Type of Article:  Original Research

Volume 7; Issue 3 (June 2019)

Page No.: 3069-3076

DOI: https://dx.doi.org/10.16965/ijpr.2019.123


Sneha Thomas *1, Rinkle Hotwani 2.

*1 MGM Institute of physiotherapy, Aurangabad, Maharashtra, India.

2 Associate Professor, MGM Institute of physiotherapy, Aurangabad, Maharashtra, India.

Address for Correspondence: Dr. Sneha Thomas, PT, MGM Institute of physiotherapy, Aurangabad, Maharashtra, India.   E-Mail: snehast92@gmail.com


Background: Low back pain is a very common problem in adults. The clinical application of intermittent pelvic traction has become the common treatment for lumbar radiculopathy and is also used by clinicians in day to day practice. Only few authors have studied about the effectiveness of self neural tissue mobilization during intermittent pelvic traction. Hence the study was undertaken with an intention to find out the effect of intermittent pelvic traction with and without self neural tissue mobilization on pain and functional disability in patients with lumbar radiculopathy.

Methodology: 74 patients with lumbar radiculopathy were included in the study. Subjects were randomly divided into two groups. Group A received only IPT and Group B received IPT with SNTM for 20 minutes with 10 second hold and rest time respectively. The treatment was given initially for 6 days continuously thereafter the treatment was given on alternate days for 1 week. Pre and post intervention pain (VAS) and functional disability (ODI) measures were noted.

Results: On comparison between pre and post interventional values of pain and functional disability using paired ‘t’ test, a significant difference (p<0.001) were found in both the groups. As well as the present study showed significant decrease in the pain measurement (p=0.023) and functional disability measures (p=0.043) in group treated with IPT with SNTM.

Conclusions: This study concluded that both IPT and IPT with SNTM are effective in both pain and functional disability measures. But when both groups were compared with each other, the IPT with SNTM was more effective than that of IPT alone. So it can be chosen as a treatment for lumbar radiculopathy.

Key words: Lumbar radiculopathy, Intermittent pelvic traction, Self neural tissue mobilization.


