MRI Unreliable For Diagnosing Sciatica

Sciatica is a relatively common medical condition, affecting an estimated 13-40% of people during their lifetime. The most common cause is a herniated disc. Magnetic resonance imaging (MRI) is frequently used to examine patients with sciatica symptoms and lumbar-disc herniation.

However, the link between MRI findings and clinical outcome is controversial. Several studies have shown a high rate of disc herniation in people who have no symptoms. This has led some researchers to question the value of MRIs for sciatica patients, given the high rate of MRI abnormalities found in patients with no pain. Abnormal MRI findings often result in invasive procedures such as surgical treatment or epidural injections, despite the debate over the value of MRI findings.

A recent study sought to add to the understanding of MRI imaging for sciatica patients. The study involved 283 patients, all of whom underwent MRI at the start of the study and after one year. The researchers assessed the MRI for visible disc herniation.

After one year, 84% of patients reported a favorable outcome. Disc herniation was visible in the MRI images of 35% of patients who reported a favorable outcome, and 33% with an unfavorable outcome.

Therefore, MRI assessment of disc herniation after one year did not appear to be effective at distinguishing patients with a favorable outcome and those with an unfavorable outcome. Further research is needed in order to fully assess the value of MRI in making clinical decisions for patients with persistent sciatica.

Reference

el Barzouhi A, et al. Magnetic resonance imaging in follow-up assessment of sciatica. New England Journal of Medicine 2013; 368(11):999-1007. doi: 10.1056/NEJMoa1209250.

Physiotherapy Eases Sciatica

According to analysis of a recent study, physical therapy sessions provide both immediate and long-term relief for patients with sciatica.

The research involved 165 patients with moderate or severe sciatic pain. They participated in physical therapy sessions for three months. Immediately after a PT session, 85 percent of patients reported reduced leg pain through centralization. Centralization happens when the radiating leg pain associated with sciatica retreats to the spine, where the pain originated, and is associated with a good prognosis in sciatica patients. In this study, researchers were investigating whether certain patients were more likely to experience centralization following a PT session.

The researchers concluded that because the majority of participants experienced centralization, physical therapy can reduce sciatic pain, regardless of the type of disc lesion causing pain. Following three months of physical therapy, all of the patients involved in the study reported a reduction in leg pain and improved ability to perform daily activities. Those who saw immediate centralization reported the most significant improvement, but even those who did not find immediate relief after one physical therapy session experienced long-term improvements in sciatica symptoms. All patients involved found that these benefits remained at a follow-up visit one year after the therapy sessions.

This study confirms that physical therapy reduces radiating leg pain for many patients, providing both short and long-term results.

References

Albert H, Hauge E, and Manniche M. Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions? European Spine Journal201; DOI 10.1007/s00586-011-2018-9.

Albert, Hanne and Claus Manniche. The efficacy of systematic active conservative treatment for patients with severe sciatica.: A single-blind randomized clinical controlled trial. Spine 2011; doi: 10.1097/BRS.0b013e31821ace7f.

Chiropractic, Sciatica, Back Pain

Work-related sciatica is clinically challenging and an expensive problem for our health care systems. One recent study found that workers with sciatica are significantly more likely to be prescribed opioids for their condition.1 Another study found that workers with low back pain and sciatica showed the highest level of disability of all back pain patients.2

With these issues in mind, the orthopedic medicine department of a hospital in Norway has examined the effectiveness of chiropractic treatment with patients with severe sciatic pain. This new study3 looked at 44 workers who presented at the hospital with severe sciatic pain that required hospitalization. “The patients underwent clinical, neurologic, and radiological examinations as well as laboratory screening, including urine specimens, parameters of infection, and system diseases.”

