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  • Q&A with Australian Health Practitioners

    Chiropractic or Osteopath treatment for Lumbar Prolapsed Disc?

    Hi,

    Would like to understand what methods and / or science is behind treating a L4/L5 prolapsed disc from these occupations? I have heard mixed results and my own experience with an Osteopath so far was not a success. Currently looking at my available options.

    Many thanks
  • Find a professional to answer your question

  • 4

    Thanks

    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Mudgee Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    I'll represent the chiropractors on this one and hopefully can help you understand the methods and science between treatment of such a condition. I'm sure an Osteopath will be able to assist in outlining their methods and science as well.

    Chiropractors are known as non surgical spine specialists, so I can see why your question has been directed at us. Currently, there is an increase in the body of evidence in support of the techniques chiropractors use to assist the body in recovering from such an injury. Chiropractors use a variety of techniques and most chiropractors will utilise more than one to assist an individuals recovery. This ranges from adjustments such as  spinal mannipulative technique, activator methods, sacro occipital technique to movement based and soft tissue therapies sich as myofascial release techniques, post isometric relaxation stretching etc.

    Most of the current research is based around spinal manipulative technique as it has been the most prominent used by the profession.

    Below is a few studies that you may want to look further into. Also to note, in the larger class of spinal pain, multiple studies and guidlines have been adopted by worldwide bodies that recommend a trial of conservative care (chiropractic treatment) before surgical care as a standard. These have been published in such areas such as the Cochrane review, Americal College of physicians and Americal Pain Society Guidelines. More recently this has also been adopted at the University of Pittsburgh Medical Center after a landmark study. More information can be found here.

      Manipulation or Microdiskectomy for Sciatica?
    A Prospective Randomized Clinical Study

    J Manipulative Physiol Ther. 2010 (Oct);   33 (8):   576–584
    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 (lumbar disc herniation/prolapse) 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.

    Cost and Use of Conservative Management of
    Lumbar Disc Herniation Before Surgical Discectomy

    Spine J. 2010 (Jun);   10 (6):   463–468
    Lumbar discectomy is one of the most common spine surgical procedures. The average charge for discectomy procedure was $7,841. Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate. This study reviewed the costs associated with various conservative measures.

    Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations:
    A Systematic Review and Risk Assessment

    J Manipulative Physiol Ther 2004 (Mar);   27 (3):   197–210
    Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.   An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

    Single-blind Randomised Controlled Trial of Chemonucleolysis
    and Manipulation in the Treatment of Symptomatic Lumbar Disc Herniation

    Eur Spine J 2000 (Jun);   9 (3):   202–207
    Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. In this study it was shown that for managing disc herniations, the cost of treatment failures following a medical course of treatment averaged 300 British pounds per patient, while there were no such costs following spinal manipulation.

    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.

    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);   19 (9):   597—606
    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.


  • Btn

    HealthShare Member

    Thank you for your response, 

    I'm six months into the herniated disc injury. I had an MRI back in early September which showed a 1.2 cm free disc fragment stuck in my spinal canal. I had a cortisone injection which helped a lot and got me mobile again. However, since just before Xmas I have had two sudden flare ups which prevented me from standing for more than a few minutes but on both occasions after a few days of rest, ice and pain killers came good again. 

    I went back to the surgeon who suggested I get an updated MRI last week. If the MRI showed no change then he suggested surgery being my only option. Lucky (or unlucky) it showed an improvement with about 50% reduction in size. I am now back to a wait and see with continuing of conservative treatment. What an on going ordeal. 

    I'm continuing with my PT treatment and will start on clinical Pilates. I do my floor exercises as directed and walk about 12km each day. 

    As the disc is a free fragment lodged in my spinal canal how can manipulation (if suitable) treat such a condition? Or alternatively how would such a condition be best treated conservatively? 


  • 2

    Thanks

    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Mudgee Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Unfortunately, the fact that this has “sequestrated and migrated” means that conservative care is much more difficult.

    As the disc fragment is now loose, you are relying on what is known as macrophage activity. The ability for the body to know that the disc is a foreign object, and it will send cells to clean it up. 

    A percentage of people do recover from this, however you should be wary that extended periods of neural irritation can lead to long lasting symptoms even after the irritating component has been resolved. 

  • 2

    Thanks

    Spring is an osteopathic clinic and we treat people through all stages of life including children, teenagers with study strains, athletes, new mums, tradesmen, desk … View Profile

    Lumbar disc problems are extremely common and require a multi-focal treatment. As an osteopath there are many techniques that would help improve your pain. Obviously we cannot correct the disc bulge but we can help manage your symptoms through a variety of techniques. In my experience I have found that soft tissue, muscle-energy and articulatory techniques to the surrounding areas to be quite effective. The goal is to remove the pressure from the spinal nerves and improve the body's ability to compensate from the injury. I personally don't perform spinal manipulation as this in some cases can actually worsen symptoms. I have found that the techniques mentioned above in addition to self-management strategies and light exercise to be extremely effective in reducing disc pain.

    I also recommend to my patients to do light exercises such as swimming to help reduce symptoms. Swimming is extremely effective as it is low-impact and works many muscle groups and areas. Give us a call at Spring Osteo on 9830 7044 to discuss your treatment plans.

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