Back and Leg Pain (Lumbar Radiculopathy)  as a Result of Disc Herniation and the Long Term Effect of Chiropractic Care


90% of all low back-lumbar disc herniation patients got better with chiropractic care

A report on the scientific literature 



By

Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

The term "herniated disc" has been called many things from a slipped disc to a bulging disc. For a doctor who specializes in disc problems, the term is critical because it tells him/her how to create a prognosis and subsequent treatment plan for a patient. To clarify the disc issue, a herniated disc is where a disc tears and the internal material of the disc, called the nucleus pulposis, extends through that tear. It is always results from trauma or an accident. A bulging disc is a degenerative "wear and tear" phenomenon where the internal material or nucleus pulposis does not extend through the disc because there has been no tear, but the walls of the disc have been thinned from degeneration and the internal disc material creates pressure with thinned external walls. The disc itself "spreads out" or bulges.

There are various forms and degrees of disc issues, but the biggest concern of the specialist is whether nerves are being affected that can cause significant pain or other problems. The problem exists when the disc, as a result of a herniation or bulge, is touching or compressing those neurological elements, which is comprised of either the spinal cord, the nerve root (a nerve the extends from the spinal cord) or the covering of the nerves, called the thecal sac.

With regard to the structure that we have just discussed, the doctor must wonder what the herniation of the neurological element has caused. In this scenario, there are 2 possible problems, the spinal cord and nerve root. If the disc has compromised the spinal cord, it is called a myelopathy (my-e-lo-pathy). You have a compression of the spinal cord and problems with your arms or legs. An immediate visit to the neurosurgeon is warranted for a surgical consultation. The second problem is when the disc is effecting the spinal nerve root, called a radiculopathy. It is a very common problem. A doctor of chiropractic experienced in treating radiculopathy has to determine if there is enough room between the disc and the nerve in order to determine if a surgical consultation is warranted or if he/she can safely treat you. This is done by a thorough clinical examination and in many cases, an MRI is required to make a final diagnosis. Most patients do not need a surgical consultation and can be safely treated by an experienced chiropractor.

While herniations can occur anywhere, it was reported by
Jordan, Konstanttinou, & O'Dowd (2009)  that 95% occur in the lower back.  "The highest prevalence 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" (http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence).

It was reported by Aspegren et al. (2009) that 80% of the chiropractic patients studied with both neck and low back (cervical and lumbar) disc herniations had a good clinical outcome with post-care visual analog scores under 2 [0 to 10 with 0 being no pain and 10 being the worst pain imaginable] and 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. A study by Murphy, Hurwitz, and McGovern (2009) focused only on low back (lumbar) disc herniations and concluded that, "Nearly 90% of patients reported their outcome to be either 'excellent' or 'good'...clinically meaningful improvement in pain intensity was seen in 74% of patients (p. 729)." The researchers also concluded that the improvements from chiropractic care was maintained for 14 1/2 months, the length of the study, indicating this isn't a temporary, but a long-term solution. It was reported by BenEliyahu (1996) that 78% percent of the low back-lumbar disc herniation patients were able to return to work in their pre-disability occupations, which is the result of the 90% of all low back-lumbar disc herniation patients getting better with chiropractic care as discussed above.

These are the reasons that chiropractic has been, and needs to be, considered for the primary care for low back-lumbar disc herniations with resultant pain in the back or legs.
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for herniated discs and low back or leg pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.com and search your state.




References:

1. Jordan, J., Konstanttinou, K., & O'Dowd, J. (2009, March 26). Herniated lumbar disc. Clinical Evidence. Retrieved from http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence
2. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). 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. Journal Manipulative Physiological Therapy 32(9), 765-771.
3. Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal Manipulative Physiological Therapy, (32)9, 723-733.

4. BenEliyahu, D. J. (1996). Magnetic resonance imaging and clinical follow-up: Study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal Manipulative Physiological Therapy, 19(9), 597-606.

Share this

Submit to DeliciousSubmit to DiggSubmit to FacebookSubmit to Google BookmarksSubmit to StumbleuponSubmit to TechnoratiSubmit to TwitterSubmit to LinkedIn
Published in Leg-Feet Problems

Pregnancy, Back Pain & Chiropractic

A report on the scientific literature 



By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

 
"Back pain during pregnancy can be significant in terms of intensity and resulting disability" (Stuber & Smith, 2008, p. 447). It often exacerbates (magnifies) an underlying problem with the change in body mechanics as the pregnancy progresses and the fetus grows. One study found that 35.5% of woman had at least moderately severe back pain during 1 or more of their pregnancies. The pain scales of the pregnant woman (on the Owestry rating scale of 0-10, where 0 is no pain and 10 is the worst pain imaginable) ranged from 5.86 to 9.21.1
 
One of the problems with patients not seeking care during pregnancy is this can become a long- term chronic condition and inherently more difficult to resolve as muscles and connective tissue compensate to accommodate the increasing forward center of gravity. Over time, the tissue becomes "patterned" to the 9 month temporary state and abruptly changed, upon delivery. These multiple, sudden changes can cause a weakening of the supportive tissue, creating an abnormal chronic problem if not stabilized during pregnancy.
 
One study, in a retrospective review of 179 pregnant woman in 5 clinics regarding back pain during pregnancy and labor, found that 85% reported relief of their low back pain as a direct result of chiropractic care. In an unrelated study, 25% had complete remission of their back pain, 50% reported feeling very well and 15% were feeling better. Only 10% reported no changes
.1
 
In one study, the average pain scale prior to chiropractic care was 7.58 out of 10 and while they were under chiropractic care was 4.25. A second study revealed the average pain scale before chiropractic care was 5.9 and post chiropractic care 1.5 out of 10 on the Owestry scale.
 
This author, having practiced chiropractic for 30 years and cared for 100’s of pregnant patients during that time, has had similar results in the clinical setting. The primary reason these pregnant patients have sought chiropractic care has been that it is a drugless approach and it works. Beyond that, pregnant patients shouldn't spend 9 months in pain. They should be able to enjoy an active pregnancy and get the exercise needed to have a healthy, full-term labor and delivery.
 
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for pregnant patients with back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.comand search your state.



References:


1.  Stuber, K. J., & Smith, D. L. (2008). Chiropractic treatment of pregnancy-related low back pain: A systematic review of the evidence. Journal of Manipulative and Physiological Therapeutics, 31(6), 447-454.

Share this

Submit to DeliciousSubmit to DiggSubmit to FacebookSubmit to Google BookmarksSubmit to StumbleuponSubmit to TechnoratiSubmit to TwitterSubmit to LinkedIn
Page 2 of 2