Back Pain

• An Engineering Masterpiece
Your hips are a masterpiece of engineering. You sit on them, need them to walk (your legs connect to them) and they provide an attachment for dozens of muscles and ligaments.
But like any precision instrument, if they’re not fitting just right, all kinds of problems could arise. Does one leg appear shorter than the other? Do you have leg, knee, buttock, hip or low back weakness or pain? Do your joints “click” when you walk? Do your feet flare out or in? If you answered yes, it’s time to get a chiropractic checkup.

• Subluxations Can Be Corrected By Your Chiropractor
Subluxations are a distortion, jamming or locking of your structural system that irritates, pulls or compresses (“pinches”) your nerves; unbalances your posture; weakens your discs; stretches your ligaments, tendons and muscles and can upset your general health. As terrible as all this sounds, many times subluxations are often initially painless. You may have one right now and not know it.

• Hip Joints
A joint is where two bones meet and your hips have a few of them. One of them is a ball-and-socket joint where the head (“ball”) of the thighbone meets the acetabulum (“socket”) of the hip. Another is the sacroiliac (SI) joint, formed where the sacrum and the ilium meet. And another is the symphysis pubis, where the pubic bones meet in the front (they separate a little during childbirth so the pelvic cavity can enlarge).

• The Hips & Pelvis
When you were born you had many more bones—in fact each of your hip bones was originally three separate bones: the ileum, ischium and pubis. They fused at about puberty. Behind your hipbones are your sacrum and coccyx; in front they form your pubic bones. Together all these bones make up your pelvis. A woman’s pelvis is wider than a man’s and is more curved—for delivering babies.

• Lower Back, Thigh & Buttock Pain
“Dysfunction in the hip joint may be a primary factor in the development of … lower back pain” says one report.3 Studies have implicated an unbalanced hip in most adults with low back pain.1-2 Another states: “On confronting a patient in severe pain of sciatic [leg pain] … the first thought should be “sacroiliac” not “disc” … [with] manipulation … surgical treatment is forgotten.”4

• Pelvic Organs & Your Hips
The nerves from the spinal column in the lower back and hips connect to the bladder, kidneys, prostate, vagina and pelvic organs, uterus and lower intestines. It is very important to ensure that the nerves to these organs are free of any irritation, compression or stress.5

When your hips are uneven, your legs become uneven; one appears longer than the other. More pressure is placed on the long leg when you walk: the knee, hip, ankle and foot on that side of your body may show pain and pressure. This is most noticeable when you lie down and is often used
as a chiropractic test.

In fact, for over a century chiropractors have noticed the intimate relationship between spinal health and hip, sacroiliac and leg problems.6-7

• Hip Problems In Children
Since childhood is a very physical time full of falls, accidents, cuts, scrapes and occasional serious injuries, children should have their spines checked regularly, including their hips, their leg lengths and their SI or sacroiliac joints by a doctor of chiropractic to ensure they are free of subluxations. Chiropractors and body workers have often observed that a stressful birth can damage a child’s spine and structural system and can cause problems in adult life if not corrected.11-15

• Pregnancy
Pregnant women make hormones to relax their joints for easier delivery of the baby. However, if their spines are not healthy, instability of the hip (and other) joints may be revealed and may make what should be a joyous time one of pain. Chiropractic care is particularly helpful during and after pregnancy. Chiropractors have noticed that a properly aligned SI joint, hip and spine helps ensure a more comfortable pregnancy and a safer and easier delivery and post-partum recovery.8-10

• Conclusion
Chiropractic checkups should be part of your family’s healthcare regime. This is especially important for children since sacroiliac and lower back problems may have their origins in childhood.

Pregnant women should definitely have a chiropractic exam since the stress of pregnancy and trauma of childbirth affect the hips and entire spinal column.

Why wait for a problem to arise? See your chiropractor for a checkup now.

