Chiropractic Management of Symptomatic Lumbar Disc Herniation: A Retrospective Case Series

Abstract

Background: Lumbar disc herniation is a common cause of low back pain and radiculopathy, significantly impacting quality of life. While conservative care is often recommended, data from specific clinical settings can provide valuable insights. Methods: This retrospective case series reviews the outcomes of seven adult patients diagnosed with lumbar disc herniation (ICD-10 M51.26) at a single private chiropractic practice (Pure Wellness Chiropractic - Middletown). Data including initial and final pain scores, treatment duration, and therapeutic protocols were extracted from patient records. Interventions were multi-modal, incorporating techniques such as spinal adjustments (Diversified, Thompson), flexion-distraction, spinal decompression, and soft tissue therapies. Results: The cohort of seven patients achieved a mean pain reduction of 92% (median 92%). Treatment durations ranged from 3 to 12 weeks. Patient-reported outcomes included the ability to resume activities of daily living, improved sleep, and cessation of reliance on pain medication. Conclusions: The findings from this small case series suggest that a multi-modal chiropractic approach may be effective for pain reduction in patients with symptomatic lumbar disc herniation. The significant improvements observed in this cohort highlight the potential benefits of this conservative care strategy, warranting further investigation through more rigorous controlled studies.

Methods

This study was a retrospective case series conducted by reviewing patient records at Pure Wellness Chiropractic - Middletown, a private practice in Middletown, DE. The objective was to document outcomes for patients with a diagnosis of lumbar disc herniation who underwent a course of chiropractic care.

Inclusion criteria for this series were: 1) a recorded diagnosis of lumbar disc herniation, such as ICD-10 M51.26 (Other intervertebral disc displacement, lumbar region); 2) completion of a full course of care at the clinic; and 3) documented pre-treatment and post-treatment pain scores, allowing for calculation of change. A total of seven patient files meeting these criteria were included in the analysis. Data were de-identified to protect patient privacy.

Information extracted from the clinical records included patient age range, gender, chief complaint, initial and final self-reported pain scores on a numeric rating scale, treatment timeframe, and the specific treatment protocols administered. The clinic's providers, including Dr. Eric Marks, Dr. Todd A. Richardson, and Dr. Ken Decker, utilize a multi-modal treatment approach. Interventions documented in the patient files included Diversified, Thompson, and Gonstead adjustments, Sacro Occipital Technique (SOT), Activator methods, extremity adjustments, myofascial release, Cox flexion-distraction, and spinal decompression therapy.

The primary outcome measure was the percentage of pain reduction, calculated from the initial and final pain scores reported by each patient. Functional improvement was noted qualitatively based on patient-reported narratives but was not measured with a standardized index.

Discussion

The results of this retrospective case series suggest that a multi-modal chiropractic care plan can be associated with substantial improvements in pain for patients with symptomatic lumbar disc herniation. The observed mean pain reduction of 92% in this cohort of seven patients is a clinically significant finding. This level of improvement enabled patients to resume activities of daily living, improve sleep quality, and reduce reliance on over-the-counter pain medication, as noted in their qualitative reports.

The therapeutic approach at Pure Wellness Chiropractic - Middletown is not monolithic; it combines various manual techniques tailored to the individual. The use of flexion-distraction and spinal decompression, both of which are non-surgical techniques designed to reduce intradiscal pressure and promote a more favorable environment for disc healing, was documented in several of the successful cases. These modalities, when combined with spinal adjustments to restore segmental motion and soft tissue therapies to address muscular guarding and trigger points, may create a synergistic effect that contributes to the positive outcomes observed.

While the natural history of lumbar disc herniation can involve spontaneous improvement, the rapid and significant pain reduction seen in these cases, often within three to six weeks, suggests the therapeutic intervention played a direct role. These outcomes align with the broader clinical goal of conservative management: to provide symptom relief and functional restoration while avoiding more invasive procedures. The findings from this Middletown, DE practice provide real-world evidence that supports the use of chiropractic care as a viable option for patients suffering from this condition. However, due to the study's design, these results must be interpreted with caution. They do not prove causality but rather highlight a strong association that merits further, more rigorous scientific investigation.

Limitations

This study has several important limitations inherent to its design. As a retrospective case series, it lacks a control group, making it impossible to determine if the observed improvements were due to the interventions, the natural history of the condition, a placebo effect, or regression to the mean. The data were collected from existing clinical records, which were not designed for research purposes, potentially leading to incomplete or inconsistent documentation. The reliance on self-reported pain scores is a subjective measure, and the study did not include objective functional outcome measures like range of motion metrics or standardized disability questionnaires. Furthermore, the study was conducted at a single clinic, and the results may not be generalizable to other chiropractic practices with different providers, patient populations, or treatment philosophies. There is also a potential for selection bias, as the series only includes patients who completed their care plan, possibly excluding those who discontinued care due to a lack of perceived improvement.