Sciatica, Low Back Pain and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
 
Many people have heard the term, Sciatica. Sciatica literally means inflammation of the Sciatic nerve. The Sciatic nerve is a large nerve that runs from the lower back, through the buttocks and then down the leg. It is a combination of all the spinal nerves in the lower back. Injury or swelling in any one single nerve can cause “Sciatica” and pain down the path of the nerve. Some people feel it in their toes, some in the knee and some just in the buttocks like something is jabbing them. The pain can come from many different sources, most commonly from the lower back.   Treatment is generally targeted to the parts of the body that are creating the “pain down the leg”. These parts include the bones of the spine, the intervertebral discs or the muscles that lie over the top of the Sciatic Nerve. 
 
A recent study in 2008 reviewed all the scientific research related to Chiropractic and lower back pain along with leg complaints, some of which went back to the 1980’s!  The research related to lower back pain and leg pain is growing and showing the effectiveness of Chiropractic care and Sciatica.  The authors reported “The purpose of this work is to provide a balanced interpretation of the literature to identify safe and effective treatment options in the care of patients with low back pain and related disorders.”1 The paper revealed the following information:
 
1.      Acute Back Pain – there is evidence that the chiropractic adjustment has better short term efficacy than mobilization or diathermy (a physical therapy treatment that heats up the tissues).
 
2.      Chronic Back Pain – the chiropractic adjustment combined with strengthening exercises was as effective at pain relief as Non-steroidal anti-inflammatory drugs (Ibuprofen) with exercise. They also stated there was fair evidence that the chiropractic adjustment was better than physical therapy and home exercise for reducing disability. There was evidence that the chiropractic adjustment improved outcomes more than general medical care or placebo in the short term and to physical therapy in the long-term.
 
“Patients overall were more satisfied and felt they were provided better explanations about their pain from practitioners who used manual therapy {chiropractic adjustments.}”1 There were many research studies that were reviewed in this paper but here are some of the highlights.
 
“The group receiving manipulation [chiropractic adjustment] had a shorter treatment time and a more marked improvement. At 6 month follow-up, the manipulation [chiropractic adjustment] group showed better neuromotor system function and a better ability to continue employment. Disability was lower in the manipulation [chiropractic adjustment] group.” 4
 
“Outcomes from manipulation [chiropractic adjustment] were better for neurologic and motor function as well as disability”4
 
 
 
For the Sciatica patients…….
 
“For patients with LBP [low back pain] and restricted straight leg raise test [laying on your back, legs straight then having someone lift your straight leg in the air] manipulation [chiropractic adjustment] conferred highly significant relief, more than alternate interventions.” 2
 
“Coxhead et al included among their subjects patients who had at radiating pain at least to the buttocks. Interventions included traction, manipulation, exercise, and corset, using a factorial design. After 4 weeks of care, manipulation [chiropractic adjustment] showed a significant degree of benefit on one of the scales used to assess progress.” 3
 
“Manipulation [chiropractic adjustment] was reported to be superior to conventional therapy.”
 
Doctors of Chiropractic have been treating lower back pain with and without leg pain for a very long time. It is an extremely safe and effective approach to Sciatica. Pain down your leg should never be ignored and a Doctor of Chiropractic is trained to determine the cause. 
 
 
 
 
1.      Dana Lawrence DC MMedEd, William Meeker, DC, MPH, Richard Branson, DC, Gert Bronfort, DC, PhD, Jeff R. Cates DC, MS, Mitch Hass, DC, MA, Michael Haneline, DC, MPH, Marc Micozzi, MD PhD, William Updyke, DC, Robert Mootz, DC, John Triano, DC, PhD and Cheryl Hawk, DC, PhD. Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints: A literature synthesis. J Manipulative Physiol Ther 2008;31:659-674.
2.      Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott SM, Sittampalam Y. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatolo 1987:26416-23.
3.      Coxhead CE, Inskip H, Meade TW, North WR, Troup JD. Multicenter trial of physiotherapy in the management of sciatic symptoms. Lancet 1981;1:1065-8.
4.      Arkuszewski Z. The efficacy of manual treatment in low back pain: a clinical trial. Man Med 1986;2:68-71.
5.      Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982;61:273-8. 

