Surgery or conservative chiropractic care for leg pain due to a disc herniation; which is a better option?
You find yourself in pain one morning with the ache shooting down into your leg. You may not recall anything that would create these types of symptoms and although, you have had back pain in the past, it always seemed to work itself out. Now, you have a difficult time sitting, standing, walking and your spouse has just helped you put your socks on this morning after you had to cancel plans to go out the night before due to the pain; has this been something you’ve experienced?
Many of us who have had this experience may have waited a few days to see if the problem self resolves as it always did. Others found themselves visiting their primary doctor who diagnosed them with sciatica and sent them to someone else after their pain medication and muscle relaxants did not relieve the ache. After a few weeks of this, your primary doctor may have sent you to an orthopedic, for an MRI and on occasion, a chiropractor or a therapist.
If you are new to this scenario, chances are you are beginning to panic when the problem does not improve, and you may be wondering if you need surgery, or some other intervention to resolve the problem. Most studies on lower back and sciatic disc pain are highly biased so it is difficult to figure out if surgery is your best option. The two best studies between the surgical option and surgery suggest surgery provided faster relief of leg pain, but that differences between surgery and conservative care diminished after 1-2 years. At the annual follow-ups, both groups of patients had substantially improved after two years (1). Another study confirmed that there were no major differences between conservative care and surgery in the long-term.
Another approach that is very effective is to see a chiropractor who performs flexion distraction, sometimes called the Cox Technique (2). Flexion distraction is a commonly used chiropractic method that affects the disc with distraction since the table moves under the doctors control. After a number of visits on the Flexion table, most patients will get relief over a series of visits, even with moderate nerve root impingement from a disc problem.
If you have suffered from a problem such as the one described in this article, the pain may not be disc related at all. Sciatica seems to have become a catch all description for leg pain and before the MRI is ordered (MRI’s will often show a history of degeneration and damage, and may not be definitive for why you are in pain). Often, the reason behind the pain is a functional (sacroiliac, gait related), rather than structural (disc) problem.
The best advice for those experiencing back, leg or sciatic pain is to visit a chiropractor first. As our annual deductibles have gone up, it is possible that the healthcare system will eat through your high deductible with tests, office visits and medications before you get any relief. In the chiropractic world, most chiropractors will work on you using a working diagnosis, which does not need to be confirmed by an MRI that often may cost more than the care the chiropractic regimen they suggest. It is not unusual for an uncomplicated case to markedly improve in under 10 visits so you can be back to your old self. Once you find a chiropractor you know and trust, they are someone you are likely to need from time to time.
While having the experience of back and leg pain is a horrible one, finding out why it happened in the first place can be both enlightening and help prevent future events. The book, Cheating Mother Nature, what you need to know to beat chronic pain is a good place to start since it explains the mechanisms behind why most people hurt.
Often, the problems begin at the feet, and affect the way you move and walk. A good chiropractor will look at how you stand, and move and be able to figure out many of the mechanisms that are behind why the problem began in the first place. Often, people who experience back and leg pain find out these are familial traits and they were just unaware of the consequences. The long term management of biomechanical back and leg pain can make the difference between success and failure in both your treatment and your long term prognosis.
The most important thing is not to panic. Back and leg pain can take a while to resolve but with the right care , you can be back doing what you did before without pain.
1. Jacobs, WC, M. van Tulder, M Arts, SM Rubinstein, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review.” European Spine Journal 2011;20(4): 513-22.
Read Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com and other booksellers.