On-Site Chiropractic Services

Anheuser-Busch is the world’s leading brewing company. One of their wholesalers, Brewers Distributing, is located in Peoria, IL. Many of their employees spend most of their time moving around heavy cases and kegs of beer. “Having noticed a large number of workers compensation cases due to lifting-related injuries, the company decided to introduce several workplace wellness programs to prevent these injuries from occurring in the first place. One of these programs involved weekly, on-site chiropractic visits, free of charge to any employee.” The chief financial officer at Brewers Distributing believes that on-site chiropractic has given his employees the greatest benefit.

The on-site chiropractic services at Brewers Distributing are provided by a young, new graduate chiropractor, who is also establishing his practice in Peoria. He works on-site at Brewers Distributing on Thursdays. The cost to the employee for this on-site chiropractic care is free (the doctor is paid by Brewers Distributing). If an employee needed help outside of that weekly window of time, they can visit the doctor in his office.

The strategy at Brewers Distributing is that by treating minor musculoskeletal problems their employees develop, they are preventing such problems from developing into a serious injury that would need to be covered by workers’ compensation. The view is that it is a win-win-win situation, a strategy that benefits the employee, which reduces costs, which benefits the employer.

The author of the article, Annie Locke, notes (1):

“While some business owners and administrators might dismiss such a program as too expensive, it has actually saved Brewers a significant amount of money. In the two years since it was implemented, the number of employee sick days has declined by 22 percent, while the accident rate has been cut in half. Consequently, the company’s workers’ compensation costs have experienced a dramatic reduction, with premiums declining by more than 25 percent.”

“With that in mind, Brewers has encouraged others to adopt similar programs. At a recent industry conference, the company’s on-site chiropractic program was recognized as a ‘best practice’ among the hundreds of attendees. Katie Waddington, human resources manager, presented information about the program at the conference. ‘A lot of people at first think, Oh my goodness, that costs to have a chiropractor in your facility!’ But when you really look at the numbers… it makes sense. We have the return on investment and the statistics to prove it.’”


One hundred sixteen million (116,000,000) Americans suffer from chronic pain (2). Their pain is distributed as follows (3):

Low Back Pain 28.1%

Knee Pain 19.5%

Severe Headache/Migraine 16.1%

Neck Pain 15.1%

Shoulder Pain 09.0%

Finger Pain 07.6%

Hip Pain 07.1%

Back pain, neck pain and severe headache/migraine comprise some of the most prevalent chronic medical problems in America. Back and neck pain are found among approximately 25% of the US population aged 18 to 44 years and 33% of the US population aged 45 to 64 years. Severe headaches or migraines are found in approximately 20% of the population aged 18 to 44 years and 15% aged 45 to 64 years (4):

Back Pain


Neck Pain

Severe Headache



18-44 years



45-64 years



The direct costs in the United States for the treatment of back and neck pain are escalating (5):

Back problems are the second most common cause of disability in the United States, accounting for tens of billions of dollars in lost wages (6).

Chiropractic care has a proven record as an effective treatment for back pain, neck pain, and headache. A few such examples are briefly presented here:


Chiropractic care offered at an on-site health center has the potential to reduce the economic costs and the clinical burden of musculoskeletal conditions.

Searching the National Library of Medicine using the “PubMed” search engine with the key words “on-site chiropractic” two pertinent articles are found, and reviewed below.

Value of Chiropractic Services at an On-Site Health Center

Journal of Occupational and Environmental Medicine

August 2012; Vol. 54; No. 8; pp. 917-921

Curt A. Krause, DC, Lisa Kaspin, PhD, Kathleen M. Gorman, MPH, Ross M. Miller, MD, MPH (17)

Chiropractic care has been demonstrated to be an effective treatment for back pain, neck pain, and headache. This study is a retrospective claims analysis and clinical evaluation that was performed to assess the influence of on-site chiropractic services on health care utilization and outcomes. It may be the first study to evaluate the impact of chiropractic when offered at an on-site [work place] health center.

The on-site health centers’ mission was to enhance patients’ health, promote patient satisfaction, increase productivity, and decrease absenteeism by delivering convenient and excellent care in a high-tech work place environment. Utilization of on-site chiropractic services offers patients more convenient care than they would receive off-site. Given the convenience and quality of care provided by on-site health centers, it was hypothesized that on-site chiropractic care would be more beneficial than off-site clinic care.