References

1. Jackson RP, Kanemura T, Kawakami N et al. Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine. 2000;25(5):575-586.
2. Bourne IHJ. Back pain—what can we offer? British Medical Journal. 1979;I:1085.
3. Faye LJ, Hooper PD. The hips as an overlooked cause of low back pain: a case report. Chiropractic Technique. 1994;6(1):9-13.
4. Bourdillon J, Day E. Spinal Manipulation (4th Edition). Norwalk, CT/Los Altos, CA: Appleton and Lange, 1987;228-230.
5. Browning JE. Distractive manipulation protocols in treating the mechanically induced pelvic pain and organic dysfunction patient. Chiropractic Technique. 1995;7(1):1-11.
6. Rose KA, Kim WS. The effect of chiropractic care for a 30-year-old male with advanced ankylosing spondylitis: a time series case report. JMPT. 2003;26(8):524-532.
7. Cassidy JD, Kirkady-Willis WH, McGregor M. Spinal manipulation for the treatment of chronic low back and leg pain: an observational study. In AA Buerger & PE Greenman (Eds.), Empirical Approaches to the Validation of Spinal Manipulation. Springfield, IL: Charles C. Thomas, 1985.
8. Berg G et al. Low back pain during pregnancy. Obstetrics Gynecology. 1988;71:71-75.
9. Wentling P. More on OMT in obstetric care. Journal of the AOA. 1975;74.
10. Adams JP. Chiropractic and nutritional management and its effect on the fertility of a diabetic amenorrheal patient: a case report bio. JVSR. October 12, 2003:1-2.
11. Mierau DR, Cassidy JD et al. Sacroiliac joint dysfunction and low back pain in school aged children. JMPT. 1984;7(2):81-84.
12. Lewit K. Functional disorders (fixations) of the spine in children. Manuelle Therapie. 1973:50-54.
13. Biedermann HJ. Kinematic imbalances due to suboccipital strain in newborns. Manual Medicine. 1992;6:151-156.
14. Stone-McCoy PA, Grande NA, Roy I. Reduction of congenital torticollis in a four month old child with vertebral subluxation: a case report & review of literature. JVSR. January 7, 2008:1-8.
15. Anderson C. The consequences of birth trauma. A case report of failure to thrive in an infant with cephalohematoma and congenital torticollis.
The Chiropractor’s Choice. June 2004:15.

© 2014 Tedd Koren, D.C. & Koren Publications Inc. All rights reserved. • 1-800-537-3001 • www.korenpublications.com • KGN

• What Does Your Chiropractor Do?
Once your chiropractor frees you of subluxations, your body and mind function better.
Your chiropractor is specially trained to locate and free your body from a severe abnormality that interferes with your proper function called a subluxation. A slight misalignment or distortion of your structural system, including your spine, that affects your discs, nerves, ligaments and ultimately, your entire body.
• Low Back Pain
Low back pain is very, very common. About 85 percent of the population will experience disabling low back pain at least once during their lives! That’s almost all of us. The problem is so bad that, according to one researcher, at any given time 6.8% of the US adult population is suffering from an episode of back pain lasting more than two weeks.1
That’s a lot of bad backs. The estimated cost of this problem in the US is over $100 billion a year.2

• More Than Low Back Pain
When you hear the word chiropractic do you think of care for back and neck complaints? Many people do and yet the world’s first chiropractic patient (1895) was deaf and recovered his hearing after a chiropractic adjustment. The second chiropractic patient was relieved of a heart condition. Thousands soon praised chiropractic for saving them from headaches, colds, allergies, asthma, sciatica, arthritis, seizures, ear infections, stomach trouble, gynecological problems and many other conditions including back pain.

