AIM- Effect of Bent Leg Raise Technique on Pain & Functional Disability Among Patients with Specific Low Back Pain with Radiculopathy.

OBJECTIVE- 1. To find out effect of bent leg raise technique on pain among patients with specific low back pain with radiculopathy. 2. To find out effect of bent leg raise technique on functional disability among patients with specific low back pain with radiculopathy.

PROCEDURE- Ethical clearance will be obtained from institutional ethical committee. Patients will be screened according to clinical inclusion and exclusion criteria. Informed consent form will be taken from the subjects. The purpose and procedure will be explained to patients selected for the study. The selected patients will be randomly allocated into 2 groups experimental and control group by using randomized computer-generated sequence method. Physiotherapist & patients will be blinded to allocation.  Allocation concealment will be done using envelop method. The pre-test outcome measures will be recorded. And the treatments will proceed till 1 week. After 1 weeks the outcome measures will be assessed, and the data will be interpretated by statistical analysis tests. The result data will be represented in tabular formats. CONSORT guidelines will be followed in study.

INTERVENTION PROTOCOL-

EXPERIMENTAL GROUP - Bent Leg Raise Technique 

 Patient’s position: The patient will be positioned in a supine lying position with the affected knee rested on the therapist shoulder so as hip and knee were bent at 90 and 90 degrees.
Therapist’s position: The therapist will be standing beside the side to be treated facing the patient. 
Hand placement: The therapist hand will place on the lower end of femur bone of the affected side.
Technique: The patient’s flexed knee will place over the therapist’s shoulder while the popliteal fossa of the affected knee rested on the therapist shoulder.  Then the patient will ask to push the therapist shoulder with his leg then voluntary relax. At this point of relaxation, the therapist pushed the bent knee up as far as possible in the direction of the shoulder on the same side of the affected leg without making the patient feel pain. This stretch maneuver will be sustained for 5-10 seconds and then relaxed if the pain or restriction eased; the hip will take into further flexion. It will be ensured that there was no pain during the procedure. If the patient will felt pain the direction of the leg raise will alter by medial rotating or abducting the hip. The contra lateral leg will keep relaxed and allowed to move as it goes. At the end of the range, the position will hold for 10 seconds, and limb brought back to neutral position.
Dosage – (7-10 sec hold /3 times / session with rest interval of 1 min) 5 times / week up to 1 week.

CONTROL GROUP - Control Group will receive conventional physiotherapy i.e., Neural tissue mobilization and Mckenzie exercises. 

1. Neural tissue Mobilization (NTM) -   Patient Position: Patient lies supine on the plinth.

Therapist position: The therapist passively raises the patient’s leg into a SLR until the initial onset of pain. Hip is then flexed and extended in a small range of motion.

Duration: 2 min (with 1 minute rest in-between sets                     Repetition: 3 sets.

2. Spinal Extension Exercise (Mckenzie Exercise)-    Spinal Extension Exercise (Mckenzie exercise) were taught to the patient and to do 5 days with 10 seconds hold and for10 repetitions.

1. Prone position lying flat (patient lies flat on their stomach) 2. Prone position propped on elbows (patient lies flat on their stomach and props themselves onto their elbows with the spine in extension). 3. Prone position propped on hands (patient lies flat on their stomach and props themselves onto their hands with elbows in full extension, with the spine in extension). 4. Standing lumbar extension (patient stands upright with feet shoulder-width apart and puts hands on the lower back while extending the spine). 5. Sustained Extension- Patient lies prone with the table positioned in extension, creating a gradual and sustained extension stress to the lumbar spine. Gradually lift the table up into more extension Use this for patients – kyphotic deformity - Major derangements.