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Shorter articles outlining the author's perspective or summarising those of recognised experts on a topic relevant to physiotherapy


Efficacy of spinal manipulative therapy in the treatment of symptomatic lumbar disc herniation.


Spinal manipulation, lumbar disc herniation, sciatica, low back pain

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name, position, institution of all authors + address for correspondence

Abstract synopsis

Efficacy and safety of spinal manipulation therapy in the treatment of symptomatic lumbar disc herniation (LDH) is the focus of this essay. High velocity low amplitude, short lever rotational technique in side lying posture is the common technique being practiced in cases of LDH. This perspective discusses on four different essential and practical considerations of SMT in the treatment of LDH; inclusion/exclusion criteria, clinical efficacy, mechanism of action, and risk/benefit and safety.

Background or context

Sciatica secondary to lumbar disc herniation (LDH) is one of the common causes of low back pain
with radiating pain in leg with estimated lifetime incidence of between 2% and 40% and is the
major source of disability causing functional impairments [1] [2]. Many studies [17,21,26] have
shown consensus over trial of conservative or non-operative treatment prior to surgical
intervention for majority patients with symptomatic LDH unless immediate surgery is indicated
for cauda equina syndrome (CES) or rapid and progressive neurological deficits. However,
conclusive evidence for efficacy of both conservative and surgical approaches in the treatment
of symptomatic LDH is yet to be determined and Spinal Manipulation Therapy (SMT) is no
exception [22]. Many literatures have advocated safe use of SMT and its clinical efficacy
[7,8,14,16,21,22] whilst some authors are against the use of SMT and have demonstrated various
complications of SMT in cases of LDH [2,17,19]. This article aims to discuss evidences published
on various literatures on risks and benefits, possible mechanism of action, and its clinical
implications, and efficacy of side lying rotational high velocity low amplitude thrust (HVLAT)
manipulation of lumbar spine in the management of patients with symptomatic LDH like sciatica
due to LDH, which may support in the development of evidence based standard clinical guidelines
to practice SMT in cases of LDH.


discussion of a topical aspect or an area of physiotherapy, If the area is controversial then a balanced discussion should be provided. Where view points are the author's opinion this hsould be made clear.


summary or article. Points for further discussion including how to continue the discussion, ie online. Points for further research.

Funding and Declarations

funding for the systematic review and any potential conflicts of interest

Author Biography

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  1. McMorland G, Suther E, Casha S, Plesis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A perspective randomized clinical study. J Manipulative Physiol Ther 2010; 33:576-84.
  2. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The Spine Journal 2006; 6:131-7.