In rotational side-posture lumbar manipulation, the impact of the facet joints limits axial rotation of the lower lumbar vertebrae and consequently prevents annulus fibrosus tearing . In the present study, patients with sequestrated LDH who had neurological signs were excluded because these patients may have bowel and bladder disorders, and many (but not all) of them are thus candidates for surgery . In the present study manipulation was applied in the neutral flexion–extension position to reduce the risk of injury.