The hospital chiropractor then performed a chiropractic examination on each patient that included an analysis of posture and gait, passive and active range of motion, and palpation of the lumbar spine. “The main treatment consisted of joint adjustment techniques of the lumbopelvic fixations, usually performed in a side posture position…Joint adjustments in other parts of the spine and limbs were usually necessary as a result of the compensatory dysfunction.” Ice treatment was applied after the adjustment, since there was soft-tissue soreness experienced by the patients.

“Patients were treated daily while they were in the hospital; they were treated for 3 days a week for the first 2 weeks while they were in the clinic. Depending on need, some patients received follow-up treatment once or twice a week for some time. Following Norwegianpublic health regulations, cost refunding is limited to 14 treatments; therefore, the total number of treatments rarely exceeded this number.”

The authors found the following:

  • All of the patients had experienced three or more weeks of pain before hospitalization.
  • 35 patients underwent MRI and 7 had CT scans; there were no structural changes on any of the imaging tests.
  • After the treatment, 40 patients (91%) returned to work full-time within an average of 21.1 days.
  • Two patients returned at reduced work levels: one at 80% and another at 50%.

“The positive effects of cooperation between orthopedic surgeons and chiropractors may be measured in the reduced duration of sick leaves.” The study refers to Norwegian public health records that show that the average patient with sciatica is disabled for 72 days; in this study, the time to return-to-work was just 21 days—a 70% reduction.

The authors point to how chiropractic can improve functioning in the spine:

Stimulation of “muscle spindles caused by sprain strain has been shown to be capable of starting a long-lasting train of action potentials in the motor neuron (i.e., long-lasting muscle contraction in the motor unit in question). Similarly, a brief inhibitory impulse, such as that from antagonistic muscles, may stop the signal train in the motor neuron. Chiropractic joint adjustment probably provides a similar inhibitory impulse. The chiropractic joint adjustments must cross the barrier of passive joint motion range to stimulate muscle spindle receptors.”

  1. Stover BD, Turner JA, Franklin G, et al. Factors associated with early opioid prescription among workers with low back injuries. Journal of Pain 2006;7(10):718-25. 
  2. Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
  3. Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.

Smoking Linked to Sciatica and Chronic Pain

New research suggests that smoking may increase your odds of developing chronic pain including sciatica. A study surveyed 6,000 Kentucky women who were asked about their experience with pain. Women reported suffering from chronic pain conditions including sciatica, fibromyalgia, nerve problems, and chronic pain in their lower backs, necks, and joints.

Daily smokers were the worst off of all participants; they were 104% more likely than non-smokers to have chronic pain. Occasional smokers were 68% more likely and former smokers were 20% more likely to experience chronic pain than non-smokers. In fact, daily smoking was more closely linked to chronic pain than other common factors like obesity, age, and lack of education.

Despite the strong link between chronic pain and smoking, researchers hesitated to draw conclusions just yet on whether smoking actually causes chronic pain. Researchers wondered whether smoking is a direct cause of chronic pain or if women started smoking in order to cope with pain. Although further research is needed, it is clear that safer methods of relaxation exist to treat chronic pain like chiropractic treatment, massage, and relaxation therapy.  A chiropractor can counsel you on safe methods of  treating and coping with sciatica pain.

Reference

Mitchell, Michael et al. “Associations of Smoking and Chronic Pain Syndromes in Kentucky Women.” The Journal of Pain 12.8 (August 2011): 892-899. Accessed October 10, 2011. doi:10.1016/j.jpain.2011.02.35.

 

Is sciatica worse for women?

Women with sciatica are more likely to have a slower recovery rate than men with the same condition. In a recent study, 28% of women had unsatisfactory outcomes after one year of treatment, compared to just 11% of men. Patients with unsatisfactory outcomes suffered from higher pain and disability levels as well as slower recovery rates compared to other patients.

The researchers tracked the progress of 283 patients with severe sciatica. The patients were treated with surgery, conservative care, or a combination of both. By the end of the study, 83% of patients had recovered, reflecting the generally positive prognosis of sciatica. But 17% of patients were still experiencing severe pain, and the majority of those patients were women. Gender differences in recovery rate were not affected by the type of treatment patients received.

