Comparison of Muscle Energy Techniques and Myofascial Release on Low Back Pain Due to Sacroiliac Joint Dysfunction
Condition: Sacroiliac Joint Dysfunction; Low Back Pain
MeSH terms: Joint Diseases; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The aim of this research is to compare the effects of Muscle Energy Techniques and Myofascial
      Release on Lumbar Range of motion, pain and disability in patients of low back pain due to
      Sacroiliac Joint Dysfunction, Randomized controlled trials were done at a private clinic, The
      Health Professionals Bahria Town Phase 6, Islamabad. The Sample Size was 30. The subjects
      were divided into two groups, 15 subjects in Interventional group A receiving conventional
      physical therapy treatment alongside METs for hamstrings, iliopsoas and piriformis muscle
      while the other 15 subjects in Interventional group B receiving conventional physical therapy
      treatment with direct myofascial release of hamstrings, iliopsoas and piriformis muscle.
      study duration was of 6 months. Samling technique applied was non.probability sampling. Only
      females of age group 40-55 yrs having sacroiliac joint pain with limited lumbar range of
      motion were reduced. Tools used in the study were Numeric Pain Rating Scale(NPRS), Modified
      Oswestry Disability Index(MODI), Pelvic and bubble Inclinometer. Data was analyzed through
      SPSS 21.
    

Detailed description: 
      Sacroiliac joint is the most common source of low back pain affecting 70-85% of adults.
      Accordingly, 13-30% of patients with lower back pain have Sacroiliac joint dysfunction. The
      main mechanism for developing sacroiliac joint dysfunction includes different unidirectional
      pelvic shear force along with repetitive torsional force and inflammation which produces not
      only the lower back pain but also groin and gluteal pain. Muscle imbalances has also been
      sighted as possible cause of pain. This theory states that the sacroiliac joint itself is
      unaffected, but the musculature surrounding the sacroiliac joint is in form of dysfunction.
      This muscular imbalance could limit the flexibility of muscle of low back pain and ultimately
      begin a syndrome of chronic disuse culminating in decreased function and heightened pain. The
      use of a combination of tests showed a high sensitivity and specificity to indicate the
      presence of sacroiliac joint dysfunction that includes FABER, posterior shear and resisted
      abduction pain provocation tests.

      Treatment of sacroiliac joint pain is variable and no set method or protocol of treatment has
      been found to be efficacious and reliable. Interventions to treat pain of SIJ dysfunction
      includes Non-steroidal Anti-Inflammatory drugs(NSAIDs), physical therapy, corticosteroid
      injections, osteopathic manipulations(manual medicine), radiofrequency denervation,
      sacroiliac joint belts and surgery. Muscle Energy Techniques is the most commonly used manual
      medicine techniques that depends on method of using low amplitude muscle contractions against
      resistance thinking that it would improve vascular circulation and have a positive influence
      on static and dynamic posture. this techniques was further modified by having patients use
      their muscles in a controlled position against a counterforce. Muscle energy techniques have
      several uses that can help increase muscle strength, increase range of motion(ROM) and
      decrease edema.

      Myofascial release techniques(MFR) are another manual medicine technique that is described as
      'designed to stretch and reflexively release patterned soft tissue( particularly the muscles
      and fascia) and joint related restrictions'. myofascial abnormalities may lead to connective
      tissue fibrosis, increased tissue stiffness and further movement impairment which may lead to
      low back pain chronicity.

      In a study conducted by D. Sharma et al in 2014 on comparing the effects of muscle energy
      techniques and mobilizations in treating sacroiliac joint dysfunction focusing on piriformis,
      quadratus lumborum and erector spinae muscles, concluded that METs and mobilizations are both
      effective in treating chronic low back pain due to sacroiliac joint dysfunction. Outcomes
      were measured on first day and then after 1st and 2nd week from each subject, pain and
      disability by Visual Analogue Scale and Modified Oswestry Disability Index
      Questionnaire(MODI) In a randomized controlled trial conducted by Arguisuelas et al in 2017
      for studying the effects of Myofascial release (MFR) for quadratus lumborum, psoas muscle,
      thoracolumbar fascia and lumbar paravertebral muscles in Non-specific chronic low back pain ,
      it was concluded that myofascial release therapy produced a significant improvement in both
      pain and disability. Pain was measured by means of Short Form Mc Gill Pain Questionnaire
      (SF-MPQ) and Visual Analogue scale and disability measured with Roland Morris Questionnaire.

      In another study conducted by Sabah et al in 2019 concluded that muscle energy techniques for
      iliopsoas, hamstrings, erector spinae and quadratus lumborum is an effective treatment for
      decreasing anterior pelvic tilting angle and reducing pain in patients with chronic SIJ
      dysfunction. The study findings revealed a statistical significant decrease of anterior
      pelvic tilting angle in group A(p<0.001), also a significant decrease in pain in the 2 groups
      compared with the pre-intervention values(p<0.001) In 2020, Faryal et al conducted a study in
      peshawar, concluded that muscle energy technique targeting quadratus lumborum, iliopsoas and
      piriformis muscle and maitland mobilizations are both effective in treating the chronic
      sacroiliac joint dysfunction in terms of decreasing pain and disability when using
      lumbopelvic stabilization exercises as an adjunct therapy with them.

      In previous studies both muscle energy techniques and myofascial release therapy has been
      proven to be effective in treating chronic low back pain due to sacroiliac joint dysfunction.
      Currently to our knowledge there exists very weak evidence to which one technique can be
      proved to be more effective than the other. The purpose of this study is to compare the
      effects of both these therapies on pain and functional status in patients with sacroiliac
      joint dysfunction in addition to conventional physical therapy treatment protocols.
    

Intervention name(s): Muscle Energy Technique; Myofascial release
Intervention type(s): Other; Other
Intervention description(s): METS-Post isometric relaxation will be applied for piriformis, iliopsoas and hamstrings muscle. There will be three repetitions for each muscle, once per day and thrice a week for three weeks; Myofascial Release will be done for piriformis, iliopsoas and hamstrings muscle. There will be three repetitions for each muscle, once per day and thrice a week for three weeks
Other intervention name(s): Transcutaneous Electrical Nerve Stimulations and Hot pack; Transcutaneous Electrical Nerve Stimulations and Hot pack
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: sacroiliac Joint Dysfunction; Muscle Energy Techniques; Myofascial Release; Pain; Disability; Range of Motion