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.

Chiropractic Increases Spinal Flexibility for Low Back Pain

For many people who suffer from low back pain, chiropractic treatments ease their symptoms and increase flexibility. But why does it work? And which patients are most likely to benefit? Recently, a team of researchers based in the United States and Australia set out to investigate the effect of one chiropractic technique on spinal stiffness in patients with low back pain. They found that chiropractic manipulation can have an immediate effect on spinal stiffness and muscle growth in certain patients.

Repeated studies have confirmed the effectiveness of high impact, low velocity spinal manipulation (SMT) for reducing low back pain. Yet although it is known that SMT has a direct effect on spinal muscles, and that it stimulates a patient’s nervous system, many questions remain about exactly how SMT works. For this study, the researchers recruited 48 subjects with low back pain from physical therapy clinics and through community advertisements. The subjects were evaluated for several factors that might decrease the likelihood that their treatment would succeed – factors such as longer length of injury and fear avoidance (avoiding activity because of the fear that it may cause pain).

Each participant underwent three SMT sessions, held over a one-week period. Before and after each session, the participants rated their pain levels on a scale of 0-10 and were measured for spinal stiffness. The researchers also took ultrasounds to assess the thickness of the patient’s back muscles.

Their results showed that after patients received SMT, there was an immediate and measurable improvement in stiffness. The patients also reported experiencing less disability from their low back pain after SMT. In their measurements of muscle growth, researchers found that muscle thickness increased more quickly in patients who had been categorized as likely to have a positive outcome. This muscle increase lasted through the one-week follow-up period, which indicates that the benefits of SMT could be prolonged, especially when combined with exercise treatments designed to build muscle in the lower back.

Although the researchers acknowledge that their sample size was small, and their results preliminary, these findings help confirm that chiropractic can have immediate beneficial effects for patients suffering from low back pain. They also show that the human body has a complicated reaction to SMT, with both stiffness and muscle thickness playing a roll in the outcome of treatment.

Fritz JM, Koppenhaver SL, Kawchuk GN, Teyhen DS, Hebert JJ, Childs JD. Preliminary investigation of the mechanisms underlying the effects of manipulation: exploration of a multi-variate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine. 2011 March 15.

Chiropractic Can Prevent Back Pain

Back pain is a very common condition, affecting one out of three adults. Experts estimate that chronic back pain costs the US about $100 billion each year in direct and indirect costs. Low back painAs with all health issues, it’s better and easier to prevent back pain than it is to treat it after it occurs. A recent study set out to see if chiropractic was effective in treating chronic low back pain and preventing flare-ups in the future.

The authors studied 30 patients who had back pain for at least six months. All patients were subjected to a one-month control period that consisted of no treatment. This was included so that the researchers could observe the natural course of the back pain symptoms.

After this baseline period, half of the patients received intensive chiropractic treatment consisting of 12 treatments in one month, then no treatments for nine months. The other half of the patients received the same intensive treatment, but also received maintenance chiropractic treatments every 3 weeks for nine months. At the end of the nine-month period, both groups were again examined.

The authors found that both groups experienced a dramatic reduction in pain from the treatments that lasted during the entire study period. The patients who received continuing care, however, had significantly reduced disability from their back pain, while the patients who received the initial care with no follow-up had their disabling symptoms return to pre-treatment levels.

The authors conclude that chiropractic is effective at relieving pain and keeping your back healthy over the long term. If you or someone you know is suffering from back pain, give us a call us at for an appointment.

Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics 2004;27:509-514.

