Acute and Chronic Herniated Discs Have Significantly Favorable Outcomes With Chiropractic Care

95% Reported Improvement 

A report on the scientific literature 

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

Approximately 70% of the population will have back pain at some point in time in their life according to Lehman ET. Al. (2014). The pain ranges from mild to either moderate or severe and can often be debilitating and associated with or without leg pain if it’s originating from your lower back. Treatment for this common problem is usually broken up into two categories, surgical versus conservative care however, I am going to break it into three categories: surgical, medication and conservative care. This article is going to focus on the continual growing body of evidence of treatment of herniated discs via conservative care and specifically with a chiropractic spinal adjustment.

It was reported by McMorland, Suter, Casha,du Plessis, andHurlbertin 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study. 

The study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates. Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery.

Although the previous report concluded that a chiropractic spinal adjustment is an effective treatment modality for herniated disc a more recent study (Lehman ET. Al. (2014), further clarifies the improvement with chiropractic care. This study considered both herniated discs and radiculopathy or pain radiating down into the leg as a baseline for analysis. The study also considered acute and chronic lumbar herniated disc pain patients.

In this study the acute onset patient (the pain just started) reported 80% improvement at 2 weeks, 85% improvement at 1 month, and a 95% improvement at 3 months. The study went on to conclude that the patient stabilized at both the six month and one year mark after the onset of the original complaint. Although one might argue that the patient would have gotten better with no treatment it was reported that after two weeks of no treatment only 36% of the patients felt better and at 12 weeks up to 73% felt better. This study clearly indicates that chiropractic is a far superior solution to doing nothing and at the same time helps the patient return to their normal life without pain, drugs or surgery.

             Chiropractic Care and Herniated Discs with Leg Pain

The caveat is that there are patients who could need drugs or surgery and an accurate diagnosis is paramount and it is incumbent upon the doctor of chiropractic to be fully trained in both the diagnostic and treatment facets of care. It is also important that the chiropractor is well-versed in MRI protocols and interpretation as well as disc pathology to be able to triage the patient accordingly based upon the clinical presentation inclusive of the MRI results.

Chiropractic is one of the safest treatments currently available in healthcare and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration.  Whedon et al. (2014) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM (spinal manipulation) induces injury into normal healthy tissues has been identified.(Whedon et al.,2014, p. 5) 

References:

1. Leeman S., Peterson C., Schmid C., Anklin B., Humphryes B., (2014) Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow Up, Journal of Manipulative and Physiological Therapeutics, 37 (3) 155-163
2. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiscectomy for sciatica? A prospective randomized clinical study.Journal of Manipulative and Physiological Therapeutics, 33
3. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2014). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69.Spine, [Epub ahead of print]1-33.

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Disc Herniations and Low Back Pain Post Chiropractic Care

88% of patients reported continued improvement at 1 year post-care

A report on the scientific literature 

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

Robert Reiss DC

According to Hoy et. al. (2014), "Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP [low back pain] ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs)...LBP causes more global disability than any other condition" (p. 968). Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) wrote that, "Back pain is the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388).

There are many treatment options available that fall into one of two categories, surgical or conservative care.  Spinal manipulation/adjustments are one of the most widely used conservative treatment options with doctors of chiropractic performing the majority of them.  There have been various studies comparing the effectiveness of spinal manipulative therapy (SMT) on low back pain (LBP) patients with disc herniations to other therapies, all of which have been inconclusive. 

But now, a 2013 study by Leemann, Peterson, Schmid, Anklin, and Humphreys concluded that, “a large percentage of acute and importantly chronic lumbar disc herniation patients treated with high-velocity, low-amplitude side posture SMT reported clinically relevant “improvement” with no serious adverse events” (p. 162). The study’s purpose was to evaluate patients with low back pain and leg pain that was the result of a herniated lumbar disc which had been confirmed by magnetic resonance imaging.  The patients were treated with high-velocity, low-amplitude spinal manipulations by chiropractors.  The patients’ outcomes of self-reported global impression of change and pain levels were collected at various time points up to 1 year.

The results showed significant improvement for all outcomes at all of the time points.  “Patients responding ‘better’ or ‘much better’ were categorized as ‘improved,’ and all other patients as ‘not improved.’ ‘Improved’ was the primary outcome measure. ‘Slightly improved’ was not considered clinically relevant improvement” (Leemann et al., 2013, p. 158).  At 1 year, 88.0% were much better or better. According to the authors, “The results in this current study are encouraging when considering that it is chronic LBP patients who are a large economic burden with greater use of prescription medications and increased use of other health care resources” (Leemann et al., 2013, p. 161).

To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiropracticDirectory.com and search your state.

References:

1. Hoy, D., March L., Brooks, P., Blyth, F., Woolf, A., Bain, C.,…Buchbinder, R. (2014). Extended Report, The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73, 968–974.

2. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E. (2006). Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.

3. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. .Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.

4. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4), 387-402.

5. Leemann, S., Peterson, C. K., Schmid, C.,  Anklin, B., & Humphreys, B. K. (2013).  Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: A prospective observational cohort study with one-year follow-up. Journal of Manipulative and Physiological Therapeutics, 37(3), 155-163.

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