The profile of chiropractors managing patients with low back-related leg pain: analyses of 1907 chiropractors from the ACORN practice-based research network

Abstract

Background Approximately 60% of people with low back pain also have associated leg pain symptoms. Guidelines for low back pain recommend non-pharmacological approaches, including spinal manipulation - a therapy provided by chiropractors. However, limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Our objective is to describe the prevalence, profile and practice characteristics of Australian chiropractors who often treat LBRLP, compared to those who do not often treat LBRLP. Methods This is a cross-sectional analysis of a nationally representative sample from the Australian Chiropractic Research Network (ACORN). This study investigated the demographic and practice characteristics as well as clinical management of chiropractors who ‘often’ treated patients with LBRLP compared to those who treated LBRLP ‘never/rarely/sometimes’. Multiple logistic regression models identified independent factors associated with chiropractors who ‘often’ treated patients with LBRLP. Results A total of 1907 chiropractors reported treating patients experiencing LBRLP, with 80.9% of them ‘often’ treating LBRLP. Chiropractors who ‘often’ treated LBRLP were more likely to manage patients with multi-site pain including axial low back pain (OR = 21.1), referred/radicular neck pain (OR = 10.8) and referred/radicular thoracic pain (OR = 3.1). While no specific management strategies were identified, chiropractors who ‘often’ treated LBRLP were more likely to discuss medication (OR = 1.8), manage migraine (OR = 1.7) and degenerative spine conditions (OR = 1.5), and treat women during pregnancy (OR = 1.6) and people with work-related injuries (OR = 1.5), compared to those not treating LBRLP frequently. Conclusions Australian chiropractors frequently manage LBRLP, although the nature of specific management approaches for this condition remains unclear. Further research on the management of LBRLP can better inform policy makers and educators interested in upskilling chiropractors to deliver safe and effective treatment of LBRLP.

The profile of older adults seeking chiropractic care: a secondary analysis

“…Of the 946 older patients diagnosed with a back problem, 83 (5%) had radiating back pain. Chiropractors report regularly treating patients experiencing low backrelated leg pain, and in those chiropractors who 'often' treat low back-related leg pain, they were more likely to treat degenerative spine conditions [32]. While the methods of this study do not allow us to report the specific diagnosis of older patients with radiating back pain, symptomatic lumbar spinal stenosis is often characterized by neurogenic claudication, defined as symptoms of pain, weakness and/or numbness radiating into one or both buttock, thigh, or lower leg [33].…”

Comparison Between PE-TLIF and MIS-TLIF in the Treatment of Middle-Aged and Elderly Patients with Single-Level Lumbar Disc Herniation

“…Low back pain has a lifetime prevalence of 84% 1 and has a high prevalence in middle adulthood and old age, 2 60% of which are also accompanied by leg pain symptoms. 3 Although non‐surgical treatment is the primary treatment for these conditions, those with intractable symptoms may need surgical treatment, especially middle-aged and elderly patients, whose disc, intervertebral ligaments, paravertebral muscle, facet joint cartilage have degenerated, and are usually accompanied by lumbar instability, discectomy combined with spinal fusion is a better choice. 4 When traditional open surgery was used for the treatment of patients with LDH, the operative incision needed to be lengthened, which may result in greater surgical trauma, as well as increased bleeding and infection risk.…”