Previous studies have shown that women are also more likely to have chronic pain and disability from other musculoskeletal conditions. Research suggests that there are various biological and social factors that could play a role in these gender differences. Smoking and obesity have also been linked to sciatica and chronic pain in women.

Since most of the women in the study did recovery after one year, it’s important to remember that being female doesn’t guarantee a poor recovery. Still it’s crucial to take steps to prevent chronic pain with early treatment, exercise, and improved posture.

 

Reference:

Peul W, Brand R, Thomeer R, and Koes B. Influence of gender and other prognostic factors on outcome of sciatica. Pain 2008;138: 180-191.

Inheriting the risk of sciatic pain

Scientists have discovered a new risk factor for developing sciatic pain: your genes. Though scientists have suspected that genes play a role in sciatica, this study examines the impact of familial history on the risk of lumbar disc disease. The term lumbar disc disease refers to a set of spinal degenerative disorders that leads to sciatica characterized by  low-back pain and  radiating leg pain.

In the study, researchers analyzed records  from the Utah Population Database, which includes data dating back to early settlers. Using familial genealogy of 1264 patients, researchers were able to track the presence of lumbar disc disease over several generations. They found that having a close relative quadrupled your risk for lumbar disc disease. But if you’re parents didn’t have lumbar disc disease, you’re not off the hook: even having a distant cousin can elevate your risk.

Genetics isn’t the only cause of sciatica; mechanical stress on the spine, occupational loading, aging, and even smoking has been linked to sciatica. Learning whether you have a genetic risk of lumbar disc disease can help you take additional steps to prevent or minimize sciatic nerve pain.References

Patel, Alpesh. William Ryan Spiker. Michael Daubs, Darrel Brodke, and Lisa A. Cannon-Albright. “Evidence for an Inherited Predisposition to Lumbar Disc Disease.” The Journal of Bone and Joint Surgery. February 2011; 29(3): doi

The Effects of Sciatica on Your Muscles

Patients who suffer from sciatica are at risk for developing muscle atrophy. A recent British study found that patients with sciatica had decreased muscle mass, also known as muscle atrophy.

Muscle atrophy occurs in people that have a restricted range of motion due to an injury or medical condition. Developing atrophy can further reduce muscle strength and mobility. In patients with low-back pain, weakened muscles can cause patients to compensate in other ways leading to further injury.

That’s why it’s important to seek treatment for sciatica before it worsens. Unlike medications, chiropractic treatment actually addresses the cause of sciatica – an injury or disc herniation pinching the sciatica nerve. Chiropractors adjust and realign the spine to reduce pressure on the sciatica nerve, and in doing so, significantly relieve the pain. Chiropractic treatment, along with strong core and back muscles, is a powerful way to recover and prevent sciatica.

Reference

Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. British Journal of Radiology. November 2010.0: 58136533.

Feelings About Work and The Outcome of Lumbar Discectomy

Surgical decompression for prolapsed/herniated lumbar intervertebral disc is the most frequently performed spinal intervention. This recent study explored psychological assessments, in particular the psychosocial aspects of work, in predicting the outcome of lumbar discectomy. The authors also assessed general medical data and utilized MRI scanning to identify abnormalities. Their hope was that these varied assessments would help predict postoperative outcome and return to work status.

46 patients who had lumbar discectomy surgery were followed for two years. Before the operation the authors evaluated the patients’ low back pain history, performed a physical, and ran the MRI examinations. All patients reported at least radicular leg pain. 27 patients had minor neurological deficits and 11 had major deficits.

