The purpose of the present study to compare between the effect of neurodynamic moblizaton and Mulligan SNAG's moblization on patients with chronic unilateral discogenic sciatica.
Sciatica is a common problem in patients suffer from lumbar disc prolapse with an incidence of five cases per 1000 adults in developed countries . Sciatica causes significant disability. When applying neurodynamics, tension occurs in the nervous system, and pressure within the nerve increases due to the decrease of the cross-sectional area, and the axonal transport system lengthens the sciatic nerve after shortening because of the influence of the surrounding related structures and hamstring flexibility . After extention of the nerve and muscle, muscle performance is improved because of increases in the number of muscle fiber segments and cross-sectional area of muscle fibers.The majority of the research concerned with SNAG techniques has concentrated on the study of peripheral joints and the cervical region. Few studies have been concerned with the effects of SNAG on the lumbar spine. The rest of the available research was in the form of case reports or case series. Only 5 trials have investigated different effects of the SNAG technique when applied to the lumbar region. This study will improve the conservative treatment for sciatica and will decrease the cost of treatment and disability of the patient.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
66
the patients will receive neurodynamic mobilization in the form of opening technique which include; static opening and dynamic opening. also, sliding and tensioning technique+ selected physical therapy program
sustained natural apophyseal glide SNAGs are mobilisation techniques and are used as part of the Mulligan Concept+ selected physical therapy program The patient position is stitting on the edage of the plenth non weight bearing position. The therapist will stand behind the patient, the therapist will apply SNAG for 3 repetitions during the initial screening session,the patient will be asked to lean forwared while applying the technique .the therapist apply onle from fove to seven repetitions.patients who experienced no worsening or showed improvement of pain and ROM were considered good indication for the effectivness of treatment .
Faculty of physical therapy, Cairo University
Cairo, Egypt
pressure pain threshold
ALgometer offer real-time visual \& auditory feedback to control \& monitor applied pressure rates to measure pressure pain threshold.
Time frame: up to four weeks
pain intensity
Sciatica Bothersomeness Index will be used to assess pain intensity. An index based on patients reporting of symptoms which reflects the troubled patient is going through with his sciatica symptoms. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain.
Time frame: up to four weeks
Range of motion assessment of straight leg raise
A unilevel inclinometer will be used to assess the straight leg raise (SLR) test. From supine lying position on a flat plinth towards the side of the examiner, with the neck in a neutral position. The examiner places one hand under the Achilles tendon and the other hand held the inclinometer. The inclinometer must be held in a vertical position during the SLR test by the examiner's hand between the index and the middle fingers and center of inclinometer will be positioned on the lower third of tibia. The leg will be lifted perpendicular to the point at which the patient expressed the perception of pain and the therapist will prevente any knee flexion. The angle of hip flexion during SLR will be measured
Time frame: up to four weeks
disability
Roland-Morris Disability Questionnaire will be used to assess disability.The RMQ is a 24-item patient-reported outcome measure that inquires about pain-related disability resulting from LBP and discogenic sciatica .total RMQ score ranging from 0 to 24; higher scores represent higher levels of pain-related disability
Time frame: up to four weeks
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The program of therapeutic exercises consisted of upper and lower back exercises. Each exercise will repeat from ten to thirty times, three repetitions in three sets with rest one to two minutes between the sets. The repetition of each exercise vary according to the physical ability of each patient. Lower back strengthening exercises: From prone lying position, the patient will asked to raise one lower limb then the other then both lower limbs+ TENS and US