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Original Article
ABSTRACT
Background: Various manual therapy techniques are known to treat discogenic pain. Research is limited and
controversial in the effectiveness of manual therapy for treatment of lumbar radiculopathy due to lumbar disc
disease. In manual therapy, Mulligan has described spinal mobilisation with leg movement technique, for
improvement in lumbar lesion resulting in pain and other signs below knee.
Purpose of the study: To find out if Mulligans Spinal Mobilisation with Leg Movement technique (SMWLM) in
conjunction with conventional treatment is better than conventional treatment alone in improving leg pain
intensity (VAS), localization of leg pain (body diagram by Donelson), back specific disability (RMQ) in patients
with lumbar radiculopathy (L5/ S1 nerve root) in lumbar disc herniation.
Methods: The study is a randomized controlled trial performed on 30 patients with lumbar radiculopathy. Both
the groups received back extension exercises, hot pack, precautions and ergonomic advice. The experimental
group received SMWLM technique in addition to the conventional treatment. Outcomes included leg pain
intensity, Roland Morris Questionnaire and body diagram by Donelson.
Results: There was significant improvement in VAS (p=0.000), body diagram (p=0.000 for experimental group
and p=0.003 for conventional group) and Roland Morris Questionnaire score (p=0.000) within the groups.
Between group analysis showed significant improvement in VAS (p=0.000), body diagram score (p=0.000).
Although there was significant improvement in Roland Morris Questionnaire score within the groups but there
is no significant difference between the group (p=0.070).
Conclusion: Spinal Mobilization with Leg Movement technique in addition to conventional physical therapy
produced significant improvement in leg pain intensity, location of pain and back specific disability in patients
with lumbar radiculopathy in lumbar disc herniation.
KEYWORDS: Lumbar disc herniation, Lumbar radiculopathy, Manual therapy, physical therapy, Spinal Mobilization
with Leg Movement.
Address for correspondence: Sahiba Yadav. ISIC Institute of Rehabilitation Sciences, Vasant Kunj,
Sector-C, New Delhi, India. Email: sphysiotherapist@gmail.com
Accepted: 01-09-2014
Published: 11-10-2014
INTRODUCTION
ISSN 2321-1822
712
Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
ISSN 2321-1822
Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
ISSN 2321-1822
Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
Data Analysis:
The Statistical Package of Social Sciences (SPSS)
for windows version 19.0 was used to analyze
the data. Analysis was done for 30 subjects who
completed the study. The outcome variables of
the study included leg pain intensity on VAS,
Body Diagram by Donelson and Roland Morris
Questionnaire.
Paired t-test was used for comparing the pretreatment and post-treatment scores of each
variable for both the groups (within group
analysis). Independent t-test was performed to
check the homogeneity of subjects before
intervention and also to compare the effect of
both the intervention on the various outcome
(between group analysis).
Statistical significance was set at P < 0.05. P value
> 0.05 was considered as non significant
difference while P value < 0.05 was considered
to have represented a significant difference.
Value of confidence interval was set at 95%.
Groups
Mean + S.D
Pre test
59.33 + 14.30
Post test
38.66 + 15.00
Pre test
4.47 + .640
Post test
3.87 + .834
Pre test
9.20 + 2.93
5.53 + 2.23
VAS
B.D
0.000*
3.674
0.003*
9.811
0.000*
Independent t-test for between group comparisons was done for difference of pre-test and
post-test reading between the two groups for
each outcome measure. The results revealed
significant differences in VAS for leg pain intensity (p = 0.000) and Body diagram (p = 0.001).
There was no significant difference in the RMQ
score between the groups (p = 0.070). (Table 3,
Graph 3).
Groups
VAS
B.D
RMQ
Mean + S.D
Pre test
63.56 + 6.54
Post test
32.73 + 10.09
Pre test
4.80 + .414
Post test
3.47 + .640
Pre test
10.40 + 3.52
Post test
5.60 + 2.69
t value
Sig. ( p value)
12.894
0.000*
10.583
0.000*
10.212
0.000*
ISSN 2321-1822
Outcome
Measure
Mean + S.D
Group 1
Group 2
0.000*
0.001*
0.070
NS
715
Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
ISSN 2321-1822
716
Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
ISSN 2321-1822
CONCLUSION
In conclusion, SMWLM in conjunction with
conventional therapy produced significantly
more improvement in leg pain intensity,
localization of leg pain and SLR over conventional
therapy alone in patients with lumbar
radiculopathy in lumbar disc herniation.
Although, SMWLM did not produce significant
improvement in RMQ score over the
conventional therapy group, the mean scores
and number of patients reaching MCID were
better in SMWLM group. We recommend use
of SMWLM technique in patients with lumbar
radiculopathy in lumbar disc herniation for a
better and more effective treatment of the
population mentioned.
ACKNOWLEDGEMENT
We would like to thank all the participants of the study.
Special thanks to staff of ISIC Institute of Rehabilitation
Sciences,New Delhi, Bara Hindu Rao Hospital, Malka Ganj
for providing the assistance required by the authors to
conduct the research. Lastly, we would like to express
our sincere thanks to Mr. Kulwant Singh for helping in
analyzing the data.
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1702-1709.
2. John N. Awad, Ronald Moskovich. Lumbar disc
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Sahiba Yadav et al.. EFFECTIVENESS OF SPINAL MOBILIZATION WITH LEG MOVEMENT (SMWLM) IN PATIENTS WITH LUMBAR RADICULOPATHY
(L5 / S1 NERVE ROOT) IN LUMBAR DISC HERNIATION.
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