Effects of Muscle Energy Technique combined with Sciatic Nerve Mobilization for sciatica in patients with chronic lumbar disc herniation

INTERVENTION: This is a three‐arm, parallel‐group, randomized controlled trial. Participants in all three groups will receive their respective interventions three times per week for four consecutive weeks (total of 12 sessions). All interventions will be delivered at the same clinical setting. The specific interventions for each arm are described below. All physiotherapy interventions will be delivered by a single licensed physiotherapist with over 5 years of clinical experience in musculoskeletal rehabilitation. Prior to the trial, the therapist will complete standardized training on the study protocol to ensure consistent delivery of all techniques across all participants and groups. To control for detection bias, all outcome assessments (VAS, ODI, SF‐36) will be performed by an independent assessor who is not involved in any treatment procedure and is blinded to group allocation. Participants will be instructed not to disclose their group assignment to the assessor during subsequent assessments. Due to the nature of the physical intervention, blinding of the treating physiotherapist and participants is not feasible; therefore, assessor blinding will be employed, and the treating therapist will not be involved in any outcome measurement procedures. Treatment fidelity and adherence across all groups will be monitored through session attendance checklists, therapist documentation of participant tolerance and subjective responses during each visit, and recording of any protocol deviations or adjustments made. 1. Arm 1 ‐ Experimental Group (MET + SNM + Conventional Treatment) Participants in this arm will receive a combination of Muscle Energy Technique (MET), Sciatic Nerve Mobilization (SNM), and conventional treatment (TENS and Cat‐Camel exercise).< CONDITION: Chronic lumbar disc herniation with unilateral sciatica; ; Chronic lumbar disc herniation with unilateral sciatica Musculoskeletal ‐ Other muscular and skeletal disorders PRIMARY OUTCOME: Pain intensity[Measured using the Visual Analogue Scale (VAS), 0–100mm scale Baseline (Week 0), Week 4 (post‐intervention, end of 4‐week intervention; primary timepoint), and Week 8 (follow‐up, 4 weeks post‐intervention completion).] SECONDARY OUTCOME: Functional disability[Measured using the Oswestry Disability Inde X(ODI) Baseline (Week 0), Week 4 (post‐intervention, end of 4‐week intervention), and Week 8 (follow‐up, 4 weeks post‐intervention completion).] Health‐related quality of life[Measured using the Short Form‐36 (SF‐36) Baseline (Week 0), Week 4 (post‐intervention, end of 4‐week intervention), and Week 8 (follow‐up, 4 weeks post‐intervention completion).] INCLUSION CRITERIA: Adults aged 30 to 60 years with MRI‐confirmed chronic lumbar disc herniation at L4‐L5 or L5–S1, unilateral sciatica consistent with clinical symptoms, symptom duration of more than 3 months, and ability to provide written informed consent.