The Impact of Spinal Manipulation on Lumbar Proprioception and its Link to Pain Relief: A Randomized Controlled Trial

Manual therapy, such as spinal manipulation (SM), is commonly used to treat non-specific chronic low back pain (CLBP), although its mechanisms remain poorly understood. It has been hypothesized that the mechanical forces applied during spinal manipulation (SM) influence proprioceptive function, which is often impaired in patients with CLBP. This study aimed to investigate the effect of a single SM intervention on lumbar proprioceptive function and its potential relationship with analgesic effects in patients with CLBP. In a single-blind randomized controlled trial, data from 142 adults with or without CLBP were analyzed after random assignment to receive lumbar spinal manipulation (LMANIP), lumbar mobilization (LMOB), or no intervention (NI). The primary outcome was the proprioceptive weighting (PW) ratio, which reflects the central nervous systems preferred source of proprioceptive input for balance control, specifically from the lumbar and ankle muscles. PW ratios were assessed immediately before and after intervention by analyzing postural sway changes during vibrotactile stimulation (60 Hz). PW changed in both healthy participants and patients after the intervention, with a significantly stronger lumbar-steered PW following LMANIP compared to NI ({beta} = -0.047, t(422) = -2.71, p = 0.007) and LMOB ({beta} = -0.039, t(422) = - 2.17, p = 0.030). Moreover, LMANIP was particularly effective in reducing pain in patients with stronger lumbar-steered PW before intervention (p < 0.017). These findings suggest that a single SM session enhances proprioceptive input from the lumbar muscles and that the strength of the analgesic effect is associated with the baseline PW status.