To determine the effectiveness of the on-site chiropractic care, patients were asked to complete functional-assessment questionnaires appropriate to their care:

Patients with headache, neck pain, and low back pain who were treated with chiropractic on-site showed significant improvement in both pain and functional status:

Efficacy of On-site Chiropractic Care in Functional Status


Percent Improvement

Headache Disability Index



Neck Pain Disability Index



Oswestry Low Back Pain Questionnaire



Research has shown that functional improvements resulting from chiropractic care increase the ability to perform work-related activities.

In claims for musculoskeletal injuries treated by medical doctors and chiropractors, treatment by chiropractors, resulted in fewer lost workdays and lower workers’ compensation payment. There is evidence that patients with chiropractic coverage will directly substitute chiropractic care for medical care. Chiropractic patients have lower utilization of ancillary medical services.

Patients treated at the off-site chiropractic office were significantly more likely to have a physical therapy visit and an outpatient physician visit. Patients in the on-site chiropractic group had lower odds of having a physical therapy visit and also had fewer physical therapist visits. In this study, “patients receiving chiropractic care on-site were less likely to have a physical therapy visit and outpatient [physician] visit.”

These authors made these following points:

“Chiropractic care offered at an on-site health center could reduce the economic and clinical burden of musculoskeletal conditions.”

“Patients treated off-site were significantly more likely to have physical therapy and outpatient visits. In addition, the average total number of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group.”

“These results suggest that chiropractic services offered at on-site health centers may promote lower utilization of certain health care services, while improving musculoskeletal function.”

“The average total numbers of health care visits, radiology procedures, and musculoskeletal medication use per patient with each event were significantly higher for the off-site group.”

“Significant reductions in all functional assessment measures were observed, suggesting that the cohort experienced substantial improved functional status for all the three musculoskeletal conditions.” “Further evidence of the on-site chiropractic care’s effectiveness is the change in patient- reported functional status after treatment. That is, over the study period, there was a statistically significant decrease in the average HADI, NPDI, and OLBQ scores.” “These findings confirm that on-site chiropractic care successfully improved patients’ daily functioning.”

“Compared with alternatives, including physician visits, hospitalizations, and surgery, chiropractic care is considered a cost-effective treatment.”

“[Treatment with] on-site chiropractic services was associated with lower utilization of certain health care services, as well as improved functional outcomes.”

“The results of this study support the value of chiropractic services offered at on-site health centers.”

In this study, “the average total numbers of health care visits, radiology procedures, and musculoskeletal medication use per associate with each event were significantly lower for the on-site [chiropractic] group.”

These authors suggest that on-site chiropractic care is used as an alternative to off-site physical therapy and physician care. “Lower health care utilization among the on-site group may also be related to the characteristics of effective chiropractic care.”

There is evidence that chiropractic care is less invasive and more conservative than alternative treatments. “Patients with chiropractic coverage seemed to be avoiding more surgeries, hospitalizations, and radiographic imaging procedures.”

The improved functional status found in this analysis indicates potential for reduced indirect costs, including absenteeism and productivity losses, with on-site chiropractic services.

This unique study highlights the potential benefits for all [employees, employers, costs benefits] concerned by offering on-site chiropractic services for employees,


Impact of Chiropractic Services at an On-Site Health Center

Journal of Occupational and Environmental Medicine

September 2014; Volume 56; No. 9; pp. 990–992

Sylvia L. Kindermann, MPH; Qingjiang Hou, MS; Ross M. Miller, MD, MPH (18)

The objective of this study was to compare the influence of employer-sponsored, on-site chiropractic care against community-obtained care on health care utilization. It was a retrospective claims analysis study, using 876 on-site and 759 off-site participants.

Doctors of chiropractic promote wellness and injury prevention. Chiropractic care has been demonstrated to deliver effective treatment for the symptoms of musculoskeletal conditions. On-site chiropractic care has been shown to deliver substantial value through convenience of access, high quality of care and delivery, and lowered overall costs.

Employer-sponsored worksite clinics could control costs and increase workplace productivity while providing high quality and convenient care to their employees.

These authors make these background points:

In this study, the authors found: