Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 9 , Pages 723-733 , November 2009

A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up

  • Donald R. Murphy, DC

      Affiliations

    • Clinical Director, Rhode Island Spine Center, Pawtucket, RI
    • Clinical Assistant Professor, Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI
    • Adjunct Associate Professor, Department of Research, New York Chiropractic College, Seneca Falls, NY
    • Corresponding Author InformationSubmit requests for reprints to: Donald R. Murphy, DC, Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860
    • ,
  • Eric L. Hurwitz, DC, PhD

      Affiliations

    • Associate Professor of Epidemiology, Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Mānoa, Hawaii
    • ,
  • Ericka E. McGovern, DC

      Affiliations

    • Staff Chiropractic Physician, Rhode Island Spine Center, Pawtucket, RI

Received 18 April 2009 ,Revised 15 July 2009 ,Accepted 27 July 2009.

References 

  1. Hurwitz EL, Shekelle P. Epidemiology of low back syndromes. In:  Morris CE editors. Low back syndromes: integrated clinical management. New York: McGraw-Hill; 2006;p. 83–118
  2. Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988;318:291–300
  3. Memmo PA, Nadler S, Malanga G. Lumbar disc herniations: a review of surgical and non-surgical indications and outcomes. J Back Musculoskel Rehabil. 2000;14:79–88
  4. Skogsbergh DR, Kowalski MH. The intervertebral disc and its syndromes. In:  Morris CE editors. Low back syndromes: integrated clinical management. New York: McGraw-Hill; 2006;p. 149–184
  5. Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskelet Disord. 2007;8:75
  6. Murphy DR, Hurwitz EL, Nelson CF. A diagnosis-based clinical decision rule for patients with spinal pain. Part 2: Review of the literature. Chiropr Osteopath. 2008;16:8
  7. Murphy DR, Hurwitz EL, Gregory AA, Clary R. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther. 2006;29:279–287
  8. Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord. 2006;7:16
  9. Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy related lumbopelvic pain treated according to a diagnosis-based clinical decision rule: a prospective observational cohort study. J Manipulative Physiol Ther. 2009;32;[in press]
  10. Murphy DR, Rosenblum A. Return to work after two years of total disability: a case report. J Occup Rehab. 2006;16:253–260
  11. Shacklock M. Clinical neurodynamics. A new system of musculoskeletal treatment. Edinburgh: Elsevier; 2005;
  12. Swensen RS. Neurologic examination. In:  Haldeman S editors. 3rd ed.. Principles and practice of chiropractic. New York: McGraw-Hill; 2005;p. 537–560
  13. Lawrence DJ, Meeker W, Branson R, Bronfort G, Cates JR, Haas M, et al. Chiropractic management of low back pain and low back–related leg complaints: a literature synthesis. J Manipulative Physiol Ther. 2008;31:659–674
  14. Gudavalli MR, Cox JM, Cramer GD, Baker JA, Patwardhan AG. Intervertebral disc pressure changes during low back treatment procedures. In: BED—Advances in Bioengineering. 1998;p. 39
  15. Gudavalli MR, Cox JM, Cramer GD, Baker JA, Patwardhan AG. Intervertebral disc pressure changes during a chiropractic procedure. In: BED—Advances in Bioengineering. 36:1997;p. 215–216
  16. Gudavalli M, Cambron J, McGregor M, Jedlicka J, Keenum M, Ghanayem A, et al. A randomized clinical trail and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine. 2005;15:1070–1082
  17. Butler DS. The sensitive nervous system. Adelaide, Australia: Noigroup Publications; 2000;
  18. McKenzie RA, May S. The lumbar spine: mechanical diagnosis and therapy. 2nd ed.. Waikenae, NZ: Spinal Publications; 2003;
  19. Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10:207–218
  20. Laslett M, McDonald B, Aprill CN, Tropp H, Oberg B. Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules. Spine J. 2006;6:370–379
  21. Stern PJ, Cote P, Cassidy JD. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. J Manipulative Physiol Ther. 1995;18:335–342
  22. Chaitow L, Liebenson C. Muscle energy techniques. 2nd ed.. Churchill Livingstone: Edinburgh; 2001;
  23. Simons DG, Travell JG, Simons LS. Myofascial pain and dysfunction: the trigger point manual. Volume 1. Baltimore: Williams and Wilkens; 1999;
  24. Murphy DR, Morris CE. Lumbopelvic sensorimotor training and functional stabilization. In:  Morris CE editors. Low back syndromes: integrated clinical management. New York: McGraw-Hill; 2006;p. 741–780
  25. Staal JB, Hlobil H, Twisk JWR, Smid T, Koke AJA, van Mechelen W. Graded activity for low back pain in occupational health care. Ann Int Med. 2004;140:77–84
  26. Klaber Moffett JA, Carr J, Howarth E. High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine. 2004;29:1167–1172
  27. Bolton JE, Breen AC. The Bournemouth Questionnaire. A short-form comprehensive outcome measure. I. Psychometric properties in back pain patients. J Manipulative Physiol Ther. 1999;22:503–510
  28. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158
  29. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulative Physiol Ther. 2004;27:26–35
  30. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–168
