Disc Herniation and Conservative Care

 1. Low Back Disc Herniation...

Most disk injuries to the low back result from a lifetime accumulation of injury to the spine and usually occur as "the last straw that breaks the camels back." Most people are involved in simple tasks such as bending over to pick up a toothbrush, or reaching into the refrigerator and picking up a gallon of milk when they experience sudden severe pain in the back shooting down into the foot. There are many different types of disk injury and it is important that a proper diagnosis be sought out, an area where Chiropractors are experts in. Traditional medical care usually consists of pain medications and muscle relaxants followed by limited bed rest and physical therapy with less than adequate results. Other options like surgery are sometimes offered with severe or prolonged complicated cases. According to a 1994 U.S. Department of Health and Human Services study, overall low back disk surgery has a 40% success rate. Decompression of the disk is what surgery is attempting to do, trying to relieve pressure upon delicate nerve tissue. We would like to inform you that there are other conservative options available for people who suffer from a disk herniation. One such treatment that is offered in this office is intermittent lumbar traction through the use of the flexion/distraction technique.

The Flexion/distraction technique is a specialized table and treatment protocol developed by Dr. James Cox. It has been used for many years in the chiropractic profession for the treatment of low back disk injuries. It has allowed for the reduction of symptoms in many low back disk problems. It acts to decompress the disk and reduce pressure on delicate nerve tissue. A recent study in The Journal of the Neuromusculoskeletal System followed the progress of a surgical candidate, with a proven disk herniation, through conservative care utilizing the flexion-distraction technique. After his treatment protocol the patient stated that his previous pain had completely resolved and that he has resumed all normal activities of daily living. The conclusion of the article was that this alternative in conservative care may be of benefit to a large number of patients. And that the surgical option might be reduced with the use of flexion/distraction technique.

Medline Articles on Low Back Disc Herniation

  • Manipulative therapy in lower back pain with leg pain and neurological deficit.
    Bergmann TF, Jongeward BV. Methods Department, Northwestern College of Chiropractic, Bloomington, MN 55431, USA.
    J Manipulative Physiol Ther 1998 May;21(4):288-94

    OBJECTIVE: To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery. CLINICAL FEATURES: The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation. INTERVENTION AND OUTCOME: 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. CONCLUSION: We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. Although significant questions remain for the evaluation and treatment of lumbar radiculopathy (sciatica) with disc herniations, there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.
  • Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations.
    BenEliyahu DJ
    J Manipulative Physiol Ther 1996 Nov-Dec;19(9):597-606

    OBJECTIVE: To prospectively investigate the effect of chiropractic management on clinical and anatomical outcome of disc pathomorphology in previously magnetic resonance imaging (MRI)-documented disc herniation of the cervical and lumbar spine. SETTING: Private practice. SUBJECTS: Twenty-seven patients with MRI-documented and symptomatic disc herniations of the cervical or lumbar spine. A prospective clinical case series. DESIGN: All patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Precare evaluations also included clinical examination and visual analog scores. Patients were then treated with a course of care that included traction, flexion distraction, spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by postcare follow-up MRI scans, clinical examination and visual analog scores. Percentage of disc shrinkage on repeat MRI, resolution of clinical examination findings, reduced visual analog pain scores and whether the patient returned to work were all recorded. RESULTS: Clinically, 80% of the patients studied had a good clinical outcome with postcare visual analog scores under 2 and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. There was a statistically significant association (p < .005) between the clinical and MRI follow-up results. Seventy-eight percent of the patients were able to return to work in their predisability occupations. CONCLUSION: This prospective case series suggests that chiropractic care may be a safe and helpful modality for the treatment of cervical and lumbar disc herniations. A random, controlled, clinical trial is called for to further substantiate the role of chiropractic care for the nonoperative clinical management of intervertebral disc herniation.

  • Clinical and CT analysis of 35 cases of lumbar disc herniation before and after non-operative treatment.
    Ye RB, Zhou JX, Gan MX. Chendu Research Institute of Sports Injury.
    Chung Hsi I Chieh Ho Tsa Chih 1990 Nov;10(11):667-8, 645

    35 cases of lumbar disc herniation were examined by clinical diagnosis and CT scanning. The results showed that there were 36 disc herniation (1 case of dual disc herniation). The radius vector of disc was 6.3 mm and the transverse diameter was 18.6 mm. There were 30 cases with sac of dura mater of spinal cord or nerve roots pressed and adhesive, yellow ligaments pachismus, lateral recessus filling and narrow bony lumbar vertebral canal. All patients were treated by means of manipulation. The clinical results showed that 29 cases (82.8%) had superior effects and 33 cases were effective. The clinical effective rate was 94.2%. CT re-scanning showed that disc reposition completely returned was 6 cases, and partially returned was 24 cases. The successful rate of the reposition by manipulation was 83.3%. The clinical analysis and CT showed that herniation of lumbar disc could be repositioned by means of manipulation. The reposition of herniation of disc was a key factor in clinical results but was by no means the only one. With regard to long duration of illness, repeated invasion, combined narrow bony lumbar vertebral canal, and non-improved central type herniation after a long period of treatment, the herniation of disc should be treated by operation.

