Comparison of MET and AIS on Erector Spinae Muscle in Low Back Pain
Condition: Mechanical Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The main objective of the study was to compare the effectiveness of Muscle Energy Technique
      and Active Isolated Stretching on Erector Spinae Muscle in the management of Mechanical Low
      back Pain (LBP) and to find out that which technique is better for the treatment of
      mechanical LBP
    

Detailed description: 
      Lumbar spine "mobilization and manipulation" relieves the hypomobility in the intervertebral
      joints which results in pain reduction and significant improvement in lumbar spine ROMs. In
      dry needling, trigger point is palpated and tiny needle is inserted in hyperirritable point.
      Local twitch response is noted. Referred pain pattern may appear followed by pain relief and
      trigger point release. In this technique, pain is relieved by spontaneous positioning and
      maintains a non-painful tension in hypertonic muscle. When subject is placed in a non-tension
      position pain is decreased up to 70%. In Instrument assisted soft tissue mobilization:
      Various instruments like beveled edges,tools are used for soft tissue mobilization and
      decreasing pain threshold.

      MUSCLE ENERGY TECHNIQUE (MET) is actually a sort of "myofascial release soft-tissue method"
      in which the patient is given a command to use the muscles actively in a direction opposite
      to the force applied by the therapist which results in the enhancement of joint ROM and
      flexibility. In MET, "sub-maximal active resisted isometric contraction of muscle" is
      performed for couple of times after that the muscle is stretched passively which results in
      the increment in ROM, desired muscular length and flexibility.

      The concept which is used in MET is the reciprocal inhibition in which "the muscle which is
      faulty placed in mid range and the practitioner resists the greatest power either
      isotonically or isometrically". The patient is instructed to breathe in with the application
      of force and breathe out as the muscle is being lengthened For convenience, therapeutic
      exercises and specialized manual therapy treatment protocols can be divided into two main
      levels although the treatment of LBP depends on the condition of patient, intensity of pain,
      diagnosis and signs and symptoms. First level includes therapeutic exercises like "Range of
      Motion (ROM) exercises, stretching exercises, strengthening exercises and aerobic exercises"
      whereas second level includes advances manual therapy treatment protocols which includes
      specialised techniques like dry needling, strain counter strain, , lumbar stabilization
      exercises, MET, AIS etc When patient performs the exercises actively, nutritional supply gets
      enhanced to the soft tissues in lower back which keeps the vertebras, muscles, joints and
      ligaments sound. Lower back exercises keep the patient's spine healthy by maintaining its
      flexibility and strength and additionally, they decrease the chances of re-occurrence of LBP.

      Most commonly advised back exercises by physical therapists in the management of low back
      pain are "aerobic conditioning, stretching exercises, and strengthening exercises, McKenzie
      Exercises and lumbar stabilization exercises Lower back stretching exercises increase ROM and
      improves flexibility. Literature also recommends to stretch "hamstrings, piriformis and
      gluteal muscles" once or twice a day. Stretching exercises includes hamstring stretch or
      straight leg raising (SLR), knee to chest stretch, piriformis muscle stretch, etc Lower back
      stretching exercises increase ROM and improves flexibility. Literature also recommends to
      stretch "hamstrings, piriformis and gluteal muscles" once or twice a day. Stretching
      exercises includes hamstring stretch or SLR, knee to chest stretch, piriformis muscle
      stretch, etc On alternate days, doing aerobic exercises for 30 to 40 minutes a day for three
      times in a week, helps in the long-term reduction of LBP because by these exercises,
      nutrition supply can be enhanced to the soft tissues which promotes healing. Such type of
      exercises includes "walking, jogging, bicycling, swimming, etc Mobilization of lumbar spine,
      electrotherapy treatment, Stretching and strengthening exercises, postural correction of the
      individuals which are suffering from LBP are routine treatment protocols. Conventional
      physical therapy treatment is effective as it decreases the pain and improves the patient's
      functional outcome for patients of chronic LBP, but erector spinae muscle length remains
      compromised. Muscle energy technique and Active isolated stretching technique are advanced
      treatment protocols for getting improvement in muscle length by which patients get better in
      few sessions.
    

Intervention name(s): Muscle Energy Technique; Active Isolated Stretching; Conventional Treatment
Intervention type(s): Other; Other; Other
Intervention description(s): Muscle energy technique was repeated 4 times per session every day for 3 days a week for 4 weeks after the application of moist heating pad for 30 minutes before each session.; The patient was asked to sit in an upright seated position and flex his/her knees 12 to 18 inches. Patient was asked to tuck the chin, exhale, and firmly contract the abdominal muscles as he/she curls their body forward. He/she was also guided not to bounce or make rapid movements at the end range of the active motion. Then, he was asked to move back to the starting position and repeat the same procedure for 8 to 10 times. Stretch on the end range was not more than 2 seconds.
This technique was repeated 10 times per session every day for 3 days a week for 4 weeks after the application of moist heating pad for 30 minutes before each session.; Conventional physical therapy treatment includes the application of moist heating pad for 30 minutes on lower back/ lumbar region prior to the intervention to both groups.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Group A (MET) and Group B (AIS)
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Active Isolated Stretching; Muscle Energy Technique; Mechanical Low Back Pain