Recent research articles primarily about lower back conditions
336-294-8383
| Located across from the Wesley Long ER in the 522 N. Elam Professional Building Greensboro, NC 27403-1151 |
OTHER CAUSES FOR SPINAL RADICULOPATHY Here are two interesting studies which
support two other mechanisms than commonly accepted that have mostly only been
the object of speculation until recently. Both concluded that the theory of chemical
radiculitis (leakage of chemical mediators or inflammatory cytokines, which are produced
in the disc), first put forth 30 years ago, is a likely process. This means that an annular
tear (or chemicals from facet joint irritation) may be the cause of radiating symptomatology
that may even progress more distally than the knee, which has not been common wisdom
until this point. This is the first reference I have ever seen that suggests that facet
syndrome, with its associated chemical irritation potential, can indeed produce
radiculopathy. The pain typically associated with facet syndrome is thought to be
scleratogenous and not dermatomal. Facet joint symptoms derive from the middle branch
of the posterior primary ramus and adhere to Hilton's Law (the nerve that innervates the
joint, also innervates the muscles that move that joint and the fascia that covers the
muscle). This typically can result in deep pain that is local, pain secondary to muscle
spasm and pain distal from the join that goes along the fascia covering. Thus, it does
make sense to me that chemical changes at the nerve root level can result in true
radicular pain. In most cases, facet syndrome does progress below the knee and there are
no neurological changes with reflexes or muscle strength. Depending upon the level,
symptoms from the lumbar area region can progress from the spine to the hips, buttocks,
groin, testes in the male, abdomen, thigh but again, rarely below the knee. As facet joint
presentations are among the most common seen, this may explain the significant success
of manual treatment for the spine, such as manipulation and, in some cases, traction.
Tachihara H, Kikuchi S, Konno S, Sekiguchi M. (2007) Does facet joint inflammation induce
radiculopathy?: an investigation using a rat model of lumbar facet joint inflammation.
Spine. 15;32(4):406-12. and also this study: Peng, B., W. Wu, et al. (2007). Chemical
radiculitis. Pain 127(1-2): 11-6. Thanks also to Dr. Tom Hyde for his additional thoughts on
this article.
---
CHOOSING THE CORRECT TEST FOR SPINAL STENOSIS In our office, we have an interest in
treatment of spinal stenosis, since manipulation shows benefit in certain cases. Spinal
manipulation (particularly flexion-distraction manipulation), while it cannot affect osseous
vertebral canal diameter, can decompress the disc, which is important in a multifactorial
spinal stenosis, as it helps "make more room." See the article following this one for more
information on this. Magnetic resonance imaging is commonly used to diagnose lumbar
spinal stenosis, but in this study, electrodiagnosis is examined. It has been used to
diagnose spinal stenosis for more than 60 years, but there have been no masked,
controlled trials of the use of electrodiagnosis for that purpose until this study and it is
compared with MRI. 150 symptomatic and asymptomatic volunteers underwent both MRI
and electrodiagnosis, finding that imaging does not differentiate symptomatic from
asymptomatic persons, whereas electrodiagnosis does, with the conclusion that MRI was
improperly being selected in examination for this condition. Haig AJ, et al. (2007)
Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back
pain, and no back symptoms. J Bone Joint Surg Am. 2007 Feb;89(2):358-66.
---
EXAMINING CONSERVATIVE MEASURES IN THE TREATMENT OF LUMBAR SPINAL STENOSIS
While it is widely held that non-surgical management should be the first line of approach
in with lumbar spinal stenosis, little is known about the efficacy of non-surgical treatments
for this condition. This prospective consecutive case series with long term follow up for
57 individuals examined the use of spinal distraction manipulation (DM) and neural
mobilization (NM) techniques. Patients feedback was obtained with the Roland Morris
Disability Questionnaire. Among positive results, the mean improvement in disability was
5.2 points, which was considered to be clinically meaningful. Clinically meaningful
improvement in disability was seen in 73.2% of patients. The authors concluded that a
treatment approach focusing on DM and NM may be useful in bringing about clinically
meaningful improvement in disability in patients with stenosis, which is consistent with
what we have noted in our office. In our experience, predicting which patients will
respond is not a simple task, but a trial treatment period of two to four weeks is not only a
revealing test, but is rarely met with additional discomfort. Any discomfort noted in this
office has been fleeting, with no residuals. Additionally, certain exercises can also
sometimes be helpful, in our experience, and Bodak and Monteiro wrote an excellent
article about exercises for stenosis in 2001. R Murphy; Eric L Hurwitz; Amy A Gregory;
Ronald Clary (2006). A Non-Surgical Approach to the Management of Lumbar Spinal
Stenosis: A Prospective Observational Cohort Study. BMC Musculoskelet Disord. 7(16)
---
SITTING ON AN EXERCISE BALL AT WORK Does sitting on an exercise ball during the work
day help strengthen trunk muscles? These authors measured muscle activity after
prolonged sitting on an exercise ball and found no differences between a ball group and
non-ball group for 14 muscles examined. S.M. McGill, , N.S. Kavcic and E. Harvey (2006)
Sitting on a chair or an exercise ball: Various perspectives to guide decision making. Clin
Biomech (Bristol, Avon). 2006 May;21(4):353-60.
