A recent piece published in the European Journal of Integrative Medicine has taken a novel look at the potential offerings when it comes to manual therapy modalities and the workforce. Specifically, the study looked at how manual therapy (including spinal manipulation) might impact upon absenteeism and presenteeism in the workforce. While chiropractic research is commonly focused on either the resolution of musculoskeletal disorders or the effects of subluxation on things like strength, balance, mental performance or other brain-based functions, this paper represents an interesting move into the broader potential applications of chiropractic care.

Absenteeism is generally defined as employees calling in sick to work, and presenteeism usually refers to the amount of people attending work despite being sufficiently unwell to take leave. Both can represent a large cost to businesses and economies as productivity takes a dive if employees are unable to perform their jobs due to illness.

That’s where the paper in question comes it. It was published in December 2019, and took a look at the impacts of musculoskeletal disorders on these aspects of workforce. Research currently indicates that issues like chronic low back pain, neck pain, work-related upper limb disorders, and repetitive strains are the leading cause of absenteeism in European workplaces [1].

It is thought that the cause of these work-related issues stem from the repetitive and sustained use of keyboards and mice, poor posture, or issues relating to heavy lifting. There is already a plethora of research out there that indicates excessive sitting is a health concern, and with the number of desk-based jobs across the world and an increase in sedentary lifestyles, it stands to reason that this could become an issue for employers.

Such occupational health issues in the workforce can, and commonly do, result in increased absenteeism, presenteeism, lower levels of motivation, and reduced productivity. This further reduces productivity, and overall performance of individuals and their mental health. Presenteeism has been suggested to be 1.5x more costly to an employer than absenteeism [1].

So where does chiropractic care come in?

The study in question was a literature review of “the prevalence of work-related musculoskeletal disorders to identify the efficacy of spinal manipulation and mobilization techniques commonly employed by manual therapists to manage common musculoskeletal disorders.”

While the body of evidence was far from extensive, it did form the basis of an argument that perhaps employers would benefit from onsite delivery of manual therapies in order to prevent and treat work-related musculoskeletal issues.

It’s a novel approach, both in terms of the delivery of chiropractic and other manual therapies and in terms of occupational health and safety considerations at work. It is certainly a thought worth further investigation beyond an opinion paper and literature review. Still, the paper did yield some interesting findings.

The authors found that:

  • Chronic musculoskeletal pain remains undiagnosed in up to 42% of adult cases.
  • Traditional biomedical interventions seem to be frequently ineffective in dealing with musculoskeletal injuries (nonspecific back pain).
  • The risk of developing comorbidities such as fatigue, depression, and anxiety can further increase rates of absenteeism and presenteeism. 
  • Early intervention allows for early action and quicker self-reliance by actively managing their condition. This speeds up the return to work and normal daily life.
  • Systematic review and meta-analysis of early interventions to promote work participation (patients with chronic pain) showed a reduction in absenteeism of over 50% and a reduction on the development of comorbid mental illnesses.

Overall, it paints a picture of manual therapies as a “positive health at work” strategy when used as an intervention or part of the occupational health strategy.  For the sake of the paper, manual therapy was defined as ‘Working the musculoskeletal system with specialised techniques that aim to reduce pain, improve movement and encourage blood flow.”  Two trials referenced in the paper found that spinal manipulation specifically was found to be a cost effective addition to caring for back pain (UK BEAM trial) and a confident recommendation can be made to treat low back pain and neck pain (Bronfort et al.) [1].

The authors stated that, “Reviews of the literature show that manual therapy treatments in the workplace have an overwhelmingly positive effect on decreasing work-related injuries and MSDs [musculoskeletal disorders], therefore increasing work productivity and worker satisfaction leading to a decrease in absenteeism and presenteeism. Also, the cost-effectiveness of including manual therapists in occupational health services is supported by data.

It is certainly an interesting paper, and with interesting timing given the challenges faced by organisations during and post Covid19. As the world of work adapts to the challenges of a global pandemic, this becomes an interesting consideration for employers looking to protect their employees and increase productivity.

The paper was limited in that it was only a literature review that couldn’t test any clear “cause and effect” relationships. Still, it gives good context and considerations, especially in relation to spinal manipulation which we know is the heartland of chiropractors. Further research is needed, but it still represents an interesting consideration for chiropractors and employers alike. 


Rodrigues dos Santos BM, Mendes C. Manual therapy and its role in occupational health: Reducing absenteeism and presenteeism by treating chronic pain with spinal manipulation and mobilization in the workplace. European Journal of Integrative Medicine. 2020;35:101078. doi:10.1016/j.eujim.2020.101078


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