Back-Related Leg Pain: Spine Manipulation Helps

Sept.18, 2014 -- In people with back-related leg pain, spinal manipulation therapy plus home exercise and advice provided more short-term improvement in pain and ability to move than home exercise and advice alone, according to a recent study.

Spinal manipulation is done by applying pressure to a joint of the spine using a device or your hands. This is also known as a chiropractic adjustment.

Gert Bronfort, DC, PhD, from the Center for Spirituality & Healing at the University of Minnesota, and colleagues presented their findings in an article published in the Sept. 16 issue of the Annals of Internal Medicine.

"Most patients with BRLP [back-related leg pain] are treated with prescription medications and injections, although little to no evidence supports their use," the researchers write. "Surgical approaches are also commonly applied, although there is only some evidence for short-term effectiveness compared with less invasive treatments."

Doctors are increasingly recommending spinal manipulation therapy (SMT), exercise, and education.

Study Details

The researchers compared short-term (12 weeks) and long-term (52 weeks) effects of spinal manipulation plus home exercise and advice (HEA) with HEA alone in 192 people with leg pain. The people were randomly assigned to either treatment group.

Those in the HEA group got four hour-long sessions of home exercise and advice -- to help them manage pain, prevent the return of pain, and boost their involvement in daily activities -- over the course of 12 weeks. People in the SMT plus HEA group got the same help, as well as up to 20 sessions of spinal manipulation therapy by a chiropractor.

The participants answered questionnaires to describe how well they felt after getting treated.

Results

SMT plus HEA showed a significant advantage over HEA after 12 weeks but not at 52 weeks.

The spinal manipulation plus home exercise and advice group had more improvement in low back pain, disability, physical score, overall improvement, and satisfaction compared with the HEA group at 12 weeks. There were no significant differences between the groups for mental health score.

"At 12 weeks, 37% of patients receiving SMT plus HEA had at least a 75% reduction in leg pain, compared with 19% in the HEA group," the researchers write. Pain was completely relieved in 20% of those in the SMT plus HEA group compared with 5% in the HEA group.

At 12 weeks, 56% of people in the SMT plus HEA group reported using medication for their symptoms compared with 63% in the HEA group.

At 52 weeks, the SMT plus HEA group had more improvement than the HEA group in overall improvement, satisfaction, and medication use only. Medication use was reported by 42% of those in the SMT plus HEA group compared with 66% of those in the HEA group.

For patients with ongoing back-related leg pain, spinal manipulation in addition to home exercise and advice “is a safe and effective conservative treatment approach, resulting in better short-term outcomes than HEA alone," the researchers conclude.

Author Dr. Evans reports receipt of grants from the US Health Resources and Services Administration for this work. The other authors have disclosed no relevant financial relationships.


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