This study will be conducted to evaluate the effect of sciatic nerve slider mobilization on pain intensity. Also, to evaluate the impact of sciatic nerve mobilization on functional disability, and to determine the influence of sciatic nerve slider neurodynamics on functional balance performance.
Chronic unilateral lumbar painful radiculopathy (duration ranged from 3 to 18 months).
During the evaluation session, repeated lumbar movements did not improve or worsen lower extremity symptoms.
Positive straight leg raise (SLR) response. A positive SLR test was defined as the presence of both of these findings: (1) the test reproduced the patient's symptoms and (2) the symptoms decreased with the ankle plantar flexion component of the test.
Unilateral Pain radiating below the knee, with leg pain equal to or more severe than the accompanying back pain.
Systemic diseases such as autoimmune and metabolic diseases.
Previous Lumbar Spine surgery.
Lumbar spine stenosis.
Spinal deformity.
Parallel
Selected conventional physical therapy program
Other interventionThe program will include: 1- Transcutaneous electrical nerve stimulation (TENS) will be applied at Lumbosacral area, with pulse frequency of 100 Hz for 15 minutes. 2\) Manual therapy intervention: Myofascial release will be performed on low back muscles and gluteus, piriformis, hamstring, and calf of the affected lower extremity applied for 20 minutes. Following side posture positional distraction, the wedge pillow will be removed and the patient is maintained in the same position. The physical therapist performed passive spinal rotation mobilization. Finally, high-velocity low-amplitude (HVLA) manipulation will be applied from the same position. 3\) Core stability exercises: They are consisted of of side plank on knee or ankle on both sides, and clamshell exercise. The clamshell exercise consists of three sets of ten repetitions. Side plank will be performed three times in a static manner for 10-20 seconds or up to patient failure.
Sciatic nerve slider mobilization
Other interventionMobilization will be applied from supine position, alternating hip flexion with knee extension and dorsiflexion, and knee flexion with plantar flexion, performed three times for 1 minute straight leg raising technique rhythmically
Pain pressure threshold
It will be assessed by pressure pain algometer to measure this tenderness to palpation. An electronic digital algometer (Biotronik Care, Mars OneSKU: SF1005, India). Manual palpation with mild pressure will be utilized from supine to the common peroneal nerve, which passes behind the head of the fibula and runs around the neck of the fibula; from prone to the sciatic nerve at the midpoint of a line from the ischial tuberosity to the greater trochanter of the femur; and the tibial nerve, which bisects the popliteal fossa at the midpoint of the popliteal crease. Positive reporting consists of pain or discomfort on the symptomatic side, as well as greater pain or discomfort on the symptomatic side than on the asymptomatic side. Three measurements will be performed at each test site, with a 10-second pause between each. The average of the three measurements will be calculated.
Functional Disability
The Roland-Morris Disability Questionnaire will be used to assess functional disability. It includes 24 items with face validity to describe patients with low back pain. The Roland-Morris Disability Questionnaire has excellent psychometrics, is simple to administer, and has been found to be effective in therapy research studies. Items are scored 0 if left blank or 1 if endorsed, for a total RMQ score ranging from 0 to 24; higher scores represent higher levels of pain-related disability.
Balance Evaluation
It will be assessed by the Berg Balance Scale (BBS) is an objective measure of static and dynamic balance abilities. The scale consists of 14 functional tasks commonly performed in everyday life. Scoring uses a five-point ordinal scale, with scores ranging from 0 to 4. Maximum score of 56 points is possible. Lower scores indicate poor balance.
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