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ABSTRACT
Objective: Spinal Manipulative Therapy (SMT) is a routinely applied treatment modality for various musculoskeletal conditions, including low back pain. The precise mechanisms by which SMT elicits its effects are largely unknown, but recent research supports a multi-system explanation recognizing both biomechanical and neurophysiological mechanisms. Although the evaluation of changes in clinical presentation is complex, objective neurophysiological measures of sensitivity to movement (e.g. neurodynamic tests) can be a valuable clinical indicator in evaluating the effects of SMT. This review aimed to synthesize current literature investigating the effects of SMT on lower limb neurodynamics.
Method: Eight electronic databases were systematically searched for randomized controlled trials (RCT) that applied SMT (against any control) and evaluated lower limb neurodynamics (Passive Straight Leg Raise or Slump Test). Selection and data extraction were conducted by one researcher, reviewed by a second author. Risk of bias (RoB) was assessed using the Cochrane Back Review Group criteria.
Results: Eight RCTs were included, one with high RoB. SMT produced a clinically meaningful (≥6⁰) difference in five of these studies compared with inert control, hamstring stretching, and as an adjunct to conventional physiotherapy, but not compared with standard care, as an adjunct to home exercise and advice, or when comparing different SMT techniques. Findings compared to sham were mixed. When reported, effects tentatively lasted up to 6 weeks post-intervention.
Conclusion: Limited evidence suggests SMT-improved range of motion and was more effective than some other interventions. Future research, using standardized Neurodynamic tests, should explore technique types and evaluate longer-term effects.
Level of Evidence: 1a
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No potential conflict of interest was reported by the authors.
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Notes on contributors
Christina Melanie Maxwell
Christina Melanie Maxwell is an experienced Physiotherapist who specializes in the management of musculoskeletal injuries and conditions. She was graduated from Queen Margaret University in 2011 (with a BSc in Physiotherapy) and Glasgow Caledonian University in 2016 with an MSc in Musculoskeletal Physiotherapy. She has worked as a research assistant for the University of Limerick and has worked clinically across a range of community and hospital settings. This article reports on work conducted as her Master’s dissertation.
Douglas Thomas Lauchlan is a Senior Lecturer in Physiotherapy at Glasgow Caledonian University. He was graduated from both Queen’s College, Glasgow in 1990 (with a BSc Physiotherapy) and Glasgow Caledonian University in 2002 with an MSc in Physiotherapy. He has been teaching at GCU since 2005 and became a Senior Fellow of the Higher Education Academy in 2016. He has worked in a variety of healthcare and sporting environments during this time and continues to practice within the GCUClinic and with the Scottish Football Association.
Philippa Margaret Dall is a senior research fellow at Glasgow Caledonian University. She was graduated from the Universities of Newcastle-upon-Tyne (with BSc in physics with medial applications) and Strathclyde (with a PhD in bioengineering). She has extensively published in peer review journals, and her current research interest is focused on the objective measurement of physical activity and sedentary behavior in a free-living environment. She is an expert working group member for the 2018 update of the UK CMO physical activity guidelines.