Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy: a randomized controlled trial

Key points

1. 01Non-surgical decompression plus routine physical therapy outperformed routine physical therapy alone on every primary and most secondary outcomes after 4 weeks
2. 02Pain reduction was 3.61 cm vs 0.96 cm on VAS (large effect d=1.07) in favour of the decompression group
3. 03Lumbar flexion improved by 3.21 cm vs 0.77 cm and extension by approximately 1.80 cm vs 0.99 cm, both with large effect sizes
4. 04Functional disability (ODI) improved by 14.72 vs 10.32 points and back muscle endurance by 42.55 s vs approximately 24.32 s in favour of decompression
5. 05Quality of life improved significantly in the physical role and bodily pain domains for the decompression group; other QOL domains did not differ significantly between groups

How it was conducted

Design

Single-blind randomised controlled trial

Participants

60 patients (28 male, 32 female) aged 25-55 years with lumbar radiculopathy confirmed by clinical examination and X-ray or MRI

Setting

Outpatient physical therapy department, Pain Center Lahore, Pakistan; January 2020 to June 2021

Groups

Experimental (n=30): spinal decompression therapy (SPINEMT device) plus routine physical therapy; Control (n=30): routine physical therapy alone (TENS, ultrasound, hot pack, core stabilisation exercises, stretching)

Duration

4 weeks, 3 sessions per week (12 sessions total)

Primary outcomes

Pain intensity (VAS 0-10) and lumbar range of motion (modified-modified Schober test)

What they found

• Pain (VAS): mean change 3.61 plus or minus 1.27 vs 0.96 points; F(1,57) significant p<0.001; effect size d=1.07 (95% CI 0.53-1.61) favouring decompression group
• Functional disability (ODI-U): mean change 14.72 vs 10.32 points; F(1,57)=17.260, p<0.001; effect size d=0.98 (95% CI 0.45-1.52) favouring decompression group
• Back muscle endurance: mean change 42.55 s vs approximately 24.32 s; F significant p=0.002; effect size d=0.61 (95% CI 0.09-1.13) favouring decompression group
• Lumbar flexion ROM: mean change 3.21 cm vs 0.77 cm; F(1,57)=93.43, p<0.001; effect size d=2.47 (95% CI 1.79-3.14) favouring decompression group
• Lumbar extension ROM: mean change approximately 1.80 cm vs 0.99 cm; F(1,57)=12.23, p<0.001; effect size d=0.87 (95% CI 0.34-1.40) favouring decompression group
• SF-36 Role Physical (RP): mean change 12.77 vs 0.41 points; p=0.019, F(1,57)=6.17; effect size d=0.622 (95% CI 0.10-1.14) favouring decompression group
• SF-36 Bodily Pain (BP): mean change 14.30 vs 7.08 points; p=0.016; effect size d=0.649 (95% CI 0.13-1.17) favouring decompression group
• SF-36 Physical Functioning, General Health, Vitality, Social Functioning, Role Emotional, Mental Health domains: no statistically significant between-group difference (p>0.05)

Limitations

• The experimental group received additional therapy time compared to the control, which may have introduced a Hawthorne effect and inflated patient-reported outcomes
• Patients could not be blinded to treatment allocation due to the nature of the intervention, which may have biased self-reported outcomes
• No long-term follow-up was conducted (limited by COVID-19 pandemic), so durability of benefits beyond 4 weeks is unknown
• Some control group therapies (TENS, ultrasound, hot pack) are not internationally guideline-based, limiting generalisability outside the Pakistani clinical context

Why it matters

For patients

Patients with lumbar radiculopathy may achieve faster and greater pain relief and functional recovery if their physical therapy programme includes non-surgical spinal decompression, though long-term benefits remain unconfirmed.

For clinicians

Clinicians should consider adding computerised non-surgical decompression to conventional physical therapy for lumbar radiculopathy, while noting that additional treatment time and potential placebo-related effects may partly explain the results.

For readers

This single-blind RCT provides moderate-quality evidence that spinal decompression is a useful adjunct, but the absence of a sham control and short follow-up mean higher-quality trials are needed before routine adoption.