The purpose of this study is to investigate whether adding conventional physical therapy modalities to transforaminal epidural steroid injection (TFESE) provides additional benefits in patients with acute radicular pain due to lumbar disc herniation. While TFESE is a known effective treatment for radicular pain, this research aims to evaluate if physical therapy can further improve pain duration, functional level, disability, and depression scores.

Participants will be divided into two groups based on their ability to attend a physical therapy program:

Group 1: Patients receiving only ultrasound-guided TFESE and a standard home exercise program.

Group 2: Patients receiving ultrasound-guided TFESE combined with 10 sessions of physical therapy (including hot-pack, therapeutic ultrasound, and TENS) and a standard home exercise program.

The study will compare the effects of these treatments on pain intensity, disability, spinal range of motion, and depression levels. Assessments will be conducted at baseline (before injection), 1 hour after injection, and at the 1st and 3rd-month follow-up visits.

This study is designed as a single-center, prospective, observational study. Participants are patients diagnosed with lumbar disc herniation (LDH) via physical examination and magnetic resonance imaging (MRI) who present with acute radicular pain symptoms.

Intervention Groups:

Patients are divided into two groups based on their ability to participate in a physical therapy program.

Group 1 (TFESE + PT): Participants receive only ultrasound-guided TFESE.

Group 2 (TFESE Only): Participants receive ultrasound-guided transforaminal epidural steroid injection (TFESE) followed by 10 sessions of conventional physical therapy.

Both groups are provided with a standard home exercise program focusing on lumbar range of motion, core stabilization, and strengthening of abdominal and back muscles.

Injection Procedure:

The TFESE is performed under ultrasound guidance using a convex probe (3 MHz). With the patient in the prone position, the needle (22-gauge, 3.5 inch, Quincke-tip) is inserted using an in-plane approach toward the lateral aspect of the lamina. After confirming the position in both axial and parasagittal planes and performing negative aspiration, a mixture is injected. The injectate consists of 2 ml 20 mg/ml Lidocaine Hydrochloride, 1 ml Betamethasone Dipropionate/Sodium Phosphate (5 mg + 2 mg/ml), and 3 ml 0.9% Sodium Chloride.

Physical Therapy Protocol:

The physical therapy program for Group 1 consists of 10 sessions, including hot-pack application, therapeutic ultrasound, and Transcutaneous Electrical Nerve Stimulation (TENS).

Follow-up and Assessment:

Clinical evaluations and patient-reported outcomes are recorded at baseline, 1 hour post-injection, and at 1-month and 3-month follow-ups. These assessments include pain intensity (NRS), functional disability (Oswestry Disability Index), depression levels (Beck Depression Inventory), and neuropathic pain presence (DN4).

Inclusion Criteria:

• Patients aged between 18 and 65 years.
• Diagnosis of lumbar disc herniation confirmed by physical examination and Magnetic Resonance Imaging (MRI) within the last 6 months.
• Presence of acute radicular pain symptoms lasting more than 3 months.
• Failure to respond to conservative medical treatments (e.g., medication, rest).
• Voluntary participation and signed written informed consent.

Exclusion Criteria:

• History of previous lumbar spinal surgery.
• Presence of progressive motor deficits or Cauda Equina Syndrome.
• Pregnancy or breastfeeding.
• Diagnosis of malignancy, inflammatory rheumatic diseases, or neurodegenerative disorders.
• Severe obesity (Body Mass Index > 40 kg/m²).
• Known allergy to injection materials (Lidocaine, Betamethasone).
• Active local or systemic infection.
• Presence of bleeding disorders or use of anticoagulants that cannot be safely discontinued.
• Having received an epidural steroid injection or a clinical physical therapy program within the last 3 months.

Individual participant data will not be shared to ensure the privacy and confidentiality of the participants, in accordance with the informed consent provided and the institutional ethics committee guidelines. Only aggregated study results will be made available through publication.