Two years later, with questionnaires, the authors investigated the patients’:

  • Work-related mental stress
  • Job Satisfaction
  • Job Resignation
  • Support Network at Work
  • Level of Pain Relief
  • Disability in Daily Activities
  • Return to “any” work
  • Surgical Outcome

The authors found that a high occurrence of job resignation, which is a feeling of dissatisfaction coupled with feeling forced to accept the job as it is, predicted disability in daily activities. Other significant predictors of disability and pain relief were MRI-identified nerve root compromise and neural compromise. The authors found that in most patients, the pain is likely to subside after resolution of the neurological problem. In cases where the irritation persists, however, “disc protrusion could be the initiating factor for low back and leg pain, but psychological factors might be more relevant in perpetuating pain.”

Yet, psychological aspects—not physical findings—played a vital role in predicting return to work. Since occupational mental stress, job satisfaction, and depression were major predictors, the authors then considered working conditions, rather than low back pain, as influencing return to work status. They write:

“These findings indicate that patients with stressful work conditions do not tend to return to work even if the discectomy was successful from a surgical point of view. Improvements in working conditions, particularly from the psychological point of view, could play a significant role in the rehabilitation of a patient after discectomy, a finding which needs further attention and evaluation…Furthermore, this study highlights the importance of psychological aspects of work which should be taken more into account, in further research. It also implies that psychologically favorable working conditions may be an important preventive factor for chronic disability.”

Schade V, Semmer N, Main C, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain 1999;80:239-249.

What causes radicular pain after an auto collision?

Radicular pain, or radiating pain, is caused by interference or pinching of the spinal nerves. This results in pain, tingling, or numbness in parts of your body far from the actual source of the problem.

If your spine is injured, there are a number of things that can affect the nerves.Injured ligaments and muscles can cause inflammation of the nerve root, which can disrupt the function of the nerve. If a spinal disk is damaged, it can cause the disk to bulge or herniate, pinching the nerve. And if the spinal joints begin to calcify, it can cause spinal stenosis, or a narrowing of the canal that the spinal nerves pass through.

All this can lead to a number of conditions such as sciatica, carpal tunnel syndrome, low-back pain, shoulder pain, and more. It’s crucial to treat these conditions to prevent further nerve damage or worsening symptoms.

The key to treating radicular pain is to pinpoint its source in the spine. After determining the root of your pain, a chiropractor can relieve pressure on the impinged nerves. This allows the nerves to heal by reducing inflammation and irritation.

Multiple studies have confirmed the efficacy of chiropractic adjustments in alleviating radicular pain. If you’re looking for a natural, effective pain relief, chiropractic could help. Call our office to learn more.

References

Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. Journal of Chiropractic Medicine 2008; 7(3):115-25.

Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.

Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. Journal of the Canadian Chiropractic Association 2012; 56(1):18-28.

Herniated Discs and Chiropractic

The debilitating pain caused by a herniated disc is unfortunately all too common. This condition is the end result of a longer process of degeneration. Fortunately, chiropractic care can provide relief for most simple herniated disc injuries.

A herniated disc is commonly referred to as a slipped disc. Cartilaginous discs, situated between each vertebra in the spine, act as shock absorbers for your back. They provide cushioning between the hard, bony vertebrae that make up the spine. A disc injury is more accurately referred to as a bulge or a rupture, where the bulging disc puts pressure on nerves and can no longer function properly.

A herniated disc occurs as the end result of a degenerative process. Underlying factors of a disc injury may include:

  • disc dehydration, where insufficient water absorption ages the tissues and causes rigidity;
  • unusual types of stress on the discs, and
  • excessive weight on the discs.

These factors cause slow degeneration of disc quality, leading eventually to the herniation. A rupture can occur through sudden movement, such as lifting a heavy item or even sneezing. It is important to note that the act of sudden movement is not the cause; the degenerative process is what causes the disc to ultimately slip.

Most simple herniated disc injuries can be treated with low-force chiropractic techniques or with traditional alignment methods. However, more extreme disc injuries that involve an advanced loss of strength, sensation or reflexes should be referred to a spine specialist for further evaluation and intensive treatment.