Lumbar Radiculopathy
Conditions
Keywords
Neural Mobilization, Mulligan Technique, Manual Therapy
Brief summary
Lumbar radiculopathy is a spinal nerve root disorder often caused by lumbar disc herniation or compression, leading to radiating leg pain, restricted movement, and functional difficulties. This condition significantly disrupts daily activities and overall quality of life. While medication and exercise are common treatments, manual therapy techniques are gaining recognition for their non-invasive and effective outcomes in relieving symptoms and improving patient function.
Detailed description
This randomized clinical trial will be conducted in Physiotherapy outpatient department of Jinnah Hospital Lahore. It will include 52 participants, aged 20 to 40 years, meeting clinical criteria for lumbar radiculopathy. Participants will be selected from an outpatient physiotherapy department and assigned randomly into two equal groups. Group A will receive the MBLR technique, while Group B will undergo the SMWLM technique. Both interventions will be applied three times a week for four weeks under standardized protocols. Key outcome measures include pain intensity assessed using the Numeric Pain Rating Scale (NPRS), neural mobility evaluated through the Straight Leg Raise (SLR) and Slump Test, and functional status measured using the Oswestry Disability Index (ODI), Timed Up and Go (TUG) test, and 5 Repetition Sit-to-Stand test for postural balance. Assessments will be conducted at baseline, after 2 weeks, at 4 weeks post-intervention, and at 8-week follow-up. Data analysis will be done by SPSS version 25. To ensure objectivity, all assessments will be conducted while keeping the patient unaware of their group assignment.
Interventions
OTHERMulligan Bent Leg Raise (MBLR)
Patient Position - Supine at edge of plinth * Affected hip and knee flexed to 90° * Hand of affected side under head and neck Therapist Position - Stands in walk stance, lateral to affected limb Therapist Hand Placement - Inner shoulder under popliteal fossa * Both hands grasp lower thigh Mobilization Procedure - Apply longitudinal traction along femur * Flex hip toward same side shoulder until first resistance * Patient performs isometric hold (5 sec) * On relaxation, increase hip flexion if pain free * Hold new position \~20 sec * Repeat 3 times if tolerated Precautions - Maintain knee flexion * No need to stabilize opposite leg
Patient Position - Side-lying on unaffected side near edge * Affected leg on top, supported by assistant * Hip abducted \~10°, extended; knee flexed \~45° Therapist Position - Primary therapist behind pelvis * Assistant supports upper leg during movement Therapist Hand Placement - Supported thumb on spinous process of affected vertebra * Gentle transverse pressure maintained throughout movement Mobilization Procedure - Assistant helps patient actively lift leg (SLR) * Movement within pain free range * If symptoms appear, hold for \~3 sec then return * Start with 3 reps; increase to 6 with light overpressure as tolerated Precautions - Stay within non painful range * Maintain steady, controlled transverse pressure * Avoid excessive force, especially early on
Sponsors
Riphah International University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Age 20 to 40 years (26) * Diagnosed patient with Unilateral Lumbar Radiculopathy secondary to L4/L5 and L5/S1 lumbar posterolateral disc buldge confirmed on MRI (12) * Posterolateral Lumbar Radiculopathy
Exclusion criteria
* • Presence of red flags (e.g., cauda equina syndrome, severe neurological deficits). * Previous spinal surgery within 1 year. * Severe osteoporosis or vertebral fractures. * Pregnant women. * Systemic inflammatory or autoimmune diseases.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| NPRS for pain | upto 4 weeks | Pain intensity will be evaluated using the Numeric Pain Rating Scale, which ranges from 0 indicating "no pain" to 10 representing the "worst possible pain." It has shown excellent test-retest reliability, with intraclass correlation coefficients (ICC) ranging between 0.95 and 0.98 in individuals with musculoskeletal conditions |
| SLR and Slump test for neural mobility | Upto 4 weeks | To assess neural mobility, the Straight Leg Raise and Slump Tests will be employed. These are well-established clinical tools for identifying lumbar nerve root irritation. The SLR test demonstrates strong diagnostic accuracy (\~81%) and excellent inter-rater reliability with kappa values above 0.90 and aprox 0.71 for slump test |
| Oswestry Disability Index test for functional outcome | Upto 4 weeks | The ODI will be used to determine the level of functional disability associated with lower back pain. It includes 10 items that assess various aspects of daily activity. The tool has proven to be highly reliable (Cronbach's alpha = 0.87) and valid across different patient populations with lumbar spine conditions |
| Time up and go (TUG) test for functional outcome | Upto 4 weeks | Balance and functional mobility will be measured using the TUG test, which involves timing a patient as they rise from a chair, walk three meters, turn, return, and sit down. This test is highly reliable (ICC = 0.82 to 0.99) and shows good concurrent validity in both spinal and geriatric populations (34). The cutoff value for balance and functional mobility TUG test is 7.2 sec |
| Five repetition sit to stand test | upto 4 weeks | The 5 Rep Sit-to-Stand Test will be used to assess lower limb strength and functional performance. The patient gets to their maximum standing position and then sits back down five times as fast as they can without the use of their hands or arms. It has demonstrated excellent reliability (ICC \> 0.90) and shows strong correlation with functional ability (36). The cutoff value is \> 10 sec for 5 rep sitting to standing and standing to sitting transition |
Countries
Pakistan
Contacts
CONTACTAmna Zia, PhD*
CONTACTSamrood Akram, PhD*
PRINCIPAL_INVESTIGATORAmna Zia, PhD
King Edward Medical University
PRINCIPAL_INVESTIGATORMuniba Tahir
Riphah International University, Lahore Campus
Outcome results
None listed