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- MakaleAçık Erişim2026Spinal Manipulation, Dynamic Neuromuscular Stabilization, and Their Combination in Chronic Non-Specific Low Back Pain: A Four-Group Randomized Clinical Trial
Alak, İsmail; Hatik, Sefa Haktan; Büyükkirli, İlker Can; Aydin, Emine Busra
Spinal manipulation (SM) and stabilization-focused exercise are commonly used in chronic low back pain, yet evidence on their combined effects is limited. This randomized controlled trial compared SM and dynamic neuromuscular stabilization (DNS), alone or combined, in chronic non-specific low back pain. Forty-eight participants were randomized (1:1:1:1; n=12/group) using a computer-generated sequence with opaque sealed-envelope concealment to Control, SM, DNS, or SM+DNS (SMDNS). Interventions (except Control) were delivered twice weekly for 4 weeks. Outcomes (VAS, ODI, RMDQ, DNS-HS, PostureScreen) were assessed at baseline and follow-up. Assessor blinding was not feasible (treating physiotherapist also assessed outcomes); analyses used coded group labels.Within-group analyses showed significant improvements in most outcomes (p<0.05), except for postural deviation in the SM group and frontal postural deviation in the DNS and SMDNS groups. Between-group comparisons indicated greater early pain reduction with SMDNS at the second assessment (p<0.05). By week 4, pain decreased most in DNS and SMDNS (VAS Δ=−3), while SM showed Δ=−2 and Control showed no change. Disability improved most in DNS/SMDNS (ODI Δ=−13.39/−15.38; RMDQ Δ=−5.24/−5.77). Week-4 effect sizes favored SMDNS over Control and SM for key outcomes (VAS D2 g=2.07 vs Control, 1.24 vs SM; ODI PC2 g=1.73 vs Control, 1.05 vs SM; RMDQ PC2 g=1.34 vs Control, 0.23 vs SM). Overall, adding SM to DNS may enhance early pain relief; the magnitude of between-group differences (effect sizes with 95% CIs) supports interpretation, while clinical relevance should be considered alongside established MCIDs and confirmed in larger trials with longer follow-up.
- MakaleAçık Erişim2025COMPARISON OF INSTANT EFFECT OF LUMBAL AND SACROILAC SPINAL MANIPULATION ON FLEXIBILITY AND JUMPING PERFORMANCE IN PROFESSIONAL SOCCER PLAYERS
Dönmez, Beyza; Hatik, Sefa Haktan; Büyükkirli, Ilker Can; Aydin, Emine Busra
Recent evidence suggests that spinal manipulation can acutely improve mobility and lower-limb performance. This study compared the acute effects of lumbar and sacroiliac chiropractic manipulation on flexibility nd jump performance. Forty-five healthy male participants were randomly assigned to three groups: a Lumbar Manipulation Group (LMG; n = 15), a Sacroiliac Manipulation Group (SMG; n = 15), and a Control Group (n = 15). Flexibility was assessed using the V-Sit and Reach test, while performance was evaluated with vertical and horizontal jump tests. Lumbar manipulation was applied to the dysfunctional lumbar segment in the LMG, and sacroiliac joint manipulation was applied to the dysfunctional sacroiliac region in the SMG. No intervention was performed in the control group. Both manipulation techniques resulted in significant acute improvements in mobility and jump performance compared with the control group (p < 0.05), with the greatest improvement observed in vertical jump height (p = 0.001). No significant differences were found between the LMG and SMG. Spinal manipulation to the lumbar and sacroiliac regions appears to produce acute improvements in mobility and lower-limb power. These findings suggest that spinal manipulation may serve as a short-term performance-enhancing intervention.