Chiropractic Before or After a Spinal Injection: The Facts!

Suffering through the pain associated with a disc herniation can be debilitating. When a spinal disc is pressing on a nerve it can result in excruciating pain that may seem like it will never go away.

Quite often medical doctor’s recommend nerve root injections (also known as Epidural Steroid Injections) if they see on an MRI that the disc is pressing on a nerve. But how many times do they also recommend chiropractic care with the injections? Not often enough.

Over 9 million spinal injections are given every year for spine-related pain. That is over 24,000 every day! Injections are often given when a patient is suffering from radiculopathy or a compressed nerve root.

Over 24,000 SPINAL injections are given every day!

I believe there is a better, research-supported way to find relief. But first, let's set the stage a bit.


The 3 tissues that can pinch a nerve and cause pain are:

  • Spinal Discs

  • Bone Spurs and Osteophytes

  • Ligament Overgrowth and Hypertrophy

Whether the compression is caused by a disc, ligament, or bone- the nerve doesn't care. It's aggravated and causing pain. Statistically, many of these people are going to visit their medical doctor to find relief. Over 30% of the patients in a primary care doctors office are there for treatment of a musculoskeletal complaint.

When they go to see their medical doctor with radiculopathy, the medical doctor may prescribe an anti-inflammatory, and perhaps physical therapy. Then an MRI is ordered. 

What do they find? 

Well, if it's a disc pressing on the nerve, the next stop for that patient is quite often a physiatrist, pain management doctor, or neurologist for a spinal injection. The goal of the injection is to decrease the inflammation and "numb" the area, which may provide temporary relief at best. And what happens when the injections stop working? It's off to the surgeon.

I believe there is a better path to relief.

I thought it would be interesting to look at the research showcasing the use chiropractic or injections for the treatment of radiculopathy. First up was a study from JMPT in 2013. The title is "symptomatic MRI-confirmed lumbar disc herniation patients comparing high-velocity low amplitude spinal manipulative therapy or image guided lumbar nerve root injections."

 And guess what the researchers found?


The researchers found, "both of the treatment groups had significant decreases in their pain scores at one month with a 60 percent reduction for the spinal manipulative therapy cohort and a 53 percent reduction for the nerve root injection group".

The spinal manipulation group had much better outcomes than the nerve root injection group.

Additionally, they found, "lumbar nerve and injections are commonly used, and accepted treatment option for these patients whereas lumbar spinal manipulation as a treatment for disc herniation remains controversial amongst some healthcare professionals." 

That tells us that there is some work to do on the relationships building front. With the volume of nerve root injections and all the risks- people should be exploring conservative care, such as chiropractic, first!
(in the absence of red-flags and extenuating circumstances)

Keep in mind this is a symptomatic, MRI-confirmed lumbar disc herniation. The disc is placing direct pressure on the nerve. And while both groups found improvement, the chiropractic group, the spinal manipulation group, ultimately outperformed the nerve root injection group. That's exciting!

The fact that a conservative care option can outperform a ton of steroids being dumped on an inflamed nerve is impressive.

Additionally, another study titled "spinal manipulation post-epidural injection for lumbar and cervical radiculopathy: a retrospective case series" had some interesting results. For instance, happens if you give an adjustment to someone who has already had an injection? 

Unfortunately, many people believe they are past chiropractic when they get the injection. And the researchers found the opposite is true.

They found, "the majority of the patients showed a positive response with only one treatment procedure".

Additionally, the researchers found, "theoretically epidural injections are proposed to address the inflammatory and central components of spinal pain whereas spinal manipulation is proposed to address the mechanical and neural aspects of the pain syndrome". 

mri-case 1-image.JPG

Spinal manipulation is proposed to address the mechanical aspect of the pain, and you're getting physical motion into the joint with many chiropractic techniques. But they also cited the neural elements such as the impact to a central nervous system and the opening of the foraminal canals, decreasing the pressure on the nerve.  

Finally, the researchers found, "this data suggests that spinal manipulation post-epidural injection is a safe non-surgical procedure to use in the treatment of a patient with radiculopathy of spinal origin." 

So not only do many patients get well with chiropractic care before (or instead) of getting an injection, but even those individuals who went through an injection still saw improvement with chiropractic care.

This research is important information for your patients to know and is also as a great conversation starter for the providers in your community. Those conversations may save dozens, if not hundreds of people from going through expensive and sometimes dangerous, injections. 

We've featured both of these pieces of research as monthly research for our members of The Evidence Based Chiropractor; which is the complete system for relationship building with other healthcare providers in your community. Click here to learn more!