Therapeutic Effects of Instrument-assisted Versus Sound-assisted Soft Tissue Mobilization in Chronic Non-specific Low Back Pain

University of Lahore60 enrolled

Overview

Chronic low back pain (CLBP) is the most common medical problem observed among musculoskeletal pain and spinal pain problems. It can reduce the movements due to muscular imbalances, decreased activity of daily living, and effects on health-related quality of life. It is the major cause of activity limitation, work absence, and reported clinical issues. Most of the cases of low back pain remained undiagnosed and received only symptomatic management.

There is limited literature on advanced soft tissue release techniques provided by primary healthcare practitioners specific to low back pain. Some of the studies are based on soft tissue mobilization using a mechanically assisted method, but they have limited outcomes, acute effects, and small sample sizes, which limit their generalization. Further literature is limited in the comparison of IASTM and SASTM. Further, there are limited techniques that can facilitate practitioners to identify the restrictions. Firstly, instrument-assisted soft tissue mobilization (IASTM), due to its body contour and shape, recognizes specific tissue lesions and restriction sites while targeting specific points rather than using manual methods that cover a larger contact area. Using the mechanotransduction phenomenon, its mechanical stimuli initiate biochemical signals that trigger cellular responses and ultimately functional improvement. Biomechanically, fascial elasticity, fascial stiffness, and viscosity absorb and distribute forces. While tissue hydration level is increased, that is compromised in chronic low back pain. Secondly, sound-assisted soft tissue mobilization could be an intervention for treating musculoskeletal disorders. The SASTM technique has the potential to be a game-changer in pain management after IASTM. The sound decreases as adhesions are broken. While breakdown of scar tissue can be a facilitator for ease of movement patterns.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Interventions

SASTMDEVICE

The therapist will apply sound instrument-assisted soft tissue mobilization (SASTM) with a convex plastic (Ceramic) tool (Beer JA, 2019).

IASTMDEVICE

The IASTM technique contains a protocol for treatment that contains five components: i. Examination, ii. warm-up exercises 5 min iii. IASTM treatment (e.g., 30-60 seconds per session), iv. Post treatment stretching and strengthening, v. Icing (only when sub-acute inflammation is of concern).

ExerciseOTHER

In conventional therapy, patients will be given an exercise program that will be targeted to low back muscles. This will be include three type of exercise focusing on stretching, strengthening and postural correction exercise.(Yana et al., 2024)

Eligibility

Sex: ALLMin age: 40 YearsMax age: 55 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pain between the inferior gluteal folds and the costal margins. * Pain with a duration of a minimum of 24 weeks. * Moderate to severe pain (\>3) was measured using the Numeric Pain Rating Scale. * Straight Leg raise Limited (hamstring tightness) Exclusion Criteria: * Pain in lower back with radiating/referring but limited to proximal legs * Pain for the last 03 months and at least half of the days in the last six months. * Presence of neurological problem/deficit/disease (e.g., nerve root compression, motor deficit, paresthesia) and lower limb symptoms. * Presence of disease like Infection, tumors, spondylolisthesis grade II or higher, vertebral fractures, identifiable cause like endometriosis * Medicine like immunosuppression or steroid medication; * Spinal deformities * History of severe rheumatic, orthopedic, or cardiovascular disease in the last three months before study participation. * Previously diagnosed Osteoporosis * SIJ dysfunction is evaluated by a positive compression test. * BMI over 35. * Skin allergy or hypersensitivity that can lead to skin irritation due to IASTM/SASTM tools.

Outcomes

Primary Outcomes

Pain Intensity

The pain will be assessed using Chronic Pain grading Scale (CPGS).

Time frame: Pain intensity will be noted at baseline ,after the 2nd week, 3rd week, 4th week, and follow up will be taken at 2nd month, and after the 4th month post intervention.

Flexibility

Modified-Modified Schober Test will be used to measure Lumbar flexibility.

Time frame: The lumbar flexibility will be noted at basline after the 2nd week, 3rd week, 4th week, and follow up will be taken at 2nd month, and after the 4th month post intervention.

Secondary Outcomes

Function

Functional movement Screen (FMS) will be used.

Time frame: The functional movement screening will be noted at baseline, after the 2nd week, 3rd week, 4th week, and follow up will be taken at 2nd month, and after the 4th month post intervention.

Disability

Roland Morris Disability Index will be used to measure disability Index.

Time frame: Disability will be assessed before treatment, after the 2nd month, and 4th month post-intervention.

Hamstring Flexibility

Active knee Extension Test will be used to assess hamstring Flexibility.

Time frame: Hamstring flexibility will be measured at basline, 2nd month, and after the 4th month post intervention.