Health News

Our clinic practices evidence-based healthcare. This means that we use the best available scientific evidence to guide us in our treatments. The following research reviews provide information about current topics related to chiropractic care:

Chiropractic Manipulation in Acute Discogenic Sciatica

Synopsis. One hundred and two patients with acute back pain and sciatica with disc protrusion were randomized to active and simulated manipulation. Interventions were done 5 days per week by experienced chiropractors, using a rapid thrust technique. The number of sessions depended on pain relief, up to a maximum of 20 sessions.

Results. Manipulation compared with placebo 6 months after therapy was much better for low back pain (effect size 1.68) and leg pain (effect size 1.08).*

Study Quality. Overall, this was a high quality study.

Conclusion. Chiropractic care delivered a very large clinically important pain reduction benefit at six months, and no patient experienced an adverse event.

Clinical Comment. This high quality study was designed and implemented by medical doctors. Practitioners managing patients with acute back pain and sciatica with protruding discs should consider chiropractic care as a first option. The magnitude of these findings is impressive.

Santilli V, Beghi E, Finucci S. 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. Spine J 2006;6:131-7.

Glucocorticoids in Acute Discogenic Sciatica

Synopsis. Double-blinded randomized controlled trial. The use of glucocorticoids in the treatment of acute discogenic sciatica (prolapsed disc) is controversial. Sixty patients with acute sciatica (<6-week duration) of radiologically confirmed discogenic origin were randomized to receive placebo or a single IV bolus of 500 mg of methylprednisolone.

Results. Glucocorticoids compared with placebo was a little better at day one (effect size .26 for pain) but worse at day ten (effect size -.09 for pain).*

Study Quality. Overall, this was a high quality study.

Conclusion. IV glucocorticoids had a clinically tiny benefit at one day that quickly faded. Additionally, there was no improvement in functional disability or clinical signs of radicular irritation.

Clinical Implications. The failure of glucocorticoids directly contrasts with the success of chiropractic in an equivalent patient population. Practitioners managing patients with acute back pain and sciatica with protruding discs should avoid IV glucocorticoids.

Finckh A, Zufferey P, Schurch MA, Balague F, Waldburger M, So AK. Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial. Spine 2006;31:377-81.

Chiropractic Reduces Surgery Rates

Synopsis. This study is an analysis of claims data from a managed-care health plan over a 4-year period. The use rates of advanced imaging, surgery, inpatient care, and radiographs were compared between employer groups with and without a chiropractic benefit.

Results. On a per-episode basis, the rates in the group with coverage were reduced by the following: surgery (32.1%); computed tomography (CT)/magnetic resonance imaging (MRI) (37.2%); plain-film radiography (23.1%); and inpatient care (40.1%). For patients with neck pain, the use rates were reduced per episode in the group with chiropractic coverage as follows: surgery (49.4%); CT/MRI (45.6%); plain-film radiography (36.0%); and inpatient care (49.5%).

Research Quality. Reasonable quality with the conclusions following the data.

Conclusion. For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs.

Nelson CF, Metz RD, LaBrot T. Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain. JMPT 2005;28:564-569.

Spinal Manipulation Is Effective in Chronic Neck Pain

Synopsis. This was a systematic review of randomized clinical trials in patients with chronic neck pain. Selections from the initial search were made by two investigators. Selected studies were scored using the Cochrane Collaboration Back Review Group for Spinal Disorders list. Two assessors scored studies separately, and disagreements were resolved by consensus. A cutoff score of 60% was used for selecting trials for analysis.

Mean effect size for manipulation.*
6 weeks 1.63
12 weeks 1.56
52 to 104 weeks 1.22

There were no serious adverse events reported in the manipulation studies.

Study Quality. Overall, this was a high quality study.

Conclusion. There is evidence that subjects with chronic neck pain show clinically important short- and long-term improvements from a course of spinal manipulation. Comment. Spinal manipulation should be considered a first-line choice for patients with chronic neck pain.

Vernon H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther 2007;30:215-27.

* "Effect size" is a statistic that measures treatment effect (benefit). A positive effect size number favors the study treatment. Following is the benchmark for effect size: 0.2 means there is a small treatment effect; 0.5 means there is a medium treatment effect; and > 0.8 means there is a large treatment effect.

Seniors Can Protect Themselves

Researchers examined the associations between physical activity, physical function and occurrence of low back pain in an elderly population. A total of 1,387 persons aged 70-100 provided data on physical activity, overall physical function and low back pain at baseline and at follow-up two years later.

Performing strenuous physical activity (e.g., more than 30 minutes of walking, heavy gardening, dancing, bike riding, other sports) at baseline was strongly protective against having any low back pain and having 30 days or more of low back pain during the past year.

Participants with poor initial physical function experienced the strongest protective effect of strenuous physical activity. A dose-response association between increasing frequency of strenuous physical activity and magnitude of this protective effect were found (e.g., exercise 2x/week is better than 1x/week). These findings add to the evidence that afflictions associated with aging can be reduced by participating in regular activity. Strenuous physical activity at least once a week is protective for occurrence of low back pain in seniors.

Spine 2007;32:76-81.

Add Years to Your Life

This clinical trial tested the benefits of the traditional Mediterranean diet (TMD) and a low-fat diet. A total of 372 subjects at high cardiovascular risk (210 women and 162 men; age range, 55- 80 years) were recruited, and changes in low-density lipoprotein were evaluated. After 3-month diet, average low-density lipoprotein levels decreased for those on the TMD but there were no changes in the low-fat diet group.

These findings provide additional evidence to recommend the TMD as a useful method against risk factors for coronary heart disease. Previous studies found that the TMD is associated with a reduction in coronary heart disease, cancer and overall mortality. The protective effect of this diet is thought to be associated with its richness in antioxidants. Yet, the effect of antioxidants has been inconsistent. No benefit has been demonstrated in trials with antioxidant vitamin supplements.

TMD Diet

The typical TMD diet includes (1) the use of olive oil for cooking and dressing; (2) increased consumption of vegetables, nuts, and fish products; (3) consumption of white meat instead of red or processed meat; (4) preparation of homemade sauce by simmering tomato, garlic, onion, and aromatic herbs with olive oil to dress vegetables, pasta, rice, and other dishes; and (5) for alcohol drinkers, following a moderate pattern of red wine consumption.

Arch Intern Med 2007;167:1195-203.