How often should a Patient be treated with manipulation?

We do not know the answer but early evidence from a small study suggests that high-frequency care initially may have some short-term benefit.

Patients were randomly allocated to visits (1, 2, 3 or 4 visits/week for 3 weeks) and to treatment regimen (spinal manipulation only or spinal manipulation with PM). All patients received high-velocity low-amplitude spinal manipulation. Half received one or two of the following PM at each visit: soft tissue therapy, hot packs, electrotherapy or ultrasound. Pain intensity: At 4 weeks, there was a substantial linear effect of visits favoring a larger number of visits: 5.7 points per 3 visits (SE=2.3, p=.014). At 4 weeks, a visits effect was noted (p=.018); the slope for group means was approximately 5 points per 3 visits. There were no group differences at 12 weeks. CONCLUSIONS: There was a positive, clinically important effect of the number of chiropractic treatments for chronic low back pain on pain intensity and disability at 4 weeks. Relief was substantial for patients receiving care 3 to 4 times per week for 3 weeks.

A similar study was performed with patients diagnosed with cervicogenic headache demonstrating similar results.

Haas, M, Groupp, E, Kraemer, D. F. Dose-response for chiropractic care of chronic low back pain. Spine J 2004;4:574-583.

Disc Herniation and Radiculopathy

After recently attending a workshop on lumbar radiculopathy by Dr. Mir Ali, M.D., of OAD orthopedics, spinal surgery, I was reminded just how many different treatment options there are to this complex problem. Here is an overview of Disc Herniation and its symptoms.


The disc can be viewed a lot like a jelly donut. It is somewhat circular with an outer area and a center or core (nucleus). When the core bulges into the outer layer it is a bulging disc and can press on sensitive nerve structures. When it breaks into the outer layer (like the dough but with the consistency of crab meat) it is a herniation. Sometimes it breaks totally out of the disc and becomes a free fragment which can be a serious condition causing loss of bowel or bladder function or numbness in the groin (cauda equina syndrome)-usually a surgical emergency.


What Causes a Herniated Disc? The causes are many. Basically, weakness in the outer layer of the discs or the inability of the disc to handle the pressure load of the nucleus causes the fibers to rupture allowing the nuclear material to escape its containment. Lifting improperly, traumatic injuries, coughing, sneezing, and straining activities have all resulted in disc herniations.

What are the Symptoms of a Herniated Disc?

•Pain: pain can be severe in the back and leg(s). If the pain is immediately more severe in the leg, we are concerned about a free fragment (sequestered disc). Pain is usually worse with sitting.
•Radiating sciatic pain (radiculopathy).
•Muscle weakness
•Numbness and Tingling
How are disc injuries diagnosed? An orthopedic and neurological and x-ray examination normally needs to be performed to determine other possible sources (piriformis syndrome, osteoarthritic spurring, etc.). A MRI may be necessary to establish the location and severity of the herniation.

What are my Treatment Options?

•In less severe cases, conservative management works effectively including: spinal manipulation (chiropractic), physical medicine modalities for pain control (interferential current, ice, laser, Massage Therapy), acupuncture, rehabilitation exercises, medications.
•More severe cases may require epidural steroid injections, surgical excision of the herniation, disc replacement or fusion.
•Cauda equina symptoms generally require emergency surgery.

Many other conditions may mimic a disc herniation and are effectively treated non-surgically.

In any case a through evaluation is needed by a competent healthcare professional. If you or anyone you know suffers from disc herniation please call 630-474-9500.

-Dr. Blake Schaffnit , D.C.