Chiropractic care demonstrated better results than the natural history for both acute & chronic lumbar disc herniations.

Outcomes of Acute & Chronic Pts w MRI-confirmed Symptomatic Lumbar Disc Herniations (LDH) receiving HVLA SM.
Leemann S, DC, Peterson CK, RN, DC, ME Humphreys BK, DC, PhD, et al. JMPT 2014 epub ahead of print.

Comments: This 2014 study documents that chiropractic adjustments accelerate the recovery time for both acute and chronic lumbar disc herniations when compared to the natural history of recovery. Until very recently the database on effectiveness of adjustments for disc herniation has been poor, but this study, which follows on the heels of several other recent papers, demonstrates the effectiveness of chiropractic adjustments in promoting recovery based on disability scores, numerical pain rating scores, and patient global impression of change. This outcomes are considered today, to be the standards to evaluate patient-centered outcomes.

Prospective study evaluates 148 (18-65 yrs) LBP Pts w leg pain & MRI-confirmed LDH Tx w chiro HVLA SM in terms of outcomes of self-reported Pt global impression of change (PGIC), numerical pain rating scale (NPRS) &Oswestry at 2 wks, 1, 3, 6 & 12 months.
Methods: :Specific lumbar SM was dependent on if LDH was intraforaminal or paramedian on MRI. Outcomes: Pt global Impression of Change (PGIC), Numerical pain rating scale (NPRS) for LBP & leg pain &Oswestry at baseline, 2 wks, 1, 3, 6 & 12 mos.

Results: There were significant improvements for all outcomes at all follow-up times. At 3 mo, 90.5% of Pts were “improved” w 88.0%“improved” at 1 yr. Although acute Pts improved faster by 3 mos, 81.8% of chronic Pts reported “improv’t” at 3 mo& 89.2% “improved” at 1 yr. There were no adverse events.
Conclusions: A large percent of acute & importantly chronic LDH Pts treated (Tx) w chiro HVLA SM reported clinically relevant improvement.

Discussion:Previous studies identified LBP + leg pain as a negative prognostic factor for improv’t w chiropractic, but a recent, large study found radiculopathy wasn’t a negative predictor. The % of Pts reporting clinical improvement in this study is surprisingly good, with ~ 70% of Pts improved as early as 2 wks of care. By 3 mos, up to 90.5% improved & then stabilized at 6 mo& 1 yr. It may be argued that most of the effect is explained by natural history & this might contribute significantly to outcomes in ALBP Pts, but, for chronic Pts any positive effect due to natural Hx should already have occurred. The natural Hx of sciatica in acute LDH is favorable, with 36% reporting major improv’t in 2 wks& up to 73% having resolution of leg pain by 12 wks. Acute Pts in this study had more substantial improv’t& improved more quickly than chronic Pts, with >80% reporting clinical improv’t as early as 2 wks& 94.5% improved at 3 mo. These results are better than the natural Hx statistics. Even chronic Pts w t mean duration Sx>450 days, reported significant improv’t, although this takes slightly longer.>81% reported being “improved” at 3 mos, & t 89.2% reporting improv’t at 1 yr was slightly higher than the percent of acute Pts.