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The Somatic Connection  |   July 2014
Patients With Magnetic Resonance Imaging–Verified Lumbar Disk Herniations Benefit From Chiropractic High-Velocity, Low-Amplitude Spinal Manipulative Therapy
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   July 2014
Patients With Magnetic Resonance Imaging–Verified Lumbar Disk Herniations Benefit From Chiropractic High-Velocity, Low-Amplitude Spinal Manipulative Therapy
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 588-589. doi:10.7556/jaoa.2014.115
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 588-589. doi:10.7556/jaoa.2014.115
Web of Science® Times Cited: 27
Leeman S, Peterson CK, Schmid C, Anklin B, Humphreys BK. Outcomes of acute and chronic patients with magnetic resonance imaging–confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: a prospective observational cohort study with one-year follow-up [published online March 11, 2014]. J Manipulative Physiol Ther. 2014;37(3):155-163. doi:10.1016/j.jmpt.2013.12.011.  
Swiss chiropractic researchers carried out a prospective cohort study of patients with magnetic resonance imaging–verified lumbar disk herniation (LDH) with accompanying physical symptoms using high-velocity, low-amplitude spinal manipulative therapy (SMT). Three chiropractors in the same office affiliated with a university chiropractic medicine program followed specific SMT procedures depending on whether the herniation was intraforaminal or paramedian. A total of 148 patients, aged 18 to 65 years, were enrolled in the study. 
In addition to LDH, inclusion criteria were back pain, leg pain, or both, and 1 or more of the following: decreased straight-leg raising, deficit in detection of cold, reduced response to pinprick, decreased muscle strength in a corresponding myotome, or decreased or absent deep tendon reflex. Patients were excluded if they had tumors, infections, inflammatory spondylarthropathies, acute fractures, Paget disease, severe osteoporosis, body mass index greater than 30, or neurogenic claudication. 
Primary outcome measures were a numeric rating scale, with 0 indicating no pain and 10 indicating worst pain imaginable; the Oswestry pain and disability questionnaire; and the patient's global impression of change, measured on a scale ranging from “much worse” to “much better.” All data were collected at baseline and at 2 weeks, 1 month, 3 months, 6 months, and 1 year after intervention was initiated. 
The SMT procedures—which, on the basis of the authors' description, did not resemble procedures used by osteopathic physicians—included a chiropractic drop table procedure, which was performed with paramedian LDH patients lying on their unaffected side and intraforaminal LDH patients lying on their affected side. The mean number of SMT procedures applied per patient in the first month of data collection was 11.20. 
Statistically significant progressive improvement was noted from the 2-week through the 1-year data points for the numeric rating scale and Oswestry questionnaire. On the patient's global impression of change scale, 80% of patients with acute pain (<12 weeks) and 47% of patients with chronic pain (>12 weeks) reported feeling much better at 2 weeks. By 1 year, 86% of patients with acute pain and 89% of patients with chronic pain reported feeling better. These findings for the chronic pain patients are surprising, as the natural history for chronic pain patients with sciatica has been found to be 80% improvement at 1 year.1 
The authors point out that because of the study's design, the reported benefits cannot be attributed to SMT. In addition, follow-up magnetic resonance imaging data were not obtained. This study was selected for review because it describes the apparently successful application of high-velocity, low-amplitude SMT in patients with magnetic resonance imaging–verified LDH without any adverse events. These findings add to the body of evidence that manual therapy is a safe and effective treatment for patients with spine conditions. 
Reference
Reference
Peul WC, van Houwelingen HC, van den Hout WBet al. Surgery versus prolonged conservative treatment for sciatica. N Eng J Med. 2007;356(22):2245-2256. [CrossRef]