---
TRACTION FOR THE LOWER BACK Lumbar spine traction for resolution of lumbar spine
symptoms has received low marks in the last decade. In this retrospective study, 94
patients received 30-minute treatments daily for the first 2 weeks tapering to 1
session/week for eight weeks. 73% of these subjects with a median pain duration of 260
days had a diagnosis of herniated disc, degenerative disc disease (68%), or both (27%)
confirmed by MRI. At 31 weeks follow-up, 83% reported improvement, with a median
satisfaction of 9/10. Although randomized double-blind trials are needed, this is the first
study of this type to clearly report supportable benefits from lumbar spine traction.
Another study which also validates traction is coming out this year from the Mayo Clinic.
In our office, we have used traction for many years, and we support the use of this
therapy. However, it is the same as any other treatment: proper patient selection is one
of the most important factors in achieving a desirable outcome. Macario A, Richmond C,
Auster M, Pergolizzi JV. (2008). Treatment of 94 outpatients with chronic discogenic low
back pain with the DRX9000: a retrospective chart review. Pain Pract. 8(1):11-7.
---
PSYCHOSOCIAL FACTORS AND LOW BACK PAIN This cohort study looked at the impact of
psychosocial factors, both work and nonwork-related, on the prevalence of low back pain
(LBP) after 6.6 years on average, using self-administered questionnaires a cohort from a
larger study group. The conclusions were that psychosocial factors, both at work and in
other situations, constitute definite risks for the development of low back pain. For men
this is related to low decision-making latitude and low social support at work, and less
significantly to job strain, low wages, work stress or depression. High job insecurity, work
stress and depression were less significant factors in the development of back pain in
women. My observation is that external stress can be a frequent contributor in low back
pain, but it is interesting how this study demonstrated the differences in effects between
men and women. Clays E, et al. (2007) The Impact of Psychosocial Factors on Low Back
Pain: Longitudinal Results From the Beltress Study. Spine. vol. 32, Iss. 2, pp. 262-268.
---
THE RESPONSE OF CHRONIC LOW BACK PAIN TO MANIPULATION Most studies of
chiropractic spinal manipulation and the treatment of lower back conditions have dealt
with acute lower back conditions, but this randomized double-blind trial comparing active
and simulated manipulation for 102 patients in rehabilitation medical centers in Italy
examined chronic lower back conditions as well as those with a radicular component. The
authors are rehabilitation physicians at the University of Rome. Manipulation was
performed up to 5 days per week by chiropractors, with a up to a maximum of 20 sessions,
with patients' VAS scores assessed at admission and at 15, 30, 45, 90, and 180 days. At
each visit, all indicators of pain relief were used. Four times as many patients reported
pain relief in the manipulation group versus the sham treatment group. This is an
interesting study which would seem to indicate much more examination of conservative
measures for chronic low back pain is needed, particularly for spinal manipulation. A key
point, in my experience, is that manipulation is capable of improving focal joint movement
and gross range of motion, meaning that pain receptors are less likely to be stimulated.
Santilli V, Beghi E, Finucci S. (2006) Chiropractic manipulation in the treatment of acute
back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of
active and simulated spinal manipulations. Spine J. 6(2):131-7.
