Abstract
BackgroundApproximately 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.MethodsThis 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.ResultsA 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.ConclusionsAustralian 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.
Highlights
60% of people with low back pain have associated leg pain symptoms
Leg pain caused by ligament, joint or disc structures of the low back is generally classified as referred pain while radicular pain is associated with nerve root compression, largely caused by a herniated intervertebral lumbar disc [3]
This study aimed to investigate: 1) the proportion of Australian chiropractors who regularly treat patients who present with lumbar pain and associated referred or radicular symptoms; and 2) the practitioner, clinical practice and clinical management characteristics factors associated with those chiropractors who frequently manage patients who present with lumbar pain and associated referred or radicular symptoms
Summary
60% of people with low back pain have associated leg pain symptoms. Limited empirical data has examined the characteristics of chiropractors managing patients with low back-related leg pain (LBRLP). Leg pain caused by ligament, joint or disc structures of the low back is generally classified as referred pain while radicular pain is associated with nerve root compression, largely caused by a herniated intervertebral lumbar disc [3]. There is substantial variation in the prevalence of radicular low back pain, with estimates ranging from 1.6 to 43% [4]. These variations likely reflect the numerous criteria, definition and assessment methods relating to referred and radicular symptoms in the peer-reviewed literature [5]. For consistency we here employ the terms “referred” and “radicular” to signify low back-related leg pain (LBRLP)
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