Is Chiropractic treatment good for Degenerative Disc Disease?

Chiropractic treatment for degenerative disc disease (DDD) is a topic of ongoing research and debate. Some studies have explored the use of chiropractic care, including spinal decompression, as part of a multimodal treatment approach for DDD. For example, a case report described the use of nonsurgical spinal decompression as part of a multimodal chiropractic treatment plan for a patient with a disc herniation. 

Chiropractic treatment has been studied for its effectiveness in managing degenerative disc disease and related conditions, with various research findings supporting its benefits:

1. Pain Alleviation and Function Increase:
   • Chiropractic Techniques: This aspect involves various chiropractic techniques such as spinal manipulation, modalities (like heat, ice, electrical stimulation), and exercise rehabilitation.
   • Spinal Manipulation: This is a key element of chiropractic care, where a chiropractor applies a controlled amount of force to a specific part of the spine. This technique can help to realign the spine, relieve pressure on nerves, and improve spinal movement.
   • Modalities: These adjunct treatments can help in reducing inflammation, improving circulation, and decreasing muscle tension, which are crucial in managing pain and discomfort associated with degenerative disc disease.
   • Exercise Rehabilitation: Chiropractors often prescribe specific exercises tailored to the patient’s condition. These exercises can help strengthen the muscles supporting the spine, increase flexibility, and improve posture, which in turn helps in stabilizing the spine and alleviating pain.
   • Evidence of Efficacy: The study by Christoph Hammer (2004) demonstrated that these combined chiropractic treatments could effectively alleviate pain and increase function in a patient with a disc herniation, a common issue in degenerative disc disease (Hammer, 2004).
2. Improvement in Lumbar Function:
   • Chiropractic Manipulation for Degenerative Scoliosis: Degenerative scoliosis, often a consequence of degenerative disc disease, can lead to an asymmetric degeneration of the disc and adjacent vertebrae, resulting in a curvature of the spine.
   • Relieving Pain and Restoring Function: The manipulation techniques used in chiropractic care can help in aligning the spine, relieving the uneven pressure on the discs and nerves, thus reducing pain.
   • Improving Lumbar Function: Chiropractic manipulation can improve the range of motion in the lumbar (lower back) region. This is crucial for patients with degenerative scoliosis as it helps in maintaining mobility and function.
   • Clinical Observation: The study by Luoxiang Li et al. (2022) provides evidence that chiropractic manipulation can be effective in not only relieving pain but also in improving lumbar function in patients with degenerative scoliosis, a condition related to DDD (Li et al., 2022).

Other benefits may include

1. High Rate of Good Clinical Outcomes: For cervical and lumbar disc herniations, chiropractic care has reported good clinical outcomes in 80% of patients, with many returning to their predisability occupations (Beneliyahu, 1996).
2. Long-term Efficacy: A study demonstrated the efficacy of physiotherapy/chiropractic treatment in treating degenerative disc disease over a mean follow-up of 28.5 months (Singh, 2012).
3. Success with Specific Techniques: Activator-assisted spinal manipulative therapy and Activator Methods Chiropractic Technique have shown positive results in treating symptoms related to DDD and low back pain (Roberts & Wolfe, 2012; Polkinghorn & Colloca, 1998).
4. Widely Used Treatment Option: Chiropractic manipulation is a commonly used treatment for lumbar degenerative disc disease, indicating its acceptance in clinical practice (Kim & Branch, 2006).
5. Treatment for Associated Conditions: It’s also effective for treating conditions associated with DDD like sciatica and adjacent segment pathology (Chu, 2020; Chu & Lee, 2022).
6. Conservative Treatment Modality: Chiropractic work is considered among the preferred conservative treatment modalities for DDD (Harmon et al., 2020).
7. Symptomatic Treatment for Acute Low Back Pain: For acute uncomplicated low back pain, spinal manipulation, including chiropractic, is recommended as a symptomatic treatment (Ernst & Assendelft, 1998).
8. Need for More Studies with Better Methodology: Although effective, more studies with better research methodology are needed to strengthen the evidence base (Assendelft et al., 1992).
9. Chiropractic Biophysics Methods: These methods have shown efficacy in treating chronic low-back pain and restoring lumbar lordosis in some cases of degenerative disc disease (Paulk & Harrison, 2004).
10. Potential Risks: It’s important to note that in some cases, manipulative therapy may precipitate protrusion of a disc in chronically degenerating discs, potentially leading to long-term disability (Brien & Brien, 1992).

