Effects of Cyriax Manipulation with Traditional Physical Therapy on Pain, ROM and Disability in Patients with Discogenic Lumbar Radiculopathy: A Randomized Controlled Trial

Abstract

Background: Discogenic lumbar radiculopathy can cause persistent pain, restricted lumbar mobility, and functional disability. Cyriax manipulation is used as a manual therapy approach, but its additional benefits when combined with traditional physiotherapy require further investigation. Objective: To compare the effects of Cyriax manipulation combined with traditional physiotherapy versus traditional physiotherapy alone on pain intensity, lumbar range of motion, and functional disability in patients with discogenic lumbar radiculopathy. Methodology: This single-blind, parallel-group randomized controlled trial was conducted at Allied Hospital, Faisalabad, Pakistan, from March to May 2025. Individuals with a history of spinal surgery, fracture, or neurological disorders were excluded. Fifty-four participants were randomized equally to Cyriax manipulation plus traditional physiotherapy or traditional physiotherapy alone. Both groups received 18 treatment sessions over six weeks. Pain, lumbar range of motion, and functional disability were assessed at baseline, mid-treatment, post-treatment, and follow-up using the Visual Analogue Scale, inclinometer, and Modified Oswestry Disability Index, respectively. Data were analyzed using mixed-model analysis of variance, with statistical significance set at p<0.05. Results: Both groups demonstrated changes in pain intensity, functional disability, and lumbar range of motion over the assessment period. Mean pain scores decreased from 5.96 at baseline to 2.44 at follow-up in the combined-treatment group and from 5.70 to 3.74 in the traditional physiotherapy group. Disability scores improved after treatment in both groups, although some deterioration was observed at follow-up. The available comparative results do not consistently establish statistically significant between-group differences across all outcomes. Conclusion: Adding Cyriax manipulation to traditional physiotherapy was associated with a greater descriptive reduction in pain. However, its overall superiority for improving pain, lumbar range of motion, and disability remains unconfirmed.