Chiropractic Treatment Benefits Back-Related Leg Pain

chiropractic for spinal stenosis back and leg painAn article published in the Annals of Internal Medicine this month concluded that home exercise and advice was more effective when combined with spinal manipulation for leg pain related to spinal problems. The study, which took place in Minnesota and Iowa, involved 192 patients with back-related leg pain, a common symptom of spinal stenosis, that had lasted for at least 4 weeks.

These patients were treated either with home exercise and advice (HEA) or HEA plus spinal manipulation (SMT) for 12 weeks and back-related leg pain was assessed at 12 weeks and at 52 weeks in all but thirteen of the patients. Secondary outcomes were determined by the patients also reporting their degree of low back pain, disability, global improvement, satisfaction, medication use and general health status, and being objectively assessed at 12 weeks by physicians blinded to which intervention they had received.

Better Short-Term Leg Pain Relief

Those in the SMT and HEA group had more profound improvement in back-related leg pain at 12 weeks but not at 52 weeks, while almost all of the secondary outcomes improved more with the combined therapy at 12 weeks. After a year the improvement advantage was sustained only for global improvement, satisfaction, and medication use. No serious adverse events or deaths occurred related to the treatments.

Typical treatment for back-related low back pain is prescription painkillers and corticosteroid injections, despite a plethora of recent studies finding little to no benefit of these over placebo and a considerable risk of adverse effects, including accidental overdose, liver damage, cardiovascular complications, and even an increased risk of osteoporosis and spinal fracture.

Many patients with leg pain related to back problems like spinal stenosis wish to avoid surgery because of anticipated difficulties with recovery and return to normal activities, as well as fear of complications from anaesthesia, infection, hardware failure and scarring. In some cases surgery is simply not appropriate, although many younger people are keen to undergo surgery as a quick fix for a back problem, not realising that the problem may return or that the surgery itself can weaken spinal stability and cause future difficulties.

Alternatives to Back Surgery for Spinal Stenosis

The slower, more subtle ‘fix’ of combined spinal manipulation, exercise and education might not be as attractive for those wanting to get back to their busy lives but these therapies are increasingly being recognised as offering the best option for many patients. In this latest study the home exercise and advice consisted of 4 hour-long sessions designed to help with pain management, as well as to prevent recurring pain and increase engagement with daily activities over the course of the 12 weeks of treatment.

The patients in the HEA and SMT group had the same four sessions in addition to up to 20 sessions of chiropractic spinal manipulation (by a qualified and experienced chiropractor). By 12 weeks, 37% of patients receiving combined therapy had at least a 75% reduction in leg pain, compared with just 19% in the group receiving HEA alone. In fact, back-related leg pain was completely relieved in 20% of the patients receiving combined home exercise and advice with spinal manipulation, compared to just 5% in the HEA group.

Reduced Pain Medication Use with Chriropractic Treatment

The use of pain medications was also lower in those undergoing chiropractic treatment, with 56% of these patients reporting medication use at 12 weeks, comparedto 63% in the HEA group. By 52 weeks, medication use for symptoms was reported in 42% of patients in the SMT and HEA group, compared to 66% of those in the HEA group.

The authors concluded that home exercise and advice is more effective in the short-term, and for some people in the long-term, when combined with spinal manipulation (chiropractic treatment) for back-related leg pain from conditions such as spinal stenosis.


Gert Bronfort, DC, PhD; Maria A. Hondras, DC, MPH; Craig A. Schulz, DC, MS; Roni L. Evans, DC, PhD; Cynthia R. Long, PhD; and Richard Grimm, MD, PhD. Spinal Manipulation and Home Exercise With Advice for Subacute and Chronic Back-Related Leg Pain: A Trial With Adaptive Allocation. Ann Intern Med. 2014;161(6):381-391.

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