90.5% of Patients Report Improvement With Chiropractic After Only 3 Months
This study looks at what is the best treatment for MRI confused disc herniations that produces low back pain or leg pain. Not only what’s the best treatment, but comparing the effect of that treatment from 3 months to 1 year. The bottom line of the study is that a “large percentage of acute and importantly chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement.
As clinicians, we are well aware that approximately 70% of the population will have back pain at some time. We are also aware that low back pain with associated leg pain due to a herniated intervertebral disc is one the most severe and disabling forms of back pain. These patients are placed in two categories; conservative care or surgical care. Unfortunately as most Doctor’s of Chiropractic(DC) know, conservative care does not typically include chiropractic care. Instead it may include medications, corticosteroid nerve root or epidural injections, bed rest, and/or physical therapy. In certain cases chiropractic spinal manipulation may be used as a last resort effort, but it’s inclusion in the therapy is usually based on a referral from a friend or family member.
The patients in this study were treated with high-velocity, low amplitude spinal manipulation and were tracked in regards to progress made at short, medium, and long term outcome evaluations. The patients in this study were between 18 and 65 years, experiencing back pain and moderate to severe leg pain in a dermatomal pattern with at least one of the following:
- Decreased straight leg raiser test
- Deficit in detection of cold sensation
- Reduced response to pinprick
- Decreased muscle strength in corresponding myotome
- Decreased or absent deep tendon reflex corresponding to the involved segment
- MRI confirmed lumbar disc herniation at the corresponding spinal segment
All prospective patients with pathologies of the lumbar spine that are contradictory to chiropractic manipulative treatments were excluded.
The results of the treatment were as follows:
- Nearly 70% of the patients improved as early as two weeks after start of treatment
- This number increased to 90.% of patients at the end of 3 months, and then stabilized at 6 months and 1 year follow ups
These results of are particularly encouraging when considering how it is chronic low back pain patients who are a large economic burden and put a greater tax on health resources. These patients also are more likely to abuse opioid based prescription pain medications and develop addictive behaviors.
In trying to interpret the results, some may say that the improvement can be explained by the ‘natural history’ of low back pain, and that in most cases it is self resolving. However, that does not explain the benefit experienced by patients complaining of chronic low back pain who experienced improvement following the chiropractic treatment. The results of the acute patients are even more telling, in which at 2 weeks, 80% of patients who received treatment experienced improvement, compared to 36% who had not. Even at 12 weeks, a greater proportion of acute low back pain patients who received chiropractic treatment report improvement at 94.5%, compared to 73% who do not.
For the chronic patients in this study, with a history of low back pain over 450 days, more than 81% reported improvement at 3 months following chiropractic, and at 1 year 89.2% reported improvement.
This study confirms what practicing chiropractors already know; that a large percentage of acute and importantly chronic lumbar disc herniation that were treated with a high velocity, low amplitude spinal manipulation reported clinically relevant improvement with no adverse side effects. The patient population even included cases where the disc herniation had penetrated the peripheral annular fibers of the disc or were sequestered.
This study is another example of confirmatory scientific research, in addition to the already existing clinical experience, that shows the beneficial effects of chiropractic treatment in musculoskeletal conditions. Perhaps we should share this information with the rest of the world!