From the Guidelines
Chiropractic care is not recommended for treating enthesopathies due to the lack of evidence and potential risks, particularly cervical spine complications. For enthesopathies, the following treatments are recommended:
- Rest and activity modification to reduce stress on the affected area
- Ice or heat therapy for 15-20 minutes, 3-4 times daily
- Over-the-counter NSAIDs like ibuprofen (400-600 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours) for pain and inflammation
- Gentle stretching and strengthening exercises as tolerated
- Physical therapy for a tailored exercise program and manual therapies The American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis conditionally recommends against using chiropractic therapy due to the absence of evidence and potential risks 1. Key points to consider:
- The guideline recommends against chiropractic therapy for rheumatoid arthritis management, which may be applicable to enthesopathies
- Other integrative interventions, such as acupuncture, massage therapy, and thermal modalities, may be considered for pain management, but the evidence is limited and the certainty of evidence is low or very low 1
- The primary focus should be on conservative therapies, such as rest, activity modification, and physical therapy, to reduce stress on the affected area and promote healing.
From the Research
Effectiveness of Chiropractic Care for Enthesopathies
- There is limited evidence to suggest that chiropractic care is effective for treating enthesopathies 2.
- A case study found that chiropractic care, including spine and extremity manipulation and rehabilitation, may be beneficial in treating a patient with extraforaminal L4 nerve entrapment, which can cause enthesopathy-like symptoms 3.
- However, this study does not directly address the effectiveness of chiropractic care for enthesopathies.
Alternative Treatments for Enthesopathies
- A study found that a combination of enzyme therapy and laser therapy was more effective in treating enthesopathies than laser therapy alone 4.
- Another study found that injection therapy, including prolotherapy, can provide significant relief of axial pain and tenderness caused by enthesopathies, even in patients with "failed back syndrome" 5.
- Ultrasound therapy has also been shown to provide clinically important improvement in the treatment of calcific tendonitis, a type of enthesopathy 2.
Chiropractic Management of Tendinopathy
- Chiropractors often provide conservative interventions, including manual therapies, spinal manipulation, and exercise, to treat tendinopathy, which is a type of enthesopathy 2.
- However, the evidence for the effectiveness of these interventions is limited, and more research is needed to fully understand their benefits and limitations.