Manipulation Responders Have Higher Disc Diffusion

Manipulation Responders Have Higher Disc Diffusion

Dr. GJohn Mullen Blog, Injuries, Latest&Greatest Leave a Comment

The use of spinal manipulation is quite common in chiropractic, physical therapy, and osteopathic treatments. Yet, the physiological adaptation following a spinal manipulation is not well understood. This study looked at the response to a single spinal manipulation.

What was done

Nineteen adults between 19 – 45 years (M=6, F=13) of age participated in this study. All had the low back pain of at least 2/10. Each participant went under a T2-and-diffusion-weighted lumbar magnetic resonance imaging (MRI) scan before, and after, receiving a single treatment of spinal manipulation therapy (SMT). The SMT was performed to the lumbar spine.

Exclusion criteria included lumbar disc extrusion, nerve compression, spondylolisthesis, sacralization of lumbar vertebra.


Participants who had a 2-point decrease in pain were recorded as responders (12 of the patients) had an increase in apparent diffusion coefficient (ADC; measured by taking the diffusion of water in the nucleus pulposis) at L1-2, and L5-S1, compared to the non-responders (7 patients). No significant group-by-time interactions were observed at the L3-4 and L4-5 levels. Non-responders had a significantly higher BMI.


Improvements in pain following SMT are possibly from diffusion effects in nucleus pulposis. The ADC in the SMT was similar compared to another study only doing 10-minutes of mobilization and prone press-up. This decrease in pain could be for many reasons, one being a reduction in pressure gradient and chemical forces.

Practical Implication

Lumbar SMT appears beneficial for acutely decreasing pain in half of the patients after those with certain conditions are already removed. This acute improvement may be from the ADC.



  1. Beattie PF, Butts R, Donley JW, Liuzzo DM. The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1. J Orthop Sports Phys Ther. 2013 Nov 21. [Epub ahead of print].

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