  31. Vroomen PCAJ, de Krom CTFM, Knottnerus JA. Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement. Spine. 2000;25:91–97
  32. Hunt DG, Zuberbier OA, Kozlowski AJ, et al. Reliability of the lumbar flexion, lumbar extension, and passive straight leg raise test in normal populations embedded within a complete physical examination. Spine. 2001;26:2714–2718
  33. McCombe PF, Fairbank JCT, Cockersole BC, Pynsent PB. Reproducibility of physical signs in low-back pain. Spine. 1989;14:908–918
  34. Lurie J. What diagnostic tests are useful for low back pain?. Best Pract Res Clin Rheumatol. 2005;19:557–575
  35. Rebain R, Baxter GD, McDonough S. A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000). Spine. 2002;27:E388–E395
  36. Perle SM, Kawchuk GN, Perrault T, Adams W. Radiographically determined anatomical location of point of peak pressure during pisiform and hypothenar contact manipulation procedures. In: Proceedings of the International Conference on Spinal Manipulation Oct 5-6. Toronto: Foundation for Chiropractic Education and Research; 2002;p. 20
  37. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J. 2003;3:460–465
  38. Laslett M, Young SB, Aprill CN, McDonald B. Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aus J Physiother. 2003;49:89–97
  39. Richardson C, Jull G, Hodges P, Hides J. Therapeutic exercise for spinal segmental stabilization in low back pain. Scientific basis and clinical approach. Edinburgh: Churchill Livingstone; 1999;
  40. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296:2441–2450
  41. Wilson-MacDonald J, Burt G, Griffin D, Glynn C. Epidural steroid injection for nerve root compression has short term but no long term effect: a randomised controlled trial. Spine J. 2004;4:20S
  42. Kopp JR, Alexander AH, Turocy RH, Levrini MG, Lichtman DM. The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus. A preliminary report. Clin Orthop Relat Res. 1986;211–218
  43. Alexander AH, Jones AM, Rosenbaum DH. Nonoperative management of herniated nucleus pulposus patient selection by the extension sign. Orthop Rev. 1992;21:181–188
  44. Werneke M, Hart DL. Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine. 2001;26:758–764
  45. Werneke MW, Hart DL. Centralization: association between repeated end-range pain responses and behavioral signs in patients with acute non-specific low back pain. J Rehabil Med. 2005;37:286–290
  46. Werneke M, Hart DL, Cook D. A descriptive study of the centralization phenomenon a prospective analysis. Spine. 1999;24(7):676–683
  47. Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000;9:202–207
  48. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131–137
  49. Murphy D, Byfield D, McCarthy P, Humphreys K, Gregory A, Rochon R. Interexaminer reliability of the hip extension test for suspected impaired motor control of the lumbar spine. J Manipulative Physiol Ther. 2006;29:374–377
  50. Hicks GE, Fritz JM, Delitto A, Mishock J. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84:1858–1864
  51. Mens JMA, Vleeming A, Snijders CJ, Koes BJ, Stam HJ. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine. 2001;26:1167–1171
  52. McGill S. Low back disorders. Evidence-based prevention and rehabilitation. Champaign, IL: Human Kinetics; 2002;
  53. Rackwitz B, de Bie R, Limm H, von Garnier K, Ewert T, Stucki G. Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehab. 2006;20:553–567
  54. Bakhtiary AH, Safavi-Farokhi Z, Rezasoltani A. Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. J Back Musculoskel Rehab. 2005;18:55–60
  55. Hlobil H, Staal JB, Twisk J, Koke A, Ariens G, Smid T, et al. The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12-month results of a randomized controlled trial. J Occup Rehabil. 2005;15:569–580
  56. Lindstrom I, Ohlund C, Eek C, et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992;72:279–290[discussion 91-3]
  57. DeLeo JA, Winkelstein BA. Physiology of chronic spinal pain syndromes from animal models to biomechanics. Spine. 2002;27:2526–2537
  58. Smeets R, Vlaeyen J, Kester A, Knottnerus J. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7:261–271
  59. Schonstein E, Kenny D, Keating J, Koes B, Herbert RD. Physical conditioning programs for workers with back and neck pain a Cochrane systematic review. Spine. 2003;28:E391–E395
  60. Kaapa EH, Frantsi K, Sarna S, Malmivaara A. Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine. 2006;31:371–376
  61. Asenlof P, Denison E, Lindberg P. Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain. J Pain. 2005;6:588–603
  62. Senstad O, Leboeuf-Yde C, Borchgrevink C. Frequency and characteristics of side effects of spinal manipulative therapy. Spine. 1997;22:435–441
  63. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA neck pain study. J Manipulative Physiol Ther. 2004;27:16–25
  64. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM. Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study. Spine. 2005;30:1477–1484
  65. Carey TS, Boden SD. A critical guide to case series reports. Spine. 2003;28:1631–1634

PII: S0161-4754(09)00271-1

doi: 10.1016/j.jmpt.2009.10.007

Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 9 , Pages 723-733 , November 2009

Article Tools

* Image Usage & Resolution