Herniated, slipped, or ruptured discs affect 80% or more of the population. Most individuals don’t even realize they suffered a vertebral subluxation, as it shifted slightly but returned on its own and healed itself. Herniated disc/s symptoms can subside over time and can heal on their own. However, there are times when chiropractic is necessary to help the slipped or ruptured disc back into correct alignment and to help prevent re-injury or the development of new ones.
When Chiropractic Is Necessary
When an individual’s ability to move is limited is definitely when chiropractic is necessary. Individuals twist and turn their bodies, and the rotational force that comes from lifting and moving objects at home, work, school, sports, or lifting weights increases the risk of disc injury.
The lumbar spine or lower back is the most common location for a herniated disc injury.
The pain can spread to the glutes and legs, causing sciatica or sciatica-like symptoms.
When back pain spreads to the shoulder through the arm, it s caused by a herniated neck/cervical disc.
When the cushioning material from the disc/nucleus pulposus presses on surrounding nerves, it causes inflammation, pain, and numbness.
Individuals can suffer a herniated disc after changing a flat tire, stepping/slipping out of the bath/shower, or coughing and sneezing.
Healing
Herniated discs can be treated with ice packs and heat, over-the-counter medications, and anti-inflammatories. However, if these approaches are not producing results, chiropractic and physical therapy could be necessary to address the pain, reactivate the body’s healing system, and get the body’s circulation energy flowing. Exercises/movements are recommended depending on the injury to allow the musculoskeletal system to realign and circulate the nutrient-rich blood.
Evaluation
The chiropractic team must check if the individual is cleared for chiropractic care. Some individuals cannot undergo chiropractic adjustments because of the following:
The chiropractor will assess the injury and damage by evaluating the spine’s overall health, not just the painful areas.
They will inquire about medical history and conduct a physical examination.
Diagnostic tests could be necessary depending on the condition.
The team will evaluate the following criteria:
If reflexes are normal.
If there is muscle loss or decreased muscle strength.
If there is numbness or loss of sensation.
Loss of reflexes, muscle strength, and sensation could indicate the need for more aggressive treatment.
Depending on what is found, they may refer the individual to a spinal surgeon or specialist.
Techniques
Chiropractic focuses on restoring structural integrity to the body, reducing pressure on neurological tissue, and re-establishing a normal range of motion. With this treatment, pain and inflammation will be reduced or eliminated, and regular movement and reflexes will return. The body is realigned, stress is reduced, and the body’s natural energy can repair the damage. Adjustments involve:
HVLA is a high velocity, low amplitude short thrust to vertebrae that are out of position.
Mobilization involves low-velocity manipulation, stretching, and moving affected muscles and joints.
Joint cavitation expels oxygen, nitrogen, and carbon dioxide from the vertebrae and releases pressure on the affected area.
This technique uses a drop table while the chiropractor uses quick thrust and release manipulation.
Logan Basic Technique
This technique uses a light touch to level the sacrum.
Thompson Terminal Point Technique or Thompson Drop
This table technique adjusts with a weight mechanism to keep the patient in the correct position before the thrust is applied.
DOC Decompression Table
References
Danazumi, Musa S et al. “Two manual therapy techniques for management of lumbar radiculopathy: a randomized clinical trial.” Journal of osteopathic medicine vol. 121,4 391-400. 26 Feb. 2021, doi:10.1515/jom-2020-0261
Kerr, Dana, et al. “What Are Long-term Predictors of Outcomes for Lumbar Disc Herniation? A Randomized and Observational Study.” Clinical orthopedics and related research vol. 473,6 (2015): 1920-30. doi:10.1007/s11999-014-3803-7
Lurie, Jon D et al. “Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial.” Spine vol. 39,1 (2014): 3-16. doi:10.1097/BRS.0000000000000088
Wang, Jeffrey C et al. “Epidural injections for the treatment of symptomatic lumbar herniated discs.” Journal of spinal disorders & techniques vol. 15,4 (2002): 269-72. doi:10.1097/00024720-200208000-00001
Yussen, P S, and J D Swartz. “The acute lumbar disc herniation: imaging diagnosis.” Seminars in ultrasound, CT, and MR vol. 14,6 (1993): 389-98. doi:10.1016/s0887-2171(05)80032-0
Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.1�An 18-year follow-up of almost 93?000 women in the Nurses� Health Study revealed a dose-response association of weight gain and obesity with several cancers.2
Obesity Increase
The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2�It is therefore not surprising that obesity accounts for a significant portion of health care costs.
