270,000 Patients Can't Be Wrong!
What do you do if you have back pain and sciatica caused by a herniated disc? This research study showed that 97% of people got back to normal without surgery!
Hot of the press, this research was published in July 2020. The authors looked at almost 280,000 patients suffering from back pain and sciatica to see what treatments they did to get better.
In round numbers, 270,000 (97%) of these patients got back to normal without surgery.
Approximately 10,000 (3%) failed to recover using conservative treatments and went on to have surgery.
What Treatments Worked?
Non-Surgical (conservative) treatments that worked included (in no particular order):
Why Didn't the Treatment Work in the 3%?
Remember, almost 10,000 people with lumbar disc herniations tried those conservative treatments but didn’t get better so they went on and had surgery. The authors tried to see if there was anything unique or special about those patients that might predict why they didn’t respond. What did they find?
Not much. People that did not respond had other health problems layered on top of their herniated disc. Things like diabetes, obesity and smoking. They also tended to be males less than 50 years old and were using opioid medication for pain control.
How Long Did It Take To Get Better?
Six (6) weeks seemed to be the magic number. Careful with that, however. That doesn’t mean they were 100% after six weeks. People that ultimately got better without surgery tended to show significant improvement in the initial six weeks of treatment, but it isn’t uncommon to still be reminded your body is continuing to heal even 6 months or a year later. Most are back to their normal lives, however still need to be mindful of certain movements or activities.
I know in our clinic, our care plans define this pretty clearly. We need to see significant improvement within four to six weeks of beginning treatment in order to justify continuing along that path. If things aren’t getting better within that time frame, then it is time to switch gears and consider other treatment options.
Be Careful Of What Treatments Are Called
What’s In A (Treatment) Name? Remember these authors said the main conservative (non-surgical) treatments that worked were:
You need to be careful not to confuse the name of a health care provider with a specific treatment. Case in point, saying someone got better with medication, chiropractic or physiotherapy treatment is a bit vague. You need to dig deeper to consider things like:
- What type of meds?
- What treatment(s) did the physiotherapist do?
- What treatment(s) did the chiropractor do?
Saying someone got better from “Chiropractic” treatment may not be that helpful. Chiropractic treatment isn’t just about cracking backs (Spinal Manipulation). Here is how we structure a care plan for people suffering back pain and/or sciatica due to a herniated lumbar disc.
Directional Preference: We investigate whether your sciatica has a directional preference. This means that certain movements and positions reduce your pain while others make it worse. This phenomenon was first recognized and developed by a famous physiotherapist, Robin MacKenzie. Good thing there aren’t any laws prohibiting chiropractors from adopting some physio-based treatment into their clinical approach (and Vice Versa – we know Physios who have trained up and become certified to use Spinal Manipulation as part of their treatment approach).
We have a special (fancy) treatment table we use to test for this. If your condition does have that (which most do), then we can build treatment around using that treatment table, along with manual therapies to improve your back’s ability to move into those ranges of motion. That stimulates healing to the injured disc tissues.
A bit long-winded, I know but it was meant to illustrate that this treatment wouldn’t normally be called “Chiropractic” treatment because it doesn’t necessarily involve Spinal Manipulation. BUT, the treatment is done by our chiropractors so what’s in a name????
If you want to see this treatment in action, check out this short, 3 1/2-minute demonstration video. It will help you understand things a bit better, especially if you are nervous that a chiropractor might crack your back and hurt you. You can watch Dr. Gord as he shows you this nice gentle approach to fixing back pain and sciatica.
This article gets into the safety of chiropractic treatment for disc herniations in more detail.
Let’s talk about Physiotherapy Treatment.
Similar to calling something Chiropractic treatment, you need to be careful of this definition. What works is Active Rehabilitation. What tends to not work are passive treatments such as modalities like TENS, Interferential Current, Heat or Ice Packs and ultrasound machines.
In our clinic, we introduce active rehabilitation very early in the care plan. All of our practitioners work like that, so no matter if you are in with a chiropractor, physiotherapist or even one of our massage therapists, your treatment plan will be built on an Active Care Platform.
Active care means we help you understand what you can begin doing to help yourself get better. That means you are active in your recovery – you aren’t just dependent on a health care provider to fix you. This ranges from pain-relieving strategies in the early stages, Spine Sparing Strategies, which allow you to resume your normal activities in ways that are safe, all the way up to those dreaded “Do Your Exercises” to rebuild your strength and flexibility. Remember, once you have been injured, the body stops moving the area in an effort to protect it. Little or no movement in an area means that it will weaken quite quickly. Don’t make the mistake of thinking that you are back to normal once the pain settles down. If you don’t rebuild the strength and mobility, you leave yourself more vulnerable to future problems.
What Should I Do?
If you want to talk to one of our clinicians to learn more or find out if our treatment approach can help you, contact us.
Title: An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures
Authors: Daniel T. Lilly, MD, Mark A. Davison, MD, Cody M. Eldridge, BS, Ravinderjit Singh, BS, Eric Y. Montgomery, BS, Carlos Bagley, MD, MBA, Owoicho Adogwa, MD, MPH
First Published July 7, 2020
Title: Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study
Authors: Cesar A. Hincapié, George A. Tomlinson, Pierre Côté, Y. Raja Rampersaud, Alejandro R. Jadad, J. David Cassidy