It is commonly assumed that if someone has a ruptured disk in the spine, and especially if there is a pinched nerve, the only option is surgery. When I suggest manipulation for these problems, the reaction is usually one of shock, with the idea that manipulation would make the problem worse.
Actually nothing could be further from the truth. Manipulation is a very safe and effective treatment for disk ruptures. During our training, we were exposed to many different types of manipulation, ranging from the more manual styles appropriate for a football player or weight lifter, to gentler styles better suited for an osteoporotic patient. We also were taught styles of treatment specific for disk ruptures, as well as training to spot the rare cases that need surgery urgently. While we see the positive results in our individual practices, you no longer have to take our word for it — the research is starting to back up our claims.
To test the effectiveness of manipulation for disk ruptures, a Swedish study used 50 patients whose MRIs showed a disk rupture in the neck, along with signs of a pinched nerve. They were treated by chiropractors, three to five times a week for the first few weeks, then less often as they improved.
The researchers monitored how the patients progressed over three months. After only two weeks, 55 percent noticed improvement, and by three months 86 percent were improved. None were made worse by the treatment, other than temporary soreness. This is very similar to the results of an outcome study of low-back surgery, with 87 percent of the patients saying they would choose the surgery again.
Many patients assume manipulation for a disk injury would be risky. However, the research does not support this at all; in fact, manipulation carries far less risk than surgery, or even medications. One study reviewed multiple research papers over the last several decades, as well as insurance claims, looking for cases where there were serious side effects from manipulation given specifically for cases of disk rupture. Their conclusion was that the rate of serious side effects was about one in every 3.7 million treatments, which translates to 0.000027 percent.
This compares quite favorably to a complication rate for lumbar microdiscectomy (the least invasive form of disk surgery). In a paper published by the Mayo Clinic, they calculated a complication rate of 6 percent with a mortality rate of 0.06 percent, or six deaths for every 10,000 operations. Also, within a year, 6.1 percent of the patients needed a repeat surgery. The authors were thrilled with these numbers, and stated that the “risks of serious complications are extremely low” for this surgery.
Even anti-inflammatory drugs (aspirin, Celebrex, Aleve, ibuprofen) are quite a bit riskier than manipulation, with an estimated mortality rate of 0.015 percent from gastrointestinal bleeding alone.
You don’t have to be a math major to realize that manipulation, with a 0.000027 percent risk of serious side effects, basically a zero percent risk of fatality, and nearly identical outcomes, is a great alternative to surgery for ruptured disks. Of course, there are cases that only respond to surgery, and a few very rare cases where patients need it urgently. But experience has shown, and now the research agrees, that manipulation is a preferred first-line treatment for the condition.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.