• Surgery And Medical Treatments
Standard medical approach to back pain varies depending on the severity of the condition. Muscle relaxants, painkillers, rest and physical therapy such as traction, diathermy, ultrasound, hot packs and cold packs are sometimes used. These approaches are often found wanting however.3 Even bed rest has been found ineffective for a serious form of back and leg pain called sciatica.4

If the problem doesn’t improve or worsens then surgery may be recommended.
The medical approach is at times necessary—even back surgery has a place. However, research is revealing that spinal surgery for acute lower back problems should rarely be performed.5

The most complex (and expensive) back surgeries are increasing and much of it is unnecessary. 6 “The most complex type of back surgery has increased dramatically between 2002 and 2007, with a 15-fold increase,” says co-author Richard Deyo, MD, MPH. In 2002, the rate of complex surgery was 1.4 per 100,000 people in Medicare. It jumped to 19.9 per 100,000 just five years later. 7

• Failed Back Surgery Syndrome
Many of those who have had back surgery report a recurrence of their symptoms within a year or two of the operation and may return to the operating table. This has been referred to as failed back surgery syndrome. It causes severe and constant pain. Of the nearly 300,000 back surgeries performed each year, 20 to 40% fail.8
For example, Lynn Johnson, MD, of the American Academy of Pain Medicine states: “Just about any approach is better than having surgery because all the studies have shown that, if you take a surgical population and non-surgical population, they all seem to do the same in five years.” He supports conservative measures such as chiropractic before suggesting surgery.10
Studies reveal that spinal surgery is no better than less invasive care; “Outcomes after five years are similar when surgical and non-surgical approaches are compared….”9

• The Chiropractic Approach
Research studies repeatedly reveal that chiropractic helps those with lower back pain to recover faster and at less cost.11-13
Chiropractors have helped millions of people with low back problems, often saving them from pain, disability, drugs and surgery. The chiropractor’s purpose is to gently and painlessly rebalance and realign your spine and structural system to relieve pressure on your nerves, discs and muscles.

Major government studies from the US, UK, Canada and New Zealand have reaffirmed what chiropractic patients have been telling their friends with back pain for years: “Why don’t you see my chiropractor? You’ll get better much faster than from drugs or surgery—and it’s safer too.” Studies repeatedly reveal that chiropractic care is more effective than other approaches for low back pain.

In one study of 700,000 people whose health insurance plan covered chiropractic care, it was estimated that $16 million was saved as a result of using chiropractic.14

As one study concluded: “Chiropractic was particularly effective in those with fairly intractable pain—that is, those with a history of severe pain…. The percentage of chiropractic patients who were ‘very satisfied’ with the care they received for low back pain was triple that for patients of family physicians.”15

Why are the results so overwhelmingly in favor of chiropractic? Because painkillers, muscle relaxants, Valium™, braces, physical therapy and surgery are not designed to correct subluxations. Chiropractic is!

• In Conclusion
For over a hundred years people with all kinds of health conditions have visited their doctors of chiropractic. Many have initially come for back pain, but then discovered so many other ways chiropractic care can help them and their family.

The goal of chiropractic is to free your body from subluxations, permitting realignment of your entire structural system and releasing stress on your nervous system so your entire body may function at its optimum.

