Effectiveness of Myofascial Release, Muscle Energy Technique and Stretching of Quadrartus Lumborum Muscle in Patients with Non-Specific Low Back Pain


Affiliations

  • Krishna Institute of Medical Sciences “Deemed to Be” University, Krishna College of Physiotherapy, Karad, Maharashtra, 415539, India
  • Krishna Institute of Medical Sciences “Deemed to Be” University, Department of Neurosciences, Krishna College of Physiotherapy, Karad, Maharashtra, 415539, India

Abstract

Background: Low back pain is attributed to be the most commonly encountered health condition and considered to be one of the leading cause of disability. It is known to occur in all age groups in both developed as well as developing countries. About 80% of the patients have moderate to severe pain affecting their activities of daily living, with females more affected than males. Almost 90% of low back pain is of non-specific type. Quadratus lumborum is one of the deep muscles located closer to center of rotation of spinal segment having an ideal muscle length controlling motion at spine. Activities like sustained repetitive movements, twisting, bending, and sedentary posture for prolong duration, muscle imbalance, etc. leads to trigger point formation making quadratus lumborum as a common source of low back pain. Aim: To determine the combined effect of myofascial release therapy, muscle energy technique and stretching of Quadratus Lumborum muscle in Non-specific low back pain in a short duration span. Methods: In this Experimental study design, two groups were divided as Control and Experimental group with a pre and post test format for both groups. 35 participants were selected and divided into 2 groups by using the Random Sampling Technique using the inclusion and exclusion criteria. Outcome measures assessed were Numerical Pain Rating Scale (NRPS), Oswestry Disability Index (ODI) and Lumbar Range of Motion with Modified Schober’s Test. A specifically designed treatment protocol for individual group was used for duration of 2 weeks. Statiscal Analysis: Paired and Unpaired t test were used for the analysis of the data. Results: The results of the study showed extremely significant difference between both the groups for NPRS and ODI with p<0.0001 using unpaired t test considered extremely significant. The increase in mean values is extremely significant for Lumbar ROM while comparing the pre and post-test values for mean difference of experimental group than control. The improvement in lumbar flexion, side flexion is more marked than for extension with minimal to no difference in rotation. Conclusion: The combined effect of Myofascial release, Muscle energy technique and stretching of Quadratus Lumborum has shown to be effective in treatment of patients with non-specific low back pain.

Keywords

Muscle Energy Technique, Myofascial Release, Non-Specific Low Back Pain, Quadratus Lumborum

Subject Discipline

Bachelor of Physiotherapy

Full Text:

References

Maher C, Underwood M, Buchbinder R. Non-specific low back pain. The Lancet. 2017 Feb 18; 389(10070):736-747. https://doi.org/10.1016/S0140-6736(16)30970-9.

Maleki S. Low Back Pain: A Case Study. Physical Therapy Scholarly Projects; 2015. p. 610. https://commons.und.edu/ptgrad/ 610/.

Voight M, Hoogenboom B, Prentice W. Musculoskeletal Interventions: Techniques for Therapeutic Exercise. McGraw Hill Professional; 2006 Dec 5.

Mooney V. Clinical Orthopaedic Rehabilitation, Steven B.Brotzman, MD, and Kevin Wilk, PT, Mosby/Elsevier, 2003. The Spine Journal. 2004 May 1; 4(3):555. https://doi.org/10.1016/j.spinee.2003.09.002.

Luomajoki HA, Beltran MB, Careddu S, Bauer CM. Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: a systematic review and meta-analysis. Musculoskeletal Science and Practice. 2018 Aug 1; 36:1-1. https://doi.org/10.1016/j.msksp.2018.03.008. PMid:29631119.

Kisner C, Colby LA, Borstad J. Therapeutic Exercise: Foundations and Techniques. Fa Davis; 2017 Oct 18.

Vohra S, Jaiswal VC. Effectiveness of strain counterstrain technique on quadratus lumborum trigger point in low back pain. IOSR J Sports Phys Educ. 2014; 1:53-58. https://doi.org/10.9790/6737-0165358.

Barge AS, Barge SM. Quadratus lumborum: One of the many significant causes of low back pain. Indian Journal of Pain. 2018 Sept. 1; 32(3):184.

Van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal. 2011 Jan 1; 20(1):19-39. https://doi.org/10.1007/s00586-0101518-3. PMid:20640863 PMCid:PMC3036018.

Mallia J. An Integrative Approach to Lower Back Pain.

Casato G, Stecco C, Busin R. Role of fasciae in nonspecific low back pain. European Journal of Translational Myology. 2019 Aug 2; 29(3). https://doi.org/10.4081/ejtm.2019.8330. PMid:31579477 PMCid:PMC6767839.

Grover C, Christoffersen K, Clark L, Close R, Layhe S. Atraumatic back pain due to quadratus lumborum spasm treated by physical therapy with manual trigger point therapy in the emergency department. Clinical Practice and Cases in Emergency Medicine. 2019 Aug; 3(3):259. https://doi.org/10.5811/cpcem.2019.4.42788. PMid:31404175 PMCid:PMC6682240.

