Comparative Effects of Kinesiotherapy vs. Proprioceptive-Deep Tendon Reflex

Comparative Effects of Kinesiotherapy vs. Proprioceptive-Deep Tendon Reflex (P-DTR) Therapy on Pain Relief and Functional Recovery in Patients with Sciatica: A Clinical Study

George-Sebastian Iftimie ^1,2,, Elena Costescu ^3,4,^†, and Cristina-Elena Moraru ^1,†

¹ ”Alexandru Ioan Cuza” University of Iasi, Faculty of Physical Education and Sports, 3 Toma Cozma Street, Iasi, 700554; ktgeorgeiftimie@gmail.com

² “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Falculty of Medical Bioengineering, 16 Universitatii street, Iasi, 700115

³”Alexandru Ioan Cuza” University of Iasi; Faculty of Physics, 11 Carol I Boulevard, Iasi, 700506

⁴ “Apollonia” University of Iasi, Faculty of Medicine, 11 Pacurari Street, Iasi, 700511; naturaone@gmail.com

* Correspondence: naturaone@gmail.com; ktgeorgeiftimie@gmail.com (G.S.I.)

Abstract: Background: Musculoskeletal disorders, particularly those associated with chronic or subacute sciatica, remain a signifiant cause of disability worldwide. Conventional rehabilitation programs such as kinesiotherapy (K) focus on restoring mobility and strength, while newer approaches like Proprioceptive–Deep Tendon Reflex (P-DTR) therapy target dysfunctional neuromuscular pathways. This study aimed to compare the clinical effects of K and P-DTR therapies on pain and functional recovery. Methods: Thirty patients (mean age 45.2 ± 8.2 years) with musculoskeletal disorders were subdivided into two homogeneous groups: K and P-DTR. Each intervention was applied three times per week for six weeks. Pain intensity (VAS), flexibility (Lasegue Test, Fingertipss-to-Floor Test, Schober Test), and neural tension (Slump Test) were assessed before and after treatment. Data were analyzed using the Mann–Whitney U Tests (p < 0.05) and Wilcoxon signed-rank. Results: Both groups showed significant reductions in pain and improvements in flexibility (p < 0.001). The P-DTR Group demonstrated greater gains in pain reduction (ΔVAS = –6 vs. –4) and neural mobility (ΔLasegue = +32° vs. +15°) compared with the K Group (p = 0.02 and p = 0.01, respectively). Conclusion: Both kinesiotherapy and P-DTR effectively improved pain and function, but P-DTR produced superior outcomes. These findings suggest that integrating P-DTR into standard rehabilitation protocols can enhance neuromuscular re-education and functional recovery in patients with sciatica.

Keywords: proprioceptive; tendon; reflex; P-DTR; sciatica; lower back pain, kinesiotherapy, musculoskeletal disorders

1. Introduction

Musculoskeletal disorders, particularly those involving the lumbar spine, represent one of the most pressing public health concerns of the 21st century. According to the Global Burden of Disease study, low back pain (LBP) remains the principal cause of disability burden worldwide, with prevalence rates exceeding 50% in the general adult population at some point in their lifetime [1,2]. This condition is not only a significant source of personal suffering but also a major contributor to socioeconomic costs, with lost productivity and healthcare expenditure reaching billions of dollars annually [3].

The etiology of sciatica and related musculoskeletal dysfunctions is multifactorial [4,5] often involving a combination of biomechanical, neurological, and psychosocial components. Pathophysiological mechanisms may include disc degeneration, nerve root irritation, altered motor control, and impaired proprioception. These changes manifest clinically as pain, reduced mobility, muscle weakness, and functional disability [6] Multiple and varied therapeutic approaches to musculoskeletal imbalances exist in both literature and clinical practice [7]. Given this complexity, treatment approaches must target not only pain relief but also restoration of functional capacity and neuromuscular control.

Rehabilitation Approaches

Conventional kinesiotherapy (K) is widely recognized as a cornerstone in the management of musculoskeletal disorders. Exercise-based interventions—comprising stretching, strengthening, stabilization, and motor control training—have consistently demonstrated benefits in reducing pain, improving flexibility, and preventing recurrence of symptoms [8,9]. Kinesiotherapy emphasizes active patient participation, progressive load adaptation, and functional integration, making it a central element of most evidence-based rehabilitation protocols [10].

