Fascial-muscular Lengthening Therapy in the Patients With Chronic Low Back Pain.
Condition: Chronic Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The purpose of this study is to assess and evaluate tight iliopsoas muscle in patients with
      chronic low back pain and to increase hip flexor flexibility in the patients with chronic low
      back pain by using the technique of manual fascial-muscular lengthening therapy .
    

Detailed description: 
      Chronic low back pain is one of the the most prevalent complaint in the patients. Low back
      pain is affecting the population socially and economically, and it is also a leading public
      health problem, being the very common reason for absentees from work . Living with chronic
      low back pain leads to not only physiological but also psychological modifications. Low back
      pain is associated with many biomechanical factors that must not be ignored because in some
      cases mechanical loading results in acute disc prolapse and can also cause low back pain

      The iliopsoas muscle is the primary and the most strongest hip flexor and it plays vital role
      in the stability of the lumbar spine for axial compression but it has very little movement
      function on the lumbar spine. Like other postural muscles it functions as stabilizer, and for
      spinal stability iliopsoas activity is essential although iliopsoas can only produce minimum
      movements in the sagittal plane. It is assumed that muscle weakness and other structural
      factors can cause low back pain and activity limitation. As the psoas muscle is the postural
      muscles so it also has tendency to become tight Psoas muscle tightness is responsible for
      causing back pain by inhibiting the lumbar and SI-joint range of motion but in the literature
      there is more focus on hamstring tightness rather than on iliopsoas tightness .The psoas
      muscle should not be ignored when evaluating and treating low back pain. because iliopsoas
      muscle tightness can also manifest low back pain, giving the symptoms of lumbosacral region
      pain, contralateral gluteal region pain and radiating pain in contralateral leg.

      There has been a lot of procedures which are used to increase muscle flexibility of tight hip
      flexors e.g. Active and passive stretching , manual fascial-muscular lengthening therapy , a
      form of Active Release Technique, proprioceptive neuromuscular facilitation soft tissue
      mobilization and strengthening of psoas muscle.

      Stretching programmers are often part of Physical Therapy treatment plan to increase muscle
      flexibility. A study done on Passive versus active stretching of hip flexor muscles in
      subjects with limited hip extension. concluded that active and passive stretching of tight
      hip flexors will increase the flexibility of hip flexors and range of motion in patient with
      low back pain

      A study on "Low Back Pain with Psoas Tightness" in 2012 and concluded that the low back pain
      begins when there's irritation in the psoas muscle and he used soft tissue mobilization
      techniques and strengthening program of hip flexors to treat chronic low back pain which
      resulted in diminished back pain.

      A study on The clinical and biomechanical effects of fascial- muscular lengthening therapy on
      tight hip flexor patients with and without low back pain in 2014 and concluded that by using
      fascial-muscular lengthening therapy there was a reduction in low back pain. There was
      increase in the range of passive hip extension and there was also significant decrease in
      iliopsoas tightness in the patients with or without low back pain.

      A study on Immediate effect of application of the pressure technique to the psoas major on
      lumbar lordosis in 2018 in which mechanical pressure, which is similar to fascial-muscular
      lengthening therapy, was applied to the psoas major muscle and concluded that pressure
      technique reduced psoas major stiffness along with reducing lumbar extension on every
      segment.
    

Intervention name(s): fascial- muscular lengthening therapy; Stretching's of iliopsoas muscle; the conventional therapy
Intervention type(s): Other; Other; Other
Intervention description(s): Patients in this group will receive interventional therapy
To perform this technique:
Have the patient in side lying position
Hip is maximally flexed to shorten the iliopsoas muscle.
Therapist fingers should be on to the targeted area.
Apply gentle pressure in upward direction.
While maintain the pressure, stretch the muscle by moving the hip in extension through full ROM.
Therapist will maintain the pressure in opposing direction. This is considered as one pass. This technique is performed bilaterally. Patients in this group will also receive the conventional therapy which will include:
Hot pack for 15 minutes.
Myofascial release of iliopsoas.
TENS for 15 minutes.; Patients in this group will receive the interventional therapy which will include:
Stretching's of iliopsoas muscle which can be done in two positions:
modified lunge position.
The prone stretch.
Patients in this group will also receive the conventional therapy which will include:
Hot pack for 15 minutes.
Myofascial release of iliopsoas
TENS for 15 minutes.; the conventional therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: FMLT; Chronic LWP; ROM; ODI; NPRS