Dysfunction in the sacroiliac joint (SIJ), located in the pelvis, can be a cause of sciatica, resulting in back pain that radiates down the leg and below the knee.
Scientists have questioned what the best treatment option is for patients with SIJ-related leg pain. In a recent study, researchers compared three treatment options: physical therapy, chiropractic manual therapy, and intra-articular injections of corticosteroids. Patients included 51 adults with leg pain associated with the sacroiliac joint. Researchers analyzed the effectiveness of each method after 6 weeks of selected treatments, and again after 12 weeks. The results for each patient was categorized as either a success or failure, based on relief or worsening of symptoms and average pain scores.
The study’s findings revealed that manual therapy is the superior choice for treating leg pain associated with the SIJ. The success rate for chiropractic manual therapy was 72%, compared to just 20% for physiotherapy and 50% for corticosteroid injections. Researchers also found that neither physical therapy nor injections resulted in significant pain relief, whereas manual therapy resulted in a significant improvement on pain scores.
Due to the success rate and pain reduction of manual therapy, the study authors concluded that chiropractic should be the first treatment of choice in patients with SIJ-related leg pain. They hoped that their findings would be confirmed by further research with a larger sample size.
Additional research has highlighted the efficacy of chiropractic for sciatica, even after surgery has failed.
Visser L, Woudenberg N, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. European Spine Journal 2013 [online]. doi: 10.1007/s00586-013-2833-2.
Disc Surgery (Discectomy,) Sciatica (Leg Pain) & Lumbar Disc Herniation
Surgery vs. Chiropractic Care
60% of Surgical Candidates Avoid Surgery with Chiropractic
A report on the scientific literature
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
According to a group at MayoClinic.com (2010), "Sciatica refers to pain that radiates along the path of the sciatic nerve and its branches — from your back down your buttock and leg. The sciatic nerve is the longest nerve in your body. It runs from your spinal cord to your buttock and hip area and down the back of each leg. Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk" (http://www.mayoclinic.com/health/ sciatica/DS00516).
Sciatica symptoms include: Pain "…likely to occur along a path from your low back to your buttock and the back of your thigh and calf. Numbness or muscle weakness along the nerve pathway in your leg or foot. In some cases, you may have pain in one part of your leg and numbness in another. Tingling or a pins-and-needles feeling, often in your toes or part of your foot. A loss of bladder or bowel control. This is a sign of cauda equina syndrome, a serious condition that requires emergency care" (Mayo Clinic Staff, 2010, http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms).
A prime symptom of sciatica is leg pain in conjunction with herniated discs. As reported by the US Chiropractic Directory in 2010, "Pain radiating down your leg secondary to a herniated disc is a common and often disabling occurrence. A disc in your spine is comprised of 2 basic components, the inner nucleus pulposis that is gelatinous in composition and the outer annulus fibrosis that is fibro-cartilaginous and very strong. When a person experiences trauma and the forces are directed at the spine and disc. The pressure on the inside of the disc is increased (like stepping on a balloon) and the internal nucleus pulposis creates pressure from the inside out. It tears the outer annulus fibrosis causing the internal material to go beyond the outer boundaries of the disc. This has often been misnamed a ‘slipped disc’ because the disc doesn’t slip or slide, it is torn from the trauma allowing the internal material to escape.
Conversely, a bulging disc, which gets confused with a herniated disc, is a degenerative "wear and tear scenario" that occurs over time with the annulus fibrosis degenerating. This can also be a "risk factor" allowing the disc to herniate with less trauma due to the degeneration or thinning of the disc walls. This, however, is a conversation for another article.
Lifetime prevalence of a herniated disc has been estimated to be 35% in men and 45% in woman and it has been estimated that 90% of all leg pain secondary to herniated discs occurs at either the L4-5 or L5-S1 levels. It has also been reported that average duration of symptoms is 55.9 weeks, underscoring the critical necessity for finding a viable solution for these patients"
It was reported by McMorland, Suter, Casha, du Plessis, and Hurlbert in 2010 that over 250,000 patients a year undergo elective lumbar discectomy (spinal surgery) for the treatment of low back disc issues in the United States. The researchers did a comparative randomized clinical study comparing spinal microdiscectomy (surgery) performed by neurosurgeons to non-operative manipulative treatments (chiropractic adjustments) performed by chiropractors. They compared quality of life and disabilities of the patients in the study.
This study was limited to patients with distinct one-sided lumbar disc herniations as diagnosed via MRI and had associated radicular (nerve root) symptoms. Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates.
60% of Surgical Candidates Avoid Surgery with Chiropractic
Both the surgical and chiropractic groups reported no new neurological problems surfaced and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. Of those patients choosing surgery as the primary means of treatment, 15% reported a failed surgical outcome and then chose chiropractic as a secondary choice. Of those 15% with failed surgeries, all were reported to have performed worse in clinical outcomes.
While it is clear that an accurate diagnosis could dictate that many patients require immediate surgery, many also do not. The above study indicates that a conservative non-operative approach of chiropractic care prevented 60% from needless surgery. While a larger study would give us more information, based upon the outcomes, cost factors and potential increased risks of surgery, it was concluded that chiropractic is a viable, first line treatment option.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with surgical lumbar discs and sciatic pain.
1. Mayo Clinic Staff. (2010, April 22). Sciatica, Definition. MayoClinic.com, Retrieved from, http://www.mayoclinic.com/health/sciatica/DS00516
2. Mayo Clinic Staff. (2010, April 22). Sciatica, Symptoms. MayoClinic.com, Retrieved from http://www.mayoclinic.com/health/sciatica/DS00516/DSECTION=symptoms
3. Studin, M. (2010). Herniated discs, radiating pain and chiropractic. US Chiropractic Directory. Retrieved from http://www.uschirodirectory.com/index.php/patient-information/item/235-herniated-discs-radiating-pain-and-chiropractic
4. McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33 (8), 576-584