In recent years, Proprioceptive–Deep Tendon Reflex (P-DTR) therapy has emerged as an innovative neuromuscular intervention [11]. This approach is grounded in the understanding that dysfunctional afferent signals from proprioceptors may contribute to maladaptive reflexes, impaired movement patterns, and persistent pain. P-DTR aims to identify abnormal sensory input and reset neuromuscular responses by applying specific manual stimuli to tendon receptors, thereby normalizing sensorio-motor integration [12,13]. While preliminary reports suggest promising outcomes in terms of pain modulation and functional restoration [11] robust comparative evidence with established therapies such as kinesiotherapy is still lacking.

Clinical Assessment in Rehabilitation

To objectively evaluate the effectiveness of rehabilitation programs, clinicians frequently employ standardized functional tests and patient-reported outcome measures [14]. Among these, the Lasegue (Straight Leg Raise) Test, Schober index, Fingertipss-to-floor distance, and Slump Test provide reliable indicators of flexibility, neural tension, and spinal mobility. Pain intensity, a key determinant of quality of life, is commonly quantified through the Visual Analogue Scale (VAS), a validated and widely used tool in clinical research [3,6]. These instruments, when combined, allow for a comprehensive assessment of both subjective and objective therapeutic outcomes [14].

Rationale and Aim of the Study

Although both kinesiotherapy and P-DTR are used in clinical practice, direct comparisons between the two modalities remain scarce. Kinesiotherapy has a long-established evidence base, whereas P-DTR represents a relatively novel approach with growing clinical adoption. Considering the global burden of musculoskeletal disorders and the need for cost-effective and efficient rehabilitation strategies, it is crucial to determine whether P-DTR offers superior or complementary benefits compared to standard exercise-based therapy.

This study endeavors to evaluate and compare the effects of kinesiotherapy and P-DTR on pain reduction and functional outcomes in patients with musculoskeletal impairments. By applying standardized clinical tests (Lasegue, Schober, Fingertipss-to-floor, Slump) and VAS pain ratings before and after six weeks of therapy, we aim to provide evidence-based insights into the relative effectiveness of these two approaches.

2. Results

2.1. Participant Characteristics

A total of 30 patients (mean age = 45.2 ± 8.2 years, 53% female) completed the study. Patients were evenly distributed between the Kinesiotherapy Group (K) (n = 15) and the P-DTR Group (n = 15). No significant baseline differences were observed between groups in terms of age, sex, or initial pain levels (p > 0.05).

2.2. Summary of Key Results

Table 2.1. Median clinical outcomes (baseline vs. final) by treatment group.

Measure	Group	Baseline Median	Final Median	Δ (Change)	p (within-group)	p (between-groups)
VAS (0–10)	K	8.0	3.0	–4.0	<0.001	0.02
VAS (0–10)	P-DTR	8.0	2.0	–6.0	<0.001
Lasegue (°)	K	30	44	+15	<0.001	0.01
Lasegue (°)	P-DTR	31	66	+32	<0.001
Schober (cm)	K	16.5	19.5	+3.0	<0.01	0.09
Schober (cm)	P-DTR	16.3	21.0	+4.5	<0.01
Fingertips-to-Floor (cm)	K	35	29	–6.0	<0.01	0.11
Fingertips-to-Floor (cm)	P-DTR	36	27	–9.0	<0.01

Dataset summary: n = 30. Group counts: {‘K’: 15, ‘P-DTR’: 15}.

For each parameter, we provide per-group (K, P-DTR) and overall boxplots (initial vs final), a bar chart of median changes (Δ), and concise statistical (p-values) and clinical interpretations.

1. Motor deficit

Patients with sciatica underwent motor deficit evaluation before and after treatment, specifically focusing on ankle dorsiflexion and plantar flexion function. The assessment protocol included standardized manual muscle testing of dorsiflexor and plantar flexor strength, evaluation of muscle tone in these muscle groups. These received evaluations of the type: positive/negative or absolute values resulting from measurements as appropriate. We will present the evaluation results graphically below.

Figure 2.1. Motor deficit in K Group (a) intial (b) final

The initial evaluation reveals that the majority of patients in K Group presented positive motor deficit at the initial assessment, confirming the level of impairment before the application of kinesiotherapy. The final evaluation reveals an evident decrease in the proportion of patients with positive motor deficit, which reflects the beneficial effect of kinesiotherapy on neuromuscular function.

