Low Back Pain and Sciatica and Chiropractic

Chiropractic spinal manipulation is one of the most popular treatments for acute and chronic back pain and sciatica in the US. For sciatica specifically, a chiropractor can help realign the spine and possibly alleviate the pressure irritating the sciatic nerve. More research need be done to determine if chiropractic manipulation is more effective than standard medical care. Chiropractic care is proven by medical research to be more effective than placebo.^49,50,76

Read more details about Chiropractic.

A single-blind, controlled study of 84 people suffering from low back pain compared chiropractic manipulation to treatment with a diathermy machine (a physical therapy machine that uses microwaves to create heat beneath the skin) that was not actually functioning.¹⁶ The researchers asked the participants to assess their own pain levels within 15 minutes of the first treatment, then 3 and 7 days after treatment. The only statistically significant difference between the two groups was within 15 minutes of the manipulation chiropractic had better results.

In another single-blind, placebo-controlled study, researchers assigned 209 participants to one of three groups: a high-velocity, low-amplitude (HVLA) spinal manipulation; a sham manipulation group; or a back education program.¹⁷ Though this has been reported as a positive study,¹⁸ most of the differences seen between the groups were too small to be statistically significant.

Unimpressive results were also seen in a well-designed study of 321 people with back pain, comparing chiropractic manipulation, a special form of physical therapy (the Mackenzie method), and the provision of an educational booklet in treating low back pain.²⁵ All groups improved to about the same extent.

Several studies evaluated the effectiveness of chiropractic manipulation combined with a different kind of treatment called mobilization, but they too found little to no benefit.^43,45,46

On a positive note, one study of 100 people with back pain and sciatica symptoms (pain down the leg due to disc protrusion) found that chiropractic manipulation was significantly more effective at relieving symptoms than sham chiropractic manipulation.⁵⁷

For low back pain, several studies have found that chiropractic is at least as helpful as other commonly used therapies, such as muscle relaxants, soft-tissue massage, and physical therapy.^22-26,51,74 Furthermore, in one well-designed study, 2 months of chiropractic spinal manipulation produced somewhat greater pain relief than exercise therapy, and this relative superiority endured to the 1-year follow-up point.⁴¹

Safety Issues

Chiropractic manipulation appears to be generally safe—rarely causing serious side effects. ^{1 2 3} However, a temporary increase of symptoms may occur relatively frequently. ⁴ Other side effects include temporary headache, tiredness, and discomfort radiating from the site of the adjustment.

More serious complications may occur on rare occasions. These are primarily associated with manipulation of the neck. Articles have been published that document a total of almost 200 cases of more serious complications associated with neck manipulation, including stroke, vertebral fracture, disc herniation, severely increased sensation of nerve pinching, and rupture of the windpipe. ^{5 6 7 8 9 10 11 12 13} More than half of these reports involve some form of stroke, often due to a tear in a major blood vessel at the base of the neck (the vertebral artery).

Although attempts have been made to determine in advance who will experience strokes following chiropractic, they have not been successful. ¹⁴ Thus, stroke must be considered an unpredictable, though rare, side effect of chiropractic manipulation of the neck. To put this in perspective, however, the rate of complications from chiropractic is extremely low. According to one estimate, only one complication per million individual sessions occurs. ¹⁵ Among people receiving a course of treatment involving manipulation of the neck, the rate of stroke is perhaps one per 100,000 people; the rate of death is one per 400,000. ¹⁶ By comparison, serious medical complications involving common drugs in the ibuprofen family (non-steroidal anti-inflammatory drugs, or NSAIDs) are far more common. Among people using them for arthritis, NSAIDs result in hospitalizations at a rate of about four in 1,000 people, and death at a rate of four in 10,000. ¹⁷ To put it another way, the rate of complications with these common over-the-counter drugs is perhaps 100 to 400 times greater than with chiropractic.

Certain health conditions preclude spinal manipulation, such as nerve impingement causing severe nerve damage, or significant disease of the spinal bones.

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