Exercise, manipulation and traction physiotherapy in the conservative management of lumbar disc herniation: A systematic review and meta-analysis.

Published on January 1, 2025 by Dr Gruther

Key Takeaway

This meta-analysis shows that Physical Medicine and Rehabilitation or PM&R modalities (traction, exercise, and spinal manipulation) offer substantial short-term relief for lumbar disc herniation, though long-term subgroup benefits remain uncertain due to study heterogeneity.

SG T., DSC R., SR N., AG K., S K., H Z., R P., A P., HS P., A A., A S., A T., J N., D S., D J., A K., F R.. (2025). Exercise, manipulation and traction physiotherapy in the conservative management of lumbar disc herniation: A systematic review and meta-analysis.

Read the original publication →

What this study found

This systematic review and meta-analysis evaluated Physical Medicine and Rehabilitation or PM&R modalities—specifically traction, exercise therapy, and spinal manipulation—for managing lumbar disc herniation. Analyzing quantitative data across 20 trials, researchers observed strong overall treatment effects in reducing pain and disability, yielding a pooled standardized mean change of 2.28.

Key findings by treatment modality include:

  • Traction therapy: Demonstrated the largest overall effect size (SMC = 2.52).
  • Exercise therapy: Showed meaningful, robust clinical improvements (SMC = 1.97).
  • Manipulation therapy: Provided substantial functional gains (SMC = 1.91).

Meta-regression revealed that follow-up duration significantly moderated outcomes, with shorter follow-up periods demonstrating larger reported treatment effects.

Why it matters

For rehabilitation clinicians and patients navigating non-surgical care, these findings support conservative physical medicine as an effective primary strategy for discogenic back and leg pain. While traction showed the highest initial effect magnitude in this pooled cohort, exercise and manual therapy remain foundational for restoring spinal mechanics and active function. Integrating these modalities early in care plans can provide meaningful symptom relief and potentially decrease reliance on invasive interventions.

Limitations

Interpretation is tempered by substantial statistical heterogeneity across the included literature. High methodological variability—such as differences in treatment protocols, traction parameters, and outcome measurements—precludes definitive subgroup recommendations. Furthermore, because observed benefit sizes diminished over time, ongoing active conditioning and standardized long-term trials are essential to determine optimal maintenance strategies.

Continue your learning

Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Low-certainty evidence suggests structured exercise rehabilitation may reduce kinesiophobia and improve knee function after total knee arthroplasty, though substantial study heterogeneity warrants clinical caution.
Result: Low-certainty evidence suggests structured exercise rehabilitation may reduce kinesiophobia and improve knee function after total knee arthroplasty, though substantial study heterogeneity warrants clinical caution.

Physical therapist management of patients with suspected or confirmed osteoporosis – German translation and contextual adaptation of a clinical practice guideline from the Academy of Geriatric Physical Therapy (USA)

Osteoporose
Researchers successfully adapted the APTA Geriatrics osteoporosis guideline for German-speaking clinicians, establishing standardized, evidence-based physical therapy recommendations for bone health and fall prevention.
Result: Researchers successfully adapted the APTA Geriatrics osteoporosis guideline for German-speaking clinicians, establishing standardized, evidence-based physical therapy recommendations for bone health and fall prevention.

Therapeutic apheresis: An effective strategy for a combined targeting of circulating lipoproteins, inflammatory markers, PFAS, and microplastics in cardiometabolic and neurodegenerative disease?

Therapeutic apheresis shows promise as a multi-target therapy to reduce circulating lipoproteins, inflammatory markers, and environmental toxins like PFAS and microplastics in chronic disease.
Result: Therapeutic apheresis shows promise as a multi-target therapy to reduce circulating lipoproteins, inflammatory markers, and environmental toxins like PFAS and microplastics in chronic disease.

View all studies

Start your recovery today

Contact us