Effectiveness of manual therapy on central sensitization in patients with non-specific chronic low back pain: A randomized controlled trial.

Abstract

BackgroundCentral sensitization (CS), characterized by amplified nociceptive processing within the central nervous system, is considered a key mechanism in chronic nonspecific low back pain (CNLBP). Although manual therapy (MT) is widely used in musculoskeletal rehabilitation, its effectiveness in patients with confirmed CS remains unclear. This study evaluated the effects of MT on CS, pain, disability, and quality of life in individuals with CNLBP.MethodsForty participants with physician-diagnosed CNLBP and CS (CSI ≥40) were randomly assigned to either an MT group (<i>n</i> = 20) or a conventional physiotherapy group (CT, <i>n</i> = 20). Both interventions were administered over a 4-week period. Outcomes included the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and SF-36 Health Survey. Pre- and post-treatment scores were compared within and between groups.ResultsBoth groups demonstrated significant post-treatment improvements. In the MT group, significant improvements were observed in VAS, CSI, and ODI scores (all <i>p</i> < 0.001). In the CT group, significant improvements were also observed in VAS (<i>p</i> < 0.001), CSI (<i>p</i> = 0.044), and ODI (<i>p</i> = 0.009). Between-group analyses demonstrated significantly greater improvements in the MT group for CSI (<i>p</i> < 0.001), VAS (<i>p</i> = 0.045), and ODI (<i>p</i> = 0.010). Significant improvements across all SF-36 domains were observed in the MT group, whereas the CT group improved only in role limitations. Between-group comparisons showed greater improvements in physical function and general health perception in the MT group<b>.</b>ConclusionBoth interventions improved outcomes in patients with CNLBP and CS; however, adding MT to CT produced greater improvements in CS, pain, disability, and quality of life than CT alone.