Figure 2.2. Motor deficit in P-DTR Group (a) intial (b) final

In the P-DTR Group, the initial distribution shows a comparable number of patients with and without deficit, confirming the initial homogeneity between groups. At the end of P-DTR therapy, the majority of patients (80%) no longer present motor deficit, while only 20% maintain a partial deficit. This distribution confirms the high efficiency of the P-DTR method in restoring neuromuscular function and reducing motor dysfunctions.

2.2.2. Pain Intensity (VAS)

The evaluation regarding pain level was also conducted initially and finally.

Figure 2.3. Results regarding pain level on the VAS scale in K Group vs. P-DTR Group (a) intial (b) final

In the initial stage, the evaluations on the VAS Scale reveal the following initial mean values:

• K Group: 8,6

• P-DTR Group: 8,6

The proportions are identical (50%–50%), indicating complete homogeneity between samples at the initial moment. Both groups presented a high level of perceived pain, which confirms the comparative validity of the study. Statistically, the initial difference was non-significant (p = 1.000), which demonstrates equivalent starting conditions.

In the final stage, the evaluations on the VAS Scale show that the mean pain values decreased significantly after treatment:

• K Group: 4,0

• P-DTR Group: 2,3

The proportion of values in the P-DTR Group (≈ 36%) reflects a more evident decrease in pain perception relative to the group treated through classical kinesiotherapy. The difference is statistically significant ( t = 3.97 , p = 0.0005 t=3.97,p=0.0005) and indicates superior efficiency of P-DTR therapy in diminishing perceived pain at the lumbar level. Visually, the graph shows a lower concentration of residual pain in the P-DTR Group, which denotes a more complete sensory recovery.

At baseline, the median VAS score was 8.0 in both groups. After six weeks of therapy:

– K Group improved to a median VAS of 3.0, corresponding to a median ΔVAS of –4.0 (IQR –5.0 to –3.0).

– P-DTR Group improved to a median VAS of 2.0, corresponding to a median ΔVAS of –6.0 (IQR –7.0 to –4.0).

Figure 2.4. Comparative evolution Δ Scala VAS in K Group vs. P-DTR Group

Regarding the comparative evolution Δ VAS (pain reduction), we observe the mean pain reduction:

• K Group: 4,6 points

• P-DTR Group: 6,3 points

The circular graph highlights the clear difference in the magnitude of improvement, with the P-DTR Group contributing approximately 58% of the total pain reduction observed in the entire cohort. This pronounced improvement correlates with an optimization of the neuromuscular reflex response and with normalization of postural tone, confirming the cumulative effects of P-DTR intervention on the nociceptive system.

In conclusion, the graphs clearly illustrate that both therapeutic methods led to a significant decrease in lumbar pain, however:

• the K Group achieved a moderate reduction in pain;

• the P-DTR Group recorded a significantly greater and more stable decrease in pain symptomatology.

This confirms that P-DTR therapy not only reduces pain perception, but also reconfigures the reflex response of the nervous system, having a profound effect on sensorimotor recalibration and neuromuscular homeostasis.

Both groups showed statistically significant within-group reductions in pain (p < 0.001, Wilcoxon Test). Between-group comparison of ΔVAS revealed a significantly greater reduction in the P-DTR Group (p = 0.02, Mann–Whitney U Test).

2.3. Functional Outcomes

2.3.1. Lasègue Test

Among the functional tests, the Lasègue Test, a clinical maneuver used to evaluate tension and irritation of the sciatic nerve or lumbar nerve roots (especially L4, L5, S1) revealed:

Baseline medians: K = 30°, P-DTR = 31°.

Final medians: K = 44°, P-DTR = 66°.

Median change: K = +15°; P-DTR = +32°.

Figure 2.5. Lasegue Test in K Group vs. P-DTR Group (a) intial (b) final

In the initial stage, the mean values of the Lasègue angle were similar between the two groups:

• K Group: 28,67°,

• P-DTR Group: 30,67°.

The percentage difference between groups is small (approximately 48% vs. 52%), indicating initial homogeneity of the samples and comparable limitation of neuromuscular mobility. This uniformity ensures the validity of subsequent analyses and confirms that the final effects can be attributed to the therapeutic intervention, not to baseline differences.

After applying the therapeutic protocols, a significant increase in Lasègue angle values is observed in both groups, but especially in the group treated with P-DTR:

• Group K – 43,27°,

• Group P-DTR – 63,27°.

