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Published on: August 7, 2018
Exercise, manipulation and traction physiotherapy in the conservative management of lumbar disc herniation: A
Santhosh G Thavarajasingam1,2,3, Daniele S C Ramsay1,4, Srikar R Namireddy1,4
1Imperial Brain & Spine Initiative, Imperial College London, London, United Kingdom.
Introduction:
Lumbar disc herniation (LDH) is a leading cause of global back pain with significant socioeconomic impact. Conservative physiotherapy, including exercise, manipulation, and traction therapies, is a common first-line treatment. However, their relative efficacy and applicability to specific subgroups remain unclear.
Research Question:
This systematic review and meta-analysis evaluated the efficacy of these three modalities, identified factors influencing variability, and explored subgroup-specific applications.
Material And Methods:
Following PRISMA guidelines, a systematic review was conducted with searches of PubMed, MEDLINE, EMBASE, OVID, Scopus, and grey literature. Forty-three studies were included in the qualitative synthesis and 20 in the meta-analysis. Random-effects models estimated pooled standardized mean changes (SMCs), and meta-regression examined covariates influencing variability.
Results:
The pooled SMC across modalities was 2.28 (95 % CI: 1.51, 3.05), indicating large treatment effects, though heterogeneity was high (I2 = 97.9 %). Traction therapy had the highest effect size (SMC = 2.52, 95 % CI: 1.57, 3.37), followed by exercise therapy (SMC = 1.97, 95 % CI: 0.46, 3.48) and manipulation therapy (SMC = 1.91, 95 % CI: 0.24, 4.04). Follow-up duration significantly influenced effect sizes (p < 0.001), with shorter durations associated with larger effects. Qualitative findings suggested potential subgroup benefits for complex or chronic pain patients, but quantitative evidence for subgroup differentiation was limited.
Discussion And Conclusion:
Conservative therapies may effectively reduce LDH-related pain and disability, with traction therapy demonstrating the largest pooled effect size. High heterogeneity and methodological inconsistencies limit subgroup-specific recommendations. Rigorous trials and standardized methodologies are essential for optimizing evidence-based care for LDH patients.
