The trouble with mechanical treatments when chemical problems exist…& vice versa

If you haven’t read David Seamen’s clinical synopsis: The chemistry of discogenic and disc herniation pain, I highly recommend you do…its available on this site. As Chiropractors we are of course just itching to “lay hands on” our patients to find and “cure” them of their pains, mechanically. However a potential reality of discogenic pain, herniation in particular is the undeniable chemical influences perhaps driving the pain. He discusses the concept of the herniation being “turned on” by inflammation in the diet. The difficulty we face given these chemical realities is at what point do we conclude “dietary inflammation” not necessarily a “heal-able” mechanical lesion is predominant? And if we are co-treating at what point do we conclude which protocol did the work or was enough to actually “work” given the high improbability patients will follow our instructions? Will diet modification definitively stop episodes in the future? There’s no simple answer in my opinion however its’ apparent that many mechanistic-methods have substantively been able to give long-term relief (without mention of diet) and cultures whose daily physical labor and lack of sitting (and soda?) simply have less LBP disability. I have not seen any studies to date where extensive and exclusive “diet modification”, in exclusion of mechanical interventions and/or dedicated Core control exercise, was shown to substantially end LBP or sciatic, however we do know type II diabetics show an increased expression of HNP.