Proportionally, the P-DTR group represents over 59% of the total mean improvement, which suggests a significantly superior amelioration of lumbar mobility and neuromuscular decompression. This result confirms the statistical conclusions ( t = − 7.02 t=−7.02, p < 0.001 p<0.001) regarding the clearly superior efficacy of the P-DTR method.

Figure 2.6. Comparative evolution Δ Lasegue Test in group K vs. Group P-DTR (initial-final)

The difference between final and initial values (Δ) clearly highlights the efficacy of the interventions:

• Group K – mean increase of +14,6°,

• Group P-DTR – mean increase of +32,6°.

The ratio between improvements shows that patients treated with P-DTR achieved a progression over 2.2 times greater compared to those treated with simple kinesiotherapy. The pie chart highlights the predominance of the P-DTR effect on flexion amplitude, visually illustrating its efficacy in neuromechanical restoration of the lumbosacral chain.

Overall, the graphical analysis of the Lasègue Test confirms the statistical results:

Both groups started from similar levels of mobility limitation (initial stage).

Both evolved positively, however the P-DTR group achieved significantly greater gains ( p < 0.001 p<0.001). Visually, the proportion of P-DTR values in the final and comparative charts shows a clear dominance of neuromuscular mobility improvement and accelerated functional recovery.

Both groups demonstrated significant within-group improvements (p < 0.001). The between-group comparison showed superior gains in the P-DTR group (p = 0.01).

Figure 2.7. Schober Test in K group vs. P-DTR group (a) intial (b) final

In the initial stage – Schober Test initial mean values were:

• Group K: 17,8 cm

• Group P-DTR: 18,0 cm

The proportions are nearly equal (≈ 50%–50%), confirming the initial homogeneity of the samples and the absence of statistically significant differences ( p = 0.551 p=0.551). This shows that baseline lumbar mobility was comparable between the two groups before treatment application.

In the final stage – Schober Test values increased visibly after treatment:

• Group K: 19,0 cm

• Group P-DTR: 21,3 cm

The mean increase in Schober distance indicates an improvement in lumbar mobility, with enhanced extensibility of the lumbar spine. The P-DTR group occupies a dominant proportion in the graph (≈ 53%), which suggests faster and more extensive recovery of lumbar segmental function, statistically confirmed ( t = − 4.86 t=−4.86, p < 0.001 p<0.001).

Figure 2.8. Comparative evolution Δ Lasegue Test in group K vs. Group P-DTR

In the comparative evolution Δ Schober (distance increase) we observe:

Mean improvement:

• Group K: +1,2 cm

• Group P-DTR: +3,3 cm

The graph shows a clear difference in favor of the P-DTR method, which produced an almost 3-fold greater increase in Schober distance compared to classical kinesiotherapy. This reflects a stronger effect on joint mobility and on the segmental release of the lumbar myofascial chain. The result confirms the superior efficacy of P-DTR therapy in restoring fine and symmetrical lumbar movements, with direct clinical impact on posture and trunk biomechanics.

Thus, in conclusion, the graphs highlight the ascending evolution of lumbar mobility in both groups, but also the clear superiority of the group treated with P-DTR.

Proportionally, this method generated:

• a greater increase in Schober distance,

• superior lumbar flexibility,

• and accelerated functional recovery.

Therefore, both visually and statistically, the P-DTR method confirms a significantly improved therapeutic response compared to conventional physiotherapy.

2.3.2. Fingertips-to-Floor Test

Regarding the Fingertips-to-Floor Test, we obtained the following results shown in Figure 2.9.

Figure 2.9. Fingertips-to-Floor Test results in K group vs. P-DTR group (a) intial (b) final

In the initial stage of the Fingertipsss-to-Floor Test, the mean values were:

• K Group – 43,0 cm

• P -DTR Group – 39,3 cm

The differences between groups are minimal (≈ 52% vs. 48%), which indicates pre-therapeutic homogeneity. Both groups presented similar limitation of trunk flexion and lumbar mobility, confirming comparable initial conditions..

In the final stage of the Fingertips-to-Floor Test, it shows us that the mean values decreased significantly after treatment:

• Group K – 34,8 cm

• Group P-DTR – 25,0 cm

The decrease in values reflects an increase in lumbar mobility and trunk flexibility, as the Fingertips-to-floor distance reduces with improved muscular extensibility. The P-DTR group occupies a dominant proportion in the graph (approximately 58%), indicating more efficient recovery and significant improvement compared to the group treated with conventional physiotherapy.

