CHIROPRACTIC AND SCIATICA
 
   

Chiropractic and Sciatica

This section was compiled by Frank M. Painter, D.C.
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  Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

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Our usual Topical Pages list the newest studies first.   This page is different... for a reason.

By tracking a specific health topic over time, we can see the evolution of the questions asked, as well as the growing sophistication of chiropractic research. It's a different way of looking at things, and I hope you will find it as fascinating as I did.


Manipulative Therapy in Lower Back Pain With Leg Pain and
Neurological Deficit

J Manipulative Physiol Ther 1998 (May);   21 (4):   288–294

The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.

Pain, Disability, and Satisfaction Outcomes and Predictors of Outcomes:
A Practice-based Study of Chronic Low Back Pain Patients Attending
Primary Care and Chiropractic Physicians

J Manipulative Physiol Ther. 2001 (Sep);   24 (7):   433–439

Overall, long-term pain and disability outcomes were generally equivalent for patients seeking care from medical or chiropractic physicians. Medical and chiropractic care were comparable for patients without leg pain and for patients with leg pain above the knee. However, an advantage was noted for chronic chiropractic patients with radiating pain below the knee after adjusting for baseline differences in patient and complaint characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P <.002). A greater proportion of chiropractic patients were satisfied with all aspects of their care (P =.0000). The strongest predictors of primary outcomes included an interaction of radiating pain below the knee with provider type and baseline values of the outcomes. Income, smoking, comorbidity, and chronic depression were also identified as predictors of outcomes in this study.

What Do Patients Think? Results of a Mixed Methods Pilot Study Assessing
Sciatica Patients' Interpretations of Satisfaction and Improvement

J Manipulative Physiol Ther. 2003 (Oct);   26 (8):   502–509 ~ FULL TEXT

This study demonstrated that a "mixed methods" approach using qualitative research methods within a clinical trial is not only feasible but can provide interesting and useful information for trial interpretation and future study design. By providing insight to the multidimensional nature of patients' beliefs and perceptions, this technique may not only shape but also redefine the focus of patient-oriented research and health care for low back pain conditions.

Spinal Manipulation, Epidural Injections, and Self-care for Sciatica:
A Pilot Study for a Randomized Clinical Trial

J Manipulative Physiol Ther. 2004 (Oct);   27 (8):   503–508 ~ FULL TEXT

At week 12 (the end of the treatment phase), the outcome measures indicating the most improvement/change were the Oswestry disability score (mean, 22.9; SD, 19.9; effect size [ES], 1.8), leg pain severity (mean, 2.9; SD, 1.7; ES, 1.7), and if the symptoms were bothersome (mean, 25.2; SD, 16.0; ES, 1.6). Twenty-four patients were either "very satisfied" or "completely satisfied," and 22 of 32 patients reported 75% or 100% improvement. After 52 weeks, the outcome measure showing the most improvement/change was leg pain severity (mean, 2.3; SD, 2.6; ES, 1.35), followed by the Oswestry disability score (mean, 15.6; SD, 20; ES, 1.2) and if symptoms were bothersome (mean, 18.1; SD, 22.6; ES, 1.1). Eighteen patients were either "very satisfied" or "completely satisfied," and 15 of 32 patients reported 75% or 100% improvement.

The Nordic Back Pain Subpopulation Program: Validation and Improvement
of a Predictive Model for Treatment Outcome in Patients With Low Back Pain
Receiving Chiropractic Treatment

J Manipulative Physiol Ther. 2005 (Jul);   28 (6):   381–385 ~ FULL TEXT

In this study, patients with LBP who also had leg pain and LBP occurring sufficiently frequently or having lasted sufficiently long to add up to at least 30 days in the past year, and who did not report definite general improvement by the second treatment were not good candidates for short-term recovery. It is suggested that patients who fit the criteria of potential nonresponders should be carefully monitored to allow a selective approach of care.

Chiropractic Manipulation in the Treatment of Acute Back Pain and Sciatica
With Disc Protrusion: A Randomized Double-blind Clinical Trial of Active
and Simulated Spinal Manipulations

Spine J. 2006 (Mar);   6 (2):   131–137

A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). Manipulations appeared more effective on the basis of the percentage of pain-free cases (local pain 28 vs. 6%; p<.005; radiating pain 55 vs. 20%; p<.0001), number of days with pain (23.6 vs. 27.4; p<.005), and number of days with moderate or severe pain (13.9 vs. 17.9; p<.05). Patients receiving manipulations had lower mean VAS1 (p<.0001) and VAS2 scores (p<.001). A significant interaction was found between therapeutic arm and time. There were no significant differences in quality of life and psychosocial scores. There were only two treatment failures (manipulation 1; simulated manipulation 1) and no adverse events.

