Spinal manual therapy to treat lower extremity isolated pain: A systematic scoping review

Background Spinal manual therapy (SMT) is frequently employed to alleviate pain and enhance function. While traditionally applied to treat local spine disorders, SMT use in treating lower extremity issues is reported in the literature, suggesting a potential connection between these body parts. However, the clinical rationale for choosing specific SMT techniques for lower extremity complaints remains insufficiently explored.

Purpose Our scoping review aimed to systematically investigate and summarize the pathologies addressed, the type of interventions employed, and the outcomes used for assessing the effect of SMT for lower extremity isolated pain.

Method We conducted a comprehensive search of the PubMed/MEDLINE database, Scopus, ProQuest, ScienceDirect and SPORTDiscus from journal inception through February 2024, covering all study designs.

The 11-item modified Consensus on Exercise Reporting Template (mCERT) checklist was used to evaluate the reproducibility and documentation of SMT techniques. Characteristics of the articles, SMT techniques, lower extremities areas complaint and outcomes used were systematically categorized and frequency analyses were performed to identify trends and patterns in SMT application.

Results Forty-three articles fulfilled inclusion criteria. Physiotherapists and chiropractors authored 84% of the articles. The knee was the most prevalent complaint (58.2%). The 'thrust' (41.9%) and 'manipulation' (39.5%) techniques emerged as the most commonly applied SMT techniques, mainly to address pain (53.5%), muscle strength deficit (25.6%) and disability (37.2%). Notably, none of the articles fully reported all 11 items of the mCERT checklist.

Conclusion The review identified a range of SMT techniques, notably 'thrust' and 'manipulation', with an emphasis on their therapeutic application in the management of knee pathologies. SMT was used for pain relief, reducing muscular inhibition, and improving lower extremity function. However, technique descriptions were often incomplete. Future research should focus on reliable SMT techniques and their effectiveness in treating lower extremity isolated pain.

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Artikel online veröffentlicht:
23. Oktober 2025