Awad MA, Allah AH. Effect of Myofascial Release Technique Versus Mulligan Mobilization Technique on Post Natal Low Back Pain. The 20th International Scientific Conference Faculty of Physical Therapy Cairo, 6-7 April, 2019. 1-21.

Ellythy MA. Efficacy of muscle energy technique versus myofascial release on function outcome measures in patients with chronic low back pain. Bulletin of Faculty of Physical Therapy. 2012; 17(1).

Arguisuelas MD, Lison JF, Domenech-Fernandez J, MartinezHurtado I, Coloma PS, Sanchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. Clinical Biomechanics. 2019 Mar 1; 63:27-33. https://doi.org/10.1016/j.clinbiomech.2019.02.009. PMid:30784788.

Shah Y, Arkesteijn M, Thomas D, Whyman J, Passfield L. The acute effects of integrated myofascial techniques on lumbar paraspinal blood flow compared with kinesio-taping: A pilot study. Journal of Bodywork and Movement Therapies. 2017 Apr 1; 21(2):459-467.

https://doi.org/10.1016/j.jbmt.2016.08.012. PMid:28532891.

Chaitow L, Crenshaw K. Muscle energy techniques. Elsevier Health Sciences; 1 Jan 2006. p. 346.

Wilson E, Payton O, Donegan-Shoaf L, Dec K. Muscle energy technique in patients with acute low back pain: a pilot clinical trial. Journal of Orthopaedic and Sports Physical Therapy. 2003 Sep; 33(9):502-512. https://doi.org/10.2519/jospt.2003.33.9.502. PMid:14524509.

Kumar VS, MK FS, Kumar S, Velmurugan A. Effects of muscle energy technique on quadratus lumborum and active posterior pelvic tilt exercises on pain and disability in acute low back pain subjects-a comparative study. Epub. 2018 Jun; 38(1):41-51. https://doi.org/10.1142/S1013702518500051.

Muscolino JE. The Muscle and bone palpation manual with trigger points, referral patterns and stretching. Elsevier Health Sciences. 2008 Dec 1.

Devi ZK, Kumar SN, Babu KB, Ayyappan RV. Effectiveness of muscle stretching in occupation related chronic mechanical low back pain in community nurses-A single blind study. International Journal of Physiotherapy and Research. 2014; 2(1):403-410.

Page P, Frank CC, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics; 2010. https://doi.org/10.5040/9781718211445.

Macrae IF, Wright V. Measurement of back movement. Annals of the Rheumatic Diseases. 1969 Nov; 28(6):584. https://doi.org/10.1136/ard.28.6.584. PMid:5363241 PMCid:PMC1031291.

Moll JM, Wright V. Normal range of spinal mobility. An objective clinical study. Annals of the Rheumatic Diseases. 1971 Jul; 30(4):381. https://doi.org/10.1136/ard.30.4.381. PMid:5557779 PMCid:PMC1005796.

Johnson ME. A review of noninvasive tools used for measuring flexion of the lumbar spine. Physical Therapy Scholarly Projects; 1994. p. 238. https://core.ac.uk/download/pdf/235074274.pdf.

https://commons.und.edu/pt-grad/238.

Tawrej P, Kaur R, Ghodey S. Immediate Effect of Muscle Energy Technique on Quadratus Lumborum Muscle in Patients with Non-Specific Low Back Pain. Indian Journal of Physiotherapy and Occupational Therapy. 2020 Jan 1; 13(1).

Dhargalkar P, Kulkarni A, Ghodey S. Added effect of muscle energy technique for improving functional ability in patients with chronic nonspecific low back pain. Int J Physiother Res. 2017; 5(3):2082-2087. https://doi.org/10.16965/ijpr.2017.144.

Rishi P, Arora B. Impact of muscle energy technique along with super-vised exercise program over muscle energy technique on quadratus lumborum and iliopsoas on pain and functional disability in chronic non specific low back pain. Int J Physiother Res. 2018; 6(3):2748-2753. https://doi.org/10.16965/ijpr.2018.129.

Pandey E, Kumar N, Das S. Effect of stretching on shortened quadratus lumborum muscle in non specific low back pain. Physiotherapy and Occupational Therapy Journal. 2018 April-June; 11(2). https://rfppl.co.in/subscription/upload_pdf/Ekta%20Pandey_7326.pdf. http://dx.doi.org/10.21088/potj.0974.5777.11218.5.

Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. Journal of Bodywork and Movement Therapies. 2014 Apr 1; 18(2):273-281 https://doi.org/10.1016/j.jbmt.2013.05.007. PMid:24725797.

Masaracchio M, Cleland J, Hellman M, Hagins M. Short-term combined effects of thoracic spine thrust manipulation and cervical spine nonthrust manipulation in individuals with mechanical neck pain: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy. 2013 Mar; 43(3):118-127. https://doi.org/10.2519/jospt.2013.4221. PMid:23221367.

Hsieh CY, Adams AH, Tobis J, Hong CZ, Danielson C, Platt K, Hoehler F, Reinsch S, Rubel A. Effectiveness of four conservative treatments for subacute low back pain: A randomized clinical trial. Spine. 2002 Jun 1; 27(11):1142-1148. https://doi.org/10.1097/00007632-200206010-00003. PMid:12045509.


Refbacks

  • There are currently no refbacks.