Chiropractic care is safe and effective for the management of cervical radiculopathy

By James Lehman

Almost 33 years ago, I was injured in a multiple vehicle collision.  While sitting at a stoplight waiting for the light to turn green during a rain storm, my little 944 Porsche became the target of two larger cars racing to beat the red light.  In Albuquerque, New Mexico, drivers floor it when the light turns yellow and speed up to make the yellow light. Unfortunately for me, one of these drivers was turning left in front of the other accelerating vehicles. Neither made it through the intersection safely. In fact, they collided and then slid into my car. Consequently, it incurred significant damage to the entire left side of the car, a broken axil and steering wheel. The leather-wrapped steel steering wheel broke in my tightly clenched hands. Once the movement of the three vehicles ceased, my Porsche was up on the sidewalk with the right side of the car against a telephone pole.

I was only 50 yards from my clinic and on my way to the gym to play racquetball and then off to the airport to teach in Houston when the unfortunate incident took place. The loud explosion-like noise from the three-car collision caused my clinic staff to exit the clinic to find me as one of the victims. Everyone kept asking me if I was ok, which surprised me. Of course, I was fine but now my racquetball game was out of the question.

Little did I know at the time, I had fractured seven teeth and crowns, sprained my hands and spine, ruptured two cervical discs, and incurred a mild traumatic brain injury. Like many of our patients, I declined an ambulance to the emergency room. Rather than playing racquetball, I gave my report to the police and had my car hauled away. Later in the day, I flew to Houston with a connection in Dallas. Upon entering the Dallas airport, I became anxious because I did not remember my name or know where I was at or going. Yes, I had incurred a post-traumatic, mild traumatic brain injury. As a long-term result of this motor vehicle incident, I have suffered with episodes of cervical radiculopathy.

It is common for patients like me, suffering with an acute episode of neck and arm pain with paresthesias to present to primary care providers or chiropractic clinicians for treatment many years following the initial injury. I am certain that chiropractors reading this article can relate my history to many of their patients. We know how chiropractic spinal manipulation and non-pharmacological care for these patients is beneficial. What I want to address is for the benefit of primary care providers, orthopedists, and neurosurgeons who offer this sort of care.

Frequently, a cervical disc herniation is one of the neuromusculoskeletal conditions causing painful episode of cervical radiculopathy. The cervical discopathy may be compressing a nerve root with a resultant dermatomal pain pattern. When a clinical examination demonstrating radiculopathy (pain pattern, sensory and/or motor deficits) is correlated with an imaging study, a moderate neurological deficit appears suddenly. Conservative treatment is successful with the majority of these cases.

Manual medicine or therapy is a form of conservative, non-pharmacological treatment offered by chiropractic clinicians for the management of patients suffering with cervical radiculopathy. Chiropractors usually refer to this form of treatment as a chiropractic adjustment or spinal manipulation, which has been described as a high velocity, low amplitude thrust.

When the clinical efficacy of spinal manipulative treatment for spinal pain has been assessed, high-velocity low-amplitude thrust (HVLAT) manipulation and mobilization have been regarded as clinical interventions giving identical and equivalent biologic effects.

If you as a primary care provider or a medical specialist refer a patient suffering with a cervical radiculopathy and discopathy, you should expect that the chiropractic clinician will perform a focused evaluation prior to recommending spinal manipulation. The chiropractor will probably request the previous imaging studies or order specific imaging to determine the status of the cervical discs and nerve roots. The chiropractic evaluation will include a patient interview, as well as physical examination including both orthopedic and neurological examinations. The chiropractor will perform a differential diagnosis and determine if there is an upper motor neuron lesion, such as myelopathy or a lower motor neuron lesion, such a nerve root compression.

The patient with acute neck pain, arm pain, and paresthesias caused by a cervical discopathy and nerve root compression may be referred to a chiropractic clinician for evaluation and management for conservative, non-pharmacological, spinal manipulation. Evidence demonstrates that cervical manipulation and mobilization are effective for pain reduction and improved cervical range of motion immediately following the initial encounter.

A cervical discopathy with resultant compression of the spinal cord (myelopathy) will demonstrate upper motor neuron signs including hyper-reflexia, pathological reflexes, clonus, and hyper-tonic muscle weakness. This patient’s condition requires referral for a neuro-surgical consultation and spinal manipulation is contra-indicated. Whereas, a patient suffering with cervical radiculopathy will present lower motor neuron signs, such as reduced or absent deep tendon reflexes, flaccid muscle atrophy, weakness, absence of pathological reflexes or clonus.

The neuromusculoskeletal examination by the chiropractic clinician will focus on spinal posture, cervical range of motion, pain pattern, cervical compression and distraction, and reproduction of the chief concern pain. The goal of the chiropractic examination is to determine the cause of the pain and paresthesia, identify the painful tissues, determine if there are neurological deficits, and specifically locate the level of the biomechanical lesion causing the nerve root compression. This process performed prior to spinal manipulation enables the chiropractor to determine if this is a neuromusculoskeletal condition that will respond favorably to spinal manipulation and conservative chiropractic care.

As a chiropractor living with post-traumatic chronic pain because of degenerative joint and disc disease, I have endured several episodes of cervical radiculopathy. Conservative chiropractic management normally provided me with immediate relief of the pain. It is my opinion that chiropractic management of acute, episodes of cervical radiculopathy should be evaluated and managed by chiropractic clinicians.

References

Corniola MV, Tessitore E, Schaller K, Gautschi OP. Cervical disc herniation–diagnosis and treatment. Rev Med Suisse. 2015 Oct 28; 11(492):2023-9.

Evans DW. Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories. J Manipulative Physiol Ther. 2002 May; 25(4):251-62.

Thoomes EJ. Effectiveness of manual therapy for cervical radiculopathy, a review. Chiropractic and Manual Therapies (2016) 24:45