Muscle Energy Technique in Patients With Nonspecific Low Back Pain

Riphah International University28 enrolled

Overview

The aim of this Randomized control trial is to find out the comparative effects of muscle energy technique on iliotibial band versus hamstring and abdominal muscle activation in patients with non specific low back pain in improving pain intensity and functional disability. The sample size was 28. Subjects are randomly divided into two groups. 14 subjects in muscle energy technique group and 14 in hamstring and abdominal muscle activation group. Study duration was of 6 months. Sampling technique applied was Non probability purposive sampling. Subjects between the age group 18- 40 years with acute non specific low back were included. Tools used are Numeric pain rating scale and Oswestry disability index.

Non-specific low back pain is a mechanical pain of musculoskeletal origin in which symptoms vary with the nature of physical activities. It manifests as pain, muscle tension, or stiffness that is localized below the costal margin and above the inferior gluteal folds and is not attributed to a specific pathology with or without leg pain involvement. The lower back area, which extends from the end of the ribs to the start of the legs, feels tight, painful, and rigid. A study conducted to investigate the immediate effects of MET of Quadratus Lamborum in chronic low back pain patients with functional leg length discrepancy. The outcomes of the study concluded that MET showed significant changes in pelvic alignment, leg length, pain, and fatigue. In a research conducted in 2020 to see the effectiveness of exercise with balloon and interferential therapy for pain and disability in low back pain in young adults . This study concluded that greater effect of 90/90 bridge with ball and balloon exercise on patients with mechanical low back pain. Individuals with low back pain often exhibit reduced hamstring muscle flexibility and altered pelvic range of motion as shortened and inflexible hamstring muscles can exert tension on the pelvis, leading to non-specific low back pain and disruptions in lumbar pelvic rhythm. Addressing hamstring flexibility is crucial for effective management of low back pain. Moreover, disturbances in the lower extremity kinematic chain, particularly involving the iliotibial band (ITB), can further impact pelvic biomechanics. Poor muscle coordination and decreased intrinsic postural muscle activity may compromise spinal stability in individuals with low back pain. The rationale of the present study is to find out the effectiveness of muscle energy technique on iliotibial band versus hamstring and abdominal muscles activation in non-specific low back pain patients, pain and disability. To compare the effectiveness of muscle energy technique on iliotibial band and hamstring and abdominal muscles activation in non-specific low back pain patients in improving pain intensity and functional disability.

Interventions

Muscle energy technique on iliotibial bandOTHER

Post isometric relaxation involves the peripheral and central modulating mechanism by activating the muscles and joint mechanoreceptors. It can be effective for a variety of purposes including lengthening a shortened muscles, as a lymphatic or venous pump to aid the drainage of fluid or blood and increasing the range of motion. MET is a manual therapy intervention that can be used to stretch or lengthen muscles and fascia that lack flexibility.

Hamstring and abdominal muscle activationOTHER

The 90/90 exercises for abdominal and hamstring activation rotate the pelvis posteriorly in the sagittal and transverse plane, into a more neutral position. Hamstrings extend the hip, and therefore reciprocally inhibit hip flexors. Hamstrings and abdominals also aid in inhibiting paraspinal muscles via a posterior pelvic tilt / hip extension, a decrease in lumbar extension, and an increase in lumbar flexion.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 40 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Both gender * Age between 18 to 40 years. * Participants with acute non specific low back pain. * Participants with postural low back pain. Exclusion Criteria: * Participants of age more than 40 years. * Patients with history of lumbopelvic surgery. * Having history of spinal or pelvic fracture, trauma of motor vehicle accident, fracture of lower extremity. * Participants having systemic disease such as arthritis, TB, liver or kidney failure. * Participants suffering from osteoporosis, psychiatric disorders, hematomas or abscesses.

Outcomes

Primary Outcomes

Numeric pain rating scale

It is an 11-point scale comprising a number from 0 through 10; 0 indicates "no pain", and 10 indicate the "worst imaginable pain". Patients are instructed to choose a single number from the scale that best indicates their level of pain.

Time frame: 3 weeks

Modified Oswestry disability index

It is one of the most common patient-reported outcome measures used to evaluate the impact of back pain on patients" activities of daily living. It is used to access pain-related disability in people with acute, sub acute, or chronic low back pain. It consists of 10 items- 1 item on pain while the other 9 items are on activities of daily living. It is a self-administered questionnaire divided into ten sections designed to assess limitations of various activities of daily living. Each section is scored on a 0-5 scale, 5 representing the greatest disability. The index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100.