Figure 2.10. Comparative evolution Δ Fingertips-to-Floor Test results in K Group vs. P-DTR Group

Regarding the comparative evolution Δ Fingertips-to-Floor, we observe the mean improvement (distance decrease):

• Group K: −8,2 cm

• Group P-DTR: −14,3 cm

The results show that patients treated with P-DTR achieved an increase in flexibility over 70% greater compared to K group. The circular graph visually highlights the predominance of progress in the P-DTR group, which confirms the statistical results ( t = 4.17 , p < 0.001 t=4.17,p<0.001) regarding the superior efficacy of P-DTR therapy in restoring lumbar functional mobility.

Both groups improved significantly in lumbar flexibility measures, with greater improvements observed in the P-DTR group; however, between-group differences did not reach statistical significance (p > 0.05).

2.3.3. Slump Test and Motor Function

Figure 2.11. Slump Test in K Group vs. P-DTR Group (a) intial (b) final

1. Initial stage – Slump Test

Initial mean values:

• Group K: 2,1

• Group P-DTR: 2,3

The proportions are close (≈ 48% vs. 52%), which indicates initial homogeneity between samples. Both groups presented a comparable level of neuromeningeal limitation at the beginning of the study, with no statistically significant difference ( p = 0.276 p=0.276).

This confirms that the treatments were applied to groups with the same degree of functional impairment.

2. Final stage – Slump Test

After treatment, the mean scores increased significantly:

• Group K: 3,3

• Group P-DTR: 4,1

The score increase reflects improved neuromeningeal flexibility and more efficient neural discharge.

The proportion of values for the P-DTR group (≈ 55%) indicates significantly superior recovery, supported by the Mann–Whitney U Test results ( U = 65.5 U=65.5, p = 0.028 p=0.028).

This demonstrates the effectiveness of the P-DTR method in restoring gliding and elasticity of the peripheral nervous system.

Figure 2.12. Comparative evolution Δ Slump Test results in K Group vs. P-DTR Group

Comparative evolution Δ Slump Test (score increase)

Mean improvement:

• Group K: +1,2

• Group P-DTR: +1,8

The graph clearly highlights greater progress in the P-DTR group, which achieved an increase of approximately 50% over that of the K group. This difference confirms the positive effect of the P-DTR method on neuromeningeal discharge reflexes, reducing tension and improving lumbar motor coordination.

Thus, the graphs show that both groups recorded functional progress, however:

• the K Group achieved moderate improvements,

• while the P-DTR Group recorded more consistent improvement, both at the final score level and in terms of mean increase.

Improvements were noted in neural mobility and reduction of positive motor deficit signs. At final assessment, 73% of patients in the P-DTR Group demonstrated normalized motor function compared with 53% in the K Group, although this difference was not statistically significant.

In conclusion, P-DTR therapy demonstrates superior efficiency in reducing neuromeningeal tension, facilitating faster restoration of neuro-musculo-skeletal balance.

3. Discussion

The present study compared the effects of kinesiotherapy (K) and Proprioceptive–Deep Tendon Reflex (P-DTR) therapy in patients with musculoskeletal impairments associated with low back pain. Both groups demonstrated significant improvements in pain reduction and functional mobility after six weeks, but P-DTR therapy produced superior outcomes in terms of pain relief (ΔVAS = –6 vs. –4) and functional gains (ΔLasegue = +32° vs. +15°).

3.1. Functional Improvement

The significant increase in Lasegue angle in the P-DTR group indicates improved neural mobility and reduced nerve root irritation. This observation supports the hypothesis that P-DTR interventions address dysfunctional proprioceptive input, thereby enhancing motor coordination and flexibility [12]. Although improvements in Schober and Fingertips-to-floor Test were also greater in the P-DTR group, the differences were not significant from a statistical standpoint, perhaps due to the restricted sample size.

3.2. Pain Reduction

Consistent with previous research, exercise-based rehabilitation (kinesiotherapy) significantly reduced pain intensity [3,8]. However, the greater reduction observed in the P-DTR group aligns with reports that neuromodulation techniques may target not only mechanical dysfunction but also aberrant sensorimotor pathways responsible for chronic pain persistence [12,13]. These findings suggest that while conventional exercise restores mobility and strength, P-DTR may provide an additional benefit through neural recalibration.

