Comparison of Mulligan SNAG's and neural tissue mobilization in patients with lumbar radiculopathy: A randomized controlled trial

Author(s): Sufian Ahmed, Saad Shafiq, Saddam Sabri, Shumaila Kiran, Ibraheem Zafar, and Meer Zakir

Background: Radiculopathy usually comes from sciatic origin; if the sciatic nerve gets irritated due to compression then it causes pain in course of the nerve called sciatic radiculopathy. Disc herniation of L4-L5 and L5-S1 segments is the most common and sometimes irritates the sciatic nerve a condition known as Sciatica. The sign symptoms of sciatic radiculopathy have radicular pain in the lower leg following the course from the low back, buttock area and back of thigh followed by weakness of muscle and sensory involvement may be deep tendon reflex are diminished. Objective: The objectives of the study were to compare the effectiveness of two nonsurgical treatment strategies in patients with lumbar radiculopathy; to enhance the evidence-based treatment. Methodology: The study was a Randomized Control Trial (RCT), conducted in the Outpatient Department of Jinnah teaching hospital Gujranwala and LifeCare Physiotherapy and Rehabilitation Center from February 2017 to December 2017. The sample of the study consisted of 48 patients male (n=16) and female (n=32). Patients with diagnosed L4-L5/ L5-S1 disc pathology and radicular pain and confirmed from MRI were recruited for this study. An ethical approval letter was received from an institution for study. The sample size was estimated with 90 percent power and effect size of 1.01 at a significance level of 0.05 (α) came out to be 48 i.e. 24 patients in each group. Groups included in the study were: Group A: Mulligan SNAG’s Technique plus Ultrasound and Short Wave Diathermy. Group B: Neural mobilization technique plus Ultrasound and Short Wave Diathermy. Tools used for data collection are the Numeric Pain Rating Scale (NPRS), Lumber Range of Motion (ALROM), and Modified Oswestry Disability Index (MODI) questionnaire. Results: The mean change across NPRS in a group of mulligan mobilization was 6.167 as compared to 5.583 in the neural mobilization group. The mean change across MODI in a group of mulligan mobilization was 47.667 as compared to 49.667 in the neural mobilization group. Conclusion: Neural mobilizations are more effective as compared to mulligan techniques in reducing pain while mulligan mobilization seems to be more beneficial for the improvement of disabilities.%.