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Why Choose Chiropractic First?

An advantage Iowans have over some other areas of the country is the ability to seek chiropractic care without a referral, which in turn means less barriers to access chiropractic care. This is due to our designation as a portal of entry provider. This is for good reason too, as a study from February 2022 investigated the escalation of care for Medicare patients with chronic low back pain between those who sought chiropractic care initially versus those who went down the path of opioid analgesics.

Escalation of care for the purposes of this study was defined as: hospitalizations, emergency department visits, advanced imaging, specialists visits, low back surgery, interventional pain medicine techniques, and other encounters for potential complications related to chronic low back pain (1). The results of this study found that patients who initiated care with opioids were over 2.5 times more likely to have escalated care encounters than those who initially sought chiropractic care. This aligns with previous studies which also found chiropractic care is associated with decreased opioid usage and that early use of spinal [adjustments] may reduce unnecessary escalation of care, with both greater efficiency and lower costs (2,3).

Hopefully now it makes a little more sense why patients can visit a chiropractor without first having a referral from another provider. If you were unsure about the necessary route needed to seek chiropractic care, hopefully this helps answer your questions. If there are still some lingering questions regarding access to chiropractic care or if chiropractic could help someone you know, please reach out to our office!


  1. Whedon, J. , Kizhakkeveettil, A. , Toler, A. , Bezdjian, S. , Rossi, D. , Uptmor, S. , MacKenzie, T. , Lurie, J. , Hurwitz, E. , Coulter, I. & Haldeman, S. (2022). Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries. SPINE, 47 (4), E142-E148. doi: 10.1097/BRS.0000000000004118.

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