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

Why This Matters

Chronic low back pain is often treated as a structural or peripheral condition, yet growing evidence suggests central nervous system involvement plays a key role in pain persistence. This study explores whether spinal manipulation influences brain function, offering insight into how manual therapies may affect pain beyond the spine itself.

What the Research Found

This scoping review analyzed 10 studies examining brain activity changes following spinal manipulation in patients with lumbar disc herniation and chronic low back pain.

The findings suggest that spinal manipulation may induce measurable neuroplastic changes in brain regions associated with pain processing, perception, and emotional regulation.

Key Findings:

    • Spinal manipulation was associated with changes in:
      • Prefrontal cortex (pain modulation, cognition)
      • Default mode network (pain perception, internal processing)
      • Visual network (sensory integration)
    • These brain changes correlated with improvements in:
      • Pain intensity (VAS)
      • Functional disability (ODI, JOA)
      • Emotional measures (anxiety and depression scales)
    • Different types of manipulation produced distinct brain activation patterns, suggesting technique-specific effects
    • Findings support a role for central nervous system modulation in pain relief

Clinical Takeaways

    • Recognize that chronic low back pain may involve central nervous system changes—not just peripheral tissue injury
    • Be aware that spinal manipulation may influence brain function related to pain perception and emotional processing
    • Consider that improvements in pain and function may be partly mediated through neuroplastic changes
    • Understand that different manual therapy techniques may produce different neurologic effects

Where Collaborative Spine Care May Support This

Manual medicine approaches, including spinal manipulation, may influence both mechanical and neurologic aspects of chronic pain. This dual effect—addressing spinal function while also modulating central pain processing—may help explain why some patients experience improvements in pain, function, and emotional well-being with conservative care.

Reference

Cao L, Shu J, Li B. Brain functional changes following spinal manipulation therapy in patients with lumbar disc herniation and chronic low back pain: a scoping review. Front Neurol. 2026;16.
DOI: http://dx.doi.org/10.3389/fneur.2025.1712320
PubMed: https://pubmed.ncbi.nlm.nih.gov/41567532/