Effects of Neurodynamic Mobilization and Stretching Exercises for Chronic Discogenic Sciatica

Study Overview
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Brief Summary
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This study compares between neurodynamic mobilization and stretching exercises in treatment of chronic dicogenic sciatica

Detailed Description
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This study was conducted at the outpatient clinics, faculty of physical Therapy, Kafrelsheikh University to compare between the effects of slider, tensioner neurodynamic mobilization techniques and stretching exercises on pain, Range of motion (ROM) and functional disability for patients with chronic discogenic sciatica. Design of the study: A pre-test post-test three-armed comparative study design was used for comparison between the effects of slider, tensioner neurodynamic mobilization techniques and stretching exercises for patients with chronic discogenic sciatica. Selection of patients: Sample size: Using G-power software program and regarding F test study , alpha level of 0.05, confidence interval 95% and effect size of 0.25 (to detect small effects ), three groups and 6 dependent variables, the total sample size will be 36 patient (twelve in each group). To reach the specific sample size, forty-three patients were screened regarding the inclusion/exclusion criteria. Thirty-six patient with unilateral chronic discogenic sciatica from both sexes (….male and … female) were recruited from the outpatient clinics, faculty of physical Therapy, Kafrelsheikh University. Their age ranged between 21-50 years. They were randomly allocated by simple random method; to avoid selection bias, patients were asked to choose a card of three wrapped cards representing the three treatment groups: Group (A): received Slider technique only. Group (B): received Tensioner technique only. Group (C): received Stretching exercises of back extensors, hamstrings and gastrocnemius muscles only.

Official Title
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Effects of Slider, Tensioner Neurodynamic Mobilization Techniques and Stretching Exercises in Treatment of Chronic Discogenic Sciatica: A Comparative Study

Conditions
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Physical Therapy

Intervention / Treatment
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* Other: Slider, tensioner neurodynamic mobilization techniques and stretching exercises of back, hamstrings and gastrocnemius


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients diagnosed by magnetic resonance imaging (MRI) confirming disc lesion. Radicular pain for at least twelve weeks up to one year with no acute episodes for the last four weeks. Positive slump test, with reproduction of neurological symptoms. Ages of 21-50 years of both sexes. Patients with functional disabilities e.g. during lifting or walking Exclusion Criteria: Patients with sciatica due to other pathologies e.g. lumbar canal stenosis or piriformis syndrome. Patients after any spinal surgery e.g. unilateral hemilaminectomy or microdiscectomy Negative slump test. Progressive neurological symptoms e.g. hyperirritable and unstable symptoms. History of vertebral fracture or trauma. Systemic disorder e.g. diabetes mellitus. Pregnant women.

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: simple random sampling
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Slider neurodynamic mobilization technique only<br>a neurodynamic mobilization technique of the sciatic nerve with stretch on one nerve end and slackness on the other end. | Other: Slider, tensioner neurodynamic mobilization techniques and stretching exercises of back, hamstrings and gastrocnemius<br>* neurodynamic mobilization techniques of sciatic nerve and stretching exercises of back extensors, hamstrings and lower limbs for patients with chronic discogenic sciatica.<br>* Other names: sliders, tensioners and stretching exercise;|
| Active Comparator: Tensioner neurodynamic mobilization technique only<br>a neurodynamic mobilization technique of the sciatic nerve with stretch of both nerve ends. | Other: Slider, tensioner neurodynamic mobilization techniques and stretching exercises of back, hamstrings and gastrocnemius<br>* neurodynamic mobilization techniques of sciatic nerve and stretching exercises of back extensors, hamstrings and lower limbs for patients with chronic discogenic sciatica.<br>* Other names: sliders, tensioners and stretching exercise;|
| Active Comparator: Stretching exercises of back extensors, hamstrings and gastrocnemius muscles<br>Stretching exercises of back extensors, hamstrings and gastrocnemius to relief the pressure on the nerve. | Other: Slider, tensioner neurodynamic mobilization techniques and stretching exercises of back, hamstrings and gastrocnemius<br>* neurodynamic mobilization techniques of sciatic nerve and stretching exercises of back extensors, hamstrings and lower limbs for patients with chronic discogenic sciatica.<br>* Other names: sliders, tensioners and stretching exercise;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pain intensity measurements using visual analogue scale | A scale form 0 to 10 points, a less score means improvement. | Before treatment and after 2 weeks of treatment. | 
| Change in hip flexion range of motion measurement using universal goniometer. | the therapist measures it for patients, an increasing value means improvement. | Before treatment and after 2 weeks of treatment. | 
| Change in knee extension range of motion measurement using universal goniometer. | the therapist measures it for patients, an increasing value means improvement. | Before treatment and after 2 weeks of treatment. | 
| Change in ankle dorsiflexion range of motion measurement using universal goniometer. | the therapist measures it for patients, an increasing value means improvement. | Before treatment and after 2 weeks of treatment. | 
| Change in lumbar flexion range of motion measurement using universal goniometer. | the therapist measures it for patients, an increasing value means improvement. | Before treatment and after 2 weeks of treatment. | 
| Change in functional disability measurement using the oswestry disability index. | An index indicating disability level, a less score indicates improvement. | Before treatment and after 2 weeks of treatment. |