Physical Assessment of Lower Extremity Radiculopathy and Sciatica
Journal of Chiropractic Medicine 2007 (Jun);   6 (2):   75–82 ~ FULL TEXT

Several physical maneuvers are provocative to lumbosacral nerve roots or the sciatic nerve. Provocative maneuvers are intended to reproduce signs and symptoms of lower extremity radiculopathy/sciatica. Other maneuvers counter to the provocative maneuvers (palliative maneuvers) decrease nerve root and sciatic irritation and the related signs and symptoms (Figure 1).

Chiropractic Management of Low Back Pain and Low Back-Related
Leg Complaints: A Literature Synthesis

J Manipulative Physiol Ther 2008 (Nov);   31 (9):   659–674 ~ FULL TEXT

As much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.

Pain Patterns and Descriptions in Patients with Radicular Pain:
Does the Pain Necessarily Follow a Specific Dermatome?

Chiropractic & Osteopathy 2009 (Sep 21);   17 (1):   9 ~ FULL TEXT

Two hundred twenty-six nerve roots in 169 patients were assessed. Overall, pain related to cervical nerve roots was non-dermatomal in over two-thirds (69.7%) of cases. In the lumbar spine, the pain was non-dermatomal in just under two-thirds (64.1%) of cases. The majority of nerve root levels involved non-dermatomal pain patterns except C4 (60.0% dermatomal) and S1 (64.9% dermatomal). The sensitivity (SE) and specificity (SP) for dermatomal pattern of pain are low for all nerve root levels with the exception of the C4 level (Se 0.60, Sp 0.72) and S1 level (Se 0.65, Sp 0.80), although in the case of the C4 level, the number of subjects was small (n=5). In most cases nerve root pain should not be expected to follow along a specific dermatome, and a dermatomal distribution of pain is not a useful historical factor in the diagnosis of radicular pain. The possible exception to this is the S1 nerve root, in which the pain does commonly follow the S1 dermatome.

A Nonsurgical Approach to the Management of Patients With Lumbar
Radiculopathy Secondary to Herniated Disk: A Prospective Observational
Cohort Study With Follow-Up

J Manipulative Physiol Ther 2009 (Nov);   32 (9):   723–733 ~ FULL TEXT

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4–6 20-minute sessions once-a-week. Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

The Nordic Back Pain Subpopulation Program: Can Low Back Pain Patterns
Be Predicted From the First Consultation With a Chiropractor?
A Longitudinal Pilot Study

Chiropractic & Osteopathy 2010 (Apr 29);   18:   8 ~ FULL TEXT

A total of 110 patients were included and 76 (69%) completed follow-up. Thirty-five patients were examined by two chiropractors. The agreement regarding diagnostic classes was 83% (95% CI: 70 – 96). The diagnostic classes were associated with the pain course patterns and number of LBP days. Patients with disc pain had the highest number of LBP days and patients with muscular pain reported the fewest (35 vs. 12 days, p < 0.01). Men had better outcome than women (17 vs. 29 days, p < 0.01) and patients without leg pain tended to have fewer LBP days than those with leg pain (21 vs.31 days, p = 0.06). Duration of LBP at the first visit was not associated with outcome.

Manipulation or Microdiskectomy for Sciatica?
A Prospective Randomized Clinical Study

J Manipulative Physiol Ther. 2010 (Oct);   33 (8):   576–584 ~ FULL TEXT

One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3–4, L4–5, or L5–S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.   Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.

Chiropractic and Self-care for Back-related Leg Pain:
Design of a Randomized Clinical Trial
  NCT00494065
Chiropractic & Manual Therapies 2011 (Mar 22);   19:   8 ~ FULL TEXT

Back-related leg pain (BRLP) is a costly and often disabling variation of the ubiquitous back pain conditions. As health care costs continue to climb, the search for effective treatments with few side-effects is critical. While SMT is the most commonly sought CAM treatment for LBP sufferers, there is only a small, albeit promising, body of research to support its use for patients with BRLP.This study seeks to fill a critical gap in the LBP literature by performing the first full scale RCT assessing chiropractic SMT for patients with sub-acute or chronic BRLP using important patient-oriented and objective biomechanical outcome measures.

