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.
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
• 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.
Parallel
Mulligan Bent Leg Raise (MBLR)
Other interventionPatient 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
Spinal Mobilization With Leg Movement (SMWLM)
Other interventionPatient 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
NPRS for pain
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
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
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
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
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