Brain functional changes following spinal manipulation therapy in patients with lumbar disc herniation and chronic low back pain: a scoping review

TL;DR

This review explores how spinal manipulation therapy affects brain activity in patients with chronic low back pain and lumbar disc herniation, suggesting it may help by altering specific brain regions.

Contribution

The study provides a scoping review of spinal manipulation's effects on brain function in chronic low back pain patients with lumbar disc herniation.

Findings

Spinal manipulation therapies induce significant changes in brain activity and connectivity.

Modulation of the prefrontal cortex, visual network, and default mode network correlates with reduced pain and improved emotional states.

Acupoint-specific manipulation elicits distinct brain activation patterns compared to non-acupoint stimulation.

Abstract

Chronic low back pain (LBP) is a common symptom in patients with lumbar disc herniation (LDH), and spinal manipulation-related therapies can alleviate pain. This study aimed to review the clinical research evidence regarding the central nervous mechanisms of spinal manipulation in treating chronic lower back pain related to lumbar disc herniation, summarize the current state of research, identify existing gaps, and lay the foundation for future studies.

This scoping review was conducted according to established methodological frameworks. Original studies were retrieved from eight databases from inception to August 1, 2025. Of the 169 articles, 10 were ultimately selected as meeting the inclusion criteria. The data were systematically organized and categorized according to the research objectives.

The ten included studies demonstrated that spinal manipulation therapies induce significant changes in brain activity and connectivity. Key findings include modulation of the prefrontal cortex, visual network, and default mode network. These neuroplastic changes were correlated with improvements in clinical pain intensity (VAS), functional disability (ODI, JOA), and emotional states (SAS, SDS). Acupoint-specific manipulation was found to elicit distinct brain activation patterns compared to non-acupoint stimulation.

Preliminary findings indicate that spinal manipulation-related therapies may alleviate LDH-associated chronic low back pain and mood disorders by modulating regions such as the prefrontal cortex, the visual network, and the default mode network. The development of standardized clinical practices and clarification of central nervous mechanisms are vital for improving pain management in this population group.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251109911, CRD420251109911.

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