Chiropractic – Osteoarthritis, Arthritis

Numerous studies have shown that chiropractic can be an effective treatment for lumbar spinal pain. A new study1 describes the previously reported benefits of chiropractic:

“Giles and Muller compared the outcomes of acupuncture, medication, and spinal manipulation on spinal pain syndromes. Only spinal manipulation led to significant improvement. Rao et al. reported that 73% of the patients who sought pain relief treatment from both a rheumatologist and an alternative form of medicine found chiropractic care to be helpful. It may be reasonably concluded that chiropractic care is a successful treatment for lower back pain.” 1

No previous study, however, has examined the effectiveness of chiropractic for back pain symptoms in patients with osteoarthritis. This current report set out to do just that, by comparing chiropractic treatment to moist heat treatment. Previous studies2 have shown that application of heat to the affected area is an effective self-management tool for arthritis symptoms.

The authors of this study recruited 252 patients with osteoarthritis of the lumbar spine; subjects were excluded if they were currently receiving chiropractic care, physical therapy, or were using anti-inflammatory medications.

The patients were divided into two groups: the treatment group received 20 chiropractic treatments with 15 minutes of moist heat; the control group received only the moist heat treatments. The subjects were evaluated at 1, 5, 10, 15, and 20 weeks for pain levels, activities of daily living (ADL), and range of motion.

The study found significant improvements in the patients who were given the chiropractic/moist heat treatments, as illustrated by the following graph that shows average extension of the spine measured at each evaluation point:
Chiropractic helpful for osteoarthritis
 Here is a summary of the other findings:

  • Chiropractic was significantly more effective in reducing pain than moist heat alone, even though both treatments reduced pain to some degree.
  • The study examined right and left lateral flexion, average flexion, and average extension. “Chiropractic care plus moist heat is more effective than moist heat alone for improving ROM, as measured by these particular tests.”
  • Chiropractic care was also more effective in improving daily activities, while moist heat alone did not improve ADL.

The authors conclude:

“There are no studies in the literature that evaluate the effectiveness of chiropractic care in the treatment of OA. We found that chiropractic care was significantly better than moist heat alone for the treatment of OA. Although moist heat did improve low back pain, there is a more rapid and greater decline in pain under the treatment condition than with moist heat alone. The chiropractic treatment group also showed a more rapid and greater increase in range and flexion scores. With the exception of standing, sleeping, and sexual activity, chiropractic treatment participants reported a statistically significant improvement in their ADL.”

  1. Beyerman KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. Journal of Manipulative and Physiological Therapeutics 2006;29:107-114.
  2. Veitiene D, Tamulaitiene M. Comparison of self-management methods for osteoarthritis and rheumatoid arthritis. Journal of Rehabilitation Medicine 2005;(37)1:58-60.

Chiropractic & Massage Beneficial for Back Pain

Back pain is a very common complaint, affecting up to 30% of people in the United States each year, and it is one that can be difficult to treat. Recent news has raised doubt about the effectiveness of some traditional medical responses to back pain, including surgery, pain relief supplements, and even bed rest.

A study published in May 2010 looked into the effectiveness of complementary and alternative therapies on back pain. Researchers from Harvard Medical School and Brigham and Women’s Hospital in Boston used data collected as part of the 2002 National Health Interview Study to investigate the “perceivedhelpfulness” of six treatments, including chiropractic, acupuncture, massage, herbal therapy, relaxation techniques, and yoga/tai chi/qi gong.

Chiropractic and massage were the two most common treatments that participants sought out. Although nearly half of participants reported that they had turned to an alternative treatment in conjunction with conventional medicine, only a quarter of them had tried the therapy because of a recommendation from their doctor.

The researchers found that 60% of people who tried at least one of the therapies felt they had received a “great deal” of benefit from the treatment. This rate of satisfaction was highest among chiropractic patients, two-thirds of whom perceived a benefit from their treatment. Just over half of those who used massage or yoga reported that it had helped them (56%). These rates of satisfaction were lower among those who tried acupuncture (42%), herbal therapies (32%), or relaxation techniques (28%).

The researchers could not compare these results against results from nonusers of alternative or complementary therapies for back pain, and the findings are subjective. Yet their study shows that the majority of those who turn to therapies like chiropractic and massage to treat back pain can derive substantial benefit.

