RCT examines Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy
As research advances and as great chiropractic minds delve into the possibilities offered by the adjustment beyond musculoskeletal pain alone, we are discovering more and more about the possibilities tied up in chiropractic care. We now know that chiropractic care can and does have a significant impact on the brain and not just the spinal aspect of the nervous system. Yet it is still true that many people think of chiropractors when they think of back pain. Thus, a recent study looking at lumbar radiculopathy is still very relevant for the chiropractic community.
Lumbar radiculopathy is back pain caused by the compression of nerve roots exiting the spine at levels L1-S4 (the lumbosacral area of the spine). It’s a relatively common condition for which people often seek medical assistance. While symptoms include pain, tingling, loss of reflexes and more, non-invasive treatments such as physical or manual therapies are often deployed so that the patient can avoid surgical interventions.
So how does spinal manipulation fare when it comes to relieving subacute or chronic lumbar radiculopathy? A recent randomised control trial involving 92 patients with low back pain sought to answer this question. Participants were taken from a waiting list of the Imam Reza Hospital, and after exclusion criteria was applied (to eliminate other significant contributing factors), 44 participants remained and completed the study. They were randomised into two groups. Their back pain was considered chronic if it lasted more than 12 weeks.
All participants underwent a complete history and physical examination which assessed the following:
- Manual muscle testing
- Sensory testing
- Deep tendon reflexes
- Lasegue test
- MRIs or CT scans where available
All patients underwent usual care treatment which included physiotherapy and some pharmaceutical interventions, as well as heat pack and transcutaneous electrical stimulation and ultrasound treatments. All of them had an exercise regime that included flexibility, strength and aerobic exercise. However, only the patients in the manipulation group received three sessions of high-velocity, low-amplitude spinal manipulation.
Researchers were looking at a number of measurements to ascertain whether the spinal manipulation made a significant difference. They looked at:
- Index of disability
- Range of Motion (flexion, extension, right bending, left bending, right rotation, left rotation)
- Straight leg raise test (left and right)
- Back pain
- Leg pain
The findings of the study are certainly encouraging for spinal manipulation. Researchers found that, “Manipulation improved results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.” These favourable outcomes lasted at least three months following the cessation of therapy. They also found that, along with increasing the effectiveness of other treatments, range of motion and straight leg raise results also improvements significantly.
In terms of limitations, this study has a few. The list of interventions was significant, which may be unattainable for a person who suffered from the condition and didn’t wish to undergo all of those treatments. It also didn’t measure spinal manipulation’s effectiveness as a standalone in comparison with physiotherapy. Thus, it isn’t too descriptive about the benefits of chiropractic care alone. However, other studies have proven chiropractic’s benefits in terms of various types of back pain.
What this study does indicate is that manipulation improves outcomes for people undergoing treatment for lumbar radiculopathy. We look forward to more studies that examine chiropractic care as a standalone treatment for this condition. In the meantime, this randomised controlled trial offers up some favourable indicators.
- Ghasabmahaleh SH, Rezasoltani Z, Dadarkhah A, Hamidipanah S, Mofrad RK, Najafi S. Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial. The American Journal of Medicine. Available online September 2020.