“Doc! My leg is hurting me, but my back is ok. Can you help?” I hear this frequently in my practice. Many leg pain can actually be originated from the back with or without experiencing back pain. A proper examination will help to determine whether your leg pain is related to the back.
A recent study published in the Annals of Internal Medicine, September 2014, showed that patients with back-related leg pain (BRLP) experienced greater improvement with spinal manipulative therapy (SMT) plus home exercise and advice than home exercise and advice alone.
“Most patients with BRLP are treated with prescription medications and injections, although little to no evidence supports their use,” the authors write. “Surgical approaches are also commonly applied, although there is only some evidence for short-term effectiveness compared with less invasive treatments.” Clinicians are increasingly recommending SMT, exercise, and education.
The study compared 12 weeks and 52 weeks effects of SMT plus home exercise and advice with home exercise and advice alone in 192 patients with BRLP. Patients in the home exercise and advice group received 4 hour-long sessions of home exercise and advice — designed to help them manage existing pain, prevent pain recurrences, and increase their engagement in daily activities — over the course of 12 weeks. Patients in the SMT plus home exercise and advice group received the same intervention as well as up to 20 sessions of spinal manipulation therapy by a chiropractor.
|SMT plus home exercise and advice group||home exercise and advice alone|
|Reduction in leg pain at 12 weeks||37% of patients experience 75% reduction in leg pain||19% of patients|
|Complete Pain Relieve at 12 weeks||20% of patients||5% of patients|
|Medication at 12 weeks||44% reduction||37% reduction|
At 52 weeks, the SMT plus home exercise and advice group experienced more improvement than the home exercise and advice group in global improvement, satisfaction, and medication use only.
For patients with subacute and chronic BRLP, SMT in addition to home exercise and advice is a safe and effective treatment approach, resulting in better outcomes than home exercise and advice alone.