3.3. Comparison with Literature

Several systematic reviews have confirmed the efficacy of structured exercise programs for chronic low back pain [3,9]. However, evidence on neuromodulation-based therapies remains limited, with most studies being small-scale or lacking direct comparisons. Our results contribute to this emerging body of evidence by demonstrating that P-DTR may be more effective than kinesiotherapy in reducing pain and improving neural mobility.

3.4. Clinical Implications

These findings highlight the potential value of integrating P-DTR into rehabilitation protocols, particularly for patients with persistent pain and limited response to exercise-based approaches. Given its relatively short session duration and rapid effects, P-DTR could serve as an adjunct to traditional physiotherapy rather than a replacement.

3.5. Limitations

This study has several limitations. First, the sample size (n = 30) was modest, limiting the generalizability of results and reducing statistical power for secondary outcomes. Second, the study was conducted in a single center, and follow-up was limited to six weeks, preventing assessment of long-term effects or recurrence rates. Third, patient blinding was not possible due to the nature of the interventions, which may introduce performance bias.

3.6. Future Directions

Further research involving larger randomized controlled trials is warranted to confirm these preliminary findings. Longitudinal studies should also explore the durability of P-DTR effects and potential synergistic benefits when combined with conventional exercise-based therapy. Additionally, mechanistic investigations using neurophysiological markers could clarify how P-DTR influences central and peripheral pain pathways.

4. Materials and Methods

4.1.Study Design

This prospective observational comparative study was conducted between January 2023 and June 2024 at the Department of Physical and Rehabilitation Medicine, a tertiary-care academic hospital. The study adhered to the STROBE guidelines for observational studies [15,16]. The institutional ethics committee approved the research protocol (Approval No. 17/2024), and all participants provided written informed consent prior to enrollment, in accordance with the Declaration of Helsinki [17].

4.2. Participants

A total of 30 adult patients with musculoskeletal disorders associated with chronic or subacute low back pain were included.

Inclusion criteria:

Age between 30 and 60 years.
Clinical diagnosis of non-specific low back pain persisting for at least six weeks.
Presence of limited mobility or functional restriction confirmed by at least one clinical test (Lasegue, Schober, fingertip-to-floor, or Slump).
Ability to attend at least 80% of scheduled therapy sessions.

Exclusion criteria:

Previous lumbar spine surgery or significant spinal deformity.
Neurological disorders unrelated to musculoskeletal dysfunction (e.g., multiple sclerosis, Parkinson’s disease).
Severe comorbidities (uncontrolled cardiovascular disease, cancer).
Pregnancy.
Refusal or inability to provide informed consent.

The study cohorts had a mean age of 45.2 ± 8.2 years, with no meaningful statistical difference between them. The sex distribution was balanced (53% female, 47% male). Randomization into the two groups was performed by simple block randomization:

Kinesiotherapy group (K): n = 15.
P-DTR group (P-DTR): n = 15.

4.3. Intervention Protocols

Kinesiotherapy (K group)

Patients received exercise-based rehabilitation consisting of:

1. Stretching exercises: hamstrings, lumbar paraspinals, hip flexors.

2. Lumbar stabilization exercises: abdominal draw-in maneuver, bridging, quadruped arm/leg raises.

3. Strengthening exercises: progressive resistance training for trunk extensors and flexors.

4. Functional training: sit-to-stand practice, gait re-education, and posture correction.

Each session lasted 45 minutes, three times per week, for six consecutive weeks. Exercises were supervised by a licensed physiotherapist with >5 years of clinical experience.

Proprioceptive–Deep Tendon Reflex (P-DTR group)

Patients underwent P-DTR neuromodulation therapy, which consisted of:

1. Identification of dysfunctional afferent inputs through manual muscle testing.

2. Application of manual stimulation (tapping or pressure) to deep tendon receptors.

3. Integration of corrective stimuli while the patient performed controlled movements.

4. Immediate reassessment of muscle activation and pain response.

Each session lasted 30–40 minutes, delivered three times weekly for six weeks, by a therapist certified in P-DTR. This method targeted abnormal reflex arcs and sensorimotor integration, with the aim of improving neuromuscular balance and reducing pain.