References

1. Deyo RA. Description epidemiology of lower-back pain and its related medical care in the United States. Spine. 1987;12(3):264-268.
2. Legorreta AP, Metz RD, Nelson CD. Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine. 2004;164:1985-1992.
3. Acute low back problems in adults. Clinical Practice Guideline No. 14. U.S. Dept. of Health and Human Services. Public Health Service. Agency for Health Care Policy and Research, Rockville, Maryland, Dec. 1994.
4. Patrick CAJ, Vroomen MD, Marc CTFM et al. Lack of effectiveness of bed rest for sciatica. The New England Journal of Medicine. 1999;340:418-423.
5. Acute low back problems in adults. Clinical Practice Guideline No. 14. U.S. Dept. of Health and Human Services. Public Health Service. Agency for Health Care Policy and Research, Rockville, Maryland, Dec. 1994.
6. Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg. Neurol Int. 2011;2:83.
7. Deyo RA, Mirza SK, Martin BJ et al. Trends, major medical complications and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303:1259-1265.
8. Manca A, Kumar K, Taylor RS et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). Eur J Pain. 2008;12(8):1047-1058.
9. McCulloch JA. Focus issue on lumbar disc herniation: macro- and microdiscectomy [Review]. Spine. 1996;21(24 Suppl):45S-56S.
10. Hilton L. Failed back syndrome: the disturbing statistics: presented at
DG DISPATCH – AAPM. Doctor’s Guide News. February 20, 2001.
11. Wilkey A, Gregory M, Byfield D, McCarthy PW. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Alternative and Complementary Medicine. 2008;14(5):465–473.
12. Chou R, Qaseem A, Snow V. Diagnosis and treatment of low back pain. Annals of Internal Medicine. 2007;147(7):478–491.
13. Haas M, Sharma R, Stano M. Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain. JMPT. 2005;28(8):
555-563.
14. Legorreta AP, Metz RD, Nelson CF et al. Comparative analysis of individuals with and without chiropractic coverage. Patient characteristics, utilization, and costs. Archives of Internal Medicine. 2004;164:1985-1992.
15. Meade TW, Dyer S et al. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. British Medical Journal. 1990;300:431-437.

© 2014 Tedd Koren, D.C. & Koren Publications Inc. All rights reserved. • 1-800-537-3001 • www.korenpublications.com • KGN

What happens when your spine and structural system begin to degenerate? The bones in your spine begin to change shape; your discs swell, then shrink; your ligaments, tendons and muscles begin to tighten and weaken; and your entire structural system—spinal column, hips, shoulder girdle—loses its balance, flexibility, stability and strength. In addition to bone degeneration, your body chemistry, nerves and internal organs can also be affected. In time you are less able to adapt to the pressures of life; you lose the spring in your step and your youthful energy; you lose height and appear to shrink.

• What Causes Spinal Degeneration?
Spinal degeneration is usually caused by years of long-standing subluxations in your spine and structural system. What are subluxations?

• Subluxations
Stress may cause your spinal bones or vertebrae to shift from their proper places. Your vertebrae misalign and irritate the surrounding nerves, bones, discs, ligaments and other soft tissue causing them to age and deteriorate. This may cause a lot of pain but in some people may be painless. Subluxations also result in fixations or loss of mobility of a joint. This has been shown to be a major factor in degeneration.1 In addition, trauma (accidents, injuries) can result in degeneration of a joint.2

• Loss Of Height
Many people believe they lose height because they are getting “old.” Does that mean that at age 65 you wake up and find yourself shorter? Of course not. The loss of height is silent, slow and gradual, and may begin in your 20’s and 30’s! It is one of the signs of spine and disc degeneration.

• Spinal Decay
By the time a person notices any problem or feels any pain the degeneration has been going on for many years! In many people spinal degeneration is like tooth decay in that it is often a painless process.

• The Phases of Degeneration
Your spine degenerates in stages or phases:3

• Degeneration Phase 14
This phase is often seen up to age 20. Your spine loses its normal balance and its normal curves. Your nerves may be affected and the vital life energy that flows over them is affected. In addition your joints, discs, nerves and posture are stressed and age more quickly. Surprisingly, there may be no pain other than occasional minor discomfort. A slight lessening of energy and slight height loss may occur. Response to spinal care is generally good.5

• Degeneration Phase 26-7
Often seen in those ages 20 to 40. In this phase, there is evidence of spinal decay, disc narrowing and bone spurs (deformations); postural changes are much worse. This condition is very common—by age 40, 80% of males and 76% of females exhibit moderate disc degeneration.8 Spinal canal narrowing or stenosis may occur. This phase is characterized by more common aches and pains, fatigue and a diminished ability to cope with stress. Height continues to decrease. With chiropractic care, significant improvement is possible.

