Pain Relief Chiropractic

The current available research notes that 52% of all opioid prescriptions are for patients with low back pain, and over two million Americans suffer from opioid use disorder (OUD), with 47,000 dying from OUD in 2017. In light of the opioid epidemic, the high cost of diagnostic tests and invasive treatment, and the low level of patient satisfaction with such care, researchers from the Boston University School of Public Health set out to find better options for the management of low back pain. Their findings revealed that a patient’s INITIAL choice of healthcare provider plays an important role in their prospects for a successful outcome from the perspective of both the patient and the insurance company.

This prompted a major health insurance carrier to send a notice to their policy holders promoting initial care for low back pain with either a doctor of chiropractic (DC) or physical therapist (PT). The carrier notes that this move is expected to reduce the use of spinal imaging tests by 21%, spinal surgeries by 21%, and opioid prescriptions by 19%, leading to lower costs for employers and plan participants.

This recommendation is not only in line with guidelines from the American College of Physicians that non-drug, non-surgical care should be the initial course of treatment for the low back pain patient, but also a growing body of research on the effectiveness of non-surgical, non-drug approaches for managing low back pain:

• A 2020 study found that 22% of patients who initially visited their primary care doctor (PCP) received a short-term opioid prescription, with those first consulting with a PT or DC being 85-90% less likely to require an opioid prescription.
• A 2015 study found patients who first sought care from a DC were not only more satisfied with their care than those who visited a PCP first, but the overall treatment costs were lower.
• Back in 2013, researchers reviewed data from Washington state worker’s compensation cases and found that 43% of workers with a back injury who initially consulted with a surgeon ended up having surgery while just 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain.
• A study published in 2019 found that low back pain patients were less likely to see DC/PTs vs. PCPs when the insurance plan had greater restrictions on DC/PT visits (higher co-pays, deductibles, participation in programs such as a health savings account). The authors stated long-term economic and social benefits would result if health insurance benefit designs were changed to encourage LBP patients to see DC/PT provider types.

BOTTOM-LINE: It’s becoming increasingly clear that conservative treatment approaches like chiropractic care should be strongly recommended for patients with low back pain and other musculoskeletal conditions. Not only will this lead to a reduced use of potentially harmful opioids and the issues that can stem from their misuse, but there will also be cost savings for patients and insurers. As with most health conditions, the sooner a patient seeks care, the greater their likelihood for a successful treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Low back-related leg pain (LBRLP) is a common condition that drives patients into primary care clinics, including chiropractic offices, but these cases are often complex, and determining the underlying cause can be clinically challenging. Let’s take a look at the current treatment strategies for LBRLP.

To begin with, the patient’s doctor will need to determine if the leg pain is radicular or referred in nature as this will help indicate which structures or soft tissues in the lower back will need to be addressed. The term “radicular” is reserved for the presence of nerve root compression or a pinched nerve root, most commonly caused by a herniated low back disk. Referred leg pain arises from a ligament, joint, or a tear in the outer layer of the disk (which can precede herniation).

Some clinical signs and symptom that support radicular leg pain include a more specific geographic tracing of leg pain that often exceeds the level of the knee affecting the outer foot (S1 nerve), the top of the foot (L5 nerve), or the inside of the foot (L4 nerve). In radicular LBRLP, there may also be neurological loss such as sensory impairment and/or muscle weakness in a specific area or in certain muscles that can help determine the specific nerve(s) involved. Patients often describe referred leg pain as a generalized deep ache or numbness that often stays above the knee. It’s also possible for the patient to have multiple contributing causes for their LBRLP, which can make the diagnostic process more complex.

From a treatment standpoint, studies show a lack of long-term benefits for managing LBRLP with prescription medication, epidural corticosteroid injections, and surgery. However, there is evidence that spinal manipulation—a treatment provided by doctors of chiropractic—is more effective than no treatment, passive modalities, and exercise in managing LBRLP. In fact, a 2019 survey of 1,907 chiropractors revealed that 81% often treat patients with LBRLP.

More recent research suggests combining spinal manipulative therapy with exercise, and patient education may provide even better results for patients with LBRLP.  This makes sense as there have been several studies showing that a multimodal management approach for low back conditions such as degenerative joint and/or disk disease, spinal stenosis, and disk herniations is often superior to a single treatment strategy.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Serious falls can lead to a number of negative outcomes in older adults, from impaired mobility to loss of independence to early death. Thus, steps that can be taken to reduce the risk for falls will not only potentially result in a longer life, but also help support a higher quality of life in those remaining years.

Research has shown that seniors with a history of falls tend to have impaired balance and reduced muscle strength (especially in the back)—both of which are associated with advancing age. Let’s see if addressing these areas can reduce fall risk and what role chiropractic care may play in the process.

In one study, researchers compared three fall prevention approaches (educational classes, home safety assessments, and exercise training) and found that participants in the exercise group had the lowest risk for falls. Another study compared exercise on a stationary bike versus movement-based exercises using a video game system (called exergames). The results showed that the participants in the exergames group experienced greater improvements in mobility and balance. Taken together, these studies suggest that a movement-based exercise approach is effective for reducing fall risk, which coordinates with the research that shows that older adults with a history of regular exercise are less likely to have a serious fall.

