EFFECTS OF MANUAL PRESSURE RELEASE VERSUS STRAIN COUNTERSTRAIN ON REDUCING PAIN AND IMPROVING HIP MOBILITY IN NON-SPECIFIC CHRONIC LOW BACK PAIN
Authors: Riaz Virsha , Tabasum Areej , Najeeb Muneeba , Tassawur Misbah , Khaliq Farwa , Malik Kainat , Huda Noor Ul , Shoukat Iqra , Manzoor Urooj 
Published: February 2025

Background: Chronic low back pain (CLBP) is a prevalent musculoskeletal condition that significantly impacts mobility, functional capacity, and overall quality of life. Effective physiotherapeutic interventions are crucial for pain relief and functional improvement. Manual pressure release (MPR) and strain counterstrain (SCS) are widely used techniques targeting myofascial dysfunction, yet their comparative efficacy remains underexplored. Understanding their impact on pain reduction and hip range of motion (ROM) can enhance clinical decision-making and optimize rehabilitation outcomes for individuals with non-specific CLBP.
Objective: To compare the effects of manual pressure release and strain counterstrain techniques on pain intensity and hip ROM in individuals with non-specific CLBP.
Methods: A randomized clinical trial was conducted on 92 participants (49.2% males, 50.8% females) aged 25 to 40 years with non-traumatic CLBP persisting for more than three months. Participants were recruited through convenient sampling and randomly assigned to two intervention groups. Group A received manual pressure release, while Group B underwent strain counterstrain therapy. Both interventions were administered three times per week for eight weeks. Pain intensity was assessed using the Visual Analog Scale (VAS), and hip ROM (flexion and extension) was measured using a goniometer. Pre- and post-intervention comparisons were conducted using the Wilcoxon Signed-Rank Test for VAS and paired samples t-test for hip ROM. Between-group differences were analyzed using the Mann-Whitney U Test for VAS and independent samples t-test for hip ROM, with statistical significance set at p<0.05.
Results: Within-group analysis revealed significant improvements in VAS scores in both groups (p<0.001). Group A showed a reduction in pain from 4.7±0.8 to 1.2±1.05, whereas Group B demonstrated a decrease from 5.3±1.2 to 2.2±1.4. Hip ROM also improved significantly in both groups (p<0.001). In Group A, right hip flexion increased from 60.4±4.7° to 73.6±5.1°, and left hip flexion from 57.5±4.7° to 73.4±4.5°, while right hip extension improved from 13.3±3.1° to 22.2±2.5° and left hip extension from 15.3±2.6° to 21.4±2.4°. In Group B, right hip flexion increased from 61.7±6.5° to 71.5±5.1°, and left hip flexion from 61.0±4.2° to 70.2±4.1°, while right hip extension improved from 13.08±2.5° to 16.71±1.3° and left hip extension from 12.21±2.9° to 16.61±1.7°. Between-group analysis indicated that Group A achieved significantly greater improvements in pain reduction (p=0.032) and hip ROM (p<0.05) compared to Group B.
Conclusion: Both manual pressure release and strain counterstrain techniques were effective in reducing pain and improving hip ROM in individuals with CLBP. However, manual pressure release demonstrated superior efficacy in enhancing hip flexion and extension and reducing pain severity, making it a potentially more effective therapeutic option for CLBP management.