The effects of spinal manipulative therapy on lower limb neurodynamic test outcomes in adults: a systematic review

Research output: Contribution to journalArticle

Accepted/In press

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Original languageEnglish
JournalJournal of Manual and Manipulative Therapy
StateAccepted/In press - 9 Jan 2019

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 recognising 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 synthesise current literature investigating the effects of SMT on lower limb neurodynamics.
Method: Eight electronic databases were systematically searched for randomised 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 was conducted by one researcher, reviewed by a second. 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 (=6°) 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 standardised Neurodynamic tests, should explore technique types and evaluate longer-term effects.
Level of Evidence: 1a

Keywords

  • low back pain, passive straight leg raise, randomised controlled trials, spinal mobilisation, spinal manipulation