Possible benefits

Chiropractic adjustments can help alleviate symptoms by reducing pressure on the affected discs and improving spinal function. By restoring proper alignment, chiropractic care can promote optimal spinal health and potentially slow down the progression of the disease.

Chiropractors may also incorporate other therapeutic measures, such as stretching exercises, spinal decompression, and other modalities to further enhance the effectiveness of treatment. These additional interventions can help improve flexibility, strengthen supporting muscles, and reduce inflammation in the affected area.

It is important to note that chiropractic care for degenerative disc disease should be tailored to individual needs and preferences. A thorough evaluation by a qualified chiropractor is crucial to determine the appropriate course of treatment and ensure that it is safe and effective.

While chiropractic care can provide significant relief for many individuals with degenerative disc disease, it is not a cure-all. It is best used as part of a comprehensive treatment plan that may also include other interventions such as physical therapy, pain management techniques, and lifestyle modifications.

Long-term benefits and potential risks

1. Improvement in Herniated Discs:
   • Study: Beneliyahu (1996) conducted a study focusing on patients with cervical and lumbar disc herniations receiving chiropractic care.
   • Findings: Approximately 80% of these patients had a good clinical outcome. This indicates a high rate of success in terms of symptom relief and functional improvement.
   • Significance: The study also highlighted that 78% of the patients were able to return to their pre-disability occupations, demonstrating the potential of chiropractic care in facilitating return to normal life and work activities (Beneliyahu, 1996).
2. Effective Treatment for Lumbar Disc Herniation:
   • Study: Polkinghorn and Colloca (1998) evaluated the effectiveness of the Activator Methods Chiropractic Technique in treating lumbar disc herniation.
   • Findings: The treatment was effective within 90 days, and importantly, there were no residuals or recurrences of symptoms observed over a period of one year.
   • Significance: This suggests that chiropractic treatment can be a viable alternative to more invasive treatments for lumbar disc herniation, with sustained results (Polkinghorn & Colloca, 1998).
3. Positive Outcomes in Elderly Patients:
   • Study: Roberts and Wolfe (2012) focused on an elderly patient with DDD and diffuse idiopathic skeletal hyperostosis.
   • Findings: The patient showed improvement in low back pain and ambulation following chiropractic treatment.
   • Significance: This indicates that chiropractic care can be beneficial even in older patients, who are more likely to suffer from DDD and related complications (Roberts & Wolfe, 2012).

Detailed Risks

1. Risk of Acute Lumbar Disc Herniation:
   • Study: Hincapié et al. (2018) explored the beliefs among clinicians regarding the risk of acute lumbar disc herniation from chiropractic spinal manipulation.
   • Findings: There was a variation in beliefs, indicating a lack of consensus about the risk.
   • Significance: This suggests that while some practitioners see little risk, others may be more cautious, reflecting the need for more research and clarity in this area (Hincapié et al., 2018).
2. Possibility of Disc Protrusion:
   • Study: Brien and Brien (1992) investigated the risks associated with manipulative therapy in patients with persistent back and neck complaints.
   • Findings: They noted that manipulative therapy might precipitate protrusion of a chronically degenerating disc.
   • Significance: This highlights a potential risk of injury to the cervical cord and even brain stem infarction, underlining the importance of careful patient selection and technique application in chiropractic care (Brien & Brien, 1992).
3. Uncertain Efficacy in Clinical Trials:
   • Study: López-González and Peris-Celda (2011) examined the efficacy of chiropractic manipulation in randomized clinical trials.
   • Findings: The evidence for its effectiveness, particularly in conditions like acute paraplegia, remains uncertain.
   • Significance: This uncertainty calls for more robust and well-conducted clinical trials to better understand the effectiveness and safety of chiropractic treatments in various conditions related to DDD (López-González & Peris-Celda, 2011).

