CONTEXT: The biopsychosocial approach to managing low back pain (LBP) has the potential to improve the quality of care for patients. However, LBP trials that have utilized the biopsychosocial approach to treatment have largely neglected sexual activity, which is an important social component of individuals with LBP. OBJECTIVES: The objectives of the study are to determine the effects of manual therapy plus sexual advice (MT plus SA) compared with manual therapy (MT) or exercise therapy (ET) alone in the management of individuals with lumbar disc herniation with radiculopathy (DHR) and to determine the best sexual positions for these individuals. METHODS: This was a single-blind randomized controlled trial. Fifty-four participants diagnosed as having chronic DHR (> 3 months) were randomly allocated into three groups with 18 participants each in the MT plus SA, MT and ET groups. The participants in the MT plus SA group received manual therapy (including Dowling's progressive inhibition of neuromuscular structures and Mulligan's spinal mobilization with leg movement) plus sexual advice, those in the MT group received manual therapy only and those in the ET group received exercise therapy only. Each group received treatment for 12 weeks and then followed up for additional 40 weeks. The primary outcomes were pain, activity limitation, sexual disability and phobia at 12 weeks post-randomization. RESULTS: The MT plus SA group improved significantly better than the MT or ET group in all outcomes (except for nerve function), and at all timelines (6, 12, 26, and 52 weeks post-randomization). These improvements were also clinically meaningful for back pain, leg pain, medication intake, and functional mobility at 6 and 12 weeks post-randomization and for sexual disability, activity limitation, pain catastrophizing, and phobia at 6, 12, 26, and 52 weeks post-randomization (p < 0.05). On the other hand, many preferred sexual positions for individuals with DHR emerged, with side-lying being the most practiced sexual position and standing being the least practiced sexual position by females. While lying supine was the most practiced sexual position and sitting on a chair was the least practiced sexual position by males. CONCLUSIONS: This study found that individuals with DHR demonstrated better improvements in all outcomes when treated with MT plus SA than when treated with MT or ET alone. These improvements were also clinically meaningful for sexual disability, activity limitation, pain catastrophizing, and phobia at long-term follow-up. There is also no one-size-fits-all to sexual positioning for individuals with DHR.
Reprinted from JAOA, The Journal of the American Osteopathic Association. Copyright American Osteopathic Association. Permission given with the consent of the American Osteopathic Association.

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