  1. Hestbaek L, Leboeuf-Y de C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: Eight-year follow-up of 9600 twins. Spine. 2006; 31(4); 468-472.
  2. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007; 25(2):353-371.
  3. Van Tulder, M. Koes B. Bombardier C. LBP. BestPrac. Res clin Rheumatol.2002; 16(5); 761-775.
  4. Fujii, Tomoko, and Ko Matsudaira. Prevalence of low back pain and factors associated with chronic disabling back pain in Japan. European Spine Journal 22.2 (2013): 432-438.
  5. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal: December 2010. 19(12): 2075–94.
  6. Manusov EG (September 2012). Evaluation and diagnosis of low back pain.  Care. 39(3): 471–9.
  7. Chen SM, Liu MF, Cook J, Bass S, Lo SK. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health. 2009 Jul. 82(7).797-806.
  8. Kalin, A.K Rausch-Osthoff et al. “What is the effect of sensory discrimination training on chronic low back pain? A systematic review.” BMC Musculoskeletal Disorders, 2016.
  9. Izzo et al. “Spinal pain.” European Journal of Radiology, 2015, 746-756.
  10. Nafissi S, NiknamS, Hosseini S. Electrophysiological evaluation in lumbosacral radiculopathy. Ir J neu- rol.2012; 11(3): 83-86.
  11. Steven R. Garfin. Sciatica: Description and Diagnosis. Aug 2006.
  12. Krekoukias G, Gelalis ID, Xenakis T. “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: A randomized controlled trial.” J Man Manip Ther. 2017 May; 25(2):66-73.
  13. Richard F. Ellis et al. Neural Mobilization: A Systematic review of randomized controlled trials with an analysis of therapeutic efficacy. Journal of manual & manipulative therapy. 2008; 16 :(1):8-22.
  14. Neto T, Freitas SR, Marques M, and Gomes L. “Effects of lower body quadrant neural mobilization in healthy and low back pain populations: A systematic review and meta-analysis.” Musculoskelet Sci Pract. 2017 Feb; 27:14-22.
  15. Raymond and Evans JH (2001): Loads in the lumbar spine during traction therapy. Australian Journal of Physiotherapy 47:102-108.
  16. Van der Heijden, Ajhm Beurskens, Mjm Dirx, Lm Bouter and E Lindeman. A pilot study to compare the effect of high-dose continuous lumbar tractionand low-dose continuous lumbartractionon the magnitude and rate of recovery for patients with low back pain 1995. Physical Therapy, volume 75.
  17. Yi Xiang J. Wang, Jun-Qing Wang, and Zoltsn Kaplar. Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review. Quant Imaging Med Surg. 2016 Apr; 6(2): 199–206.
  18. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution.J Consult Clin Psychol 2002; 70:678-90.
  19. Fillingim RB. Sex, gender and pain: the biopsychosocial Model in action XX vs. XY: The International Journal of Sex Differences in the Study of Health. Dis Aging 2003; 1:98-101.
  20. Wolfe F, Ross K, Anderson J, Russell IJ. Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms.J Rheumatol 1995; 22:151-6.
  21. Rollman GB, Lautenbacher S. Sex differences in musculoskeletal pain.Clin J Pain 2001; 17:20-4. 10.1097/00002508-200103000-00004.
  22. J. Nosse. Inverted spinal traction. Arch Phys Med Rehabil, 59 (1978), pp. 367-370.
  23. Constantoyannis, D. Konstantinou, H. Kourtopoulos, N. Papadakis. Intermittent cervical traction for cervical radiculopathy caused by large-volume herniated disks. J Manipulative Physiol Ther, 25 (2002), pp. 188-192.
  24. Pellecchia GL et al. Lumbar traction: A review of the literature. J Orthop Sports Phys Ther. 1994 Nov; 20(5):262-267.
  25. Cox JM, Feller J, Cox-Cid J. Distraction chiropractic adjusting: clinical application and outcomes of 1,000 cases. Topics Clin Chiropractic 1996; 3:45–59.
  26. Knutsson E, Skoglund CR, Natchev E. Changes in voluntary muscle strength, somatosensory transmission and skin temperature. The Spine Journal 8 (2008) 234–242 241.
  27. O’Connell, John E. A., Sciatica and the mechanism of the production of the clinical syndrome in protrusions of the lumbar intervertebral discs. Brit. J. Surg., 30:315-327, 1942.
  28. Smyth, J. J, and V. Wright, Sciatica and the intervertebral disc. J. Bone Joint Surg., 40A: 1401-1418, December 1958.
  29. Goddard, MD and Reid, JD: Movement indicated by straight leg raising in the lumbosoural roots, nerves and plexus, and in the intropehic section of the siciatic nerve. J Neurol Newrosurg Psychiatry 28; 12, 1965.
  30. Lundborg G 1988 Nerve injury and Repair Churchill livingstone, Edinburg.
  31. Konrad K, Tatrai T, Hunka A, Vereckei E, Korondi I. Controlled trial of balneotherapy in treatment of low back pain. Annals of the Rheumatic Diseases1992; 51:820-2.
  32. Gladson R. B, Taciane S. S, Danilo L. T, Adriano P. C, Alberito R. C: Neural mobilization and static stretching in an experimental sciatica model: an experimental study. Revista Brasileria de Fisioterapia 2009; 13(6): 493-498.
  33. Coppieters M W, Hough A D, Dilley A. Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging. J Orthop Sports Phys Ther 2009; 39(3):164-171.
  34. Ellis RF, Hing WA, Mcnair PJ. Comparison of Longitudinal Sciatic Nerve Movement with Different Mobilization Exercises: An In Vivo Study Utilizing Ultrasound Imaging. Journal of orthopaedic & sports physical therapy.2012; 42.
  35. Kumar V, Goyal M, RajendranN, Narkeesh D. Effect of neural mobilization on monosynaptic reflex – a pretest posttest experimental design. International Journal of Physiotherapy and Research. 2013; (3):58- 62.
  36. Coppieters MW, Hough AD, Dilley A. Different Nerve-Gliding Exercises Induce Different Magnitudes of Median Nerve Longitudinal Excursion: An In Vivo Study Using Dynamic Ultrasound Imaging. J Orthop Sports Phys Ther. 2009; 39(3):164-71.
  37. Coppieters MW, Butler DS. Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008; 13:213-221.
  38. Ellis RF, Hing WA. Neural mobilization: a systematic review of randomized controlled trials with an analysis of therapeutic efficacy. J Man Manip Ther. 2008; 16(1):8-22.
  39. Shacklock MO. Clinical Neurodynamics: a New System of Musculoskeletal Treatment. Elsevier Health Sciences, Edinburg, UK, 2005.
  40. Kobayashi S, Shizu N, Suzuki Y, Asai T, Yoshizawa H. Changes in nerve root motion and intraradicular blood flow during an intraoperative straight-leg-raising test. Spine.2003; 28(13): 1427-1434.
  41. Kobayashi S, Yoshizawa H, Yamada S. Pathology of lumbar nerve root compression part 2: morphological and immune histo chemical changes of dorsal root ganglion. J. Orthop. Res. 2004; 22(1):180-188.
  42. Chen C1, Cavanaugh JM, Song Z, Takebayashi T, Kallakuri S, Wooley PH. Effects of nucleus pulposus on nerve root neural activity,mechanosensitivity, ax- onal morphology, and sodium channel expression. Spine. 2003; 29(1): 17-25.
  43. Rempel MD, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: response of peripheral nerves to loading. J. Bone Jt. Surg. 1999; 81(11):1600-1610.
  44. Schmid AB, Elliott JM, Strudwick MW, Little M, Coppieters MW. Effect of splinting and exercise on in- traneural edema of the median nerve in carpal tunnel syndrome-an MRI study to reveal therapeutic mecha- nisms. J Orthop Res. 2012; 30(8):1343-50.
  45. Cleland JA, Childs JD, Palmer JA, Eberhart S. Slump stretching in the management of non-radicular low back pain: a pilot clinical trial. Man. Ther.2006; 11(4):279-286.
  46. Brown CL, Gilbert KK, Brismee JM, Sizer PS, James CR, Smith MP. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther. 2011; 19(1):26- 34.
  47. Beneciuk MJ, Bishop DM, George ZS. Effects of up- per extremity neural mobilization on thermal pain sensitivity: a sham-controlled study in asymptomatic participants. J. Orthop. Sports Phys. Ther.2009; 39(6): 428-438.

Cite this article: Sneha Thomas, Rinkle Hotwani. EFFECTIVENESS OF INTERMITTENT PELVIC TRACTION WITH AND WITHOUT SELF NEURAL TISSUE MOBILIZATION IN LUMBAR RADICULOPATHY. Int J Physiother Res 2019;7(3):3069-3076. DOI: 10.16965/ijpr.2019.123