Comparative Effects of Dynamic Stretching Versus Slider Neurodynamic Technique In Patients With Lumbar Radiculopathy

Comparative Effectiveness of Dynamic Stretching Versus Slider Neurodynamic Technique In Patients With Lumbar Radiculopathy : a Randomised Controlled Trail

This study will be a randomised clinical trial conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan. A total of 72 participants will be selected and randomly allocated into two treatment groups (36 participants in each group) using the lottery method. All screened and willing participants who meet the eligibility criteria will be assigned to either Group A or Group B.

Group A will receive dynamic stretching along with routine physiotherapy. Routine physiotherapy will include TENS (15 minutes), hot moist pack (10 minutes), soft tissue mobilisation (5-7 minutes), abdominal bracing, pelvic tilt, and alternate leg extension exercises. The dynamic stretching part will include the slump stretch, cat-camel stretch, hamstring sweeps, child pose stretch, and overhead lateral stretch. Each stretch will be performed in 2 sets of 15-20 repetitions with 1-minute rest between sets. Treatment will be provided four times per week for 6 weeks.

Group B will receive slider neurodynamic mobilisation along with the same routine physiotherapy protocol as group A. Slider neurodynamic mobilisation will be performed in the slump position, sitting at the edge of the plinth with the thighs parallel to each other and arms crossing behind the back. The examiner asked the patient to move actively and conversely from a position of neck and trunk flexion, knee flexion, and plantar flexion, to a position of neck and trunk extension, knee extension, and ankle dorsiflexion with 3 sets of 1-minute sliders and 1-minute rest between sets. Treatment will be provided four times per week for 6 weeks.

All participants will undergo assessments at baseline, at the end of the 3rd week, and at the end of the 6th week.

• Screening Participants who meet the inclusion criteria was recruited using a convenience sampling technique. This involves selecting participants who are readily available to participate in the study.
• Allocation Eligible participants were screened and informed about the study, including its purpose, procedures, potential risks, and benefits. Informed consent was obtained from each participant prior to their formal enrollment in the study.
• Randomization:

Following the baseline assessment, the randomization was conducted using the Online Randomizer tool (https://www.randomizer.org/). By specifying the group numbers, the number of participants per group, and the total number of participants, unique identification numbers were generated for each participant.

• Blindness: This study was single-blinded; the patients were kept blinded about the study and were not informed about the exercise protocol they received.

• Intervention After taking consent, participants was selected based on the inclusion criteria. Sample of 72 was then be randomly divided into two groups.

All participants received a 35-minute treatment session, 4 days per week for 6 weeks, consisting of 15 minutes of routine physiotherapy and 20 minutes of a specific intervention:

Group A (Dynamic Stretching): Routine physiotherapy included TENS (70 Hz, 100 microseconds) for 15 minutes, hot moist packs for 10 minutes, and core strengthening (pelvic tilts and leg extensions). The main intervention was 20 minutes of dynamic stretching, including the slump stretch(The patient performed a slump stretch, seated with knees bent, extending one leg at a time while flexing the trunk forward to stretch the lumbar nerve roots), cat and camel(The patient alternated between spinal flexion and extension while on hands and knees.), hamstring sweeps(The patient performed dynamic hamstring stretches, sweeping the leg forward and back to increase flexibility in the posterior chain.), child's pose, and overhead lateral stretches(The patient performed a side stretch to target the quadratus lumborum and obliques, releasing tension from the side of the back.). Each exercise was performed for 4 minutes in 2 sets of 10-15 repetitions with 1 minute rest interval.

Group B (Slider Neurodynamic Technique): Routine physiotherapy matched Group A but included 5 minutes of soft tissue mobilization. The main intervention was the Slider Neurodynamic Mobilization (NDM). Patients were seated and performed rhythmic movements: moving from neck/trunk flexion and knee flexion to neck/trunk extension and knee extension. This movement is designed to "slide" the nerve through the spinal canal without over-tensioning it. This was performed in 3 sets of 1-minute intervals.

Clinical assessments for pain (NPRS), disability (MODI), and flexibility (MMST) were recorded at baseline, the 3rd week, and the 6th week to compare the efficacy of the two protocols.

Inclusion Criteria:

- • Participants aged between 25 - 50 years of both genders are included

• Symptoms that radiate below the buttocks, thigh/ knee, and lower leg for more than 4 weeks.
• A minimum baseline Pain intensity (NPRS) >4/10. (Morsi et al., 2022)
• Diagnosis of discogenic low back pain (LBP) confirmed by MRI ( disc bulge, protrusion, and herniation) and referred by an orthopedic physician.
• LBP due to muscle tightness/ or nerve compression.
• Had a positive slump test with reproduction of neurological symptoms, and had functional disabilities in certain daily tasks as lifting or walking.

Exclusion Criteria:

• Patients with lumbar spondylolisthesis.

  • Currently pregnant women or in the early post-partum period.
  • Patients with autoimmune disease (ankylosing spondylitis, RA)
  • Previous history of trauma ( fracture, soft tissue injuries) or spinal surgery (spinal laminectomy).
  • Systemic diseases like cardiovascular disease( unstable angina, uncontrolled cardiac arrhythmias) and metabolic diseases.
  • Contraindication to exercises or usage of TENS (cardiac pacemaker, skin allergies to electrodes).