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

Christina Melanie Maxwell, Douglas Thomas Lauchlan, Philippa Margaret Dall*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
60 Downloads (Pure)


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.
Original languageEnglish
Pages (from-to)4-14
Number of pages11
JournalJournal of Manual and Manipulative Therapy
Issue number1
Early online date5 Feb 2019
Publication statusPublished - 1 Jan 2020


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


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