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Published in Sciatic Problem
Lower Back Injuries and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
One of the most common areas of the body to be hurt while working is the lower back. The injuries can be as simple as a strained muscle or sprained ligament to the more complicated intervertebral disc injury. Regardless of the structures involved, most of us have had a personal experience with a lower back injury while working or know someone that did. Finding a doctor that can determine what exactly is wrong and prescribing the right treatment is the most important aspect of healing. Chiropractic doctors are trained to determine the cause of the injury and have the experience to formulate an accurate and effective treatment plan. The cornerstone of that plan is the Chiropractic Adjustment. 
A recent research article published in 2009 revealed the results of 100 injured workers with back or neck pain that were treated with Chiropractic care. This study was in partnership with the University of Colorado School of Medicine and Lakewood Spine and Sports Center in Lakewood Colorado. The authors state in the research paper “Over the last 15 years, the percentage of pre-retirement disabled US workers has increased from 5% to 9% such that more people receive disability income that are unemployed”1. (This of course was published prior to the most recent economic downturn). They go on to note, “Consequently, finding treatment methods that encourage a safe and rapid return of the injured worker to the workforce is an important issue for all clinicians addressing occupational neck and low back pain.”1 (765)
Chiropractic care was shown in this review of 100 injured workers, 81.5% of patients with acute pain reported post treatment improvement! That is a very significant number. Chiropractic, especially when part of a larger integrated model is extremely safe and effective.
 
1.        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 PAIN TREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES. J Manipulative Physiol Ther 2009;32:765-771
 

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Published in Low Back Problems
Migraine Headaches and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
Thousands of people in the United States suffer with headaches and many do not realize there are different types of headaches that are a reaction to a variety of causes. One of the major tenants of Chiropractic is to find the cause of the problem instead of chasing symptoms. Although Migraine headaches are truly caused by changes in the flow of blood in the brain, many people refer to any headache that is severe enough to negatively affect their day a “migraine”. Many of these cases are people who have headaches on a regular basis, and for whatever reason, they slowly get worse over time. This usually results in increases in medication dosage, prescription of more dangerous drugs with more side-effects and decreases in quality of life. The research paper being reviewed stated “The estimated costs of migraines in the United States is over $17 billion per annum [year]”.1 (p 91)
This research study that was published in 2000 was titled “A randomize controlled trial of chiropractic spinal manipulative therapy for migraine”. This was designed “To assess the efficacy of chiropractic spinal manipulative therapy [Chiropractic Adjustment}  in the treatment of migraine”.1 (p 91). This study followed others that had delivered similar results. 
The authors state “However, the level of evidence is steadily increasing to the point where there is now seen to be a moderate level of efficacy for Chiropractic SMT [Spinal Manipulative Therapy/ AKA Chiropractic Adjustment] in the treatment of headaches or migraines”1 (p95). The paper also reported “The mean number of migraines per month was reduced from 7.6 to 4.1 episodes. The greatest area of improvement was medication use, for which participants were asked to note the use of medication for each episode. A significant number of participants recorded that their medication use had reduced to zero by the end of the 6-month trial”.1(p95) Expressed in other terms, 72% of participants reported significant improvement! 
When administered by trained Doctor of Chiropractic, adjustments to the neck are safe and effective. This study has also show that Chiropractic care results in the reduction of medication utilization, some of which have significant long term side-effects having a profound effect on your long term health. Chiropractic chooses to use a safe and scientifically effective approach to the management of migraine headaches and if you are suffering, Chiropractic care is just what the doctor ordered!
1.       Tuchin PJ; Pollar H; Bonello R. A randomize controlled trial of chiropractic spinal manipulative therapy for migraine. Journal of Manipulative and Physiological Therapeutics 23(2): 91-5, 2000. 