• Degeneration Phase 3
Often seen in people ages 40 to 65.9 Here there are more postural imbalances, increased nerve damage, permanent spinal scar tissue and advanced bone deformation. Physical and/or mental weakness or disability begin. Loss of height and loss of energy continue. With chiropractic care, much reversal is possible.

• Degeneration Phase 4
Often seen in those ages 65 and older. Now postural imbalance is severe and motion is limited. There is severe nerve damage and scar tissue and bones may begin to fuse. In this phase we find pain, various degrees of physical or mental disability and continued loss of energy and height. Chiropractic may still help in this phase, giving new life to old bones, offering symptomatic relief and some limited correction as well.10

• The Chiropractic Approach
It is better to wear out than to rust out.
—Richard Cumberland

Must you passively allow your spine to degenerate? No! Chiropractic can reduce, halt and even reverse spinal degeneration by improving spinal balance and posture and keeping your joints, nerves and discs healthy and strong throughout your lifetime.11-12

As one researcher writes:

The restoration of motion to a previously [fixated] joint leads to a restoration of normal joint function
and physiology.13

Further, there is increasing evidence that some spinal degeneration may be reversible.14 As another researcher has noted:

Correction of a vertebral subluxation can not only attenuate and arrest this degenerative process, but
can actually allow the condition to reverse itself.15

• Prevention
Of course, the best approach to spinal degeneration is to prevent it from occurring in the first place!

The earlier the degeneration process is identified … the better chance the patient has for its arrest and reversal.16

This means bringing your children in for periodic checkups to keep them free of subluxations. Of course, anytime someone experiences a fall, accident or other extreme stress they should have their body checked by a chiropractor to make sure that they are subluxation-free.

Stress, including emotional stress, job stress, school stress, family stress and environmental stress, takes its toll on us. For that reason you should have yourself checked periodically for subluxations that slowly and steadily drain your life of energy, strength and wholeness. See your chiropractor regularly to keep yourself free from subluxations and free from degeneration.

References

1. Cramer GD, Fournier JT, Wolcott CC, Henderson CNR. Degenerative changes following spinal fixation in a small animal model. JMPT. 2004;27(3):141-154.
2. Gelber AC, Hochberg MC, Mead LA et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine. 2000;133(5):321-328.
3. Kirkady-Willis W. Managing Low Back Pain. New York: Churchill-Livingstone. 1988;49-54:117-128.
4. Gottlieb M. Neglected spinal cord, brain stem and musculoskeletal
injuries stemming from birth trauma. JMPT. 1993;16(8):537-543.
5. Gunn CC. ‘Prespondlyosis’ and some pain syndromes following denervation supersensitivity. Spine. 1980;5(2).
6. Miller J, Schmatz B & Schultz A. Lumbar disc degeneration: correlation with age, sex and spine level in 600 autopsy specimens. Spine. 1988;13:173.
7. Ressel O, Rudy R. Biovertebral subluxation correlated with somatic, visceral and immune complaints: an analysis of 650 children under chiropractic care. JVSR. October 18 2004;1-23.
8. Sato A. The reflex effects of spinal somatic nerve stimulation on visceral function. JMPT. 1992;15(1):57-61.
9. Tachihara H et al. Does facet joint inflammation induce radiculopathy? An investigation using a rat model of lumbar facet joint inflammation.
Spine. 2007;32(4):406-412.
10. Flesia J. Renaissance: A psychoepistemological basis for the new renaissance intellectual. Colorado Springs, CO: Renaissance International, 1982.
11. Dishman RW. Review of the literature supporting a scientific basis for the chiropractic subluxation complex. JMPT. 1985;8:163-174.
12. Brantingham J, Snyder WR, Biedebach D. Spinal manipulation may help reduce spinal degenerative joint disease and disability. Dynamic Chiropractic. April 22, 1994.
13. Lantz CA. The vertebral subluxation complex. International Review of Chiropractic. September/October 1989;39.
14. Bland JH. The reversibility of osteoarthritis. Am J Med. 1983;75:16-26.
15. Ressel OJ. Disc regeneration: reversibility is possible in spinal osteoarthritis. ICA Review. 1989;45(2):39-61.
16. Ibid.

