Sciatica: Manipulation better than injections

Sciatica often starts suddenly with pain in your lower back that radiates down from your buttock to one thigh and into your leg.

You may have pain when you sit, sneeze or cough. You may also feel weakness, “pins and needles”, numbness, or a burning or tingling sensation down your leg.

Sciatica symptoms may result from general wear and tear, plus any sudden pressure on a disc.

Most commonly, this occurs when a protruding or herniated disc irritates the sciatic nerve.

Sciatica is a major source of disability and impairment of daily living activities.

About 20 percent those with sciatica experience symptoms for more than six weeks.

How do you know whether your sciatica will respond to selfcare or whether it needs professional attention? As a general rule, you should call your doctor if: • the pain is intense,

travels down your leg or prevents you from moving • your leg, foot, groin

or rectal area feels numb • you have fever,

nausea, vomiting, weakness or sweating • an injury caused

your pain

• your pain hasn’t decreased after one week

• you’ve had past episodes of back pain Fortunately, new evidence identifies an effective treatment for this debilitating condition.

A team of medical doctors and chiropractors recently published in the Journal of Manipulative and Physiological Therapeutics the results of a study involving sciatica treatment.

In this study, 102 patients with back pain and sciatica with disc protrusion received either chiropractic spinal manipulations or nerve root injection.

Both chiropractic care and nerve root injection demonstrated benefit.

Improvement was reported in 76.5 percent of spinal manipulative therapy patients and in 62.7 percent of the nerve root injections group.

Worsening was reported in 2 percent of spinal manipulative therapy patients and in 5.9 percent of the nerve root injections group.

Improvement in patients’ pain scores at

1 month were similar. Average treatment costs were $559 for spinal manipulative therapy and $730 for nerve root injections.

Spinal manipulative therapy was superior to nerve root injections on two clinical metrics and equal on another.

When considering direct procedure costs, the average cost of spinal manipulative therapy was 23 percent less expensive.

This is the first study to compare spinal manipulative therapy and nerve root injections head-to-head in this patient population.

When evaluating any therapy, you must assess not only potential benefits, but also the risks. Lumbar spinal manipulations are very safe, but nerve root injections are not.

Mayo Clinic warns patients that repeated steroid injections can weaken spinal bones and nearby muscles and upset natural hormone balance, leading to potentially serious medical conditions.

As might be expected, the greater the number of steroid injections, the greater the risk of side effects or serious adverse events.

Practitioners managing patients with back pain and sciatica with protruding discs should consider chiropractic care as a first option.