4.4. Clinical Assessments

All participants underwent evaluation at baseline (T0) and after six weeks of therapy (T1). The following standardized tools were applied:

Motor Deficit Evaluation: Classified as present/absent based on manual muscle testing (Medical Research Council scale).
- Visual Analogue Scale (VAS): Pain intensity scored on a 10 cm horizontal line, validated for musculoskeletal pain assessment [19].
- Lasegue Test (Straight Leg Raise): Passive hip flexion with extended knee until pain onset, measured in degrees with a goniometer.
- Fingertips-to-Floor Test: Distance between the middle finger and the floor during maximal forward flexion; lower values indicate greater flexibility.
- Schober Index: Measured by marking two points 10 cm apart over the lumbar spine and calculating the distance change during forward flexion.
- Slump Test: Assessed neural mechanosensitivity by sequential lumbar and cervical flexion with knee extension.

4.5. Outcome Measures

Primary outcome: Pain reduction, expressed as ΔVAS (VAS final – VAS initial).
- Secondary outcomes: Improvements in flexibility and mobility tests (ΔLasegue, ΔFingertip-to-Floor, ΔSchober, ΔSlump), as well as motor function indicators.

4.6. Statistical Analysis

All data were analyzed using Python (pandas, SciPy) and cross-checked with SPSS v.29.

Continuous variables were assessed for normality using the Shapiro–Wilk Test. As most distributions deviated from normality, non-parametric tests were applied.
- Results were expressed as medians with interquartile ranges (IQR).
- Within-group comparisons (baseline vs. post-treatment) used the Wilcoxon signed-rank test.
- Between-group comparisons of change scores were performed using the Mann–Whitney U Test.
- Categorical data (e.g., motor deficit presence) were described as frequencies and percentages.
- Significance was set at p < 0.05.
- Missing data (≤5%) were handled by pairwise deletion.

5. Conclusions

This study provides comparative evidence on the effectiveness of two rehabilitation strategies—Kinesiotherapy (K) and Proprioceptive–Deep Tendon Reflex (P-DTR) therapy—in patients with musculoskeletal impairments and chronic or subacute low back pain.

Both therapeutic modalities led to significant clinical improvements in pain reduction and functional performance after six weeks of intervention. The VAS (pain intensity) decreased substantially in both groups, with a median reduction of 4 points in the K group and 6 points in the P-DTR group (p < 0.001 for both). This finding indicates that both exercise-based and neuromodulation-based interventions effectively modulate pain perception.

Regarding functional recovery, marked improvements were observed in the Lasegue Test, Schober index, and Fingertip-to-Floor Test, reflecting enhanced flexibility and lumbar mobility. The P-DTR group demonstrated superior progress in neural mobility, as shown by a median Lasegue gain of +32° compared to +15° in the K group (p = 0.01).

The overall results suggest that P-DTR therapy provides additional benefits beyond those achieved with conventional kinesiotherapy, likely due to its action on proprioceptive and reflex pathways, which may optimize neuromuscular control and sensorimotor integration. These findings are consistent with emerging evidence supporting multimodal rehabilitation strategies combining biomechanical and neurofunctional interventions [12,13].

Clinical Implications. From a clinical perspective, the integration of P-DTR into standard rehabilitation protocols could enhance pain relief and motor function in patients with persistent low back pain. The short duration of P-DTR sessions and the rapid observed effects suggest its potential role as a complementary tool rather than a replacement for traditional physiotherapy.

Limitations. The relatively small sample size (n = 30) and the short follow-up period (six weeks) limit the generalizability of these findings. The absence of randomization and long-term follow-up precludes definitive conclusions regarding sustained effects or recurrence rates.

Future Research. Further randomized controlled trials with larger cohorts are needed to confirm these results. Future studies should also incorporate neurophysiological and imaging assessments to elucidate the mechanisms through which P-DTR exerts its therapeutic effects. Long-term evaluations will be essential to determine the durability of functional gains and pain reduction.

Contributions: All authors contributed equally to this article.

Funding: This research received no external funding.

Institutional Review Board Statement: The study was conducted under the Declaration of Helsinki, and approved by the Ethics Committee of EMPATIO CLINICS (nr. 9 from 10.01.2022) for studies involving humans.

Informed Consent Statement: Informed consent was received from all subjects involved in the study. The patient(s) has(have) given their written informed consent for this paper to be pub-lished.

Comparative Effects of Kinesiotherapy vs. Proprioceptive-Deep Tendon Reflex