Herniations

Herniations (3)

 

Cervical and Lumbar Disc Herniations and Chiropractic Care

A report on the scientific literature 




80% of the chiropractic patients studied had good clinical outcomes

By

William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

The term "herniated disc," refers to localized displacement of nucleus, cartilage, fragmented apophyseal bone, or fragmented annular tissue beyond the intervertebral disc space.[1]Simply stated, the annulus, or outer part of the disc has been torn completely through the wall allowing the inner portion, or the nucleus pulposis material to escape the inner confines in a “focal” or finite direction. Unlike a bulging disc, which an entirely different physiological process and diagnosis, caused by degeneration, a herniated disc is traumatically induced phenomena.
 
The highest prevalence of herniated lumbar discs is among people aged 30–50 years, with a male to female ratio of 2:1. In people aged 25–55 years, about 95% of herniated discs occur at the lower lumbar spine (L4/5 and L5/S1 level); disc herniation above this level is more common in people aged over 55 years.[2]

Symptoms of a Cervical Herniated Disc

A cervical (neck) herniated disc will typically cause pain patterns and neurological deficits as follows:[3]

  • C4 - C5(C5 nerve root) - Can cause weakness in the deltoid muscle in the upper arm. Does not usually cause numbness or tingling. Can cause shoulder pain.
  • C5 - C6(C6 nerve root) - Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles. Numbness and tingling along with pain can radiate to the thumb side of the hand. This is one of the most common levels for a cervical disc herniation to occur.
  • C6 - C7(C7 nerve root) - Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles. Numbness and tingling along with pain can radiate down the triceps and into the middle finger. This is also one of the most common levels for a cervical disc herniation.
  • C7 - T1(C8 nerve root) - Can cause weakness with handgrip. Numbness and tingling and pain can radiate down the arm to the little finger side of hand.
Symptoms of a Lumbar Herniated Disc

The most common symptom of a lumbar disc herniation is pain. The pain is usually described as being located in the buttock with radiation down the back of the thigh and sometimes to the outside of the calf. The specific location may vary and depends on which disc is affected (and thus which nerve root is affected). The pain (and other symptoms and signs) come from pressure on the nerve root. The pain frequently starts as simple back pain and progresses to pain in the leg. When the pain moves to the leg, it is not unusual for the back pain to become less severe. Straining such as bowel movement, coughing or sneezing are all things that tend to cause the leg pain to worsen. Very large disc herniations may cause something known as the "cauda equina syndrome". This is a rare syndrome caused by a very large disc herniation putting pressure on many nerve roots. Signs and symptoms include urinary problems (either retention or incontinence), loss of leg or foot strength, "saddle" anesthesia (loss of sensation in the area of the body that would be in contact with a saddle), decreased rectal sphincter tone and variable amounts of pain (ranging from minimal to severe).[4]

A research paper published in a Peer Reviewed Medically Indexed Journal (scientific journal,) was conducted to evaluate how patients with disc herniations responded to chiropractic care.  The authors stated “all patients were evaluated before commencement of chiropractic care by MRI scans for presence of disc herniations. Pre-care evaluations also included clinical examination and visual analog scores [asking them to rate their pain by using a number from 0 to 10]. Patients were then treated with a course of care that included traction, flexion distraction [a specific Chiropractic technique], spinal manipulative therapy, physiotherapy and rehabilitative exercises. All patients were re-evaluated by post-care 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.   This is an important study because it shows MRI scans pre-care and post-care. 

The paper goes on to report “Clinically, 80% of the patients studied had a good clinical outcome with post-care visual analog scores accompanied with 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 (completely resolved.)  One significant finding was “seventy-eight percent of the patients were able to return to work in their pre-disability occupations.”[5]
 
This study shows that Chiropractic care can be a very important part of treatment in patients, when clinically indicated with disc herniations.  Injuries such as disc herniations can have a negative impact on the ability to work and complete personal tasks.  Evaluating treatment options is paramount when deciding how best to fix the problem especially the non-surgical approach that Chiropractic offers to patients.  If you have an injury to your spine, the first step is making sure that you are diagnosed effectively and efficiently, and then engage in treatment as quickly as possible.   Although Chiropractic is effective in treating conditions in the early and late phases it has been shown to be most effective when started immediately.[6] 

This study, along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions to herniated discs. To find a qualified doctor of chiropractic near you, go to the US Chiropractic Directory at www.USChiroDirectory.comand search your state.



