All Posts tagged sciatica

Manipulation or Microdisketomy for Sciatica?

“Manipulation or Microdisketomy for Sciatica? A Prospective Randomized Clinical Study,” (Journal of Manipulative and Physiological Therapeutics, October 2010, Vol. 33 Iss. 8, p: 576-584), researchers concluded that spinal manipulation was just as effective as microdiskectomy for patients struggling with sciatica secondary to lumbar disk herniation. The patient population studied included people experiencing chronic sciatica (symptoms greater than six months) that had failed traditional, medical management. Overall, 60 percent of patients who received spinal manipulation benefited to the same degree as those who underwent surgery.

 
“To our knowledge, this is the first, randomized trial that directly compared spinal manipulation, which in this study was delivered by a Doctor of Chiropractic (D.C. or DC)” says Dr. Gordon McMorland, who co-authored the paper with neurosurgeons Steve Casha, MD, PhD, FRCSC FRCSC Fellow of the Royal College of Surgeons of Canada , Stephan J. du Plessis, MD, and R. John Hubert, MD, PhD, FRCSC, FACS FACS Fellow of the American College of Surgeons.
 
“Sciatica is a serious spinal condition that causes pain, numbness, or weakness in one or both legs. Many times when symptoms become debilitating and without further help, surgery is prescribed to alleviate discomfort. But surgery is not without financial and physical drawbacks.”

According to the study, “Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients”, more than 200,000 microdiskectomies are performed annually in the United States, at a direct cost of $5 billion, or $25,000 per procedure. In this year-long study, consenting participants were chosen randomly to receive either an average of 21 chiropractic sessions over a year or a single microdiskectomy, both with the additional integration of six supervised active rehabilitation sessions and a patient education program. If cost is assumed at $100 per chiropractic visit, there is a direct, total savings of $22,900 per manipulation patient. System-wide, this could save $2.75 billion dollars annually.

“After a year, no significant complications were seen in either treatment group, and the 60 percent patients who benefitted from spinal manipulation improved to the same degree as their surgical counterparts,” says Dr. McMorland, who also points out that, “The 40 percent of patients who were not helped by manipulation did receive subsequent surgical intervention. These patients benefitted to the same degree as those that underwent surgery initially, suggesting there was no detrimental effect caused by delaying their surgical treatment.”

“Our research supports spinal manipulation performed by a doctor of chiropractic is a valuable and safe treatment option for those experiencing symptomatic LDH, failing traditional medical management. These individuals should consider spinal manipulation as a primary treatment, followed by surgery if unsuccessful.”

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Sciatica/Piriformis syndrome

Sciatica is a symptom more than a condition, as it refers to pain which refers down the back of the legs, rather than to the cause of the pain. The cause of Sciatica can be from the lumbar spine, where a disc is irritated and is compressing the sciatic nerve, or this compression can occur at the point where the sciatic nerve passes under (or through in some cases) the piriformis muscles in the buttocks. In this case, the muscle is often overworked and in spasm, resulting in compression on the nerve. The causes of piriformis syndrome include leg length differences and muscle imbalances including tight groin muscles and weak hip abductors.

I am getting really impressive results with the warm laser, the Deep Muscle Stimulator, and neuromobilization techniques for sciatic complains. I usually know within a few sessions if I can help your condition.

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For Acute Low Back Pain, Staying Active May Be Better Than Bed Rest

June 30, 2010 — Advice to stay active vs bed rest may offer small benefits in pain and function for patients with acute low back pain  (LBP), but both approaches are comparable for patients with sciatica, according to the results of a review reported online June 16 in the Cochrane Database of Systematic Reviews.

“Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches,” the study authors write. “Low quality evidence suggests little or no difference between those who received advice to stay active, exercises or physiotherapy. Further research is very likely to have an important
impact on the estimate of effect and is likely to change our confidence in it.”

Cochrane Database Syst Rev. Published online June 16, 2010.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=20556780&dopt=Abstract

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