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Published in Headaches-Migraines

Chest Pain, Mid-Back Pain and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 
Chiropractic care is targeted to reducing the Vertebral Subluxation Complex and associated neuro-muscular conditions after more serious medical conditions have been ruled out with chest pain. Vertebral Subluxation Complex is the most common reason for pain in the middle back and chest that is not the result of a heart problem or acid reflux. In cases of non-cardiac (not involving the heart) middle back and chest pain, Chiropractic has been shown to have significant results in reducing or eliminating pain and discomfort. Many people experience pain between the shoulder blades, over the breast bone or the collar bones. In today’s society of increasing demands in the office setting, endless hours in front of a computer or all day commutes in our vehicles the stress on the thoracic spine (middle back)and chest continues to increase. Unfortunately when we sit and slouch forward, the brunt of the forces are condensed to the area just below our shoulder blades and our breast bone. We have all been cautioned to “have good posture”, but anyone that has worked a full day knows, once you are tired there is really not much you can do about your posture.
A recent study stated that “Traditionally, patients with chest discomfort are admitted to a cardiology ward because the heart is under suspicion as the pain source; however, the etiology of pain may be non-cardiac in up to 50% of cases”1 (p654). The authors continue on to say “Although patients with non-cardiac chest pain have an excellent prognosis for survival and a future risk of cardiac morbidity [complications] similar to that of the general population, approximately 3 quarters of these patients continue to suffer from residual chest pain, one half remain or become unemployed, and one half report being significantly disabled”1 (p 654)
 
The most important aspect of this study states “There is a broad agreement among clinicians that the musculoskeletal system is a potential source of pain in non-cardiac chest discomfort, but very few studies have addressed this issue systematically despite the compelling issues discussed above.”1 (p 654)   This study found that there was a significant reduction in the anxiety associated with the patient’s chest pain, the patients had a better understanding that the musculoskeletal system was the source of their discomfort and 96% of patients believed that chiropractic treatment had helped.1
 
In a case study published in 2003, the authors discovered that after the possibility of cardiac involvement was considered, Vertebral Subluxation Complex located at the junction of the breast bones and ribs in the front of the chest was the cause. Reducing the Vertebral Subluxation Complex with Chiropractic techniques had resolved this patients symptoms. 2
Chiropractic interventions into managing and/or eliminating chest and middle back pain have been shown to be safe once cardiac causes have been ruled out. Doctors of Chiropractic are trained to not only evaluate for non-musculoskeletal conditions, but to work as part of your healthcare team. 3
1.       Henrik W. Christensen, DC, MD, PhD, Werner Vach, PhD, Anthony Cichangi, Claus Manniche, MD, DMSc, Torben Haghfelt, MD, DMSc, and Poul F. Hilund-CaHsen, MD, DMSc. Manual Therapy for Patients with Stable Angina Pectoris: A Nonrandomized open prospective trial. J Manipulative Physiol Ther 2005;28:654-661
2.       Bradley S. Polkinghorn, DC, Christopher J. Colloca, DC. Chiropractic management of chronic chest pain using mechanical force, manually assisted short-lever adjusting procedures. J Manipulative Physiol Ther 2003;26:108-15.

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Hip, Knee, Ankle and Foot Problems

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
 
*in this paper, we are listing research to help the public to understand that what chiropractors do correlates with the scientific evidence.
Just as it is less common for patients to know that chiropractors treat the arms and hands, it is equally common for people to miss that the hip, knee, ankle and foot also fall under chiropractic care. In a recent study published in 2009 by Brantingham et al, 2009, the authors reviewed all the research to date that was relevant to chiropractic and treatment of the hips, knee, ankle and foot. The research is growing at an incredible rate and is an important part of chiropractic’s role in healthcare. 
 
The authors reported “The data demonstrate that most chiropractors, based upon their professional training, routinely diagnose and treat extremity conditions” (p54). They also state “Extremity treatment is the second most frequently applied procedure within the chiropractic profession, with 76.1% reportedly using spinal and extremity procedures as compared with 18.7% who limit their practice to the spine only”. (p54). 
 
The following chart will help you to see what conditions fell under the review of this research paper and how many studies there were related to a specific condition.
 
Condition
Responded to Chiropractic Care
Study Name and Date
Hip Osteoarthritis
YES
Hoeksma et al 2004
Brantingham et al 2003
MacDonald et al 2006
Knee Osteoarthritis
YES
Deyle et al 2000
Deyle et al 2005
Tucker et al 2003
Moss et al 2007
Hillerman et al 2006
Cliborne et al 2004
Currier et al 2007
Ankle Sprain
YES
Pellow and Brantingham 2001
Green et al 2001
Coetzer et al 2001
Eisenhart et al 2003
Collins et al 2004
Vicenzino et al 2006
Lopez-Rodriquez et al 2007
Kohne et al 2007
Plantar Facitis
YES
Dimou et al 2004
Metatarsalgia (pain in the foot)
YES
Peterson et al 2003
Govender et al 2007
Big Toe Pain
YES
Shamus et al 2004
Brantingham et al 2005
 
 
The authors concluded “Overall, when reviewing the increasing quantity and quality of included trials, manual therapy [Chiropractic adjustment] for lower extremity disorders appears to be of value and fundamentally safe”. (p66).
 
