Strain Counter Strain and Muscle Energy Technique in Non-specific Low Back Pain

NCT07854028 | Recruiting

• 1 other identifier: Attia Batool
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

Low back pain (LBP) is a condition characterized by fatigue, discomfort in the lumbosacral area, and a most common cause of disability . Low Back Pain (LBP) is defined as tiredness, discomfort or pain in the lower back region, radiating to lower extremities unilaterally or bilaterally. Low back pain is a bit common issue that most of the population experience sooner or later in their lives . Low back pain (LBP) is featured as pain and discomfort in the area between the costal margin and the inferior gluteal folds, with or without referred leg pain. Non-specific low back pain is the most common back pain, it is estimated that 70-80% of the entire population has experienced non-specific low back pain in their lifetime. Nonspecific low back pain (LBP) is usually defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds. It is the commonest musculoskeletal condition in the adult population and its prevalence amounts to 84%. Furthermore, it limits the activity of the affected population by 30.8% monthly and 38% every year. Consequently, CLBP poses a substantial economic burden on healthcare, social, and welfare systems. Only 15% of non-specific low back pain can be identified, while the remaining 85% are non-specific. Sixty to eighty percent of LBP patients report pain or disability a year later, and up to 40% report chronic pain. However, understanding the specific etiology of chronic nonspecific LBP remains elusive because it results from a variety of factors that can interact with each other. The diagnosis of Low Back Pain is divided into two, namely Specific and Non-specific Low Back Pain, In Specific Low Back Pain, there are certain pathophysiological mechanisms that cause symptoms such as infections of the spine, hernia nucleus pulposus, osteoporosis, rheumatoid arthritis, fractures, and tumors. In contrast to non-specific low back pain, where it is generally said that 80-90% of non-specific causes of low back pain are mechanical, and based on this percentage, 65-70% have no specific cause. Additionally, LBP restricts occupational activities and is among the main causes of absenteeism. So, it leads to high costs of health care and decreases productivity. Various factors contribute to the development of chronic LBP. Physical factors, such as reduced muscle strength and endurance are prognostic factors for chronic LBP. The occupational load carriage has the potential to alter the carrier's body posture and may lead to greater forward trunk lean. Besides, the presence and experience of nonspecific LBP could be affected by psychosocial factors, including anxiety and depression. These factors strongly influence the pain intensity during activity and degree of disability in patients with chronic nonspecific LBP. Apart from load carriage, other factors are also associated with LBP in these populations including a lack of physical fitness, higher fat mass, and long periods of sitting. Pain is the main symptom and account for disability and lack of work participation. Physiological testing shows reduced lumbar flexibility and flexion-relaxation, poorer static balance , poorer proprioception and spinal segment stability, and lower physical fitness and health-related quality of life (HRQoL) in patients with NLBP . Quadratus lumborum (QL) is a deep trunk muscle, and its tightness can trigger symptoms of significant low back tightness and discomfort. Recurrent episodes (lasting more than 3 months) are common presentations of nonspecific LBP usually accompanied by limitation of movement, long-term disability, and decreased quality of life.

Conditions

Low Back Pian

Keywords

Disability; Low Back Pain; Muscle energy technique; Strain Counter Strain

Outcome Measures

Primary Outcomes (2)

• Oswestry Disability Index

  Each component receives a score ranging from 0 to 5, with a score of 5 signifying the most severe disability. We calculate the index by dividing the total score by the range of scores. To obtain a numerical representation of the index as a percentage, we multiply the result by 100.

  Baseline; 4 Weeks

• Numeric Pain Rating Scale

  This scale is commonly used in the scientific literature and clinical practice, as it is reliable and responsive in LBP (r=0.61) and has a minimal clinically important difference of 1.99 points. This is 11 points scale ranges from 0 to 10. 0 indicates "no pain" and 10 indicates "worst pain"(26). NRS revealed that r = 0.95 with BPI pain interference; r = 0.68 with MODI, test-retest reliability is strong

  Baseline; 4 Week

Study Arms (2)

Strain Counter Strain

EXPERIMENTAL

Group A will receive strain counter strain technique for Quadratus Lumborum, Gluteus Medius, Multifidus, Erector Spinae and Iliopsoas muscles, for 1 set with 3 repetitions separated by a 30 seconds rest period and 3 sessions for a week along with conventional treatment for a total of four weeks. Pre and post intervention values will be taken on 1st day and after 4 weeks Common treatment will comprise moist heat for 10 minutes as an adjunct (2); Stretching of back, piriformis and hamstrings, hold the stretch for 30 seconds in 2 sets with 3 repetitions; and strengthening of back and abdominal muscles. Exercises consisted of 15 repetitions, 2 times with rest periods in between, with 3 sessions every week for a total of four weeks

