Chiropractic and Work Related-Sciatica

Work-related sciatica is clinically challenging and an expensive problem for our health care systems. One recent study found that workers with sciatica are significantly more likely to be prescribed opioids for their condition.¹ Another study found that workers with low back pain and sciatica showed the highest level of disability of all back pain patients.²
With these issues in mind, the orthopedic medicine department of a hospital in Norway has examined the effectiveness of chiropractic treatment with patients with severe sciatic pain. This new study³ looked at 44 workers who presented at the hospital with severe sciatic pain that required hospitalization. “The patients underwent clinical, neurologic, and radiological examinations as well as laboratory screening, including urine specimens, parameters of infection, and system diseases.”
The hospital chiropractor then performed a chiropractic examination on each patient that included an analysis of posture and gait, passive and active range of motion, and palpation of the lumbar spine. “The main treatment consisted of joint adjustment techniques of the lumbopelvic fixations, usually performed in a side posture position...Joint adjustments in other parts of the spine and limbs were usually necessary as a result of the compensatory dysfunction.” Ice treatment was applied after the adjustment, since there was soft-tissue soreness experienced by the patients.
“Patients were treated daily while they were in the hospital; they were treated for 3 days a week for the first 2 weeks while they were in the clinic. Depending on need, some patients received follow-up treatment once or twice a week for some time. Following Norwegianpublic health regulations, cost refunding is limited to 14 treatments; therefore, the total number of treatments rarely exceeded this number.”
The authors found the following:

• All of the patients had experienced three or more weeks of pain before hospitalization.
• 35 patients underwent MRI and 7 had CT scans; there were no structural changes on any of the imaging tests.
• After the treatment, 40 patients (91%) returned to work full-time within an average of 21.1 days.
• Two patients returned at reduced work levels: one at 80% and another at 50%.

“The positive effects of cooperation between orthopedic surgeons and chiropractors may be measured in the reduced duration of sick leaves.” The study refers to Norwegian public health records that show that the average patient with sciatica is disabled for 72 days; in this study, the time to return-to-work was just 21 days—a 70% reduction.
The authors point to how chiropractic can improve functioning in the spine:
Stimulation of “muscle spindles caused by sprain strain has been shown to be capable of starting a long-lasting train of action potentials in the motor neuron (i.e., long-lasting muscle contraction in the motor unit in question). Similarly, a brief inhibitory impulse, such as that from antagonistic muscles, may stop the signal train in the motor neuron. Chiropractic joint adjustment probably provides a similar inhibitory impulse. The chiropractic joint adjustments must cross the barrier of passive joint motion range to stimulate muscle spindle receptors.”

1. Stover BD, Turner JA, Franklin G, et al. Factors associated with early opioid prescription among workers with low back injuries. Journal of Pain 2006;7(10):718-25.
2. Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
3. Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139