Progressive Inhibition of Neuromuscular Structure and Neural Tissue Mobilization.

Riphah International University

Status: Not yet enrolling

Conditions: Lumbar Radiculopathy

Treatments: Other: Neural Tissue Mobilization.; Other: Progressive Inhibition of Neuromuscular Structure

Study type: Interventional

Funder types: Other

Identifiers

NCT07062705

REC/RCR & AHS/24/0168

Details and patient eligibility

About

Lumbar radiculopathy is a neuromusculoskeletal condition that is characterized as radiating pain in the leg described as electric, burning, or sharp, and is associated with dermatomal or myotomal differences and tendon reflex abnormalities. Neural mobilization is a manual therapy technique designed to alleviate nerve pain and dysfunction by gently mobilizing the nerve along its pathway. The Progressive Inhibition of Neuromuscular Structures (PINS) technique is a therapeutic approach that aims to reduce pain and muscle tension by sequentially applying pressure to specific points along a muscle or nerve pathway. This study focuses on pain, range of motion and disability with these techniques in patients with lumbar radiculopathy.

Full description

This study will be a randomized controlled trial and will be conducted in Hassan healthcare centre Gujrat. Non-probability conveninet sampling technique will be used to collect the data. Sample size of 48 subjects (per group 16) with age group between 18-40 years will be taken. Individuals having radiculopathy at level of L5-S1 (unilateral radiculopathy) and pain in the distribution of sciatic nerve (leg-dominant symptoms). Outcome measure will be taken using Numeric pain rating scale (NPRS), Oswestry Disability Index (ODI), Sciatica Bothersomeness Index (SBI), Goniometer. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria and will be equally divided into three groups. Both the Groups will receive Hot Pack, lumbar stabilization including curl ups and side bridging and stretching include hamstring stretch and piriformis stretch. Group A will receive PINS technique as per Dowling's guidelines. Group 2 will receive Neural mobilization technique. Groyup 3 will receive both PINS and neural mobilization technique. Outcome measures will be measured at baseline and after 4 weeks. Each group (both single and combined) will receive two treatments per week for 30 min each, for 4 weeks. Data analysis will be done by SPSS version 26.

Enrollment: 42 estimated patients

Sex: All

Ages: 18 to 40 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

INCLUSION CRITERIA

• Age group between 18 and 40 years(.
• Both gender male and female.
• Participants diagnosed as having a chronic (lasting three months or longer) lumbar radiculopathy.
• Diagnosed patient of having radiculopathy at level of L4-L5 and L5-S1 lesion (unilateral radiculopathy).
• Radiating pain evoked by specific clinical tests, including slump and straight leg raise.

Exclusion Criteria:

• Individuals having bilateral lumbar radiculopathy.
• Spondylolysis/spondylolisthesis
• Mechanical systemic low back pain or neoplasmic and infectious processes.
• Participants with severe nerve root compression (non-ambulant/wheelchair-bound).
• Any sign or symptom of dementia or other cognitive impairments.
• Diagnosis of claudication, previous spinal surgery, pregnancy and presence of any of the spinal red flags.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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42 participants in 2 patient groups

Progressive Inhibition of Neuromuscular Structure

Active Comparator group

Description:

The index fingers of both hands were used to palpate two connected locations, referred to as main and endpoints. along a neuromuscular structure and were the most and least sensitive sections, respectively. After identifying the primary point-the area of greatest sensitivity-a moderate ischemic compression was also applied for 30 seconds using the index finger of the other hand. Next, a second sensitive point was located using the middle finger of the same hand, proximal to the endpoint, without releasing the pressure from the index finger. The index finger pressure was released and the middle finger pressure was kept constant without releasing the endpoint pressure when it was seen that the middle finger was more sensitive to pressure than the index finger.

Treatment:

Other: Progressive Inhibition of Neuromuscular Structure

Neural Tissue Mobilization.

Active Comparator group

Description:

The patient sat well back on the end of a plinth with thighs fully supported. The patient was asked to slump or sag while examiner maintains cervical spine in neutral position. Overpressure was applied to the lumbar and thoracic flexion in attempt to bow the spine rather than the hips. With spinal flexion position maintained, the patient was asked to bend his chin to chest and then overpressure in the same direction was added. The patient was asked to extend his knee actively. The patient was asked to dorsiflex his ankle.

Treatment:

Other: Neural Tissue Mobilization.