The effect of Mulligan`s SNAG with conventional Physical Therapy Treatment on Pain, Disability, Kinematic and Coordination Between Lumbar Spine and Hip Joint during sit to stand and vice versa in People with Lumbar Discopathy.

Investigating the Effect of Mulligan`s Sustained Natural Apophyseal Glide (SNAG) Technique Combined with Conventional Physiotherapy on Pain, Disability, Kinematics, and Lumbo-Pelvic Coordination During Sit-to-Stand and Stand-to-Sit Movements in Individuals with Lumbar Disc Herniation

A single-blind randomized controlled clinical trial with stratified random sampling and parallel group design.

This study will be conducted at the School of Rehabilitation Sciences, Eligible participants who provide informed consent will be randomly assigned to two groups.Patients will be blinded to group allocation. Pre- and post-intervention assessments will be conducted by a blinded evaluator not involved in treatment delivery.

Inclusion criteria: Pain intensity between 3 and 7 on the Visual Analog Scale MRI or CT scan findings indicating disc protrusion Patients most have a directional preference for lumbar spine extension A positive result in at least one of the SLR or SLUMP tests The duration of pain and related symptoms between 6 weeks and 6 month Exclusion criteria: Presence of neurological signs sdeficits Spinal stenosis Spinal tumor Spondylolisthesis Serious pathologies such as malignancy, cauda equina syndrom Pregnancy History of corticostroid injection History of spinal injury Presence of significant hamstring tightness

Control Group: Received standard physiotherapy including: Superficial heat therapy Superficial electrical stimulation Exercises and general advices Home exercise program Mulligan Treatment Group: Received standard physiotherapy combined with the SNAG technique

Pain, Disability, Range of motion(ROM), Coordination، Lumbopelvic rhythm,

In this study, to maintain balance between the two groups regarding the influential variable, stratified block randomization will be used. Participants will first be stratified based on gender, and then randomly assigned to two equal-sized groups: the intervention group (receiving the Mulligan mobilization technique along with conventional physiotherapy) and the control group (receiving conventional physiotherapy alone). The advantage of this method is that it not only ensures an equal number of participants in both groups, but also guarantees an even distribution of the stratifying variable across the groups. The block size will be 4, with two participants in each block allocated to the intervention group and two to the control group. Allocation concealment will be ensured using sealed opaque envelopes. Each envelope will be labeled with a number corresponding to the total number of blocks. A person who is blinded to the study protocol will use a computer-generated random number sequence to select an envelope. The number on the envelope will be matched, the envelope opened, and the predefined block inside will determine the group allocation for four participants. To minimize selection bias, the randomization procedure will be conducted by an independent person who will not be involved in any other aspect of the study.

Participants in the study will be blinded to their group allocation. The researcher will organize the treatment sessions in such a way that the two groups will not have any contact with each other during the intervention period. All patient assessments, including pain intensity, disability level, and kinematic evaluations, will be conducted by an independent assessor who is not involved in the treatment of participants.