Back Neck and Spine

Who should treat a slipped disk a chiropractor or an osteopath?


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If you think you may have a "slipped disk" (herniation or disk bulge), either a chiropractor (DC), medical doctor (MD) or an osteopathic physician (DO) should be able to determine if this is true, or if your pain is caused by another problem. If it is determined that you indeed have a disk problem, most times the associated pain will go away on its own with time. In these "less severe" cases, pain control is the primary goal. Spinal manipulation by chiropractors has been shown to be effective for pain control, including for herniated disks (references 1-3 below), and there are almost no risks associated. Thus, it is always worth a try to see if a chiropractor can help.

Sometimes very severe disk problems can require a trip to a surgeon to ensure that neurological damage is not a risk. Your DC, MD, or DO should be able to inform you of whether or not you need to see a surgeon. Interestinglly, a recent study found that 60% of people who were thought to need surgery for a disk herniation causing sciatica benefited equally as well from chiropractic care as they would have from surgery (reference 4 below). Thus, seeing a chiropractor for your disk herniation has a good chance of providing the same benefit as surgery in a majority of cases. A safe approach would be to try chiropractic, if it works (60% of the time) then you can avoid surgery, if it doesnt work (40% of the time) then the option for surgery is always still there.

Note A: Neither manipulation, medication, or the increasingly popular decompression therapy can "fix" a disk problem, but, it is likely that all of these treatments can reduce the pain you are experiencing until the inflammation goes down. Thus, personal preference will play a large role in what type of doctor you decide to see.

Note B: Spinal manipulation is perfectly safe for a herniated or bulging disk (references 1-3).

Note C: Current research has suggested that a bulging disk does not cause pain by compressing nerves, but more likely by sensitizing nerves through local inflammation factors released by damaged cells and cells of the immune system (cytokines). Thus, over time as the inflammation goes down the pain will also go away. Usually, even after the pain is gone the disk bulge or herniation will remain, sometimes contacting nerves or even the spinal cord. It has been suggested that as many as 30% of the population has one or more asymptomatic (non-painful) disk bulges (references 5-7). It is likely a normal part of aging, so don't panic :)


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

2) 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;6:131-137.

3) Liu J, Zhang S. Treatment of protrusion of lumbar intervertebral disc by pulling and turning manipulations. J Tradit Chin Med 2000;20:195-197.

4) McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. 2010. Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study. J Manip Phys Ther. Volume 33, Issue 8, Pages 576-584.

5) Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69 --73.

6) Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg 1990;72:403-- 8.

7) Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The longitudinal assessment of Imaging and disability of the back (LAIDBack) Study: baseline data. Spine 2001;26:1158--66.