A 2020 study involving active-duty military personnel with chronic back pain found that adding chiropractic care to a rehabilitative program featuring isometric and balance-focused exercises resulted in improved back pain, function, muscle strength, and balance compared with a control group that received no care. In another study, researchers observed that a twelve-week chiropractic treatment program was effective in improving sensorimotor function in older adults, which is associated with a reduced fall risk.

Finally, an analysis of data from 39 studies involving 17,626 seniors found that those with pain in the neck, lower back, hip, knee, and foot were more likely to exhibit poor balance, especially those with a history of chronic musculoskeletal pain. The results from these various studies suggest that older adults can reduce their risk for serious fall by addressing current musculoskeletal complaints—of which chiropractic care is an excellent choice—and regularly engaging in exercise to improve balance and strength.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain.

If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.

Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.

Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.

If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.

If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

The roots of the sciatic nerve exit the spine through several levels in the lower back, join in the buttock region, and travel down into the lower extremities. When pressure is applied to the sciatic nerve in the lower back area, it can generate pain and other sensations down the nerve into one of the legs—a condition we commonly refer to as sciatica.

In younger and middle-aged adults, the most common cause of sciatica is a herniated disk in the lower back in one or more locations. Because of the structure of the sciatic nerve, the characteristics of the patient’s symptoms can direct their doctor of chiropractic on where to look for potential causes in the lower back:

• S1-2 Level (S1 nerve root): outer foot numb, difficulty walking on toes, weak Achilles tendon reflex
• L5-S1 Disk (L5 nerve root): inner foot numb, weak big toe and heel walking, no reflex changes
• L4-5 Disk (L4 nerve root): shin numb, weak heel walking, patellar tendon reflex loss
• L3-4 Disk (L3 nerve root): medial knee numb, weak walking up steps, weak patellar tendon reflex
• L2-3 Disk (L2 nerve root): front of thigh pain/numb, weak walking up steps, positive patellar reflex
• L1-2 Disk (L1 nerve root): groin pain/numb, weak squat and steps, no deep tendon reflex
• T12-L1 Disk (T12 nerve root): buttock numb, weak lower abdominal muscles, possible spinal cord compression

In sciatica patients under 55 years of age, the two lowest disks in the lower back—the L4-5 and L5-S1—are the culprit 95% of the time. The good news is that a systemic review of 49 published studies found that spinal manipulative therapy, the primary form of care provided by doctors of chiropractic, is an effective non-surgical treatment option for relieve local and radiating pain in patients with a herniated disk in the lower back.

Even though sciatic pain is often initially sharp and severe, most cases can by successfully managed non-surgically within three to six weeks; however, a referral to a specialist or a referral for advanced imaging (such as an MRI) may be necessary to identify additional pain sources if the patient’s pain persists. Surgery is usually restricted to those who have neurological loss and/or bowel or bladder control problems (the latter may become emergent in order to avoid permanency). As with many musculoskeletal conditions, the sooner one seeks care in the course of the disease, the more likely (and the faster) they will achieve a successful treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

In addition to neck pain and back pain, patients seek chiropractic care for many musculoskeletal conditions, including groin pain. Pain in the groin area can emanate from a myriad of causes from issues involving the reproductive organs, the renal/urinary system, the lymph glands, a pelvic flood disorder, a hip joint condition, and even a lumbar disk herniation.

For a patient with groin pain, the first thing a doctor of chiropractic will likely do is review the patient’s history and conduct a thorough examination to rule out health issues that may be better suited for the patient’s medical physician. The examination will look for potential dysfunction in the pelvis, hip, and low back that can be addressed with chiropractic care.

While musculoskeletal issues in the lower back are typically localized to that area of the body, if a spinal disk herniates and places pressure on the spinal nerves, it can lead to symptoms down the leg and even into the torso and groin. Likewise, issues in the hip like osteoarthritis, labral tears, and hip bursitis can refer pain to the groin.

Chiropractic care for these conditions will include manual therapies to restore joint motion, specific exercises to strengthen/stretch the affected ligaments and muscles, and recommendations to address inflammation, such as supplements/vitamins or ice/heat instruction.

Pelvic floor disorder (PFD) is a common condition that describes the inability to correctly relax and coordinate the pelvic floor muscles, which can lead to issues with urination and defecation, among other things. The pelvic floor is like a sling of muscle holding the pelvic organs. Our pelvic floor muscles contract and relax when we go to the bathroom. Losing the ability to relax the muscles can lead to the inability to defecate or urinate, and losing the ability to contract the muscles can result in incontinence.

Fortunately, once more serious causes are ruled out, it’s possible to resolve PFD using biofeedback, pelvic flood exercises, and relaxation techniques, all of which may be provided by your doctor of chiropractic or in conjunction with a related healthcare professional. There is the possibility that issues may be present in two or even all three areas that your doctor of chiropractic will address concurrently in order to reach a satisfactory treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.