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MRI lumbar disc herniation

Chiropractic Manipulation for Sciatica

WhenMRI confirmed disc herniation causing sciatica a patient’s leg pain is thought to be caused by an ‘active’ disc disorder, such as a disc protrusion or herniation, it is called sciatica. In this situation, chiropractors may consider the use of spinal manipulation as one potential treatment option. This form of treatment has been reported to be safe and effective. Here is a brief summary/list of the peer-reviewed literature that examines the effectiveness and safety of chiropractic spine manipulation for lumbar disc herniation causing sciatica.

Evidence of Benefit

A very recent, retrospective analysis of US patient data suggested that receiving spine manipulation from a chiropractor for newly diagnosed lumbar disc herniation is associated with significantly reduced odds of discectomy over 2-year follow-up, when compared to other forms of care. See Reference 1

Disc herniation pushing on nerve - can chiropractic spine manipulation help?

A single-blind, randomized clinical trial in 2000 compared osteopathic spine manipulation with chemonucleolysis (injections) for lumbar disc herniation with sciatica. By 12 months, there was no statistically significant difference in outcome between the treatments (for leg pain, back pain and self-reported disability), but spine manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks of the study. See Reference 2

Disc herniation causing sciatica

A randomized, double-blind trial in 2006 compared real and sham (placebo) spine manipulation for patients with disc protrusion and sciatica. Real spine manipulation by a doctor of chiropractic resulted in significantly better outcomes than sham manipulation, on the basis of the percentage of patients with resolved local pain (28% vs. 6%) and resolved radiating pain (55% vs. 20%). See Reference 3


A prospective study in 2010 found that up to 60% of patients with chronic sciatica who had failed other medical management benefited from chiropractic spine manipulation to the same degree as if they underwent surgical intervention for lumbar disc herniation. See reference 4

A prospective cohort comparative effectiveness study in 2013 found chiropractic spine manipulation to offer relief equal to that from nerve root injections for patients with lumbar disc herniation and sciatica. See reference 5

A controlled trial in 2014 found that, for patients with back-related leg pain, adding chiropractic spine manipulation to a home exercise and advice program was more effective at relieving leg pain than home exercise and advice alone. See Reference 6

Evidence for Safety

Is Chiropractic spine manipulation for sciatica safe?A systematic review in 2004 calculated the risk of chiropractic spine manipulation causing a clinically worsened disk herniation in a patient presenting with lumbar disc herniation to be less than 1 in 3.7 million. The authors concluded that the apparent safety of spinal manipulation, especially when compared with other medically accepted treatments for lumbar disc herniation, should stimulate conversations about its use in the conservative treatment plan of lumbar disc herniation. See Reference 7

A very large retrospective study recently investigated the occurrence of severe adverse events after chiropractic spine manipulation (See reference 8). In this study, severe adverse events related to spine manipulation were exceptionally rare and there were no adverse events related to worsening of disc herniations or cauda equina syndrome.


1) Trager RJ, Daniels CJ, et al. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ Open. 2022 Dec 16;12(12):e068262.

2) Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000 Jun;9(3):202-7.

3) Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6(2):131-7.

4) McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010 Oct;33(8):576-84.

5) Peterson CK, Leemann S, Lechmann M, et al. Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections. J Manipulative Physiol Ther. 2013 May;36(4):218-25.

6) Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014 Sep 16;161(6):381-91.

7) Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210.

8) Chu EC, Trager RJ, Lee LY, Niazi IK. A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy. Sci Rep. 2023 Jan 23;13(1):1254.