Spinalmanipulationandelectricaldryneedlingasanadjuncttoconventionalphysicaltherapyinpatientswithlumbarspinalstenosis:amulti-centerrandomizedclinicaltrial

Lumbar spinal stenosis (LSS) is a common condition, especially in older adults, where the spaces around the nerves in the lower back become narrowed. This narrowing can cause pain, cramping, and weakness in the legs that worsens with standing or walking and improves when sitting or leaning forward. It is the most frequent reason for spinal surgery in people over 65 in the United States. While non-surgical treatments like physical therapy are commonly used, there is limited evidence about whether adding specialized techniques—specifically spinal manipulation and electrical dry needling—to standard physical therapy can provide additional benefits for people with LSS.

The researchers conducted a randomized clinical trial across 12 outpatient physical therapy clinics in 8 U.S. states. They recruited 128 adults aged 50 and older who had symptoms of neurogenic claudication (leg pain with walking that improves with rest) and confirmed lumbar spinal stenosis on imaging. Participants were randomly assigned to one of two groups: one group received conventional physical therapy alone (exercise, manual therapy, and electro-thermal modalities), while the other group received the same conventional therapy plus two additional treatments—electrical dry needling and thrust spinal manipulation. All participants received 8 to 12 treatment sessions over up to 6 weeks, with follow-up assessments at 2 weeks, 6 weeks, and 3 months.

The study was single-blinded, meaning the examiners who assessed outcomes did not know which treatment each participant received.

At the 3-month follow-up, the group that received spinal manipulation and electrical dry needling in addition to conventional therapy showed significantly greater improvements than the conventional therapy alone group. For overall pain intensity (measured on a 0-10 scale), the combination group had greater reductions at all time points: by 2 weeks (mean difference -0.8 points, p=.012), 6 weeks (mean difference -1.1 points, p=.006), and 3 months (mean difference -1.3 points, p=.003). For disability measured by the Oswestry Disability Index (0-50 scale), the combination group showed significantly greater improvements at 6 weeks (mean difference -2.9 points, p=.019) and 3 months (mean difference -4.9 points, p<.001). Similar patterns were seen with the Roland Morris Disability Index.

Effect sizes were small at 2 and 6 weeks but reached medium magnitude at 3 months. Regarding successful outcome—defined as feeling "quite a bit better" or more on the Global Rating of Change scale—significantly more patients in the combination group achieved this at 3 months (71% vs 44%, p=.003). The number needed to treat was 3.8, meaning about 4 patients would need to receive the combined treatment for one additional patient to achieve a successful outcome compared to conventional therapy alone. Additionally, significantly more patients in the combination group completely stopped taking pain medication at 3 months (42% vs 24%, p=.033).

Adverse events were minor and included post-needling soreness (60% of combination group) and mild bruising (35.4%), both resolving within a few days.

For patients with lumbar spinal stenosis, adding electrical dry needling and spinal manipulation to a standard physical therapy program may provide meaningful additional benefits, particularly for longer-term outcomes at 3 months. The improvements in pain and disability, while statistically significant, were modest in absolute terms and did not reach the threshold considered minimally clinically important for all measures. However, the higher rate of patients reporting feeling substantially better and the reduced need for pain medication suggest real-world value for some individuals. For clinicians, this supports considering these adjunctive therapies for patients with LSS who are pursuing conservative management, especially when immediate short-term gains are less critical than sustained improvement.

The lack of a sham or placebo comparison group means some of the observed benefit could be due to non-specific effects, and the additional time and attention in the combination group may have contributed. Patients should discuss these options with their physical therapist, weighing potential benefits against factors like cost, availability of trained providers, and personal comfort with needling procedures.