Combined Effect of Low Level Laser Therapy and Neural Mobilization on Lumber Disc Prolapse

Lumbar disc prolapse is a movement of disc material out of the intervertebral disc space. Protruded nucleus comes in contact with the surrounding nerves, causing their compression that in turn results in severe radicular pain.

The purpose of this study is to assess the combined effect of low level laser therapy and neural mobilization on lumber disc prolapse, this assessment will be done through assessment of pain, functional disability, neural mobility and lumber flexion mobility.

Subjects and Methods : 40 Patients with lumber disc prolapse and radiculopathy based on clinical examination by orthopedic surgeon and (MRI) imaging aged between 30 and 50 years . This study will be a double blinded randomized controlled trial .

After including patients in the study, they will be randomly assigned into 2groups :

Control group (A) (n=20): will receive placebo laser therapy plus neural mobilization.

Experimental group (B) (n=20): patients will receive low level laser therapy plus neural mobilization Both control group and experimental group receive infrared as warming up before treatment for12 sessions, each for 15 min, 3 days per week, for a period of 4 weeks .

All patients will perform all assessment procedures accurately (straight leg raising test, slump test and Schober's test ) and will fill (VAS) and (ODI) accurately.

Mobilization will be through using slump sitting maneuver (Both techniques slider and tensioner).Neural mobilization will be applied in form of 3 sets every set 10 repetitions and the end Position was hold for 5 seconds and the rest between sets was 5 minutes. All the patients will receive 12 sessions (3 times/week for 4 weeks).

: patients receive LLLT will lie in side lying on the non-affected side which is opposite to the side of radicular pain, hip and knee in flexion 90.Twenty points were established for treatment, 12 over the lumbar spine, at the same Side of the radicular pain and 8 points over thigh for 3 sessions per weak for 4 Weeks.

The hypotheses for this study are:

• There will be significant improvement in pain after combination of LLLT and neural mobilization.
• There will be significant improvement in functional disability after combination of LLLT and neural mobilization.
• There will be significant improvement in lumber flexion mobility after combination of LLLT and neural mobilization.
• There will be significant improvement in neural mobility after combination of LLLT and neural mobilization.

Inclusion criteria

• 1-patients referred from orthopedic surgeon with diagnosis of lumbar disc prolapse and radiculopathy (subacute >3 weeks or chronic > 3 months and lasting up to 12 months) .

2-Participants had MRI examination, which confirmed the diagnosis of lumber disc prolapse in addition of radiological changes in the intervertebral discs of the spine and affection of peripheral nerve root.

3-Aged between 30 and 50 years .

Exclusion criteria

• 1- Patients who had undergone any surgical intervention in the spine. 2- Any other dysfunctions of the spine rather than lumber disc prolapse (fractures, tumors, spondylolisthesis, rheumatic diseases, and cauda equina syndrome).

3- The patient is under any medical treatment. 4- Pregnancy, cardiovascular failure, pacemaker, metal implants, skin lesions in the treatment area.

5- Neurological deficits such as myelopathy, lumber canal stenosis and Piriformis syndrome 6- Malignancy, systemic inflammatory disease, or infectious disease. 7- Acute lumber disc prolapse will be excluded.