Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Non specific low back pain is posteriorly occurring that is located between lower rib margin and gluteal fold. It is exacerbated by sustained back postures, back movements or back muscle imbalances. The aim of study is to find out which technique whether Spray and stretch technique or strain Counter strain works better in reducing pain ,improving movement ,and decreasing disability caused by tight hamstring muscles in people with non specific low Back Pain.
This double blinded randomized Clinical Trial will be conducted at Ibne Siena Hospital MULTAN through consecutive sampling technique on 30 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with spray and stretch technique and Group B will be treated with strain counter technique at the frequency of 2 sets with 5 repetitions and thrice a week. Outcome measures will be conducted through NPRS, ODI, AKE ,PKET and SLR before treatment and after 4 weeks. Data will be analyzed during SPSS software version 26. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non parametric test will be used within a group or between two groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
30
The participant will be positioned in a comfortable supine lying position on a treatment table in a quiet and suitable clinical environment. Before starting the intervention, the procedure will be explained to the participant in simple language, and verbal confirmation of comfort will be obtained. The affected lower limb will be exposed appropriately while ensuring privacy, modesty, and warmth through proper draping with towels or sheets. The participant will be instructed to relax the lower limb during the procedure. The hip will be maintained in a neutral position, and the knee will be kept straight or slightly flexed according to the participant's comfort before the stretching component begins. The therapist will first inspect the posterior thigh region to ensure that the skin is intact and suitable for vapocoolant application. The presence of any open wound, skin infection, rash, hypersens
identify the tender point Palpate the hamstring while the patient is prone or side lying locate the most tender point in belly of the muscle or near the ischial tuberosity Establish a pain scale and Ask the patient to rate the tenderness from 0 to 10 (10 being the most painful).Position of ease will be achieved by Flexing the patient's knee to about 70 to 90 degrees .Slightly abduct and externally rotate the leg to shorten the hamstring muscle (the position may vary depending on the muscle .The goal is to reduce tenderness by at least 70% .Hold the position and Maintain this position of comfort for 90 seconds Encourage the patient to relax during this time .Return the leg passively to a neutral position to avoid reactivating the trigger point .Palpate the tender point again and ask for a new pain rating.
Ibne sina hospital and research institute.
Multan, Punjab Province, Pakistan
RECRUITINGNumeric pain rate scale (NPRS)
Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale. Participants will rate their current low back pain from 0 to 10, where 0 indicates "no pain" and 10 indicates the "worst imaginable pain." The score will be recorded in points, with higher scores indicating greater pain intensity.
Time frame: Baseline and after 4 weeks of intervention
Active knee extension
Hamstring flexibility will be assessed using the Active Knee Extension Test. The participant will lie in the supine position with the hip flexed to 90 degrees and will actively extend the knee as far as possible while maintaining the hip position. The knee extension angle will be measured in degrees using a goniometer. A smaller knee-flexion deficit indicates greater hamstring flexibility.Positive AKE (For males, a positive knee extension angle is \>33.0°, whereas for females, it is \>24)
Time frame: Baseline and after 4 weeks of intervention
Passive knee extension test (PKET)
Hamstring flexibility will be assessed using the Passive Knee Extension Test. With the participant in the supine position and the hip maintained at 90 degrees of flexion, the examiner will passively extend the knee until resistance or discomfort is reached. The knee extension angle will be measured in degrees using a goniometer. A greater knee-extension angle indicates greater hamstring flexibility.
Time frame: Baseline and after 4 weeks
Oswestry Disability Index
Low back pain-related disability will be assessed using the Oswestry Disability Index. The questionnaire contains 10 sections, with each section scored from 0 to 5. The total score will be converted into a percentage ranging from 0% to 100%, where higher scores indicate greater disability.
Time frame: Baseline and after 4 weeks
Straight leg raise
Straight leg raise range of motion will be assessed with the participant in the supine position. The examiner will passively raise the participant's lower limb while maintaining the knee in extension until resistance or discomfort is reported. The hip-flexion angle will be measured in degrees using a goniometer. A greater angle indicates greater posterior-chain flexibility and straight leg raise range of motion.
Time frame: Baseline and after 4 weeks
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