2. Neck Disc Herniation...

Medline Articles on Neck Disc Herniation

  • Management of cervical disc herniation with upper cervical chiropractic care.
    Eriksen K. Eriksen Chiropractic Center, Dothan, AL 36301-1105, USA.
    J Manipulative Physiol Ther 1998 Jan;21(1):51-6

    OBJECTIVE: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.

    (Duplicated from Lumbar disc section)
  • Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations.
    BenEliyahu DJ
    J Manipulative Physiol Ther 1996 Nov-Dec;19(9):597-606

    OBJECTIVE: To prospectively investigate the effect of chiropractic management on clinical and anatomical outcome of disc pathomorphology in previously magnetic resonance imaging (MRI)-documented disc herniation of the cervical and lumbar spine. SETTING: Private practice. SUBJECTS: Twenty-seven patients with MRI-documented and symptomatic disc herniations of the cervical or lumbar spine. A prospective clinical case series. DESIGN: All patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Precare evaluations also included clinical examination and visual analog scores. Patients were then treated with a course of care that included traction, flexion distraction, spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by postcare follow-up MRI scans, clinical examination and visual analog scores. Percentage of disc shrinkage on repeat MRI, resolution of clinical examination findings, reduced visual analog pain scores and whether the patient returned to work were all recorded. RESULTS: Clinically, 80% of the patients studied had a good clinical outcome with postcare visual analog scores under 2 and resolution of abnormal clinical examination findings. Anatomically, after repeat MRI scans, 63% of the patients studied revealed a reduced size or completely resorbed disc herniation. There was a statistically significant association (p < .005) between the clinical and MRI follow-up results. Seventy-eight percent of the patients were able to return to work in their predisability occupations. CONCLUSION: This prospective case series suggests that chiropractic care may be a safe and helpful modality for the treatment of cervical and lumbar disc herniations. A random, controlled, clinical trial is called for to further substantiate the role of chiropractic care for the nonoperative clinical management of intervertebral disc herniation.

  • Chiropractic treatment of cervical radiculopathy caused by a herniated cervical disc.
    Brouillette DL, Gurske DT
    J Manipulative Physiol Ther 1994 Feb;17(2):119-23

    OBJECTIVE: To present a case of cervical radiculopathy, caused by an MRI documented herniated cervical disc, which was treated with conservative care including chiropractic manipulative therapy. CLINICAL FEATURES: A 60-yr-old woman was treated by a chiropractor for symptoms including a deep, constant, burning ache in the left arm, and severe neck and left shoulder pain. A diagnosis of acute herniated cervical disc was made based on the findings of physical examination and an MRI study of the patient's cervical spine. Important orthopedic findings included exacerbation of the radicular symptomatology with the performance of Valsalva's and cervical compression tests. Neurologic findings included absent biceps and hyporeflexive triceps reflexes on the left, as well as C6 sensory deficit and C7 and C8 sensory hypesthesia. The primary finding on the MRI scan was posterior and lateral herniation on the C6-7 disc. INTERVENTION AND OUTCOME: Treatment included chiropractic manipulative therapy, longitudinal cervical traction and interferential therapy. The patient began a regular schedule of treatments, which started on a daily basis but were gradually reduced as the patient progressed. By the third week of treatment, neck and shoulder pain was completely resolved. Subjective evaluation indicated the radicular pain to be improved by 60% within 6 wk. The patient's pain, numbness and grip strength returned to normal within 5 months. CONCLUSION: Conservative treatment including chiropractic manipulative therapy seems to be a reasonable alternative to surgery, for cervical radiculopathy caused by a herniated cervical disc. Clinical trials should be performed to evaluate long term success rate, risk of permanent disability, rate of recovery and cost effectiveness of this and other forms of treatment for cervical radiculopathy caused by herniated nucleus pulposus.

  • Chiropractic management and manipulative therapy for MRI documented cervical disk herniation.
    Beneliyahu DJ
    J Manipulative Physiol Ther 1994 Mar-Apr;17(3):177-85

    OBJECTIVE: This case study reports on three cases of patients with documented cervical disk herniations, who responded to chiropractic management and manipulative therapy. CLINICAL FEATURES: Three patients complaining of neck pain with radiation of pain and tingling into the upper extremities had positive magnetic resonance imaging scans consistent with cervical disk herniations. They also had positive neurophysiologic testing with positive thermography scans and electrodiagnostic studies. INTERVENTION AND OUTCOME: The patients were prescribed a treatment regimen consisting of chiropractic management including bracing, physiotherapy, cervical manipulative procedures, traction and exercises. The patients responded well to care as evidence by posttreatment MRI, electrodiagnostic studies, clinical exam findings and thermography scan findings. CONCLUSION: Patients with and without nerve root compression secondary to cervical disk herniation can and do respond well to chiropractic care. Chiropractic management of this condition can and should be employed prior to more invasive treatment.