© 2014 Tedd Koren, D.C. & Koren Publications Inc. All rights reserved. • 1-800-537-3001 • www.korenpublications.com • KGN

• What Is Sciatica?
Sciatic pain may follow the path of your nerve—down the back of your legs and thighs, down to your ankle, foot and toes—but it can also radiate to your back!
When the large sciatic nerve becomes inflamed the condition is called sciatica (pronounced si’ad-a’ka) and the pain can be intense!
Along with pain there may be burning, pins and needles, tingling, prickling, crawling sensations or tenderness. Ironically, the leg may also feel numb!

To complicate matters, although sciatica pain is usually in the back of the legs or thighs, in some people it can be in the front or side of the legs or even in the hips. For some, the pain is in both legs: bilateral sciatica!

• Causes Of Sciatica
Like most other conditions, sciatica has a wide variety of causes. An unhealthy spine with a protruded or ruptured disc which can irritate the sciatic nerve is one cause. Sciatica has been reported following accidents, injuries and even childbirth, usually due to spinal misalignment.2 However, advanced diabetes can also cause sciatic nerve irritation, as can arthritis, constipation, tumors and even vitamin deficiencies.

• Sciatic Nerve
Your sciatic nerve is the longest and largest nerve in your body. It begins in your lower back as five smaller nerves joining together and extends to your pelvis, thigh, knee, calf, ankle, foot and toes.

• Like A Knife
For sciatica sufferers, a good night’s sleep may be a thing of the past. Simple things like walking, bending, turning, sitting or standing up can be difficult or
impossible. Those with low back pain and sciatica show the highest level of disability of all back pain patients.1
The quality of the pain may vary. There may be constant throbbing but then it may let up for hours or even days, it may ache or be knife-like. Sometimes postural changes, like lying down or changing positions, affect the pain and sometimes they don’t. In severe cases, sciatica can cause a loss of reflexes or even a wasting of calf muscles.

• The Medical Approach
The medical approach to sciatica is usually to treat its symptoms with painkillers, muscle relaxers and orthopedic devices such as traction and physical therapy. Sciatica is particularly frustrating to treat with drugs because in many cases even strong painkillers bring little or no relief. Patients with sciatica are significantly more likely to be prescribed opioids for their condition.3

For years medical doctors have prescribed bed rest for sciatica, yet there is little objective data to show it works. In fact there is increasing evidence that it is ineffective for low back pain as well as sciatica.4

However, relief may be obtained by injecting painkillers directly into the nerve roots! As with all painkillers, there is always a risk of drug dependency. In extreme cases orthopedic surgery may be performed.

• The Chiropractic Approach
Many sciatica sufferers have experienced dramatic relief after chiropractic care.5-6 Many sufferers of sciatica and leg pain have found that chiropractic was superior to traction and pain injections, often saving them from spinal surgery.7-9

An interesting study of 44 workers with sciatic pain so severe they were hospitalized was performed in Norway. The hospital chiropractor performed adjustments and 91% returned to work full-time within an average of 21.1 days (others returned at reduced work levels). The average patient with sciatica is disabled for 72 days; in this study, the time to return to work was just 21 days—a 70% reduction.10

In another study 20 patients aged 20-65 with low back-related leg pain were divided into three groups that were given medical care, chiropractic care or steroid injections. After 12 weeks the medical and steroid injection groups showed no advantage over the safer, non-drug improvements the chiropractic patients experienced.12

In another study, 3,136 people with lower back and sciatica pain who had previously had physiotherapy and drugs with no positive results were given chiropractic care.