Kanodia AK, Legedza ATR, Davis RB, Eisenberg DM, Phillips RS. Perceived benefit of complementary and alternative medicine (CAM) for back pain: A national survey. Journal of the American Board of Family Medicine. 2010 May-Jun;23(3):354-62.

Chiropractic and Family Practice Physician Treatment Outcomes for Chronic, Recurrent Low-Back Pain

Despite the large number of patients with chronic low back pain there is little data on treatment effectiveness for this group. The authors of this feasibility study sought to answer some of the many questions on clinical management of chronic low back pain, including: “How do differences in the treatment processes relate to variations in outcomes among different types of practices and providers?” and “What is the relative benefit of different care strategies?”

In this study, forty-five chiropractors and thirty-three medical physicians collected data on patients with acute and chronic low back pain over a period of six months. This study dealt with the chronic low-back pain group consisting of 93 chiropractic patients and 45 medical patients. Physicians and patients completed questionnaires on the first visit. Follow up included a telephone interview with patients at seven to ten days, and a mailed questionnaire at one month and at three months. Physicians completed a follow up questionnaire on all subsequent visits. Patient questionnaires were administered in the waiting room before the first visit, and contained six parts. Socio-demographic information was collected. A condition specific questionnaire on low-back condition before treatment established baseline. A visual analog scale (VAS) measured pain severity. Pain quality was documented, and limitations on functional activities were assessed. General health was assessed using the Medical Outcomes Study 36-item Questionnaire (SF-36), with additional questions to screen for depression. The follow-up telephone interview included an assessment of patient satisfaction using a five point ordinal scale. The mailed follow up included a condition specific questionnaire, VAS, a questionnaire to document pain quality, and the functional limitation questionnaire.

Within the two provider groups patients differed in age, sex and employment status. Family practice physician patients tended to be older, female, less likely to be employed outside of the home, and less educated. Baseline measures of psychosocial health were similar for both groups but chronic depression of two years duration was seen in 31% of medical doctor patients compared to 14% of chiropractic patients. On general health measures at baseline, family practice patients tended to have poorer general health, with slightly greater physical impairment, and more bodily pain.

In general, chiropractic patients showed greater improvement than the medical patients at the one month follow up. Significant differences were seen in patient satisfaction, with chiropractic patients reporting greater satisfaction with information and treatment provided. The difference between the chiropractors and medical doctors was particularly evident in patient satisfaction with overall medical care. Of the patients that responded to the one-month mailed follow-up, 56% of chiropractic patients reported that their low back pain was better or much better, compared to only 13% of medical patients. Nearly one third of medical patients reported their low back pain as worse or much worse.

The authors conclude, “Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians.” The researchers note that although there is, “…ample evidence in the literature to support a specific benefit from manipulation for patients with acute low-back presentation, there is a paucity of research on the benefit of manipulation for patients with chronic low-back pain.” They hypothesize that:

“…outcome may be heavily influenced by the nature of the chiropractor-patient interaction, including more frequent visits and a process that engages the patient as a partner in the healing encounter.”

“The influence of nonclinical factors appears to receive support from this study in that good outcome for medical patients was largely dependent on good psychological health at baseline, whereas the outcome for chiropractic patients was not. It may be that chiropractors dealt more effectively (successfully) with the psychosocial components of chronic low back pain…”

This feasibility study was limited in a few respects. There were fewer medical clinic patients enrolled than there were chiropractic patients; this is largely due to the complexities of multi-physician clinics, and did not affect patient characteristics. Self-selected treatment groups are known to be biased in observational studies, and not all patients responded to the one-month questionnaire. The authors state that their purpose was “…not to study efficacy as in a randomized clinical trial but to characterize patients and practices and to explore relationships at they exist in the community.”

Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and on-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Journal of Manipulative and Physiological Therapeutics 2000;23(4):239-245.

