Progressive Inhibition of Neuromuscular Structure and Neural Tissue Mobilization.

NCT07062705 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0168
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Lumbar Radiculopathy

Keywords

Pain; Range; Disability

Outcome Measures

Primary Outcomes (1)

• NUMERIC PAIN RATING SCALE (NPRS):

  Low back and leg pain were measured using the numeric pain rating scale (NPRS), as has been used in various randomized controlled trials for NE and spinal pain. 41,42,48 The minimal detectable change for the NPRS is reported to be 2.1

  4 weeks

Secondary Outcomes (1)

• OSWESTRY DISABILITY INDEX (ODI):

  4 weeks

Other Outcomes (1)

• Sciatica Bothersomeness Index (SBI):

  4 weeks

Study Arms (2)

Progressive Inhibition of Neuromuscular Structure

ACTIVE COMPARATOR

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.

Other: Progressive Inhibition of Neuromuscular Structure

Neural Tissue Mobilization.

ACTIVE COMPARATOR

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.

Other: Neural Tissue Mobilization.

Interventions

Progressive Inhibition of Neuromuscular Structure OTHER

The index fingers of both hands were used to palpate two connected locations, referred to as main and endpoints. The locations were located along a neuromuscular structure and were the most and least sensitive sections, respectively. Once an endpoint (region of least sensitivity) was identified, the index finger of one hand was used to provide a moderate ischemia compression; the pressure was kept constant until the course of therapy was finished. 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.

Progressive Inhibition of Neuromuscular Structure

Neural Tissue Mobilization. OTHER

The patient sat well back on the end of a plinth with thighs fully supported. The patient was asked to slump. 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. The therapist was maintaining the ankle dorsiflexion as a progression for technique. The number of these sequences was repeated several times,through which the amplitude of the technique was increased according to the patient response. The technique was progressed to a point where symptoms reproduced, or it was taken to a point where resistance of the movement was encountered.

Neural Tissue Mobilization.

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Hassan Health Care Centre, Gujrat

Dhok Gujra, 50700, Pakistan

Location

Related Publications (10)

• Olofson E, Gerona C, Estrada A, Duong J. Joint and Neural Mobilization for Pain Reduction in Radiculopathy Patients: Azusa Pacific University; 2023.

  BACKGROUND

• Malik A, Ramsha M, Samad A. Outcomes of the butler neural mo-bilization technique and manual therapy for chronic low back pain in patients with lumbar radiculopathy: A cross-sectional comparative study. J Basic Clin Med Sci. 2022;1:3-11

  BACKGROUND

• Divyasree S, Kumaresan A, Vishnuram S. Effect of Mckenzie lumbar extension exercise with TENS on lumbar radiculopathy. Biomedicine. 2023;43(3):1032-5.

  BACKGROUND

• Danazumi MS, Ibrahim SU. Effectiveness of Progressive Inhibition of Neuromuscular Structures (PINS) and Spinal Mobilization with Leg Movement (SMWLM) in Lumbar Disk Herniation with Radiculopathy: A Case Report with Two Year Follow-up.

  BACKGROUND

• Takla MK. Alterations of static and dynamic balance in patients with lumbar radiculopathy. Bulletin of Faculty of Physical Therapy. 2019;24:49-55.

  BACKGROUND

• Kim KH, Leem MJ, Yi TI, Kim JS, Yoon SY. Balance Ability in Low Back Pain Patients With Lumbosacral Radiculopathy Evaluated With Tetrax: A Matched Case-Control Study. Ann Rehabil Med. 2020 Jun;44(3):195-202. doi: 10.5535/arm.19101. Epub 2020 May 29.

  PMID: 32475097 BACKGROUND

• Das S, Dowle P, Iyengar R. Effect of spinal mobilization with leg movement as an adjunct to neural mobilization and conventional therapy in patients with lumbar radiculopathy: Randomized controlled trial. J Med Sci Res. 2018;6(1):11-9.

  BACKGROUND

• Bello B, Danazumi MS, Kaka B. Comparative Effectiveness of 2 Manual Therapy Techniques in the Management of Lumbar Radiculopathy: A Randomized Clinical Trial. J Chiropr Med. 2019 Dec;18(4):253-260. doi: 10.1016/j.jcm.2019.10.006. Epub 2020 Sep 3.

  PMID: 32952470 BACKGROUND

• Berry JA, Elia C, Saini HS, Miulli DE. A Review of Lumbar Radiculopathy, Diagnosis, and Treatment. Cureus. 2019 Oct 17;11(10):e5934. doi: 10.7759/cureus.5934.

  PMID: 31788391 BACKGROUND

• Deng A, Wei L, Espiridion E. Assessing Nerve Block and Opioid Analgesics on Anxiety and Depression in Patients with Lumbar Radiculopathy. 2025.

  BACKGROUND

MeSH Terms

Conditions

Radiculopathy; Pain

Condition Hierarchy (Ancestors)

Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Muzna Munir, PhD*

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Mahnoor Baloch, MS Student

CONTACT

03153344366; balochmahnoor702@gmail.com

Muzna Munir, PHD scholar

CONTACT

03344265125; muznafmh@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 3, 2025
• First Posted: July 14, 2025
• Study Start: July 24, 2025
• Primary Completion: September 20, 2025
• Study Completion: October 20, 2025
• Last Updated: July 14, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)