Effectiveness of Chiropractic For Disk Herniation 

Chances are 7/10 of your friends has back pain [1]. Extremely disabling low back pain with leg pain is usually caused by herniated inter-vertebral disk. A variety of treatment options are available and are grouped into 2 categories: surgical and conservative care. Conservative care may include oral medication, corticosteroids and nerve root injections [NRIs], bed rest, exercise therapy, flexion/distraction therapy, and spinal manipulative therapy (SMT).

The research article “Symptomatic MRI-Confirmed Lumbar Disk Herniation Patients: A Comparative Effectiveness Prospective Observational Study of 2 Age and Sex Matched Cohorts Treated with Either High-Velocity, Low Amplitude Spinal Manipulative Therapy or Imaging-Guided Lumbar Nerve Root Injections Journal of Manipulative and Physiological Therapeutics, 2013 May; 36(4):218–25” compares chiropractic to nerve root injections.

The current standard of care for the 5% of the population with symptomatic lumbar disk herniation is nerve root injection followed by a surgical intervention. Spinal manipulative therapy is almost never recommended even though evidence shows that improvement with a chiropractic adjustment was higher than those treated with a nerve root injection (NRI). This evidence shows that “spinal manipulation, is a safe and cost effective option to treat Lumbar Disk Herniation.”

“Both of the treatment groups had significant decreases in their pain scores at 1 month with a 60% reduction for the Spinal Manipulative Therapy cohort and a 53% reduction for the Nerve Root Injection group.”

This far exceeded the minimum value of 30% required for a clinically meaningful result [24]. Especially when the researchers considered that a higher percentage (76.5% vs 62.7%) of patients in the SMT group reported being “much better” or “better” one month after care.

“Lumbar NRI’s are a commonly used and accepted treatment option for these patients, whereas lumbar spinal manipulation as a treatment for disk herniation remains controversial among some health care professionals.” The goal of this research is to show that chiropractic SMT is equally as effective to nerve root injections.

Self-reported pain and “improvement” of patients with symptomatic, magnetic resonance imaging confirmed lumbar disk herniations improved in both high-velocity, low- amplitude chiropractic spinal manipulative therapy (SMT) or nerve root injections (NRI).

“Improvement” was reported in 76.5% of SMT patients and in 62.7% of the NRI group. Both groups reported significantly reduced pain scores at 1 month (P = .0001). Average cost for treatment with SMT was US $558.75 and US $729.61 for NRI. There is no significant difference in outcomes between NRI and SMT for clinically relevant reduction in self- reported pain level and increased global perception of improvement.

This research shows that chiropractic care is a cost-effective and clinically significant. It needs to be offered as part of the conservative care options offered for people with back pain. We at ProActive Chiropractic can help if you want to try conservative care for your MRI confirmed disk herniation. If you want more information please set up a ten minute consult with one of our doctors.


1.van Tulder M, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol 2002;16:761–75.

2. Heliovaara M, Impivaara O, Sievers K, et al. Lumbar disc syndrome in Finland. J Epidemiol Community Health 1987; 41:251–8.

3. Heliovaara M, Makela M, Knekt P, Impivaara O, Aromaa A. Determinants of sciatica and low back pain. Spine 1991;16: 608–14.

4. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:403–8.

5. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo- controlled trial evaluating the effect of piroxicam. Spine 1983; 18:1433–8.

6. Eckel T, Bartynski W. Epidural steroid injections and selective nerve root blocks. Tech Vasc Interv Radiol 2009;12:11–21.

7. Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 2009;12: 699–802.

8. Peterson C, Hodler J. Evidence-based radiology (part 1): is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints? Skeletal Radiol 2010;39:5–9.

9. Roberts S, Willick S, Rho M, Rittenberg J. Efficacy of lumbosacral transforaminal epidural steroid injections: a systematic review. PMR 2009;1:657–68.

10. Abdi S, Datta S, Trescot A, et al. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 2007;10:185–212.

11. Datta S, Everett C, Trescot A, et al. An updated systematic review of the diagnostic utility of selective nerve root blocks. Pain Physician 2007;10:113–28.

12. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain: a meta- analysis of effectiveness relative to other therapies. Ann Intern Med 2003;138:871–81.

13. Oiphant D. Safety of spinal manipulation in the treatment of lumbar disc herniations: a systematic review and risk assessment. J Manipulative Physiol Ther 2004;27:197–210.

14. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J 2006;6:131–7.

15. Luijsterburg P, Verhagen A, Ostelo RW, van Os TA, Peul WC, Koes BW. Effectiveness of conservative treatments forthe lumbosacral radicular syndrome: a systematic review. EurSpine J 2007;16:881–99.

16. Lawrence DJ, Meeker W, Branson R, et al. Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis. J Manipulative Physiol Ther 2008;31:659–74.

17. Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Phys Med Rehabil Clin N Am 2011;22:105–25.

18. 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; 33:576–84.

19. Lisi AJ, Holmes EJ, Ammendolia C. High-velocity low amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature. J Manipulative Physiol Ther 2005;28:429–42.

20. Peterson CK, Bolton J, Humphreys BK. Predictors of improvement in patients with acute and chronic low back pain undergoing chiropractic treatment. J Manipulative Physiol Ther 2012;35:525–33.

21. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 2007;356:2245–56.

22. Tinetti ME, Studenski SA. Comparative effectiveness re- search and patients with multiple chronic conditions. N Engl J Med 2011;364:2478–81.

23. Fischer D, Stewart AL, Bloch DA, Lorig K, Laurent D, Holman H. Capturing the patient’s view of change as a clinical outcome measure. JAMA 1999;282:1157–62.

24. Ostelo RW, Deyo RA, Stratford P, et al. Interpreting change scores for pain and functional status in low back pain. Spine 2008;33:90–4.

25. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther 2004;27:26–35.

26. Newell D, Bolton JE. Responsiveness of the Bournemouth questionnaire in determining minimal clinically important change in subgroups of low back pain patients. Spine 2010; 35:1801–6.

27. Iversen T, Solberg TK, Romner B, et al. Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomized controlled trial. BMJ 2011;343:d5278, http://dx.doi.org/10.1136/bmj. d5278.

28. Bussières A, Taylor J, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaint in adults — an evidence-based approach: part 3: spine disorders. J Manipulative Physiol Ther 2008;31:3–60.

29. Power JR, Mishra G, Young AF. Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias. Aust N Z J Public Health 2005;29:149–54.

30. Pallant J. SPSS Survival Manual. 4th ed. New York: McGraw-Hill; 2012.