Lumbar radiculopathy is a spinal condition caused by compression or irritation of the lumbar nerve roots, leading to radiating leg pain, sensory changes, and functional disability. It commonly affects middle-aged and older adults, impairing daily activities and quality of life. Conservative treatments include medication, physiotherapy, and exercise. Spinal Mobilization with Leg Movement (SMWLM), a Mulligan technique, uses passive vertebral mobilization with active leg motion to reduce nerve compression and improve mobility. Neural flossing, or neurodynamic mobilization, enhances nerve mobility by promoting gliding of nerve roots, especially in cases of restricted neural movement. This study aims to evaluate the effects of spinal mobilization with leg movement (SMWLM) with and without neural flossing technique on pain, disability, and range of motion in patients with lumbar radiculopathy.
This single-blinded randomized clinical trial will be conducted at Noor Al-Shifa Hospital, Lahore, over 10 months following ethical approval. A total of 36 patients (18 in each group) with lumbar radiculopathy will be recruited by using non-probability convenience sampling. Group A will receive spinal mobilization with leg movement (SMWLM) with neural flossing technique, while Group B will receive spinal mobilization with leg movement (SMWLM) only. Each group will undergo treatment 3 times per week for 6 weeks, with each session lasting 45 minutes. Pre- and post-intervention assessments will include pain (NPRS), SLR range of motion (Goniometer), and disability (Modified Oswestry Disability Index). Data will be analyzed using SPSS version 26
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
The participant will be positioned in side-lying with limb where the pain radiated to on top. Therapist 1 will stand at the participant's ventral side and apply transverse glide with the thumb on the involved lumbar spinous process. Therapist 2 will then abduct the affected leg by 10° and take the limb gently into hip flexion with knee extended, while the glide will be sustained continuously by therapist 1. The entire motion during mobilization will be maintained pain-free. The participant will be positioned in side-lying with limb where the pain radiated to on top. Therapist 1 will stand at the participant's ventral side and apply transverse glide with the thumb on the involved lumbar spinous process. Therapist 2 will then abduct the affected leg by 10° and take the limb gently into hip flexion with knee extended, while the glide will be sustained continuously by therapist 1. The entire motion during mobilization will be maintained pain-free.
The participant will be positioned in side-lying with limb where the pain radiated to on top. Therapist 1 will stand at the participant's ventral side and apply transverse glide with the thumb on the involved lumbar spinous process. Therapist 2 will then abduct the affected leg by 10° and take the limb gently into hip flexion with knee extended, while the glide will be sustained continuously by therapist 1. The entire motion during mobilization will be maintained pain-free. The procedure will be repeated three times as per Mulligans rule of 3, post which the SLR test and NPRS will be re-measured
Physio house (Comprehensive Rehab Center)
Lahore, Punjab Province, Pakistan
Numeric Pain Rating Scale for Pain
It is a widely used subjective measure for assessing pain intensity, where patients rate their pain on a scale from 0 (no pain) to 10 (worst imaginable pain). It has high test-retest reliability (ICC = 0.92) and strong construct validity for acute and chronic musculoskeletal conditions
Time frame: upto 4 weeks
Goniometer for ROM
It is a clinical instrument used to measure joint range of motion in degrees, commonly applied in musculoskeletal assessments. It demonstrates excellent intra-rater (ICC = 0.95) and inter-rater reliability (ICC = 0.89), with strong validity when compared with digital motion analysis tools
Time frame: Upto 4 weeks
Modfied Oswestry Disability Index for disability
It is a self-reported questionnaire used to assess disability due to low back pain, covering aspects such as pain, mobility, and daily activities. It is a highly valid tool (construct validity r = 0.75) with excellent reliability (Cronbach's alpha = 0.90, ICC = 0.91), making it one of the most commonly used functional outcome measures in spine-related research
Time frame: Upto 4 weeks
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