## 2 Materials and Methods  
### Study Design and Participants  
In this prospective cohort study, patients from the Baile Felix Recovery Hospital (Romania) were consecutively recruited between October 2020 and January 2021. The study was approved by the local Ethics Committee (approval no. 9406/13.10.2020) and was conducted in accordance with the principles of the Declaration of Helsinki. All participants provided their written consent before participating in the study.  
Inclusion criteria were ages of 30-75 years, an MRI-confirmed diagnosis of lumbar disc herniation, and the presence of low back and/or leg pain due to disc herniation. Exclusion criteria for the study were: spinal tumor, spondylicositis, osteoporortic fractures, narrowed spinal canal (stenosis), inflammatory rheumatic diseases, and history of back surgery.  
A total of 125 patients met the inclusion criteria. From this, 77 patients signed the written consent form before participating in the study. Participants from two cohorts were included in the analysis.  
First, we followed 38 patients who benefited from a complex recovery program, composed of the conservatory physical therapy program combined with Vojta therapy procedures (Group A). The second cohort included patients who only followed the conservative physiotherapy program (Group B).  
The conservatory physical therapy program was the same for both cohorts, consisting of one treatment session daily, five times per week, and a total of 10 session.  
The physical therapy program lasted 50 min and included mobility and strength exercises and motor control exercise. The exercises focused on strengthening the trunk and pelvic floor muscles, and functional restoration techniques. Physiotherapy exercises were individualized and adapted according to the patients' specific impairments and the frequency and intensity of the exercises were adapted according to the progress.  
Patients from group A benefited from 30 min of Vojta therapy procedures, in addition to the regular physiotherapy program. The physiotherapist, who worked with both groups, had attended special courses and obtained certification from the Vojta International Society.  
The Vojta therapy program was based on the reflex locomotion method, with two complex coordination techniques: reflex rolling (with the two variants of the initial position: supine and side-lying) and reflex creeping from the prone position [24].  
Each technique started with a minute of rest in the initial position, after which the stimulation was performed. Reflexes are activated by applying painless, but firm and sustained pressure to specific stimulation points [17]. After releasing the pressure, the patient remains in the same position for one minute, with no stimulus.  
Reflex rolling from the supine position was as follows: the initial position for the patients was in dorsal decubitus. They were comfortably laid down on the back, with open eyes the head rotated 30\({}^{\circ}\) toward the side where the stimulation would be applied. After the first minute of resting, the physiotherapist stimulated the chest zone by applying pressure between the 7 th and 8 th rib.  
Reflex rolling from the side-lying position was as follows: the initial position for the patients was in the lateral decubitus. The physiotherapist stimulated the medial scapular border and the anterior superior iliac spine.  
Reflex creeping from the prone position was as follows: the initial position for the patients was in the ventral decubitus. The patients received a continuous reflex locomotion stimulus on the following areas: medial humeral epicondyle, acromion, the chest zone, scapular medial border, iliac spine, medial femoral epicondyle, calcaneus and gluteus.