CLICK THE "RESEARCH REVIEW" TABS AT TOP FOR MORE ARTICLE REVIEWS
support two other mechanisms than commonly accepted that have mostly only been
the object of speculation until recently. Both concluded that the theory of chemical
radiculitis (leakage of chemical mediators or inflammatory cytokines, which are produced
in the disc), first put forth 30 years ago, is a likely process. This means that an annular
tear (or chemicals from facet joint irritation) may be the cause of radiating symptomatology
that may even progress more distally than the knee, which has not been common wisdom
until this point. This is the first reference I have ever seen that suggests that facet
syndrome, with its associated chemical irritation potential, can indeed produce
radiculopathy. The pain typically associated with facet syndrome is thought to be
scleratogenous and not dermatomal. Facet joint symptoms derive from the middle branch
of the posterior primary ramus and adhere to Hilton's Law (the nerve that innervates the
joint, also innervates the muscles that move that joint and the fascia that covers the
muscle). This typically can result in deep pain that is local, pain secondary to muscle
spasm and pain distal from the join that goes along the fascia covering. Thus, it does
make sense to me that chemical changes at the nerve root level can result in true
radicular pain. In most cases, facet syndrome does progress below the knee and there are
no neurological changes with reflexes or muscle strength. Depending upon the level,
symptoms from the lumbar area region can progress from the spine to the hips, buttocks,
groin, testes in the male, abdomen, thigh but again, rarely below the knee. As facet joint
presentations are among the most common seen, this may explain the significant success
of manual treatment for the spine, such as manipulation and, in some cases, traction.
Tachihara H, Kikuchi S, Konno S, Sekiguchi M. (2007) Does facet joint inflammation induce
radiculopathy?: an investigation using a rat model of lumbar facet joint inflammation.
Spine. 15;32(4):406-12. and also this study: Peng, B., W. Wu, et al. (2007). Chemical
radiculitis. Pain 127(1-2): 11-6. Thanks also to Dr. Tom Hyde for his additional thoughts on
this article.
---
CHOOSING THE CORRECT TEST FOR SPINAL STENOSIS In our office, we have an interest in
treatment of spinal stenosis, since manipulation shows benefit in certain cases. Spinal
manipulation (particularly flexion-distraction manipulation), while it cannot affect osseous
vertebral canal diameter, can decompress the disc, which is important in a multifactorial
spinal stenosis, as it helps "make more room." See the article following this one for more
information on this. Magnetic resonance imaging is commonly used to diagnose lumbar
spinal stenosis, but in this study, electrodiagnosis is examined. It has been used to
diagnose spinal stenosis for more than 60 years, but there have been no masked,
controlled trials of the use of electrodiagnosis for that purpose until this study and it is
compared with MRI. 150 symptomatic and asymptomatic volunteers underwent both MRI
and electrodiagnosis, finding that imaging does not differentiate symptomatic from
asymptomatic persons, whereas electrodiagnosis does, with the conclusion that MRI was
improperly being selected in examination for this condition. Haig AJ, et al. (2007)
Electromyographic and magnetic resonance imaging to predict lumbar stenosis, low-back
pain, and no back symptoms. J Bone Joint Surg Am. 2007 Feb;89(2):358-66.
---
EXAMINING CONSERVATIVE MEASURES IN THE TREATMENT OF LUMBAR SPINAL STENOSIS
While it is widely held that non-surgical management should be the first line of approach
in with lumbar spinal stenosis, little is known about the efficacy of non-surgical treatments
for this condition. This prospective consecutive case series with long term follow up for
57 individuals examined the use of spinal distraction manipulation (DM) and neural
mobilization (NM) techniques. Patients feedback was obtained with the Roland Morris
Disability Questionnaire. Among positive results, the mean improvement in disability was
5.2 points, which was considered to be clinically meaningful. Clinically meaningful
improvement in disability was seen in 73.2% of patients. The authors concluded that a
treatment approach focusing on DM and NM may be useful in bringing about clinically
meaningful improvement in disability in patients with stenosis, which is consistent with
what we have noted in our office. In our experience, predicting which patients will
respond is not a simple task, but a trial treatment period of two to four weeks is not only a
revealing test, but is rarely met with additional discomfort. Any discomfort noted in this
office has been fleeting, with no residuals. Additionally, certain exercises can also
sometimes be helpful, in our experience, and Bodak and Monteiro wrote an excellent
article about exercises for stenosis in 2001. R Murphy; Eric L Hurwitz; Amy A Gregory;
Ronald Clary (2006). A Non-Surgical Approach to the Management of Lumbar Spinal
Stenosis: A Prospective Observational Cohort Study. BMC Musculoskelet Disord. 7(16)
---
SITTING ON AN EXERCISE BALL AT WORK Does sitting on an exercise ball during the work
day help strengthen trunk muscles? These authors measured muscle activity after
prolonged sitting on an exercise ball and found no differences between a ball group and
non-ball group for 14 muscles examined. S.M. McGill, , N.S. Kavcic and E. Harvey (2006)
Sitting on a chair or an exercise ball: Various perspectives to guide decision making. Clin
Biomech (Bristol, Avon). 2006 May;21(4):353-60.