When it comes to your health, nothing is more important than your nervous system. That is why doctors of chiropractic will always screen your spine for evidence of Vertebral Subluxation while they are attending to problems in other areas of your body. If you are suffering with problems in your hips, knees, ankles or feet, chiropractic care has been show to have positive effects on symptoms and function. Consult with a local doctor of chiropractic today, you’ll be glad you did.
 
1.       James W. Brantingham, DC, PhD, Gary Globe, DG, MBA, PhD, Henry Pollard, DG,Marian Hicks, MSLS, Gharmaine Korporaal, MTech:Chiropractic and Wayne Hoskins, BGhSc, MGhiro MANIPULATIVE THERAPY FOR LOWER EXTREMITY CONDITIONS: EXPANSION OF LITERATURE REVIEW. J Manipulative Physiol Ther 2009;32:53-71.

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Published in Leg-Feet Problems

Neck Pain, Headaches and Chiropractic

A report on the scientific literature 


 By

William J. Owens DC, DAAMLP
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
A recent study on chiropractic and conditions concluded that 18.7% of patients present with initial complaints of neck pain, making neck pain the 3rd most common reason for a chiropractic visitation7.  Bogduk and Aprill hypothesized that one of the most common causes of neck pain is related to mechanical dysfunction of the cervical spine”1. Additional reasons can be herniated intervertebral disc or pinched nerves.
 
It has been found that spinal manipulative therapy is one of the most used therapies in the management of mechanical neck disorders. There is more and more research published that shows that neck pain and headache related to mechanical dysfunction in the neck responds well to chiropractic care. Your doctor of chiropractic has the training to determine whether your pain is coming from a mechanical source. If you have to take pain killers to get through your day, experience headaches and have limited range of motion in your neck or shoulders, chiropractic care is a safe and effective treatment. 
 
The following studies were recently published on the topic of chiropractic and neck pain treatment.
 
 “…a single cervical manipulation was more effective in reducing neck pain at rest and in increasing active cervical range of motion than a control mobilization procedure in subjects suffering from mechanical neck pain”1
 
“Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”2
 
“According to a recent survey of complementary and alternative therapy use, chiropractic was frequently selected for the relief of head and neck pain,' accounting for 18 to 38 million manipulations performed annually” 2
 
“The overall results demonstrated improvement in mechanical neck pain and LBP of patients while under chiropractic care”3
 
“The best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain”.4
 
“In patients with chronic spinal pain syndromes, spinal manipulation (chiropractic adjustments,) if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit” 6
 
 
 
 
 
 
 
 
 
REFERNENCES:
1.      Raquel Martinez-Segura, PT, DO, Cesar Femandez-de-las-Penas, PT, Mariana Ruiz-Saez, PT, CO, Cristina Lopez-Jimenez, PT, DO, and Cleofas Rodnguez-Blanco, PT, DO. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. J Manipulative Physiol Ther 2006;29:511-517.
2.      McMorland G; Suter E. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther 2004;27:547-553.
3.      Mitchell Haas, D C Elyse Groupp, PhD, Mikel Aickin, PhD,Alisa Fairweather, MPH, Bonnie Ganger, Michael Attwood, Cathy Gummins, DC,and Laura Baffes, DC. Cevicogenic headache and associated neck pain: A randomized pilot study. Journal of Manipulative & Physiological Therapeutics, 2000 Jun; 23(5)
4.      Dabbs V; Lauretti WJ.A risk assessment of cervical manipulation vs. NSAIDs for the treatment of neck pain. J Manipulative Physiol Ther 1995; 18:530-6
5.      Reinhold Muller, PhD,'' and Lynton G.F. Giles, DC,PhD. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther2005;28;3-ll
6.      Bradley S. Polkinliorn, DC, and Christopher J. Colloca, DCChiropractic Treatment of Postsurgical Neck Syndrome With Mechanical Force, Manually Assisted Short-Lever Spinal Adjustments.J Manipulative Physio Ther Volume 24 • Number 9 • November/December 2001.
7.      Andrew McHardy, MChiro, Wayne Hoskins, MChiro, Henry Pollard, DC, MSportSc, PhD, Rorey Onley, MChiro, and Ross Windsham, MChiro. Chiropractic treatment of upper extremity conditions: a systematic review. J Manipulative Physiol Ther 2008;31:146-159

