Back-Related Leg Pain

Posted by on Sep 21, 2014
in the category Musculoskeletal

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. " 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.

At 12 weeks, the SMT plus home exercise and advice group experienced more improvement in low back pain, disability, physical component score, global improvement, and satisfaction compared with the home exercise and advice alone group.

 

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% patients

Complete Pain Relieve at 12 weeks

20% of patients

5% patients

Medication at 12 weeks

44% reduction

37% reduction

"At 12 weeks, 37% of patients receiving SMT plus home exercise and advice had at least a 75% reduction in leg pain, compared with 19% in the home exercise and advice group," the authors write. Pain was completely relieved in 20% of those in the SMT plus home exercise and advice group compared with 5% in the home exercise and advicegroup.

At 52 weeks, the SMT plus home exercise and advice group experienced more improvement than the HEA 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 conservative treatment approach, resulting in better short-term outcomes than HEA alone," the authors conclude.

Ann Intern Med. 2014;161:381-391. Abstract