Chiropractic Care and Lumbar Disc Issues: Evidence-Based Benefits

Lumbar disc issues, such as disc herniations and bulges, are common causes of back pain and radiculopathy. Chiropractic physicians are often on the front lines of conservative management for these conditions. Here, we explore the benefits of chiropractic care for disc issues, supported by evidence-based research.

Understanding Lumbar Disc Pathology

Disc herniations and bulges can compress nerve roots, leading to pain, numbness, or weakness in the lower extremities. However, not all disc lesions are symptomatic—studies show that asymptomatic disc bulges are present in up to 84% of individuals over 80 years old.

Evidence-Based Conservative Management

Research consistently demonstrates that most lumbar disc herniations improve with non-surgical care. Conservative management—including chiropractic care—focuses on centralizing symptoms, reducing pain and inflammation, decreasing mechanical compression, and improving core stability.

• Centralization as a Prognostic Indicator: Centralization, where pain moves from the leg to the back during specific movements, is a strong predictor of successful non-surgical outcomes. Patients whose symptoms centralize are six times less likely to require surgery compared to those whose symptoms do not centralize.
• Spinal Manipulation Therapy (SMT): SMT has shown early benefit and minimal risk when performed by trained chiropractic physicians. One prospective randomized clinical study found that SMT produced results equal to surgical decompression in 60% of lumbar disc herniation patients who had failed earlier medical management. Another study of 148 patients demonstrated significant and lasting improvement in all outcome measures, with no adverse events, when high-velocity, low-amplitude (HVLA) manipulation was applied to the level of the disc lesion.
• Comparative Effectiveness: A review of 90 randomized clinical trials for sciatica supports only a handful of interventions: disc surgery, epidural injections, non-opioid analgesia, acupuncture, and manipulation. Conservative chiropractic care is thus among the few evidence-supported options.

Adjunctive Therapies and Home Care

Chiropractic management often includes adjunctive therapies such as distraction manipulation, nerve flossing, myofascial release, therapeutic stretching, spinal traction, ultrasound, and laser. Home rehabilitation programs focus on mobility, core stabilization, and nerve mobilization exercises. There is also some evidence supporting short-term benefits from home inversion therapy for lumbar disc herniation.

Return to Function and Prognosis

Providers are encouraged to promote early return to function. Delayed return to work (beyond three months) is associated with a poor prognosis, with less than a 20% chance of returning to work after 12 months of disability.