Chiropractic, Muscle Relaxants and Back Pain

Chiropractic for back painOver ¾ of adult Americans experience lower back pain at some point in their lives, and nearly 1 in 5 experience it each year, making it important to determine which treatments are most effective. This double-blind study looked at the effectiveness of treating subacute lower back pain (LBP) with chiropractic adjustments when compared to treatment with muscle relaxants or a placebo (sugar pill).

The 146 subjects who completed the study were between 21 and 59 years old, with uncomplicated LBP lasting from 2 to 6 weeks at the start of the study. Those with underlying spinal disease or malformations were excluded. Each subject underwent chiropractic and radiographic evaluation at the initial evaluation visit. Pain was evaluated at the initial visit, and again at 2 weeks and 4 weeks.

Pain was evaluated using the Visual Analog Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire, and the Zung Self-rating for Depression scale. Shober’s test for lumbar flexibility was also given at the initial visit and again at 2 weeks.

At the initial visit, subjects were assigned to one of three groups with treatment administered over a period of 2 weeks:

  • Chiropractic adjustments and placebo pill
  • Muscle relaxants and sham adjustments
  • Placebo pill and sham adjustments (control group)

All subjects were also allowed to take acetaminophen to evaluate the need for additional self-medication.

7 chiropractic adjustments were given over the 2-week treatment period to the chiropractic adjustment group. Adjustments were tailored to the patient’s needs, and included upper cervical and lumbar (neck and back), sacral (lower back) or pelvic adjustments.

Sham treatments were designed to mimic normal visit length, dialog and procedures without the actual adjustment occurring.

Practitioners administered cyclobenzaprine HCL (5 mg), carisprodol (350 mg), and methocarbamol (750 mg) in bottles labeled “A,” “B,” and “C” to treat the subjects in the muscle relaxant group. Usage and dosage were determined by the medical practitioner’s clinical judgment, with the combination of medications determined by effectiveness and adverse reactions. Subjects could halve or double the dosage in bottles “A” and “B,” or switch to bottle “C” for bottle “A” if excessive drowsiness occurred, and were instructed to discontinue medication if side effects were severe. Acetaminophen was also offered in a bottle labeled “D.” The placebo groups were given exactly the same instructions, only their bottles contained placebos.

While the study was meant to be blind (the subjects would not be able to tell if they were receiving real or sham adjustments or medications), there was a higher tendency for the groups that received true chiropractic treatment and that received the muscle relaxants to perceive that treatment was given, and a higher perception in the sham treatment group that treatment was not given. This could be due to the effectiveness of the treatment, however.

During the 4 weeks of the study, pain was significantly reduced in all groups. Initially, the group that received chiropractic adjustment had overall higher baseline VAS scores, but after treatment, their scores were lower than the other groups, indicating an even more impressive level of improvement in the chiropractic subjects.

The change in reportedpain among the 3 groups was statistically significant: subjects in the chiropractic group reported greater pain reduction than the control group. While scores on the Oswestry Disability Index improved for all groups over the 4 weeks studied, the greatest improvement in scores occurred in the chiropractic group.

Depression and Shober (lumbar flexibility) scores improved in all 3 groups during the 4 weeks, with no difference between the groups.

GIS evaluations (which measure the physician’s assessment of improvement) showed that patients given chiropractic adjustments improved more than subjects who received muscle relaxants or placebos did.

The authors concluded:

“Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.”

Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics 2004;27:388-398.

Chronic Back Pain, Chiropractic Effective

This study based used a practice-based, observational model to look at the effectiveness of intervention in a selected group of patients with both acute and chronic lower back pain (LBP).  It compared the efficacy of chiropractic intervention with standard medical care in both types of LBP.