---
TRACTION FOR THE LOWER BACK Lumbar spine traction for resolution of lumbar spine
symptoms has received low marks in the last decade. In this retrospective study, 94
patients received 30-minute treatments daily for the first 2 weeks tapering to 1
session/week for eight weeks. 73% of these subjects with a median pain duration of 260
days had a diagnosis of herniated disc, degenerative disc disease (68%), or both (27%)
confirmed by MRI. At 31 weeks follow-up, 83% reported improvement, with a median
satisfaction of 9/10. Although randomized double-blind trials are needed, this is the first
study of this type to clearly report supportable benefits from lumbar spine traction.
Another study which also validates traction is coming out this year from the Mayo Clinic.
In our office, we have used traction for many years, and we support the use of this
therapy. However, it is the same as any other treatment: proper patient selection is one
of the most important factors in achieving a desirable outcome. Macario A, Richmond C,
Auster M, Pergolizzi JV. (2008). Treatment of 94 outpatients with chronic discogenic low
back pain with the DRX9000: a retrospective chart review. Pain Pract. 8(1):11-7.
---
PSYCHOSOCIAL FACTORS AND LOW BACK PAIN This cohort study looked at the impact of
psychosocial factors, both work and nonwork-related, on the prevalence of low back pain
(LBP) after 6.6 years on average, using self-administered questionnaires a cohort from a
larger study group. The conclusions were that psychosocial factors, both at work and in
other situations, constitute definite risks for the development of low back pain. For men
this is related to low decision-making latitude and low social support at work, and less
significantly to job strain, low wages, work stress or depression. High job insecurity, work
stress and depression were less significant factors in the development of back pain in
women. My observation is that external stress can be a frequent contributor in low back
pain, but it is interesting how this study demonstrated the differences in effects between
men and women. Clays E, et al. (2007) The Impact of Psychosocial Factors on Low Back
Pain: Longitudinal Results From the Beltress Study. Spine. vol. 32, Iss. 2, pp. 262-268.
---
THE RESPONSE OF CHRONIC LOW BACK PAIN TO MANIPULATION Most studies of
chiropractic spinal manipulation and the treatment of lower back conditions have dealt
with acute lower back conditions, but this randomized double-blind trial comparing active
and simulated manipulation for 102 patients in rehabilitation medical centers in Italy
examined chronic lower back conditions as well as those with a radicular component. The
authors are rehabilitation physicians at the University of Rome. Manipulation was
performed up to 5 days per week by chiropractors, with a up to a maximum of 20 sessions,
with patients' VAS scores assessed at admission and at 15, 30, 45, 90, and 180 days. At
each visit, all indicators of pain relief were used. Four times as many patients reported
pain relief in the manipulation group versus the sham treatment group. This is an
interesting study which would seem to indicate much more examination of conservative
measures for chronic low back pain is needed, particularly for spinal manipulation. A key
point, in my experience, is that manipulation is capable of improving focal joint movement
and gross range of motion, meaning that pain receptors are less likely to be stimulated.
Santilli V, Beghi E, Finucci S. (2006) Chiropractic manipulation in the treatment of acute
back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of
active and simulated spinal manipulations. Spine J. 6(2):131-7.
CLICK THE "RESEARCH REVIEW" TABS AT TOP FOR MORE ARTICLE REVIEWS
| This website provides recent research for health care professionals that we work with, although there is also information for patients and members of the public searching for information here. We encourage you to visit our main website for patients at http://greensboro-chiropractor.com/ |
 |  |  |  |  |  |  |