Psoas Muscle Release in Non-specific Mechanical Low Back Pain

N/ANot Yet RecruitingNCT06994364

Escola Superior de Tecnologia da Saúde do Porto40 enrolled

Overview

Nonspecific low back pain affects approximately 80% of the population at some point in their lives. The psoas muscle-positioned between the lumbar and pelvic regions-together with the paravertebral muscles, constitutes the primary muscular group responsible for dynamic stabilization of the spine. Alterations in this muscle may contribute to the onset of low back pain by modifying spinal biomechanics, particularly through increased lumbar lordosis and greater mechanical overload in the lumbar region. Latent myofascial trigger points are asymptomatic but can lead to muscle shortening and weakness. They are characterized by local tenderness and may provoke a localized muscular response known as a local twitch response. The aim of this randomized experimental study was to evaluate the immediate effect of ischemic compression applied to the trigger point of the psoas muscle on pain perception and lumbar range of motion. Researchers will compare a group with a placebo technique to see if the release of the psoas muscle produces effects in this condition. The variables analyzed in this study included low back pain, assessed using the Numeric Pain Rating Scale (NPRS); lateral lumbar flexion (right and left), measured using a tape measure (distance from the third finger to the floor); and lumbar flexion range of motion, assessed using the Schober test.

The present study will be a randomized, double-blind clinical trial designed to analyze the immediate effect of trigger point release of the psoas muscle on pain and lumbar spine range of motion in young adults with nonspecific mechanical low back pain. The research will involve a sample composed of individuals aged between 18 and 30 years, who will have experienced low back pain within one month prior to participation and will present a latent trigger point in the psoas muscle. Participants will be randomly assigned to two groups: the experimental group, which will undergo the ischemic compression technique on the psoas muscle; and the control group, which will receive a simulated technique involving listening to the mobility and motility of the small intestine. Assessments will be conducted before and after the intervention using the Visual Analog Scale (VAS), the Numeric Pain Rating Scale (NPRS), measurement of lumbar lateral flexion with a measuring tape, and the modified Schober test for trunk forward flexion. This study will aim to address the existing gap in the literature regarding the effectiveness of specific osteopathic techniques applied to the psoas muscle in relieving low back pain and improving mobility and range of motion. The methodological rigor, randomization, and double-blind design will contribute to ensuring the reliability of the collected data and the validity of the results obtained.

Interventions

Trigger point releaseOTHER

Ischemic compression technique is based on the application of manual pressure to treat trigger points. The patient was asked to lie in the supine position on the examination table. The osteopath identified the muscle through deep palpation and movement-based muscle differentiation, then applied 90 seconds of tolerable pressure to the trigger point on both sides.

Simulation of the intestinal listening technique.OTHER

The patient will be asked to lie in a supine position on the treatment table to simulate the listening technique for assessing the mobility and motility of the small intestine without influencing the final results, with the sensory hand placed below the umbilicus.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 30 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age between 18 and 30 years. * Presence of low back pain for less than 1 month. * Presence of a latent trigger point in the psoas muscle. Exclusion Criteria: * Volunteers with low back pain caused by: Disc herniation, Tumor, Infection, Fracture, Osteoporosis, Structural deformity or Inflammation. * Individuals with a history of spinal surgery. * Continuous use of analgesics. * Participants who had undergone manual therapy in the previous month. * Pregnant individuals. * Obese individuals. * Students of Osteopathy (from the 2nd, 3rd, or 4th year) and professionals in the manual therapy field. * Participants presenting red flags for osteopathic intervention. * Individuals with cognitive impairments that hindered their ability to understand the study/project.

Outcomes

Primary Outcomes

Low back pain

Low back pain was evaluated using the Numeric Pain Rating Scale (NPRS), a widely used unidimensional instrument for assessing pain intensity in adults. The NPRS is a segmented numeric adaptation of the Visual Analogue Scale (VAS), consisting of a horizontal bar with 11 points, where values range from 0 ("no pain") to 10 ("worst imaginable pain"). Each participant was asked by the researcher to indicate the number, from 0 to 10, that best represented their pain level.

Time frame: Immediately after the intervention

Range of motion

Lumbar lateral flexion was assessed using a measuring tape to evaluate the distance from the third fingertip to the floor, while lumbar flexion was measured using the Modified Schober Test. For lateral flexion, the participant stood upright and performed lateral flexion to the right, with the evaluator measuring the distance from the third finger to the floor. The same procedure was repeated for the left side. The Modified Schober Test was used to assess lumbar flexion. With the participant standing, the evaluator identified the posterior superior iliac spines (PSIS) and marked a point 15 cm above it. The participant then performed maximal forward trunk flexion with knees extended, and the distance between the two marks was measured. Lumbar flexion range was the difference between the initial 15 cm and the measurement after flexion.