Effect of Adding Two Leg-rotation to Standard Physical Therapy in the Treatment of Sciatica Secondary to Lumbar Discogenic Lesions.

Among the different causes of low back pain (LBP) is a lesion in the lumbar discs. Narrowing of the disc space and intervertebral foramina, deterioration of disc quality, and protrusion outside its anatomical perimeters can lead to pressure on the surrounding structures and cause radicular pain (Ostelo, 2020). Radicular pain that follows the course of the sciatic nerve or part of it is referred to as sciatica.

Sciatica can be so bothersome secondary to the pain experienced that it can also lead to sensory deficits, tightness in the hamstrings, and limit the person's ability to stand and walk normally, thereby reducing functional ability (Fairag et al., 2022). Emotional disturbances-such as anxiety about moving and depression of varying severity-often occur, especially in people who avoid activities that worsen their pain (Oosterhuis et al., 2019).

Sciatica can be evaluated through several methods. Pain severity is often quantified using instruments such as the visual analog scale (VAS), the numeric pain rating scale (NPRS), and the McGill Pain Questionnaire (Ramasamy et al., 2017). Sciatic nerve mobility is commonly assessed by the straight leg raise (SLR) test, which measures the hip flexion angle (H. M. Hussein et al., 2024). Meanwhile, functional questionnaires determine how sciatic pain affects everyday activities (Machado et al., 2016).

Several therapeutic options are available for treating sciatica and its associated symptoms, including surgical treatment (Machado et al., 2016), medications, physical therapy (Ostelo, 2020), and manual therapies (Kuligowski et al., 2021). Recent studies have highlighted the efficacy of manual therapy in the rehabilitation of subjects with sciatica (Clar et al., 2014). One such manual therapy is the Mulligan Concept, a relatively recent approach developed by pioneer manual therapist Brian Mulligan. Specific Mulligan techniques, such as two-leg rotation, have been described for treating sciatic pain (W Hing et al., 2020).

It has been proposed that the two-leg rotation can enhance vertebral rotation and open the intervertebral foramina, thereby assisting in relieving compressions on the nerve roots caused by prolapsed discs (Pourahmadi et al., 2018).