SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Brain Functional Changes Following Spinal manipulation therapy in Patients with Lumbar Disc Herniation and Chronic Low Back Pain: A Scoping Review
Provisionally accepted
- 1Hubei University of Chinese Medicine, Wuhan, China
- 2Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
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Purpose: Chronic low back pain (LBP) is a common symptom in patients with lumbar disc herniation (LDH), and spinal manipulation-related therapies can alleviate pain. This study aimed to review the clinical research evidence regarding the central nervous mechanisms of spinal manipulation in treating chronic lower back pain related to lumbar disc herniation, summarize the current state of research, identify existing gaps, and lay the foundation for future studies. Methods:This scoping review was conducted according to established methodological frameworks. Original studies were retrieved from eight databases from inception to August 1, 2025.Of the 169 articles, 10 were ultimately selected as meeting the inclusion criteria. The data were systematically organized and categorized according to the research objectives. Results:The ten included studies demonstrated that spinal manipulation therapies induce significant changes in brain activity and connectivity. Key findings include modulation of the prefrontal cortex, visual network, and default mode network . These neuroplastic changes were correlated with improvements in clinical pain intensity (VAS), functional disability (ODI, JOA), and emotional states (SAS, SDS). Acupoint-specific manipulation was found to elicit distinct brain activation patterns compared to non-acupoint stimulation. Conclusion: Preliminary findings indicate that spinal manipulation-related therapies may alleviate LDH-associated chronic low back pain and mood disorders by modulating regions such as the prefrontal cortex, the visual network, and the default mode network. The development of standardized clinical practices and clarification of central nervous mechanisms are vital for improving pain management in this population group.
Keywords: Brain mechanisms, fMRI, Lumbar disc herniation, Pain, Spinal manipulation therapy
Received: 13 Oct 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Cao, Shu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Lizhen Cao
Jing Shu
Bibao Li
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.