Chiropractic Treatment for Low Back Disc Herniation

(A review of the latest studies by Dr. George Cluen)

This case study reviews a non-surgical treatment path for a 60-year-old-male who was reasonably active and had a previous low back pain case before returning 15 months later with severe LBP and pain radiating from his right glute to his calf.

His presenting symptoms were:

• A 73 out of 100 on the Oswestry Low Back Questionnaire
• Numerical pain scale a 6-10
• Inability to stand up straight
• Altered gait
• Difficulty standing from a sitting position

His treatment path included chiropractic adjustments, traction therapy, and physiotherapy to be followed up by at-home exercises. An MRI and surgical consult showed a lateral L5, S1 disc rupture with L5 nerve impingement, but improvements at this point were enough to avoid surgery. A week later a CT guided nerve root steroid injection was performed. Within three days, the patient reported sleeping better, was able to return to work and drive.

After another 4 weeks of physical therapy the patient reported a 0 of 10 on the numerical pain scale and after another month the patient reported being able to return to light exercising and reported zeros across all pain scales. 

It should be mentioned that this patient is fit for their age, motivated and compliant with treatment. Either way, this study demonstrates the effectiveness of a non-surgical therapy mix from chiropractic to physical therapy and the assistance of a steroid injection.

Erhard RE, Welch WC, Liu B, Vignovi M. Far-lateral disk herniation: case report, review of the literature, and a description of non-surgical management. Journal of Manipulative and Physiological Therapeutics 2004;27:e3.

Physical Therapy VS. Self Care for Whiplash

(A review of the latest studies from Dr. George Cluen.)

Up to half of all whiplash patients are plagued with chronic symptoms, and ongoing research seeks to identify affordable, effective methods of preventing chronic pain. The standard treatment for whiplash often includes comprenhensive, long term physical therapy. While these treatments have been shown to be beneficial, researchers from the University of Australia wondered if patients could get some of the same benefits with more minimal visits and an at-home exercise program.

What they discovered was, patient education coupled with at-home exercise programs, can be equally as effective as longer, more intensive physical therapy treatments are needed. The results showed that healthcare costs could potentially be reduced and those in chronic pain could reduce their appointment load.

The study included 172 patients suffering from whiplash after an auto accident who were randomly assigned to either a physiotherapy or an advice-only group. The patients in a professional treatment path were given 20 one-hour physical therapy sessions over the course of 12 weeks. The second group received a single 30 minute session of patient education and physiotherapy, along with the at-home exercise program. After 14 weeks of care, there were no clinically significant differences between the two groups. (Note that emotional burden or any other adaptive benefits were not measured. Let's not completely discount in person physical therapy.)

What we see a lot of within our industry that patients reflect back to us within initial appointments, is that a path of drugging and physical therapy typically sums up the corrective steps before a surgery is recommended. At Auto and Work Injury Center, we educate patients about the full spectrum of alternatives and how they compliment each other. Research shows that when you combine chiropractic with physiotherapy, recovery takes on a new momentum. Chiropractic can reduce symptoms for 93% of whiplash patients, and research also shows that patients receiving chiropractic adjustments for neck pain have lower medical costs and speedier recovery compared to patients seeing only a physician or physiotherapist alone. 



References

MichaleffZA, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomized controlled trial. The Lancet 2014; pii S0140-6736(14)60457-8. doi:10.1016/S0140-6736(14)60457-8.http://www.ncbi.nlm.nih.gov/pubmed/24703832

Woodward MN, Cook JCH, Gargan MF, Bannister GC, Chiropractic Treatment of chronic 'whiplash' injuries. Injury: International Journal of Care of the Injured 1996;27(9):643-645

Korthals-de Bos IB, et al. Cost Effectiveness of physiotherapy, manual therapy, and general practitioner. British Medical Journal 2003. doi: http://dx.doi.org/10.1136/bmj.326.7395.911.