Lumbar Disc Lesion describes the undesirable midpoint on a continuum of problems, beginning with repetitive disc sprain, leading to herniation, ending in degeneration. As evidence based chiropractors know all too well, these problems are often accompanied by sciatica.
Evaluation of Lumbar Disc Lesions and Sciatica
Several orthopedic tests can help identify the presence of sciatica, although most are not specific to disc lesions. The SLR, WLR, Braggards, Milgram’s, Valsalva, and Soto-Hall tests are all quite useful, but check out this video where Dr. Brandon Steele demonstrates the single most valuable and time saving test for identifying lumbar nerve root irritation.
Chiropractic Management of Lumbar Disc Lesions
Disc herniation with radiculopathy may be successfully managed with conservative treatment (1). In fact, a new study shows that 67% of all disc herniations will resolve via conservative care. (2) Even large lesions respond; sizeable herniations trigger a significant inflammatory response and generally regress more quickly when compared to contained bulges that do not benefit from re-absorption. (3) And outcomes for non-surgical management of LDL are similar regardless of age (4).
McMorland reported that SMT produced results equal to surgical decompression in 60% of LDL patients who had failed earlier medical management. (5) Another study of 148 patients demonstrated significant and lasting improvement in all outcome measures (with no adverse events) when side posture HVLA was applied to the level of the disc lesion. (6) Likewise, patients with disc herniation who undergo SMT to the level of involvement demonstrate a significant decrease in radicular symptoms. (7) A review of 90 randomized clinical trials concerning the treatment of sciatic symptoms supports only a handful of interventions: disc surgery, epidural injections, nonopioid analgesia acupuncture, and manipulation. (8)
Marketing Chiropractic Outcomes to MD’s
Primary care physicians need to know that your evidence based chiropractic management is appropriate for lumbar disc lesions. One of the most effective means of communicating this information is to consistently update the patient’s primary care provider about each patient’s presentation and subsequent positive outcome. (Unfortunately, providers typically only hear about each other’s failures. But can you imagine what would happen if MD’s learned about every one of your success stories too?) That process truly changes perceptions and MD referrals.
Automated Chiropractic Reports
Last week, ChiroUp launched MD Connect, an automated chiropractic report generator that allows subscribers to produce an initial visit summary and a subsequent release report that gets read by busy MD’s. The process only takes about 5 seconds while your staff is preparing the patient’s ChiroUp lay condition report! Check out this video to learn more.
If you’re not already using ChiroUp’s powerful automated tools sign up here to start benefiting today.
- Saal JA, Saal JS: Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy an outcome study. Spine 1989; 14:431-436
- Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, Xue RR. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017;20(1):E45–E52.
- Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015 Feb;29(2):184-95.
- Pradeep Suri, MD, David J. Hunter, MBBS, PhD, Cristin Jouve, MD, Carol Hartigan, MD, Janet Limke,MD, Enrique Pena, MD, Ling Li, MPH, Jennifer Luz, BA, James Rainville,MD. Nonsurgical Treatment of Lumbar Disk Herniation Are Outcomes Different in Older Adults? Journal of the American Geriatrics Society J Am Geriatr Soc. 2011;59(3):423-429
- McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study . J Manipulative Physiol Ther. 2010 Oct;33(8):576-84.
- Serafin Leemann, Cynthia K. Peterson, Christof Schmid, Bernard Anklin, and B. Kim Humphreys. Outcomes Of Acute And Chronic Patients With Magnetic Resonance Imaging–confirmed Symptomatic Lumbar Disc Herniations Receiving High-velocity, Low-amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-year Follow-up. JMPT 01/2014
- Ehrler M, Peterson C Leemann S et al. Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of Outcomes Depending on the Type and Anatomical Axial Location of the Hernia in Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation. JMPT Mar-April 2016, Volume 39, Issue 3, Pages 192–199
- Lewis RA, Williams NH, Sutton AJ, Burton K, Din NU, Matar HE, Hendry M, Phillips CJ, Nafees S, Fitzsimmons D, Rickard I, Wilkinson C. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015 Jun 1;15(6):1461-1477.
About the Author
Dr. Brandon Steele
Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.