Immediate effect of mulligan's spinal mobilization with limb movements on straight leg raise test in patients with lumbar radiculopathy: A randomized controlled trial

Context: Lumbar radiculopathy is pain which starts from the lumbar spine and radiates to one or both lower limbs. Spinal mobilization with limb movement (SMWLM) has been proposed for the treatment of lumbar radiculopathy by Brian Mulligan. Studies on SMWLM have found it to have positive effect in reducing radicular symptoms, but a comparative study of SMWLM versus sham mobilization is lacking to prove the beneficial effect of SMWLM since sham procedures more clearly differentiate the efficacy of an intervention. Aims: To compare the immediate effect of SMWLM with sham SMWLM on straight leg raise (SLR) and Visual Analog Scale (VAS) in patients with lumbar radiculopathy. Settings and Design: Single-blinded randomized controlled trial. Subjects and Methods: Twenty-eight participants with lumbar radiculopathy (mean age 40.2 ± 12.2 years) were included. The trial group (n = 14) received SMWLM and control group (n = 14) received sham SMWLM. In SMWLM a transverse glide was applied with the therapist thumb just lateral to the involved lumbar spinous process and the hip was taken into flexion. Sham SMWLM was given by placing thumb just lateral to the involved spinous process without applying any glide while the limb was taken into only 10° of hip flexion. The pre- and immediate post-SLR test angle and VAS was compared within each group and postvalues was compared between the two groups. Statistical Analysis: The data were analyzed with Wilcoxon's signed-rank test and Mann–Whitney U-test. Results: Post intervention in the experimental group there was a significant increase in SLR test angle (P = 0.001) and reduction in VAS (P = 0.001) while in the control group only VAS decreased (P = 0.034). There was a significant difference between the groups in postintervention SLR test angle (P = 0.038) and VAS (P = 0.018). Conclusion: Through its biomechanical, neurophysiological effects, and marginal placebo effects, SMWLM can be used as an effective treatment technique for immediate improvement in pain-free SLR range in patients with lumbar radiculopathy.