Background: Hemiplegic patients often experience significant gait impairments, including foot drop, which affects their functional mobility and quality of life. Objective: To evaluate and compare the effectiveness of Motor Relearning Approach (MRP) versus Proprioceptive Neuromuscular Facilitation (PNF) on pain, foot drop, gait, and functional mobility in hemiplegic patients. Methodology:68 hemiplegic patients aged 45 to 65 years were randomly divided into two groups of 34 individuals apiece in this single blinded randomised clinical experiment (ClinicalTrials.gov ID: NCT06539247). Group A got MRP along with EMS; Group B got PNF along with EMS. Manual Muscle Testing (MMT) for foot drop grading and the Dynamic Gait Index (DGI) for gait analysis were the main outcome measures. Secondary results comprised the Numeric Pain Rating Scale (NPRS) for pain evaluation and the Motor evaluation Scale for functional mobility. Parametric tests were used to examine data; the Kolmogorov-Smirnov test verified a normal distribution. Analysis of variance (ANOVA) for between-group comparisons established statistical significance. Testing took place at baseline, week four, and week eight. Results:Both groups showed significant improvements in (MMT: F = 219.269, p = 0.000), (NPRS: F = 219.269, p = 0.000), (DGI: p = 0.000), and (MAS: p = 0.000). Group A (MRP + EMS) demonstrated greater gains in MMT (interaction: p = 0.000) and higher DGI scores (interaction: p = 0.000), while there were no significant differences in NPRS and MAS (p > 0.05). However, Group A (MRP + EMS) demonstrated slightly superior improvements in foot drop and gait, compared to Group B (PNF + EMS). Conclusion:In hemiplegic patients, both MRP and PNF approaches with EMS proved useful for reducing pain, foot drop, gait, and functional mobility. When it comes to lowering foot drop and gait, MRP mixed with EMS might provide more advantages than PNF with EMS. Trial registration NCT06539247