References

1. Hammer, C. (2004). Chiropractic management and rehabilitation of a 38-year-old male with an L5-s1 disc herniation. Journal of Chiropractic Medicine, 3(4), 145-52. Link
2. Li, L., Gao, J., Gao, C.-Y., Sun, W., Luo, J., Yang, K., Yu, J., Li, J., Wang, B., Yang, W., & Zhuang, M. (2022). [Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis]. Zhongguo Gu Shang = China Journal of Orthopaedics and Traumatology, 35(5), 442-7. Link
3. Beneliyahu, D. J. (1996). Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal of Manipulative and Physiological Therapeutics, 19, 597-606. Link
4. Singh, H. (2012). Lumbar Intradiscal Treatment: A Comparison between 5 Modalities (Physiotherapy/Chiropractic, IDET, Decompressor, Nucleoplasty, Disk-Fx) in 592 Cases in a Single Surgeon’s Practice. Global Spine Journal, 2. Link
5. Roberts, J. A., & Wolfe, T. M. (2012). Chiropractic management of a veteran with lower back pain associated with diffuse idiopathic skeletal hypertrophy and degenerative disk disease. Journal of Chiropractic Medicine, 11(4), 293-9. Link
6. Polkinghorn, B. S., & Colloca, C. J. (1998). Treatment of symptomatic lumbar disc herniation using activator methods chiropractic technique. Journal of Manipulative and Physiological Therapeutics, 21, 187-196. Link
7. Kim, P. K., & Branch, C. (2006). The lumbar degenerative disc: confusion, mechanics, management. Clinical Neurosurgery, 53, 18-25. Link
8. Chu, E. (2020). Taming of the Testicular Pain Complicating Lumbar Disc Herniation With Spinal Manipulation. American Journal of Men’s Health, 14. Link
9. Azúa, J. (2016). Treatment modalities for lumbar herniated discs that cause sciatica. MOJ Anatomy & Physiology, 2. Link
10. Harmon, M., Ramos, D., Nithyadevi, D., Bordett, R., Rudraiah, S., Nukavarapu, S., Moss, I., & Kumbar, S. (2020). Growing a backbone – functional biomaterials and structures for intervertebral disc (IVD) repair and regeneration: challenges, innovations, and future directions. Biomaterials Science. Link
11. Ernst, E., & Assendelft, W. (1998). Chiropractic for low back pain. BMJ, 317, 160 – 160. Link
12. Assendelft, W., Koes, B., van der Heijden, G. J., & Bouter, L. (1992). The efficacy of chiropractic manipulation for back pain: blinded review of relevant randomized clinical trials. Journal of Manipulative and Physiological Therapeutics, 15(8), 487-94. Link
13. Paulk, G., & Harrison, D. (2004). Management of a chronic lumbar disk herniation with chiropractic biophysics methods after failed chiropractic manipulative intervention. Journal of Manipulative and Physiological Therapeutics, 27(9), 579. Link
14. Chu, E. C. P., & Lee, L. H. (2022). Adjacent segment pathology of the cervical spine: A case report. Journal of Family Medicine and Primary Care, 11, 787 – 789. Link
15. Excoffon, S., & Wallace, H. (2006). Chiropractic and rehabilitative management of a patient with progressive lumbar disk injury, spondylolisthesis, and spondyloptosis. Journal of Manipulative and Physiological Therapeutics, 29(1), 66-71. Link
16. Simons, D. (2007). Low Back Pain and Myofascial Trigger Points. Journal of Manual & Manipulative Therapy, 15, 69E – 70E. Link
17. Brien, P., & Brien, M. J. (1992). Manipulative therapy and physiotherapy for persistent back and neck complaints. BMJ, 304, 1310-1311. Link

Dr. Marcus Yu Bin Pai

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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