title: Manipulative therapy in lower back pain with leg pain and neurological deficit.
abstract: OBJECTIVE
  To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.
  
  
  METHODS
  The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
  
  
  RESULTS
  The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.
  
  
  CONCLUSIONS
  We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. Although significant questions remain for the evaluation and treatment of lumbar radiculopathy (sciatica) with disc herniations, there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.
authors.affiliation: Methods Department, Northwestern College of Chiropractic, Bloomington, MN 55431, USA.
authors.forename: T F
authors.initials: TF
authors.lastname: Bergmann
authors.forename: B V
authors.initials: BV
authors.lastname: Jongeward
mesh_terms: D002684:Chiropractic / Q000379:methods*; D017679:Cryotherapy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008875:Middle Aged; D009460:Neurologic Examination; D018579:Patient Selection; D012307:Risk Factors; D012585:Sciatica / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed