EFFECTIVENESS OF NEURAL MOBILIZATION VERSUS STRENGTHENING EXERCISES IN REDUCING PAIN AND DISABILITY IN PATIENTS WITH LUMBAR RADICULOPATHY

Authors

  • Aleezay Fatima Master of science in Physical Therapy, Times University, Multan, Pakistan Author
  • Hafiz Muhammad Abu Bakar Rashid Staff Grade / Chartered Physiotherapist, Mercy University Hospital, Cork, Ireland Author
  • Dr Sidra Iqbal Consultant Physiotherapist, Med-East hospital, Paragon Housing Society, Barki Road, Lahore Author
  • Dr Syeda Fareesa Hassan Zaidi Physiotherapist, Jinnah Burn and Reconstructive Surgery Center, Lahore Author
  • Ammara Manzoor Malik Senior SLP/RBT, MHS clinic Author
  • Muhammad Abdullah Hamza Masood Physiotherapy, Services Hospital Lahore Author

DOI:

https://doi.org/10.71000/sdhd1v07

Keywords:

Exercise Therapy; Low Back Pain; Neuralgia; Pain Measurement; Physical Therapy Modalities; Radiculopathy; Rehabilitation.

Abstract

Background: Lumbar radiculopathy is a disabling condition commonly associated with radiating leg pain, sensory symptoms, and functional restriction. Conservative physiotherapy remains a preferred first-line approach, yet the comparative benefit of neural mobilization and strengthening exercises is still debated. Neural mobilization targets neural mobility and mechanosensitivity, whereas strengthening exercises improve lumbopelvic control and muscular support. Clear comparative evidence is needed to guide practical, patient-centered rehabilitation planning for individuals with lumbar radiculopathy in routine clinical settings more effectively.

Objective: To compare the effectiveness of neural mobilization and strengthening exercises in reducing pain and disability among patients with lumbar radiculopathy.

Methods: This single-center, parallel-group randomized controlled trial enrolled 44 adults with clinically and radiologically diagnosed lumbar radiculopathy. Participants were randomly allocated into Group A and Group B, with 22 participants in each group. Group A received neural mobilization using nerve sliding and tensioning techniques, while Group B received lumbar stabilization and strengthening exercises. Both groups completed 8 supervised sessions over 4 weeks. Pain was assessed by the Numeric Pain Rating Scale and disability by the Oswestry Disability Index. Wilcoxon signed-rank and Mann-Whitney U tests were applied using SPSS version 27.

Results: Pain intensity improved significantly within both groups after intervention, including Group A receiving neural mobilization (Z = -4.165, p < 0.001) and Group B receiving strengthening exercises (Z = -3.810, p < 0.001). Group A showed significant improvement across all ODI domains (p < 0.05), while Group B showed significant improvement in most ODI domains (p < 0.05), except walking (p = 0.171) and standing (p = 0.172). Between-group analysis showed a significant post-intervention difference in NPRS, with Group A having a lower mean rank than Group B, indicating lower post-treatment pain in the neural mobilization group (mean rank: 16.86 vs. 28.14; Z = -3.104, p = 0.002). However, total post-intervention ODI scores did not differ significantly between groups (mean rank: 23.27 vs. 21.73; Z = -0.465, p = 0.642).

Conclusion: Both interventions reduced pain and disability in lumbar radiculopathy. Strengthening exercises showed greater short-term pain relief, while disability outcomes remained comparable, supporting individualized physiotherapy planning.

Keywords: Exercise Therapy; Low Back Pain; Neuralgia; Pain Measurement; Physical Therapy Modalities; Radiculopathy; Rehabilitation.

Author Biographies

  • Aleezay Fatima, Master of science in Physical Therapy, Times University, Multan, Pakistan

    Master of science in Physical Therapy, Times University, Multan, Pakistan

  • Hafiz Muhammad Abu Bakar Rashid, Staff Grade / Chartered Physiotherapist, Mercy University Hospital, Cork, Ireland

    Staff Grade / Chartered Physiotherapist, Mercy University Hospital, Cork, Ireland

  • Dr Sidra Iqbal, Consultant Physiotherapist, Med-East hospital, Paragon Housing Society, Barki Road, Lahore

    Consultant Physiotherapist, Med-East hospital, Paragon Housing Society, Barki Road, Lahore

  • Dr Syeda Fareesa Hassan Zaidi , Physiotherapist, Jinnah Burn and Reconstructive Surgery Center, Lahore

    Physiotherapist, Jinnah Burn and Reconstructive Surgery Center, Lahore

  • Ammara Manzoor Malik , Senior SLP/RBT, MHS clinic

    Senior SLP/RBT, MHS clinic

  • Muhammad Abdullah Hamza Masood , Physiotherapy, Services Hospital Lahore

    Physiotherapy, Services Hospital Lahore

References

Bateman, E. A., Fortin, C. D., & Guo, M. (2025). Musculoskeletal mimics of lumbosacral radiculopathy. Muscle & nerve, 71(5), 816-832.

Danazumi, M. S., Nuhu, J. M., Ibrahim, S. U., Falke, M. A., Rufai, S. A., Abdu, U. G., Adamu, I. A., Usman, M. H., Daniel Frederic, A., & Yakasai, A. M. (2023). Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial. J Man Manip Ther, 31(6), 408-420. https://doi.org/10.1080/10669817.2023.2192975

Divya, P., Sen, S., & Tiwari, S. (2024). Motor Control Exercises: Effects on Sciatic Nerve Mechanical Sensitivity, Erector Spinae and Quadratus Lumborum Muscle Thickness, and Abdominal Endurance in Patients with Lumbar Radiculopathy. International Research Journal of Multidisciplinary Scope, 05, 1430-1438. https://doi.org/10.47857/irjms.2024.v05i04.01788

Dydyk, A. M., Khan, M. Z., & Singh, P. (2026). Radicular Back Pain. In StatPearls. StatPearls Publishing Copyright © 2026, StatPearls Publishing LLC.

El Melhat, A. M., Youssef, A. S., Zebdawi, M. R., Hafez, M. A., Khalil, L. H., & Harrison, D. E. (2024). Non-surgical approaches to the management of lumbar disc herniation associated with radiculopathy: a narrative review. Journal of clinical medicine, 13(4), 974.

El Melhat, A. M., Youssef, A. S. A., Zebdawi, M. R., Hafez, M. A., Khalil, L. H., & Harrison, D. E. (2024). Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J Clin Med, 13(4). https://doi.org/10.3390/jcm13040974

Elsayyad, M. M., Abdel-Aal, N. M., & Helal, M. E. (2021). Effect of Adding Neural Mobilization Versus Myofascial Release to Stabilization Exercises after Lumbar Spine Fusion: A Randomized Controlled Trial. Arch Phys Med Rehabil, 102(2), 251-260. https://doi.org/10.1016/j.apmr.2020.07.009

Ford, J. J., Kaddour, O., Gonzales, M., Page, P., & Hahne, A. J. (2020). Clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy. BMC Musculoskelet Disord, 21(1), 567. https://doi.org/10.1186/s12891-020-03590-x

Ghasabmahaleh, S. H., Rezasoltani, Z., Dadarkhah, A., Hamidipanah, S., Mofrad, R. K., & Najafi, S. (2021). Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy: A Randomized Controlled Trial. Am J Med, 134(1), 135-141. https://doi.org/10.1016/j.amjmed.2020.08.005

Golonka, W., Raschka, C., Harandi, V. M., Domokos, B., Alfredson, H., Alfen, F. M., & Spang, C. (2021). Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. J Clin Med, 10(11). https://doi.org/10.3390/jcm10112430

Han, S., Lee, H.-D., Jang, H.-D., Suh, D. H., Han, K., & Hong, J.-Y. (2024). Lumbar radiculopathy and fracture risk: A Korean nationwide population-based cohort study. Bone, 179, 116981.

Hincapié, C. A., Kroismayr, D., Hofstetter, L., Kurmann, A., Cancelliere, C., Raja Rampersaud, Y., Boyle, E., Tomlinson, G. A., Jadad, A. R., Hartvigsen, J., Côté, P., & Cassidy, J. D. (2025). Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review. Eur Spine J, 34(1), 263-294. https://doi.org/10.1007/s00586-024-08528-8

Jha, R., Bernstock, J. D., Chalif, J. I., Hoffman, S. E., Gupta, S., Guo, H., & Lu, Y. (2023). Updates on pathophysiology of discogenic back pain. Journal of Clinical Medicine, 12(21), 6907.

Kanchan, J., & Deepak, A. (2024). Effectiveness of Kinetic Control versus Mckenzie Execises on Functional Outcomes in patients with lumbar radiculopathy – A single blinded randomized pilot study. VIMS JOURNAL OF PHYSICAL THERAPY, 6, 45-50. https://doi.org/10.46858/VIMSJPT.6207

Kostadinović, S., Milovanović, N., Jovanović, J., & Tomašević-Todorović, S. (2020). Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil, 33(6), 897-907. https://doi.org/10.3233/bmr-201843

Lin, L.-H., Lin, T.-Y., Chang, K.-V., Wu, W.-T., & Özçakar, L. (2023). Neural mobilization for reducing pain and disability in patients with lumbar radiculopathy: a systematic review and meta-analysis. Life, 13(12), 2255.

Nitya Chophla, D. A. (2024). To Analyse the Effect of Sliders Neural Mobilisation on F wave Latency in Lumbar Radiculopathy Patients: A Pilot Study. Journal of Clinical and Diagnostic Research, 18(3), 79-. https://doi.org/10.7860/jcdr/2024/75482.19993

Parmarth, P., Srivastava, M., & Sharma, M. (2025). To Study the Effectiveness of Butler's Neural Mobilization Versus Maitland's Spinal Mobilization in Lumbar Radiculopathy. Eurasian Journal of Analytical Chemistry, 20(1).

Satpute, K., Hall, T., Bisen, R., & Lokhande, P. (2019). The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial. Arch Phys Med Rehabil, 100(5), 828-836. https://doi.org/10.1016/j.apmr.2018.11.004

Thoomes, E., Falla, D., Cleland, J. A., Fernández-de-Las-Peñas, C., Gallina, A., & de Graaf, M. (2023). Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study. Disabil Rehabil, 45(21), 3539-3548. https://doi.org/10.1080/09638288.2022.2130448

Willems, S. J., Coppieters, M. W., Rooker, S., Orzali, L., Kittelson, A. J., Ostelo, R. W., Kempen, D. H. R., & Scholten-Peeters, G. G. M. (2024). The impact of being overweight or obese on 12 month clinical recovery in patients following lumbar microdiscectomy for radiculopathy. Spine J, 24(4), 625-633. https://doi.org/10.1016/j.spinee.2023.10.023

Xie, L., Zhao, Z., Chen, Z., Ma, X., Xia, X., Wang, H., Zheng, C., & Jiang, J. (2021). Melatonin Alleviates Radiculopathy Against Apoptosis and NLRP3 Inflammasomes Via the Parkin-Mediated Mitophagy Pathway. Spine (Phila Pa 1976), 46(16), E859-e868. https://doi.org/10.1097/brs.0000000000003942

Zhu, L., Huang, Y., Hu, Y., Tang, Q., & Zhong, Y. (2021). Toll-like receptor 4/nuclear factor-kappa B pathway is involved in radicular pain by encouraging spinal microglia activation and inflammatory response in a rat model of lumbar disc herniation. Korean J Pain, 34(1), 47-57. https://doi.org/10.3344/kjp.2021.34.1.47

Downloads

Published

2026-05-12