Neuromuscular Inhibition vs Muscle Energy Techniques With Core Exercises in Mechanical Low Back Pain

NCT07258927 | Active Not Recruiting

• 1 other identifier: IUC-GSHS-2025-INITKET-01
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Chronic mechanical low back pain (CMLBP) is a common clinical problem that affects physical function, spinal mobility, and quality of life. Manual therapy techniques such as Integrated Neuromuscular Inhibition Technique (INIT) and Muscle Energy Technique (MET) are frequently used in clinical practice to reduce pain and improve function. Core stabilization exercises (CSE) have also been reported to enhance spinal stability and neuromuscular control. However, limited evidence exists comparing the combined effects of these manual therapy techniques with core stabilization exercise on clinical outcomes in individuals with CMLBP. This randomized controlled clinical study aims to compare the effects of CSE combined with INIT and CSE combined with MET on pain intensity, functional disability, lumbar range of motion, psychosocial status, muscle endurance, and quality of life in adults with chronic mechanical low back pain. Participants will be randomly assigned to one of two groups: (1) CSE + INIT or (2) CSE + MET. Each group will receive treatment two times per week for six weeks. Pain severity, functional status, lumbar mobility, patient-reported outcomes, and muscle endurance will be assessed at baseline, immediately after the intervention, and at follow-up. The results of this study will help determine whether INIT or MET provides additional benefit when combined with core stabilization exercise for improving symptoms and function in individuals with chronic mechanical low back pain.

Conditions

Chronic Mechanical Low Back Pain

Keywords

Chronic mechanical low back pain; Integrated neuromuscular inhibition technique; Respiratory muscle strength; Core stabilization exercises; Muscle energy technique

Outcome Measures

Primary Outcomes (1)

• Pressure Pain Threshold (PPT)

  Pressure pain threshold will be assessed using a handheld pressure algometer at standardized lumbar paraspinal trigger point regions. PPT is defined as the minimum pressure that produces pain. Higher values indicate reduced pain sensitivity. Units of Measure: Kilograms per square centimeter (kg/cm²)

  Baseline, Week 6 (post-treatment)

Secondary Outcomes (1)

• Disability Level (Oswestry Disability Index)

  Baseline, Week 6

Other Outcomes (4)

• Trunk Flexor Muscle Endurance

  Baseline, Week 6

• Respiratory Muscle Strength

  Baseline, 6 week

• Modified Schober Test

  Baseline, Week 6 (post-treatment)

Study Arms (3)

Core Stabilization + INIT

EXPERIMENTAL

Participants receive Core Stabilization Exercises (CSE) combined with Integrated Neuromuscular Inhibition Technique (INIT). Sessions are administered by a physiotherapist, 45-60 minutes per session, 3 times per week for 6 weeks. INIT includes ischemic compression, strain-counterstrain, and muscle energy techniques applied to active trigger points.

Behavioral: Core Stabilization Exercise (CSE); Behavioral: Integrated Neuromuscular Inhibition Technique (INIT)

Core Stabilization + MET

ACTIVE COMPARATOR

Participants receive Core Stabilization Exercises (CSE) combined with Muscle Energy Technique (MET) delivered by a physiotherapist, 45-60 minutes per session, 3 times per week for 6 weeks. Manual techniques target trigger points of quadratus lumborum, iliopsoas, hamstring, and erector spinae muscles.

Behavioral: Core Stabilization Exercise (CSE); Behavioral: Muscle Energy Technique (MET)

Core Stabilization Only

ACTIVE COMPARATOR

Participants perform only Core Stabilization Exercises (CSE), emphasizing activation of deep stabilizers (transversus abdominis and multifidus) with progressive exercises performed under physiotherapist supervision, 45-60 minutes per session, 3 times per week for 6 weeks.

Behavioral: Core Stabilization Exercise (CSE)

Interventions

Core Stabilization Exercise (CSE) BEHAVIORAL

Supervised core stabilization exercise program focusing on activation of deep trunk stabilizers (transversus abdominis and multifidus). Training includes isolated activation, quadruped exercises, bridging variations, and functional stabilization drills. Sessions last 45-60 minutes, 3 times per week for 6 weeks and are delivered by a physiotherapist.

Core Stabilization + INIT; Core Stabilization + MET; Core Stabilization Only

Integrated Neuromuscular Inhibition Technique (INIT) BEHAVIORAL

Manual therapy combining ischemic compression, strain-counterstrain, and muscle energy techniques applied to active trigger points in the lumbar/pelvic region. Target muscles include quadratus lumborum, iliopsoas, hamstrings, and erector spinae. Sessions last 45-60 minutes with integrated exercise, 3 times per week for 6 weeks and are administered by a physiotherapist.

Core Stabilization + INIT

Muscle Energy Technique (MET) BEHAVIORAL

Manual technique using therapist-guided isometric contraction of shortened muscles followed by relaxation and passive stretch. Target muscles include quadratus lumborum, iliopsoas, hamstrings, and erector spinae. Sessions last 45-60 minutes with integrated exercise, 3 times per week for 6 weeks and are administered by a physiotherapist.

Core Stabilization + MET

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Ages 18-65
• Diagnosed chronic mechanical low back pain (\>3 months)
• Pain localized between T12 and gluteal fold
• Ability to follow exercise instructions
• Voluntary consent

You may not qualify if:

• Spine surgery history
• Herniated disc with neurological deficit
• Systemic neuromuscular or rheumatologic disease
• Acute lumbar trauma
• Pregnancy
• Current participation in another clinical trial
• Use of analgesics, muscle relaxants, or physiotherapy within the past 4 weeks

Sponsors & Collaborators

• Istanbul University - Cerrahpasa: lead

Study Sites (1)

Istanbul University-Cerrahpaşa, Graduate School / Doctoral Program

Istanbul, BAŞAKŞEHİR, 34490, Turkey (Türkiye)

Location

Related Links

• General study protocol and information, including Istanbul University Cerrahpaşa Ethics Committee approval and protocol details.
• Official clinical trials registry providing general study information.
• Istanbul University institutional resources and study-related documentation.

Study Officials

• RÜSTEM MUSTAFAOĞLU

  Istanbul University-Cerrahpaşa - Graduate School of Health Sciences

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The investigator performing outcome assessments will be blinded to group allocation. Participants and care providers cannot be blinded due to the nature of the interventions.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: PT, PhD Student

Model Details: Participants will be randomized into three parallel groups: 1. CSE + INIT 2. CSE + MET 3. CSE alone.

Study Record Dates

• First Submitted: November 18, 2025
• First Posted: December 2, 2025
• Study Start: April 1, 2025
• Primary Completion: December 1, 2025
• Study Completion (Estimated): December 1, 2026
• Last Updated: April 2, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)