Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial

Am J Med. 2021 Jan;134(1):135-141. doi: 10.1016/j.amjmed.2020.08.005. Epub 2020 Sep 13.


Objective: We evaluated the efficacy of spinal manipulation for the management of nonacute lumbar radiculopathy.

Methods: In a university hospital we performed a randomized controlled trial with 2 parallel arms. Patients (n = 44) with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups. The primary outcome was the intensity of the low back pain on a visual analog scale. The secondary outcome was the Oswestry Disability Questionnaire score. We also measured spinal ranges of motion. The assessments were carried out at the baseline, immediately after intervention, and at 3 months' follow-up. All patients underwent physiotherapy. The manipulation group received three sessions of manipulation therapy 1 week apart. For manipulation, we used Robert Maigne's technique.

Results: Both groups experienced a decrease in back and leg pain significantly (all P ≤ 0.003). However, only the manipulation group showed significantly favorable results in the Oswestry scores (P < 0.001), and the straight leg raise test (P = 0.001). All ranges of motion increased significantly with manipulation (all P < 0.001), but the control group showed favorable results only in right and left rotations and in extension (all P < 0.001). Between-group analyses showed significantly better outcomes for manipulation in all measurements (all P ≤ 0.009) with large effect sizes.

Conclusion: Spinal manipulation improves the results of physiotherapy over a period of 3 months for patients with subacute or chronic lumbar radiculopathy.

Keywords: Exercise; Lumbar; Manipulation; Physiotherapy; Radiculopathy; Spinal.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Female
  • Humans
  • Iran
  • Low Back Pain / therapy
  • Lumbosacral Region*
  • Male
  • Manipulation, Spinal / methods
  • Manipulation, Spinal / standards*
  • Manipulation, Spinal / statistics & numerical data
  • Middle Aged
  • Pain Management / methods
  • Pain Measurement / methods
  • Radiculopathy / complications
  • Radiculopathy / therapy*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Visual Analog Scale

Associated data

  • IRCT/IRCT20190109042315N1