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.

(a)	(b)

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.

(a)	(b)

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.