Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial

ABSTRACT

Objectives

To determine 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).

Design

Parallel group, single-blind randomized clinical trial.

Setting

The study was conducted in a governmental tertiary hospital.

Participants

Forty (40) 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.

Interventions

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.

Outcome Measures

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.

Results

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.

Conclusion

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.

Trial Registration

Pan-African Clinical Trial Registry: PACTR201812840142310.

KEYWORDS:

• Spinal manipulation
• spinal mobilization
• lumbar disc herniation
• radiculopathy
• randomized clinical trial

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

Musa Sani Danazumi, Abdulsalam Mohammed Yakasai, Jibril Mohammed Nuhu, Mubarak Abubakar Falke, Shehu Usman Ibrahim, Salim Abubakar Rufai, Usman Garba Abdu, Isa Abubakar Adamu, Musbahu Hamisu Usman: Conceptualization, Methodology, Software.

Musa Sani Danazumi, Abdulsalam Mohammed Yakasai, Abah Daniel Frederic, Salim Abubakar Rufai, Jibril Mohammed Nuhu: Data curation, Formal analysis, Software, Visualization

Musa Sani Danazumi, Abah Daniel Frederic, Mubarak Abubakar Falke, Isa Abubakar Adamu, Usman Garba Abdu: Project administration,

Musa Sani Danazumi, Abdulsalam Mohammed Yakasai, Jibril Mohammed Nuhu, Mubarak Abubakar Falke, Shehu Usman Ibrahim, Salim Abubakar Rufai, Isa Abubakar Adamu, Musbahu Hamisu Usman, Usman Garba Abdu: Writing – Original draft preparation

Musa Sani Danazumi: Writing – review and editing

Abbreviations

ANOVA	=	Analysis of variance
DHR	=	Disc herniation with radiculopathy
HVLA	=	High-velocity, low-amplitude
ITT	=	Intention to treat analysis
NM	=	Neurodynamic mobilization
MOB	=	Mobilization
PT	=	Physiotherapist
SLR	=	Straight leg raise
P – A	=	Posterior-anterior
VAS	=	Visual analog scale
RMDQ	=	Rolland-Morris disability questionnaire
SMWLM	=	Spinal mobilization with leg movement
SMT	=	Spinal manipulative therapy
SBI	=	Sciatica bothersomeness index
SBI	=	Sciatica frequency index
SF-36	=	Short form health survey 36
TUG	=	Timed up and go test

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2192975

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.

Notes on contributors

Musa Sani Danazumi

Musa Sani Danazumi graduated as a Physiotherapist from Bayero University Kano (BUK), Nigeria, in 2014 and since then, has been involved in musculoskeletal pain management using a multimodal approach. Musa obtained an MSc in Orthopaedic and Sports Physiotherapy from BUK in 2019 and is currently a PhD candidate working with the Low Back Research Team at La Trobe University, Australia.