Comparative Effects of Mulligan Bent Leg Raise Versus Spinal Mobilization With Leg Movement in Lumbar Radiculopathy

Official title

Comparative Effects of Mulligan Bent Leg Raise Versus Spinal Mobilization With Leg Movement on Pain, Neural Mobility, Balance and Functional Disability in Lumbar Radiculopathy

Overview

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

• Other Mulligan 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 p
• Other Spinal Mobilization With Leg Movement (SMWLM)
  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

Primary outcome measures

• NPRS for pain [Time frame: upto 4 weeks]
• SLR and Slump test for neural mobility [Time frame: Upto 4 weeks]
• Oswestry Disability Index test for functional outcome [Time frame: Upto 4 weeks]
• Time up and go (TUG) test for functional outcome [Time frame: Upto 4 weeks]
• Five repetition sit to stand test [Time frame: upto 4 weeks]

Eligibility criteria

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.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Femwell Physiocare Woman Rehab clinic — Lahore

Publications

• Senol D, Erdem C, Canbolat M, Toy S, Karatas T, Baykara RA, Ozbag D, Akyurek G. Comparison of the effects of conventional physiotherapy and proprioception exercises on pain and ankle proprioception in patients with lumbar radiculopathy. J Back Musculoskelet Rehabil. 2022;35(2):421-428. doi: 10.3233/BMR-200361. PMID 34308899
• Ashraf B, Ahmad S, Ashraf K, Kanwal S, Ashraf S, Khan N, et al. Effectiveness of spinal mobilization with leg movement versus McKenzie back extension exercises in lumbar radiculopathy. 2021;15(5):1436-40.
• Fatima A, Mehmood Z, Ahmad SJJoIIMC. Effects of Mulligan Traction Straight Leg Raise Versus Passive Straight Leg Raise in Lumbar Radiculopathy Patients. 2022;17(2):86-90.
• Singh V, Malik MJRJoN. Lumbar radiculopathy managed with spinal mobilization with leg movement: A case study. 2021;20(2):246-9.
• Naidu SP, Srikantaiah S, Boyle RJIJoPT, Research. Immediate Effect of Mulligan's Spinal Mobilization with Limb Movements on Straight Leg Raise Test in Patients with Lumbar Radiculopathy: A Randomized Controlled Trial. 2023;5(1):66-72.
• Singh V, Malik MJAiR. Effect of manual therapy on pain, disability and neural mobility in patients of lumbar prolapsed intervertebral disc: a randomized controlled trial. 2022;36(3):11-8.
• Yasmeen S, Ahmad Z, Ishtiaq NJJRCoRS. The comparative effects of Butler's neural tissue mobilization and Mulligan's Bent leg raise in patients with chronic lumbar radiculopathy. 2022;10(02).
• Lin LH, Lin TY, Chang KV, Wu WT, Ozcakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life (Basel). 2023 Nov 26;13(12):2255. doi: 10.3390/life13122255. PMID 38137856

Identifiers

NCT: NCT07726823 · REC/RCR&AHS/25/0132 Muniba

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