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Published in Neck Problems

Shoulder, Arm, Elbow, Wrist, Hand and Chiropractic

A report on the scientific literature 


By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
 
*in this paper, we are listing research to understand that chiropractor care correlates with the scientific evidence.
When most people think of chiropractic care, they immediately picture the spine. Chiropractors are “back doctors” is a common misconception. The truth is that doctors of chiropractic are trained to look at the whole person, not just the spine. The neurology inside and around the spinal column is so important that it is the foundation of chiropractic philosophy, but the truth is, the entire body is controlled by the nervous system.
In the upper limbs for example, there are numerous joints, muscle and ligaments that influence posture, our ability to work and enjoy our life. Sometimes the issue is not in the spine, but in one of the arms or legs. Chiropractic doctors are trained in the anatomy of the human body and actually have more anatomy instruction than their medical counterparts. It is the foundation of what we do. A recent study was published that looked at all of the research related to chiropractic treatment of upper limb conditions. This is important because it gives a single source to study all the research that has been published in the past. In this case since 1982! 
The diagnosis and treatment of upper limb disorders is not only a part of the core curriculum of chiropractic education, but is a major part of post-graduate courses on orthopedics and neurology. When it comes to non-surgical care for the upper limbs, chiropractic is aligned perfectly to help restore pain free movement and increase strength all while maintaining the integrity of the chiropractic philosophy. Did you know that 17.1% of all presenting complaints to the chiropractic office are made up of peripheral (arm or leg) conditions with 75% of all chiropractors including adjustments to the non-spinal joints of the body? 
The following chart will help you to understand which conditions may respond well to chiropractic. In conditions where there is injury to the muscle or ligament, doctors of chiropractic are trained to use soft tissue and rehabilitative techniques. 
Condition
Responded to Chiropractic
Research Paper and Date
Shoulder Impingement Syndrome
YES
Pribicevic and Pollard 2005
Gleberzon 2005
Pribicevic and Pollard 2004
Smith 2000
Williams and Brockhohn 1994
Shrode 1994
Plezbert and Nicholson 1994
Kampschroder et al 1990
Thoracic Outlet Syndrome
YES
Rimbey 2005
Vernon 1982
Elbow Pain
YES
Konczak 2005
Coppieters et al 2004
Annis 2003
Kaufman 2000
Tchoryk 2000
Lawrence and Humphery 1997
Greenly and Bergmann 1990
Woo 1988
Frozen Shoulder Syndrome
YES
Valli 2004
Donahue et al 2003
Kazemi 2000
Harmeyer 1995
Ferguson 1995
Polkinghorn 1995
Feeley 1992
 
Separated Shoulder
YES
Kiner 2004
Stoddard and Johnson 2000
Swimmer’s Shoulder
YES
Kurtz 2004
Shoulder Instability
YES
Moreau and Moreau 2001
Rotator Cuff Tear
YES
Kazemi 1999
Buchberger 1993
 
Shoulder Tendonitis
YES
Gimblett et al 1999
Nia 1994
 
Scapular Winging
YES
Horrigan et al 1994
 
Chronic Bursitis
YES
Hammer 1993
Volstad 1983
 
Wrist Pain
YES
DeSantis 2004
Russell 2003
McDermott 2003
 
Carpal Tunnel Syndrome
YES
Davis 2004
Brunarski et al 2004
Pringle et al 2003
Brown et al 1999
Petruska 1997
Buchberger et al 1996
Valente and Gibson 1994
Mariano et al 1991
 
If you are experiencing problems with your shoulders, elbows, wrist or hands it may be time to sit and discuss your situation with a doctor of chiropractic. The conservative and hands on approach may just be what you need. 

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