RecruitingNot ApplicableNCT07573124

Efficacy of Combining Mulligan Spinal Mobilization With Leg Movement and Mechanical Lumbar Traction in Lumbar Radiculopathy

Efficacy of Combining Mulligan's Spinal Mobilization With Leg Movement Technique and Mechanical Lumbar Traction Among Patients With Lumbar Radiculopathy: A Randomized Controlled Trial

Sponsor

Khyber Medical University Peshawar

Enrollment

32 participants

Start Date

Apr 1, 2026

Study Type

INTERVENTIONAL

Conditions

Lumbar Radiculopathy

Summary

Lumbar radiculopathy (LR), often caused by disc herniation, results in significant pain, disability, and reduced quality of life. Spinal Mobilization with Leg Movement (SMWLM) is a manual technique that has shown promise, while mechanical lumbar traction is used to reduce nerve compression, though its standalone effectiveness is debated. This randomized controlled trial aims to compare the combined effect of SMWLM plus mechanical lumbar traction against SMWLM alone, both administered with conventional physiotherapy. Outcomes will be assessed over 4 weeks to determine if the combined intervention offers superior pain relief, functional improvement, and range of motion in patients with unilateral L4-L5 or L5-S1 radiculopathy.

Eligibility

Min Age: 20 YearsMax Age: 50 Years

Inclusion Criteria6

Age 20-50 years
Male and female participants
Unilateral radiculopathy due to L4-L5 or L5-S1 disc bulge, confirmed by clinical examination and MRI
Symptom duration of 4 weeks to 6 months
Positive Straight Leg Raise (SLR) test on the affected leg (<70° of hip flexion)
Pain intensity <7 on the Numeric Pain Rating Scale (NPRS; mild to moderate pain)

Exclusion Criteria6

Cognitive impairment, dementia, central cord signs
Inflammatory or degenerative spine conditions
Spine surgery within the last 6 months
Pregnant women in the later half of 2nd trimester or 3rd trimester
Muscular involvement (e.g., Deep Gluteal syndrome, Piriformis syndrome)
Currently receiving medications or other contemporaneous treatment

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Interventions

PROCEDURESpinal Mobilization with Leg Movement (SMWLM)

The therapist positions the patient side-lying on the unaffected side with the affected leg slightly abducted. A sustained transverse manual glide is applied to the spinous process of the superior vertebra of the involved lumbar segment (e.g., L4 for an L4-L5 lesion). Simultaneously, the patient actively lifts the leg into hip flexion and knee extension, ensuring the movement remains pain-free. Dosage: 3 sets of 7-10 repetitions per treatment session.

PROCEDUREMechanical Lumbar Traction

Following SMWLM, the patient is placed supine in a Fowler position with hips and knees flexed to 90°, lower legs supported. An intermittent distractive force (up to 50% of body weight) is delivered using an automatic traction device (e.g., PH-T3021). The traction cycle consists of a 30-second hold and a 10-second rest, with a 1-minute ramp-up and ramp-down, for a total of 15 minutes.

PROCEDUREConventional Physical Therapy

All participants receive a standardized conventional therapy program consisting of: * Moist hot pack on the lumbar region for 10 minutes. * Transcutaneous electrical nerve stimulation (TENS) with 50-100 ms pulse width for 10 minutes, electrodes placed over the lumbar spine and affected lower limb. * Supervised therapeutic exercises: heel sitting (lumbar flexion), drawing-in maneuver, bridging, and pelvic tilting (2 sets of 5-7 repetitions per session). * Home exercise program: same exercises performed daily, 3 sets of 10 repetitions, with progression as tolerated.