Effect of Active Versus Passive Lower Extremity Neural Mobilization in Lumber Radiculopathy
Condition: Lumbar Radiculopathy
MeSH terms: Radiculopathy
Study type: Interventional

Summary: 
      The aim of this study was to find out the effects of active versus passive lower extremity
      neuralmobilizations combined with lumbar traction and lumbar mobilization in patients with
      lumbarradiculopathy. The study was conducted in shalamar hospital Lahore and was completed
      within 6 month of time duration. Sample size of twenty four patient consists of both male and
      female aged between 45 years to 65 years. Each group contain 12 patients. Group A received
      active neural mobilizations whereas group B received passive neural mobilization along with
      lumber traction and mobilization. Patients were re assessed at the end of 6 weeks through SLR
      , NPRS and ODI.
    

Detailed description: 
      Lower back pain is found to be one of the common health condition approximately 80% of
      individual experience back pain once in their lives. Radicular lower back pain is also a
      disorder that involves the dysfunction of the nerve roots of lumbosacral region. Its symptoms
      include radiating pain with numbness, paraesthesia and muscle weakness. In general population
      the annual prevalence of lumber radiculopathy varied from 9.9% to 25% .. Many of the spinal
      structures notably ligaments, paravertebral muscles, facet joints, spinal nerve roots and
      annulus fibrosis have been considered as the main cause of the pain. Clinical examinations
      mostly aim to clarify that whether a nerve root has mechanical impingement. The common
      clinical diagnostic tests include tests for tendon reflexes, straight leg raise test(SLR),
      sensory deficits and motor weakness. Several clinicians and researchers have come up with
      several debates for the treatment of Lower back pain. But not many studies have come up that
      actually authenticates that how much effective are physical therapy interventions. The common
      treatments for radical lower back pain includes physical modalities like TENS, ultrasound,
      Heat and Cryotherapy, lumbar traction and lumbar spinal mobilizations. Kinesiotherapy
      including ROM exercises and strengthening are also used to treat lower back pain. Neural
      mobilization techniques actually help in restoring the plasticity of nervous system.
      Plasticity of nervous system is actually the ability of the nerve surrounding structures to
      adapt of shift according to other structures. The aim of mobilization is actually to increase
      the collagen flexibility that helps in maintaining the integrity and movement of the nerve
      according to its surrounding structures. Radiculopathy management and lower back pain
      management have a direct link with neural mobilization.

      However, evidence lacks whether active or passive lower extremity neural mobilization is more
      effective. Thus, the purpose of the current study is to compare the effects of active and
      passive neural mobilization in the management of lumbar radiculopathy, in combination with
      mechanical traction and joint mobilization.

      In 2016 an RCT was conducted and concluded the efficacy of neural mobilization techniques in
      patients with radicular low back pain. They concluded that neural mobilizations techniques in
      radicular low back pain are effective. They stated that these techniques reduce the pain,
      functional disability and enhance the physiological functioning of the nerve root in patients
      in low back pain with lumbosacral radiculopathy . In 2014 A comparative study was conducted
      and found that lower extremity neural mobilizations along with conventional physiotherapy
      such as lumbar traction and lumbar mobilizations improves the agility in lower extremity and
      reduces pain and disability.

      2013 a Study was conducted to observe observed the effects of neural mobilizations in the
      patients with radicular low back pain and concluded that patients treated with neural
      mobilizations showed better VAS score. They stated that further research is needed in order
      to assess the long-term effects of treatment and treatments provided on more than one
      occasion.

      The purpose of the study was to determine the effects of active verses passive lower
      extremity neural mobilizations combined lumbar traction and lumbar mobilization so that in
      future this study should be helpful for other researchers to determine which therapy is most
      helpful in rehabilitation of the patients with radicular low back pain signs and symptoms.
    

Intervention name(s): Active neural mobilization; passive neural mobilization
Intervention type(s): Other; Other
Intervention description(s): Active neural mobilization Base line treatment followed heating pad 10 minutes, lumber traction with 50 %of body weight in accordance with tolerance. 15 to 20 Lumber segmental mobilization.
Active oscillatory nerve mobilization was given in 3 sets of 10 repetition in each set with 20 sec rest time between set; Base line treatment followed heating pad 10 minutes, lumber traction with 50 %of body weight in accordance with tolerance. 15 to 20 Lumber segmental mobilization
Passive neural mobilization This oscillatory nerve mobilization was given in 3 sets of 10 repetition in each set with 20 sec rest time between set. Both groups received total 18 session 3 session per week for consecutive 6 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Active Neural Mobilization; Lumber Traction; Lumber Mobilization; Passive Neural Mobilization; Lumber Radiculopathy