Cancers
A report released on October 3, 2017, by the US Centers for Disease Control and Prevention assessed the incidence of the 13 cancers associated with overweight and obesity in 2014 and the trends in these cancers over the 10-year period from 2005 to 2014.3�In 2014, more than 630?000 people were diagnosed as having a cancer associated with overweight and obesity, comprising more than 55% of all cancers diagnosed among women and 24% of cancers among men. Most notable was the finding that cancers related to overweight and obesity were increasingly diagnosed among younger people.
From 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.2�Given the time lag between exposure to cancer risk factors and cancer diagnosis, the high prevalence of overweight and obesity among adults, children, and adolescents may forecast additional increases in the incidence of cancers related to overweight and obesity.
Clinical Intervention
Since the release of the landmark 1964 surgeon general�s report on the health consequences of smoking, clinicians have counseled their patients to avoid tobacco and on methods to quit and provided referrals to effective programs to reduce their risk of chronic diseases including cancer. These efforts, coupled with comprehensive public health and policy approaches to reduce tobacco use, have been effective�cigarette smoking is at an all-time low. Similar efforts are warranted to prevent excessive weight gain and treat children, adolescents, and adults who are overweight or obese. Clinician referral to intense, multicomponent behavioral intervention programs to help patients with obesity lose weight can be an important starting point in improving a patient�s health and preventing diseases associatedwith obesity. The benefits of maintaining a healthy weight throughout life include improvements in a wide variety of health outcomes, including cancer. There is emerging but very preliminary data that some of these cancer benefits may be achieved following weight loss among people with overweight or obesity.4
The US Preventive Services Task Force (USPSTF)
The US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral interventions delivered over 12 to 16 visits for adults and 26 or more visits for children and adolescents with obesity.5,6�Measuring patients� weight, height, and body mass index (BMI), consistent with USPSTF recommendations, and counseling patients about maintaining a healthy weight can establish a foundation for preventive care in clinical care settings. Scientific data continue to emerge about the negative health effects of weight gain, including an increased risk of cancer.1�Tracking patients� weight over time can identify those who could benefit from counseling and referral early and help them avoid additional weight gain. Yet less than half of primary care physicians regularly assess the BMI of their adult, child, and adolescent patients. Encouraging discussions about weight management in multiple health care settings, including physicians� offices, clinics, emergency departments, and hospitals, can provide multiple opportunities for patients and reinforce messages across contexts and care environments.
Weight Loss Programs
Implementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.7�Whether the lack of utilization is a consequence of lack of clinician or patient knowledge or for other reasons remains uncertain. Few medical schools and residency programs provide adequate training in prevention and management of obesity or in understanding how to make referrals to such services. Obesity is a highly stigmatized condition; many clinicians find it difficult to initiate a conversation about obesity with patients, and some may inadvertently use alienating language when they do. Studies indicate that patients with obesity prefer the use of terms such as�unhealthy weight�or�increased BMI�rather than�overweight�or�obesity�and�improved nutrition and physical activity�rather than�diet and exercise.8�However, it is unknown if switching to these terms will lead to more effective behavioral counseling. Effective clinical decision support tools to measure BMI and guide physicians through referral and counseling interventions can provide clinicians needed support within the patient-clinician encounter. Inclusion of recently developed competencies for prevention and management of obesity into the curricula of health care professionals may improve their ability to deliver effective care. Because few primary care clinicians are trained in behavior change strategies like cognitive behavioral therapy or motivational interviewing, other trained health care professionals, such as nurses, pharmacists, psychologists, and dietitians could assist by providing counseling and appropriate referrals and help people manage their own health.
Achieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.
The high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.
Corresponding Author:�Greta M. Massetti, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 ([email protected]).
Conflict of Interest Disclosures:�All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflict of Interest. Dr Dietz reports receipt of scientific advisory board fees from Weight Watchers and consulting fees from RTI. No other disclosures were reported.
Disclaimer:�The findings and conclusions in this report are those of the authors and not necessarily the official position of the Centers for Disease Control and Prevention.
References
1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K; International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer�viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. PubMedArticle
2. Zheng Y, Manson JE, Yuan C, et al. Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA. 2017;318(3):255-269. PubMedArticle
4. Byers T, Sedjo RL. Does intentional weight loss reduce cancer risk? Diabetes Obes Metab. 2011;13(12):1063-1072. PubMedArticle
5. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426. PubMedArticle
7. Batsis JA, Bynum JPW. Uptake of the centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988. PubMedArticle
8. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612-619. PubMedArticle
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
The prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are 
From 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.
The 
Implementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.
Achieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.
The high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.
