Contralateral Leg Neuro-dynamic and Spine Mobilization With Leg Movement in Patients With Sciatica

Sciatica is the broad term describe as radicular pain/ or paresthesia that originate from low back and radiate along sciatic nerve or with associated lumbosacral nerve root. Sciatica may occur unilaterally or bilaterally with or without lower extremity pain, People with sciatica describe sharp aching and radiating leg pain. It may cause neurological problem such as weakness, numbness or hypo-reflexes and in some cases bladder dysfunction may be present. Pain and discomfort in sciatica affect daily life activities such as walking, bending and running adversely which affect the quality of life.

Diabetes mellitus is a chronic hyperglycemic multisystem disorder which is characterized by either genetic or metabolic dysfunction. It is further classified into two categories type 1 diabetes mellitus (T1DM) which is genetic disorder that prevents the pancreatic beta cells to secrete insulin either due to destruction or reduced number of pancreatic beta cells and type 2 diabetes mellitus (T2DM) is a metabolic disorder in which peripheral insulin receptors of the body become resistant to insulin. The underlying pathophysiology of diabetes and lumbar spine disorders shows a strong association between lumbar degeneration and type 2 diabetes as there is increasing end product of toxic glycation, Expression of MMP-2 related to degradation of extracellular matrix and hyperglycemia induced inflammation of disc, although these changes were observed in animals as in human there is still some lacking about its pathophysiology.

Contralateral leg neuro-dynamic technique was introduced by Shacklock on Maitland concept of slump test that with in slump test position contralateral leg pain is reduced by maintaining this position. This technique is use to reduced pain and increase ROM in sciatica patients. Spinal Mobilization with leg movement was developed by Brain Mulligan, in this technique continuous lateral glides was applied on spinous process and performing actively or passively leg movement this technique is also use for sciatica patients to reduce pain and increase ROM.

The Rational of present study is to determine which technique CLNDT or SMWLM is more effective than other for Pain, ROM, and disability in diabetic and non- diabetic patients with sciatica. It will also determine effect of HbA1C level on pain, ROM and Disability on CLNDT and SMWLM techniques in Diabetic patients with sciatica