Effects of Spinal Mobilization With and Without Clinical Pilates in Patients With Lumbar Disc Herniationc Herniation

Group A will receive spinal mobilization along hot pack for 10 minutes and TENS for 10 minutes. In this group, participants will receive graded posteroanterior (PA) mobilizations on the affected lumbar segment L1-L5. The therapist will use oscillatory mobilizations of grade 1 and 2 within the pain free range depending on the patient's response and clinical evidences.

To apply spinal mobilization the members will be placed in an appropriate prone lying position on a couch and with hands on their respective sides. The therapist will place the hypothenar (ulnar) surface of the hand on the spinous process of the symptomatic lumbar vertebrae (L1-L5) while the other hand will be placed over the first hand to increase the force. Mobilization will be applied for 4 times with a 30-60 second of PA pressure and a resting interval of 20 sec. Apply 2 to 3 oscillations per sec. We'll start with the grade 1 and check the patient's response and gradually increase the grade of oscillations from 1 to 2

Group A will receive spinal mobilization along hot pack for 10 minutes and TENS for 10 minutes. In this group, participants will receive graded posteroanterior (PA) mobilizations on the affected lumbar segment L1-L5. The therapist will use oscillatory mobilizations of grade 1 and 2 within the pain free range depending on the patient's response and clinical evidences.

To apply spinal mobilization the members will be placed in an appropriate prone lying position on a couch and with hands on their respective sides. The therapist will place the hypothenar (ulnar) surface of the hand on the spinous process of the symptomatic lumbar vertebrae (L1-L5) while the other hand will be placed over the first hand to increase the force. Mobilization will be applied for 4 times with a 30-60 second of PA pressure and a resting interval of 20 sec. Apply 2 to 3 oscillations per sec. We'll start with the grade 1 and check the patient's response and gradually increase the grade of oscillations from 1 to 2

For spinal mobilization, the participants will receive the same protocol just like the members of group A. However, the participants of this group will receive a session of Clinical Pilates Exercises. The exercises will be given to all the members of group B 3 days per week and the study continues for 4 weeks. The exercise session will be divided into 4 weeks

For spinal mobilization, the participants will receive the same protocol just like the members of group A. However, the participants of this group will receive a session of Clinical Pilates Exercises. The exercises will be given to all the members of group B 3 days per week and the study continues for 4 weeks. The exercise session will be divided into 4 weeks.

Numeric Rating Scale (NPRS) is most frequently used instruments to measure pain intensity in musculoskeletal pain. The 11-point numeric with 0 representing No pain, 1-3 representing Mild Pain (nagging, annoying, interfering little with ADLs), 4-6 representing Moderate Pains (interferes significantly with ADLs), 7-10 representing Sever Pain (disabling, unable to perform ADLs). It is evident that the NPRS are practical to use, yield accurate scores, and correspond to multi-item patient-reported outcome measures. More work is needed to improve the scales' responsiveness (meaningful change) and how change scores are interpreted. In neck pain research and management, the NPRS can be a helpful single-item evaluation to support more thorough multi-item patient-reported outcome measures

The Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent functional disability. The test is considered the 'gold standard' of low back functional outcome tools. This scale contain question related to functional activities of pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life and travelling. For patients understanding, URDU version is used. Interpretation of scale are 0% to 20% for minimal disability, 21% to 40% for moderate disability, 41 % to 60 % for severe disability 61% to 80 % for crippled and 81 % to 100 %. Bed-bound

The spinous process of the 1st sacral vertebra and the 12th thoracic vertebra were considered as reference points for measuring the range of motion in bending forward and backward. The spinous process of the 12th thoracic vertebra was considered as reference point for measuring the range of motion of lumbar side flexion. Two bubble inclinometers were used simultaneously for measuring the lumbar range of motion when bending forward (in the standing position), and one bubble inclinometer for measuring the lumbar range of motion for back extension (in the standing) and side flexion (in the standing position). The actual ranges of motion of lumbar area when bending forward and backward were calculated by subtracting the number (degree) obtained by the lower inclinometer from the number (degree) obtained by the upper inclinometer