A follow-up two years later showed that 50.4% had excellent results with no painful relapses, 34.4% had relapses but then responded favorably after further chiropractic care and 15.2% showed no significant improvement.13

In a controlled study four different approaches (spinal care, traction and two types of injections) were used to deal with low back pain and sciatica. The group that had spinal care experienced the greatest degrees of recovery. Interestingly, a large number in the traction group eventually required surgery.11

Chiropractic care appears to have the most effect on sciatica when used first. Unfortunately many people seek medical care first. Even so excellent results may be obtained with subsequent chiropractic care.

• Neurogenic Claudication
Neurogenic claudication is another cause of leg pain involving damage to the spinal nerves that go to the legs. The sufferer can’t walk for long periods of time and has to stop periodically and rest. Symptoms may include pain and parasthesias (nerve sensations) that commence
after walking and disappear following a rest period. There may be cramping, pain, numbness, aching and/or fatigue usually in the calf but also in the foot, thigh, hip or buttocks. Although one way of dealing with this condition is surgery, chiropractic care should be tried first before medical and surgical techniques are used.14

• Conclusion
If you do have sciatica, from whatever cause, a chiropractic adjustment is needed to remove pressure from your nerves, rebalance your spine, take stress off your discs and permit your body’s muscles, glands and tissues to function in a more balanced manner.

All sciatica sufferers should see a doctor of chiropractic to ensure their bodies are free of subluxations.
A subluxation causes spinal misalignment, disc and nerve pressure and stresses the entire body.

References

1. Arana E, Marti-Bonmati L, Vega M et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology. 2006;35(9):641-647.
2. Fonti S, Lynch M. Etiopathogenesis of lumbosciatalgia due to disc disease; chiropractic treatment. In J. Mazzarelli (Ed.), Chiropractic: Interprofessional Research. Torino, Italy: Edizioni Minerve Medica, 1983:59-68.
3. Stover BD, Turner JA, Franklin G et al. Factors associated with early opioid prescription among workers with low back injuries. Journal of Pain. 2006;7(10):718-725.
4. Patrick CAJ, Vroomen MD, Marc CTFM et al. Lack of effectiveness of bed rest for sciatica. The New England Journal of Medicine. 1999;340:418-423.
5. Johnson EW. Sciatic nerve palsy following delivery. Postgrad. Med. 1961;30(5).
6. Barge FH. The chiropractic vertebral subluxation and its relationship to vertebrogenic lumbar pain, cruralgia and sciatic syndromes. Chiropractic Research Journal. 1995;3(2):25-39.
7. Livingston M. Spinal manipulation: a one year follow-up study. The Canadian Family Physician. July 1969:35-39.
8. Mathews JA et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. British Journal
of Rheumatology. 1987;26:416-423.
9. Osterbauer PJ, Fuhr AW. Treatment of chronic sciatica by mechanical force, manually assisted, short lever adjusting and a video assisted stretching program: a quantitative case report. Proceedings of the Consortium for Chiropractic Research Conference on Research and Education, 1992. Palm Springs, CA.
10. Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. JMPT. 2007;30:135-139.
11. Cox JM, Shreiner S. Chiropractic manipulation in low back pain and sciatica: statistic data on the diagnosis, treatment and response of 576 consecutive cases. JMPT. 1982;7:1-11.
12. Bronfort G et al. Non-operative treatments for sciatica: a pilot study for
a randomized clinical trial. JMPT. 2000;23(8):536-544.
13. Downs S. Unilateral intermittent claudication of the left lower extremity. JMPT. 1988;11:322-324.
14. Nall SK. The role of specific manipulation towards alleviating abnormalities in body mechanics and restoration of spinal motion. JMPT. 1982;5:11-15.

© 2014 Tedd Koren, D.C. & Koren Publications Inc. All rights reserved. • 1-800-537-3001 • www.korenpublications.com • KGN