The use of spinal manipulative therapy (SMT) for patients with SLDD has also been suggested; however, its safety and indications have remained debatable, particularly in individuals with disc disruption or instability . In this regard, the risk of SMT causing clinically worsened disc herniation or cauda equine syndrome in patients with LDH is estimated to be less than one in 3.7 million . A systematic review in 2004 also confirmed the safety and effectiveness of SMT for patients with SLDD .