see a chiropractor before a surgeon for a back injury?
This study cannot answer that for you, and neither can any single paper. Some back problems need a surgeon, and a few need one soon. Which provider makes sense first depends on your history and your examination, not on a figure drawn from another population in another state. Ask whoever you see what the examination found, what happens if you wait, and what would change the plan.
Where can I read the Keeney study?
The abstract is free to read on PubMed. The citation is Keeney BJ, Fulton-Kehoe D, Turner JA, Wickizer TM, Chan KC, Franklin GM, “Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State,” Spine 2013;38(11):953–964. The figures quoted on this page describe one outcome, whether a lumbar spine surgery happened within three years.
Elsewhere on this site
- All articles from HealthSpine ChiropracticThe rest of what Dr. Koser writes and shares.
- Low back pain in Tampa and CarrollwoodWhat causes it, what the examination tests for, and when imaging is worth doing.
- Back pain, neck pain, and sciatica in Tampa and CarrollwoodHow each one is examined here, and what happens after the exam.
- Car accident injuries in Tampa, and how Florida PIP differsThe workers in this study were covered by workers’ compensation. A crash injury in Florida runs through Personal Injury Protection instead, and the rules are different.
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Dr. Bobby Koser, DC, chiropractic physician. HealthSpine Chiropractic, 10330 N. Dale Mabry Hwy, Suite 205, Tampa, FL 33618, in Carrollwood. Hours: Monday through Thursday, 8:30am to 6:00pm; Friday by appointment only. This page is general health information and is not medical advice for your individual situation. Examination findings and treatment recommendations are individual.