Cervical and Lumbar Disc Herniations and Chiropractic Care
A report on the scientific literature
80% of the chiropractic patients studied had good clinical outcomes
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
The term "herniated disc," refers to localized displacement of nucleus, cartilage, fragmented apophyseal bone, or fragmented annular tissue beyond the intervertebral disc space.Simply stated, the annulus, or outer part of the disc has been torn completely through the wall allowing the inner portion, or the nucleus pulposis material to escape the inner confines in a “focal” or finite direction. Unlike a bulging disc, which an entirely different physiological process and diagnosis, caused by degeneration, a herniated disc is traumatically induced phenomena.
The highest prevalence of herniated lumbar discs is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.
Symptoms of a Cervical Herniated Disc
A cervical (neck) herniated disc will typically cause pain patterns and neurological deficits as follows:
Symptoms of a Lumbar Herniated Disc
C4 - C5(C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
- C5 - C6(C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
- C6 - C7(C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation.
- C7 - T1(C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.
The most common symptom of a lumbar disc herniation is pain. The pain is usually described as being located in the buttock with radiation down the back of the thigh and sometimes to the outside of the calf. The specific location may vary and depends on which disc is affected (and thus which nerve root is affected). The pain (and other symptoms and signs) come from pressure on the nerve root. The pain frequently starts as simple back pain and progresses to pain in the leg. When the pain moves to the leg, it is not unusual for the back pain to become less severe. Straining such as bowel movement, coughing or sneezing are all things that tend to cause the leg pain to worsen. Very large disc herniations may cause something known as the "cauda equina syndrome". This is a rare syndrome caused by a very large disc herniation putting pressure on many nerve roots. Signs and symptoms include urinary problems (either retention or incontinence), loss of leg or foot strength, "saddle" anesthesia (loss of sensation in the area of the body that would be in contact with a saddle), decreased rectal sphincter tone and variable amounts of pain (ranging from minimal to severe).
A research paper published in a Peer Reviewed Medically Indexed Journal (scientific journal,) was conducted to evaluate how patients with disc herniations responded to chiropractic care. The authors stated “all patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Pre-care evaluations also included clinical examination and visual analog scores [asking them to rate their pain by using a number from 0 to 10]. Patients were then treated with a course of care that included traction, flexion distraction [a specific Chiropractic technique], spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by post-care follow-up MRI scans, clinical examination and visual analog scores. Percentage of disc shrinkage on repeat MRI, resolution of clinical examination findings, reduced visual analog pain scores and whether the patient returned to work were all recorded. This is an important study because it shows MRI scans pre-care and post-care.
The paper goes on to report “Clinically, 80% of the patients studied had a good clinical outcome with post-care visual analog scores accompanied with resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation (completely resolved.) One significant finding was “seventy-eight percent of the patients were able to return to work in their pre-disability occupations.”
This study shows that Chiropractic care can be a very important part of treatment in patients, when clinically indicated with disc herniations. Injuries such as disc herniations can have a negative impact on the ability to work and complete personal tasks. Evaluating treatment options is paramount when deciding how best to fix the problem especially the non-surgical approach that Chiropractic offers to patients. If you have an injury to your spine, the first step is making sure that you are diagnosed effectively and efficiently, and then engage in treatment as quickly as possible. Although Chiropractic is effective in treating conditions in the early and late phases it has been shown to be most effective when started immediately.
This study, along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to herniated discs. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.
Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J MANIPULATIVE PHYSIOL THER, 1996 Nov-Dec; 19(9): 597-606
Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD, Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAINTREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES. J Manipulative Physiol Ther 2009;32:765-771.