NEW YORK (Reuters Health) – People with leg pain related to backproblems had more short-term relief if they received chiropractic carealong with exercise and advice, rather than exercise and advice alone, anew study has found.Patients with back-related leg pain, such as sciatica, are usually treatedwith prescription medications, injections and surgery.Increasingly, spinal manipulative therapy by chiropractors, exercise andself-management are being recommended as low-risk strategies for back-related leg pain, but good research studies have been lacking, experts say.“Spinal manipulation combined with home exercise may be worth tryingfor those with back-related leg pain that has lasted more than fourweeks,” Gert Bronfort told Reuters Health in an email.Bronfort, who led the study, is a researcher with the Integrative Healthand Wellbeing Research Program at the University of Minnesota inMinneapolis.“This combination resulted in advantages in pain reduction, disability,global improvement, satisfaction, medication use and general physicalhealth status after 12 weeks,” he said.Nine months after the treatment ended, patients who received chiropractictherapy were still doing better than the other group in terms of globalimprovement, medication use and satisfaction, he added.

Bronfort said that about four out of five people will develop low backpain during their lifetime, and up to 40 percent of them will developback-related leg pain.As reported in Annals of Internal Medicine, Bronfort and colleaguesenrolled 192 adults with back pain that had been radiating into the leg forat least four weeks. Patients were recruited through newspaperadvertisements, direct mail, and community posters.Half the patients received instructions for specific exercises to do at homeplus simple pain management techniques. In addition, during the first 12weeks, they visited a chiropractor up to 20 times for 10 to 20 minutes ofspinal manipulation at each visit.Patients in the other group also received the instructions for exercises andpain management techniques. They too met with a chiropractor, exercisetherapist, or personal trainer during the first 12 weeks, but for four one-hour sessions without spinal manipulation.The patients were asked to rate their pain at the beginning of the study,after the 12 weeks of treatments and again at the end of the year.At 12 weeks, 37 percent of the spinal manipulation group felt their painwas reduced by at least three-quarters, compared to 19 percent of thosewho received exercise and advice only.In addition, the patients who had spinal manipulation had higher scoresfor overall improvement and satisfaction.By the one-year follow-up, the no-manipulation group had caught up, andthere was no longer a significant difference in pain relief. But the scoresfor overall improvement and satisfaction remained higher for the patientswho received spinal manipulative therapy.“We actually find the outcomes of the home exercise alone group to bevery interesting,” Bronfort said.

Almost half of these patients experienced a 50 percent reduction in legpain symptoms in both the short (at 12 weeks) and long term (at 52weeks), Bronfort said.“That’s an important improvement and warrants future research,” he said,“We look forward to investigating how home exercise alone maycompare to usual medical treatment and/or no treatment at all.”“This is a well-conducted study by a group of well-respected chiropracticresearchers,” Sidney Rubinstein told Reuters Health in an email.Rubinstein is a researcher with the Department of Health Sciences at theUniversity of Amsterdam in The Netherlands. He wasn’t involved in thestudy, but has recently published a paper analyzing previous studies onspinal manipulative therapy.“It is perhaps the only study of good methodological quality using arobust sample of patients which examines the additional benefit of spinalmanipulative therapy in those with sub-acute or chronic back-related legpain,” Rubinstein said.Rubinstein said it would be necessary to conduct an economic evaluationto determine if the use of spinal manipulative therapy in addition to homeexercises is worth the cost.“This of course, must be considered in light of alternatives for thiscondition, such as epidural steroid injections or surgery, which are notonly much more costly but also associated with important (and serious)adverse events,” he said.Bronfort said his team feels that as long as there are no serious medicalcomplications, patients can focus on self-management strategies.“Try and keep moving . . . simple activities like taking short walks andchanging positions frequently (both advised in the home exerciseprogram) may be helpful,” he said.

But, he added, for people who have pain that is too severe for to deal withon their own, seeing a chiropractor, physical therapist, or osteopath whocan use spinal manipulation might help relieve their pain – possiblywithout the use of medications.SOURCE: Annals of Internal Medicine,

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