Other: Group A

Muscle Energy Techniques

ACTIVE COMPARATOR

Group B will receive muscle energy technique for Quadratus Lumborum, Gluteus Medius, Iliopsoas, Multifidus and Erector Spinae muscles; for 2 sets, 3 repetitions in a single session with a break of two minutes in between each repetition and 3 sessions for a week along with conventional treatment for a total of four weeks. Measurements were made before and after the intervention Common treatment will comprise moist heat for 10 minutes as an adjunct (2); Stretching of back, piriformis and hamstrings, hold the stretch for 30 seconds in 2 sets with 3 repetitions; and strengthening of back and abdominal muscles. Exercises consisted of 15 repetitions, 2 times with rest periods in between, with 3 sessions every week for a total of four weeks

Other: Group B

Interventions

Group A OTHER

Group A will receive strain counter strain technique for Quadratus Lumborum, Gluteus Medius, Multifidus, Erector Spinae and Iliopsoas muscles, for 1 set with 3 repetitions separated by a 30 seconds rest period and 3 sessions for a week along with conventional treatment for a total of four weeks. Pre and post intervention values will be taken on 1st day and after 4 weeks

Strain Counter Strain

Group B OTHER

Group B will receive muscle energy technique for Quadratus Lumborum, Gluteus Medius, Iliopsoas, Multifidus and Erector Spinae muscles; for 2 sets, 3 repetitions in a single session with a break of two minutes in between each repetition and 3 sessions for a week along with conventional treatment for a total of four weeks. Measurements were made before and after the intervention

Muscle Energy Techniques

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Participants should age between 20-40 years.
• Both gender were included.
• Participants were required to have experienced LBP lasting three to six months.
• According to Simons' criteria participants were required to have at least 3 active myofascial trigger points (MTrPs) in their lower back muscles.
• % score on the Oswestry Disability Index (ODI), have Numerical Pain Rating Scale \[NPRS\] ≥ 4.

You may not qualify if:

• The patients with red flag conditions; disc prolapse, spinal stenosis, lumbar radiculopathy and spondylosis were excluded.
• Patients who had undergone previous surgery within the last six months, psychiatric or mental deficiencies, pregnancy, or lactation.
• Participants with conditions, like osteoporosis, kidney and gastrointestinal disorders.
• Individuals with a history of spinal surgery or spinal fractures.
• Participants with congenital leg length discrepancy

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Riphah Rehabilitation Clinic

Lahore, Punjab Province, 54000, Pakistan

RECRUITING

Related Publications (6)

• Santos GK, Goncalves de Oliveira R, Campos de Oliveira L, Ferreira C de Oliveira C, Andraus RA, Ngomo S, Fusco A, Cortis C, DA Silva RA. Effectiveness of muscle energy technique in patients with nonspecific low back pain: a systematic review with meta-analysis. Eur J Phys Rehabil Med. 2022 Dec;58(6):827-837. doi: 10.23736/S1973-9087.22.07424-X. Epub 2022 Sep 28.

  PMID: 36169931 BACKGROUND

• Alahmari KA, Rengaramanujam K, Reddy RS, Samuel PS, Tedla JS, Kakaraparthi VN, Ahmad I. The immediate and short-term effects of dynamic taping on pain, endurance, disability, mobility and kinesiophobia in individuals with chronic non-specific low back pain: A randomized controlled trial. PLoS One. 2020 Sep 29;15(9):e0239505. doi: 10.1371/journal.pone.0239505. eCollection 2020.

  PMID: 32991582 BACKGROUND

• Batool K, Mehmood M, Jafar M, Gull M. Comparative efficacy of muscle energy technique and Bowen technique on hamstrings muscle tightness in chronic low back pain patients. Pak J Med Sci. 2024 Oct;40(9):2080-2084. doi: 10.12669/pjms.40.9.8517.

  PMID: 39416609 BACKGROUND

• Simson KJ, Miller CT, Ford J, Hahne A, Main L, Rantalainen T, Teo WP, Teychenne M, Connell D, Trudel G, Zheng G, Thickbroom G, Belavy DL. Optimising conservative management of chronic low back pain: study protocol for a randomised controlled trial. Trials. 2017 Apr 20;18(1):184. doi: 10.1186/s13063-017-1913-8.

  PMID: 28427472 BACKGROUND

• Stokes IA, Fox JR, Henry SM. Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. Eur Spine J. 2006 May;15(5):658-67. doi: 10.1007/s00586-005-0893-7. Epub 2005 May 20.

  PMID: 15906102 BACKGROUND

• Kalantari M, ShahAli S, Dadgoo M, Tabatabaei A. The automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without low back pain- A cross-sectional study. BMC Geriatr. 2024 Apr 2;24(1):308. doi: 10.1186/s12877-024-04934-1.

  PMID: 38565979 BACKGROUND

MeSH Terms

Conditions

Low Back Pain

Condition Hierarchy (Ancestors)

Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Syed Shakil ur Rehman, PhD

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Syed Shakil ur Rehman, PhD

CONTACT

+92 320 786661; Shakil.urrehman@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 27, 2026
• First Posted: October 2, 2026
• Study Start: June 1, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): December 1, 2026
• Last Updated: October 2, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)