Predictors of Improvement in Patients With Acute and
Chronic Low Back Pain Undergoing Chiropractic Treatment

J Manipulative Physiol Ther. 2012 (Sep);   35 (7):   525–533 ~ FULL TEXT

An important and unique finding in this current study is that although 123 (23%) of the patients with acute LBP and 71 (24%) of the patients with chronic LBP were diagnosed by their chiropractors as having radiculopathy, this finding was not a negative predictor of improvement. Radiculopathy was not simply defined as leg pain but required clinical signs of nerve root compression as determined by the examining chiropractor. Previous studies investigating outcomes from patients with LBP undergoing spinal manipulation have purposely excluded patients with radiculopathy, [2, 10, 29] and others have found that the presence of leg pain is a negative predictor of improvement. [12, 24, 30] This study purposely included these patients to evaluate this subgroup. It is quite common for patients with LBP experiencing radiculopathy to seek chiropractic care in Switzerland and to receive spinal manipulative therapy as one of the treatment options.

Conservative Management of a 31 Year Old Male With Left Sided Low Back
and Leg Pain: A Case Report

J Can Chiropr Assoc. 2012 (Sep);   56 (3):   225–232 ~ FULL TEXT

This case demonstrates positive results for the treatment of a sub-acute lumbar disc injury with conservative care. It should be noted that results cannot be extrapolated to other cases, since this is only a single case report and the rapid resolution of this patient’s symptoms could be due to the natural history of the condition or the use of multiple interventions. Sitting and slouching have been shown to aggravate low back pain, especially when a disc injury is involved. Standing and extension exercises have been shown to help combat this. There are many reports of asymptomatic disc herniations and spontaneous resolutions, as well as muscular atrophy associated with this type of injury. The prognosis of disc herniation related low back pain relates to the extent of radiation, duration of pain and other psychosocial factors. Recommended conservative care includes spinal stabilization exercises, McKenzie assessment and treatment, neural mobilizations and chiropractic modalities, including spinal manipulative therapy. Conservative management may decrease pain and increase function for the treatment of lumbar disc injuries. Active patient participation in rehabilitative care is recommended before surgical referral.

Spinal Manipulation and Home Exercise With Advice for Subacute and
Chronic Back-related Leg Pain: A Trial With Adaptive Allocation

Ann Intern Med. 2014 (Sep 16);   161 (6):   381–391

Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. For leg pain, SMT plus HEA had a clinically important advantage over home exercise and advice (HEA) (difference, 10 percentage points [95% CI, 2 to 19]; P=0.008) at 12 weeks but not at 52 weeks (difference, 7 percentage points [CI, -2 to 15]; P=0.146). Nearly all secondary outcomes improved more with SMT plus HEA at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. No serious treatment-related adverse events or deaths occurred.

The Effect of Adding Forward Head Posture Corrective Exercises
in the Management of Lumbosacral Radiculopathy:
A Randomized Controlled Study

J Manipulative Physiol Ther. 2015 (Mar);   38 (3):   167–178 ~ FULL TEXT

The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.

Pain Location Matters: The Impact of Leg Pain on Health Care Use,
Disability and Quality of Life in Patients with Low Back Pain

Eur Spine J. 2015 (Mar);   24 (3):   444–451 ~ FULL TEXT

Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.

Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk
Herniation Patients: A Comparative-Effectiveness Prospective
Observational Study of 2 Age- and Sex-Matched Cohorts
Treated With Either Imaging-Guided Indirect Cervical
Nerve Root Injections or Spinal Manipulative Therapy

J Manipulative Physiol Ther. 2016 (Mar);   39 (3):   210–217 ~ FULL TEXT

"Improvement" was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting "improvement" was noted (P = .002).

What Do Patients Value About Spinal Manipulation and Home Exercise for
Back-related Leg Pain? A Qualitative Study Within a Controlled Clinical Trial

Man Ther. 2016 (Dec);   26:   183–191 ~ FULL TEXT

This qualitative study illustrates that patient satisfaction is rooted in the quality of the patienteprovider relationship, although perceived symptom improvements, relevant clinical information about sciatica and its treatment, and the distinct qualities of those treatments are important drivers of satisfaction for patients who received non-pharmacological treatments for their back-related leg pain. Global measures of satisfaction may not adequately represent the range of patients' experiences and perceptions of spinal manipulative therapy or home exercise. In addition to providing insight to the quantitative results of the parent trial, these findings suggest that tailored interventions to enhance patienteprovider relationships may facilitate compliance and enhance satisfaction with care.

Leg Pain Location and Neurological Signs Relate to Outcomes in
Primary Care Patients with Low Back Pain

BMC Musculoskelet Disord. 2017 (Mar 31);   18 (1):   133 ~ FULL TEXT

The Quebec Task Force categories (QTFC) identify different LBP subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes. The differences between outcomes appear to be large enough for the QTFC to be useful for clinicians in the communication with patients. However, due to variation of outcomes within each category individuals' outcome cannot be precisely predicted from the QTFC alone. It warrants further investigation to find out if the QTFC can improve existing prediction tools and guide treatment decisions.


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