Brain & spine · 2025
Exercise, manipulation and traction physiotherapy in the conservative management of lumbar disc herniation: A systematic review and meta-analysis.
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Thavarajasingam SG, Ramsay DSC, Namireddy SR, Kamath AG, Kanakala S, Zaidi H, Parikh R, Peerbhai A, Ponniah HS, Arif A, Salih A, Thavarajasingam A, Neuhoff J, Scurtu D, Jankovic D, Kramer A, Ringel F
Аннотация
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.
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.