This single-blind, randomized, clinical trial was aimed at determining the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR).
Forty participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups.
Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans’ spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks.
The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization.
The results indicate that the MOB group improved significantly better than the SMT group in all outcomes (p < 0.05), and at all timelines (6, 12, 26, and 52 weeks post-randomization), except for sensory deficit at 52 weeks, and reflex and motor deficits at 12 and 52 weeks. These improvements were also clinically meaningful for neurodynamic testing and sensory deficits at 12 weeks, back pain intensity at 6 weeks, and for activity limitation, functional mobility, and quality of life outcomes at 6, 12, 26, and 52 weeks of follow-ups. The risk of being improved at 12 weeks post-randomization was 40% lower (RR = 0.6, CI = 0.4 to 0.9, p = 0.007) in the SMT group compared to the MOB group.
The authors concluded that this study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up.
Yet again, I find it hard to resist playing the devil’s advocate: had the researchers added a third group with sham-MOB, they would have perhaps found that this group would have recovered even faster. In other words, this study might show that SMT is no good for DHR (which I find unsurprising), but it does NOT demonstrate MOB to be an effective therapy.
16 Responses to Effects of spinal manipulation or mobilization for lumbar disc herniation with radiculopathy
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I wonder how they accounted for the clinician contact time differential since MOB tends to take longer to perform compared to SMT.
that should not be a problem for clever trialists.
Were they clever?
unless you have evidence to the contrary, I’d say YES
So you assume. Which is strange because one would think that would be mentioned in the methodology. But maybe you didn’t read the paper.
I tend to give the benefit of the doubt and have no reason that the authors were not clever.
How did they address it? Was it covered in the methodology?
you don’t need to confirm that you are a troll over and over again – I believe you.
Interesting. So you consider asking about a factor which could significantly alter the findings of a study as trolling.
No, I consider you a chiro troll on the back of your previous posts, behavior and mindset.
I suppose it’s easier to resort to calling me a troll than for you to share specific information from a paper you blogged.
yes, it’s not difficult to disclose what you are.
or do you think you fooled anyone by distracting them from the message of this post that SMT is ineffective nonsense?
that seems to be your specialty, chiro-troll.
EE: SMT is ineffective nonsense
Is it? Or do you just wish it to be?
patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Eur J Pain. 2017 Feb;21(2):201-216
PICO 15. Should patients with recent onset lumbar radiculopathy be offered spinal manual therapy in addition to usual care?
We observed a small, statistically significant effect in favour of the intervention on short term leg pain intensity [67, 72, 73], back pain intensity [67, 72, 73] and activity limitations [67, 73]. European Spine Journal 20 April 2017
All I asked was a simple question about the methodology on a paper Ernst blogged about. The best he can do is guess at an answer.
But for those interested….
Spinal manipulation is an option for symptomatic relief in patients with lumbar disc herniation with radiculopathy.
North American Spine Society
Clinical Guidelines for Multidisciplinary Spine Care
Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy
Copyright © 2012 North American Spine Society
The mere idea of NM being able to pull the nerves lengthwise throughout the body and through the musculoskeletal system to relieve them of the enveloping pressure is just as unenlightening as the idea of being able to treat tinnitus caused by increased local muscular tone with the idea of reducing muscle pressure around vessels with vasodilator drugs. The pinnacle of SCAM creativity in acute herniated disc is the administration of muscle relaxants. A local protective reflex due to a pathology is not interested in a muscle relaxant. So please note: SMT is dangerous nonsense, NM can’t better install electrical wires in the body by pulling and you can’t lengthen muscles by pulling on them. My questions, “How many muscles have you seen that stretched too long from the pulling” and “What do you do when the patient’s muscles have become too long from your pulling exercises?” have not yet been satisfactorily answered by physical therapists and orthopedists . Such damn nonsense tinkles in every practice and unfortunately is just as unstoppable as the noisy church bells on Sunday. Both sounds are superfluous.
This promises more success with functional problems / non-surgically solvable complaints in the movement apparatus:
https://pubmed.ncbi.nlm.nih.gov/36360614/
The takeaway message is that the quality of research was poor. Small samples sizes, ridiculous plausibility, poorly described methods. Garbage in, garbage out.