[1]
http://www.asnr.org/spine_nomenclature/discussion.shtml
[2]http://clinicalevidence.bmj.com/ceweb/conditions/msd/1118/1118_background.jsp#incidence
[3]http://www.spine-health.com/conditions/herniated-disc/cervical-herniated-disc-symptoms-and-treatment-options
[4]http://www.cinn.org/spine/herniation-lumbar.html
[5]Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. J MANIPULATIVE PHYSIOL THER, 1996 Nov-Dec; 19(9): 597-606
[6]Donald Aspegren, DC, MS, Brian A. Enebo, DC, PhD, Matt Miller, MD,  Linda White, MD, Venu Akuthota, MD, Thomas E. Hyde, DC, and James M. Cox, DC. FUNCTIONAL SCORES AND SUBJECTIVE RESPONSES OF INJURED WORKERS WITH BACK OR NECK PAINTREATED WITH CHIROPRACTIC CARE IN AN INTEGRATIVE PROGRAM: A RETROSPECTIVE ANALYSIS OF 100 CASES.  J Manipulative Physiol Ther 2009;32:765-771.
 

Share this

Submit to DeliciousSubmit to DiggSubmit to FacebookSubmit to Google BookmarksSubmit to StumbleuponSubmit to TechnoratiSubmit to TwitterSubmit to LinkedIn
Friday, 11 June 2010 18:36

Herniated Discs, Radiating Pain and Chiropractic

Written by

Herniated Discs, Radiating Pain and Chiropractic

A report on the scientific literature 



80% of chiropractic patients reported excellent or good result in a 2 year study


By
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

 

 
Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a “slipped disc” because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
 
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative “wear and tear scenario” that occurs over time with the annulus fibrosis degenerating. This can also be a “risk factor” allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
 
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients.1
 
Although many of these are surgical cases, it has been estimated that only 2-4% have actual surgical indications.Therefore, most patients need to be treated non-surgically and until recently, there have been few metrics affording guidance to the healthcare profession and public alike directing them to the right care. In a 2009 research report, culminating a 2 year study, a clear direction is now available for patients that suffer with radiating pain from herniated discs.
1 The results of the study show that as a result of chiropractic care, “clinically meaningful improvement in pain intensity was seen in 73.9% of patients (Murphy, Hurwitz, & McGovern, 2009, p. 728). "'Good' or 'excellent' improvement was reported by 80% of patients" (Murphy, Hurwitz, & McGovern, 2009, p. 723).
 
Chiropractic treatment protocols utilized were 2-3 times per week tapering down to 2 times per week and less until the patients were released from care. The reports go on to state that there were no major complications with any patient. The results of the study also suggest that patients with cervical radiculopathy (neck pain radiating in to the arms), lumbar spinal stenosis, pregnancy related lumbo-pelvic pain and chronic work related neck-arm pain may also benefit from non-surgical treatment such as chiropractic care.1
 
This study clearly shows that chiropractic is not only an alternative for disc related radiating pain, but would be the most logical place to begin care, as 80% of the patients studied got well and without being exposed to drugs, their side effects or the added burden to the healthcare system with more costly treatments. In practice, the balance of the patients who need necessary drugs or more complicated intervention would be referred to the appropriate specialist as is the standard of care within chiropractic.
 
This study along with many others concludes that a drug-free approach of chiropractic care is one of the best solutions for disc and radiating pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.uschirodirectory.com and search your state.




References:

1.  Murphy, D. R., Hurwitz, E. L., & McGovern, E. E. (2009). A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: A prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics, 32(9), 723-733.

Share this

Submit to DeliciousSubmit to DiggSubmit to FacebookSubmit to Google BookmarksSubmit to StumbleuponSubmit to TechnoratiSubmit to TwitterSubmit to LinkedIn
Tuesday, 11 May 2010 15:51

Disc Herniations, Bulges, Sciatic Pain and Chiropractic

Written by

Disc Herniations, Bulges, Sciatic Pain and Chiropractic

A report on the scientific literature 



By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
 

The authors of a recent study state, “Acute back pain and sciatica are major causes of disability, with impairment of daily living activities” (Santilli, Beghi & Finucci, 2006, ). Pain that starts in the lower back and shoots down the leg is called sciatica.  This is a very common and painful condition. The most common reason for pain down the leg is a bulge or a herniation of the soft disc between the bones of the spine.  These are called intervertebral discs, sometimes referred to as a “slipped disc.”

This research paper reported on 102 cases of patients and stated, “Patients receiving active manipulations [chiropractic adjustment] enjoyed significantly greater relief of local and radiating [shooting] acute lower back pain, spent fewer days with moderate-to-severe and consumed fewer drugs for the control of pain” (Santilli, Beghi & Finucci, 2006, ). 
If you are suffering from lower back and leg pain, a doctor of chiropractic has the training and experience to determine whether the chiropractic adjustment can help you.  Determining the exact CAUSE of your pain is the first step, treating it is the second.  Chiropractic care has been shown to be effective in helping people with lower back and leg pain. 



Refernces:

1.  Santilli, V., Beghi, E., & Finucci, S. (2006). 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. The Spine Journal 6(2), 131-137. 

Share this

Submit to DeliciousSubmit to DiggSubmit to FacebookSubmit to Google BookmarksSubmit to StumbleuponSubmit to TechnoratiSubmit to TwitterSubmit to LinkedIn

 

 

doctorspiad

AOC-ads-june-2016-02

AOC-ads-june-2016-01

More Research