2780 patients were enrolled in the study over a 2-year period (1994 to 1996) from the practices of 60 DCs (1855 patients) and 111 MDs (925 patients) in 51 chiropractic and 14 general practice clinics. Patient data was obtained at the initial visit through a questionnaire administered in person, and the patients were followed up with 7 mailed questionnaires at regular intervals over a period of 4 years. Mailings were sent at 2 weeks, 1 month, 3 months, 6 months, and 1 year after the initial visit. In phase 2, patients were followed up at 24, 36, and 48 months.

Patients were eligible if LBP was their primary complaint, and was of mechanical origin; they were excluded if manipulation was contraindicated, or the back pain was of nonmechanical origin (such as from organic referred pain).  Acute patients were those whose back pain was of less than 7 weeks duration; chronic back pain patients were those whose back pain was of 7 weeks duration or longer.

The physicians in the study delivered a variety of treatment methods. Chiropractic physicians gave care that included spinal manipulation, physical therapy, an exercise plan, and self-care education. Medical physicians gave care that included prescription drugs, an exercise plan, and self-care advice; roughly 25% of these patients were referred for physical therapy.

The primary outcomes measured were present pain severity, and functional disability, which were measured by questionnaires mailed to the patients at the above stated intervals.

The medical patients showed more severe baseline pain and disability when entering treatment, greater prevalence of pain radiating below the knee, and poorer general health status, than in patients treated by chiropractors. These differences were more pronounced in the chronic patients than in the acute patients.

A modest advantage was seen for DC care when compared with MD care in pain relief for the first 12 months. This difference was very small for acute LBP, but was greater for those with chronic LBP during the first year of treatment. There were no differences for patients cared for between 12 and 24 months. Trends in disability were similar to the pain trends, but were of smaller magnitude.

There was an advantage chiropractic care in chronic patients with pain radiating below the knee, and some small advantages were also seen in the acute patient group. Differences were also seen in chronic patients with no leg pain during the first 3 months of care. There were no differences in the 2 groups and the 2 types of medical care for pain radiating above the knee.

All patient groups saw clinically significant improvement in pain and disability over the course of treatment. Acute patients saw greater improvement, with many obtaining near complete relief of their symptoms. Most achieved symptom relief by 3 months, followed by a plateau through 12 months. This was followed by significant, clinical aggravation of pain at 12 to 24 months, with another plateau until 4 years. Little increase in disability was seen between 12 and 48 months.

Of note, at 3 years into the study, 45% to 75% of patients noted at least 30 days of pain during the previous year, even in those who had gained significant pain and disability relief through early intervention. 19% to 27% of chronic LBP patients noted daily pain during the previous year.

  • Early interevention reduces chronic pain. Those who received early intervention for acute lower back pain, at 3 years after the initial injury, reported fewer days of back pain than those who waited longer for intervention. This would support providing early intervention for patients with acute back pain, since outcomes were better than in those who delayed treatment.
  • Chiropractic is beneficial for certain kinds of pain. Chiropractic care was more effective than standard medical care in certain situations: during the first 12 months in patients with chronic lower back pain, and for the treatment of LBP with pain radiating below the knee. The majority of the relief was obtained during the first 3 months of treatment, and was sustained throughout the first year.

Haas M, Goldberg B, Aickin M, Ganger B, Attwood M. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. Journal of Manipulative and Physiological Therapeutics 2004;27(3):160-169.

Back Pain: How Chiropractic Can Help

Back pain is the leading reason people seek out the assistance of a chiropractor. A chiropractor as can help both with both pain management, and by improving the alignment of the back, they can help prevent future episodes of pain.  When you first go to see a chiropractor, he or she will take a medical history and most likely ask you questions to find out what may have triggered the pain. The chiropractor will also feel around your back to determine where the pain is coming from.

Chiropractors treat many types of back pain using spinal manipulation.  The chiropractor will have you lie down on a special table and put your arms and/or legs in certain positions.  Then he or she will apply pressure to make your bones and joints return to their proper places.  Most people feel great relief when they have this done, although some people are a little sore the next day.