Herniated Discs, Radiating Pain and Chiropractic
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.
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.