The Immediate Effect Of Shockwave Therapy On the Quadratus Lumborum (QL) Muscle Trigger Points vs Regular Back Exercises in Chronic Nonspecific Low Back Pain

Study Overview
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Brief Summary
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the study aims to compare the effect of regular back exercises with shockwave therapy by treating male patients with non-specific low back pain between the age of (20-40). Who will be devided into 3 groups, and will be treated by shockwave therapy , exercises or both combined. After signing a consent form, patients will be assigned to the groups blindly, so the patients will not know if they are in the experimental or control group. Hypothesis: The hypothesis of this study states that: o Research hypothesis: there will be a significant difference between the radial ESWT and back exercises in reducing LBP

Official Title
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The Immediate Effect Of Shockwave Therapy On the Quadratus Lumborum (QL) Muscle Trigger Points vs Regular Back Exercises in Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

Conditions
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Low Back Pain, Mechanical

Intervention / Treatment
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* Device: shockwave machine
* Other: leg and back exercises
* Combination Product: shockwave and exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Only male patients will be included. Age 20-40 years old. Non-specific LBP for at least 3 months. At least one local tenderness or active trigger point in the anatomical region of the QL muscle. Pain intensity on numerical pain scale should be more than 4 Exclusion Criteria: LBP due to a pathology or trauma. Below 20 years of age. Previous lumbar surgeries. Malignancy. Patients under medications or painkillers.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: shockwave group<br> | Device: shockwave machine<br>* shockwave therapy. 2000 impulses will be applied, 1000 on the TrPs and 1000 surrounding it, with Energy level up to 2,5 bars and frequency of 10Hz<br>|
| Active Comparator: exercise group<br> | Other: leg and back exercises<br>* the exercise program will include 5 exercises that focuses on the back and lower limbs. These exercises are: Bridge Plank Squat Push-ups Back extension Each exercise will be done for 3-5 sets.<br>|
| Active Comparator: combined group<br> | Combination Product: shockwave and exercises<br>* both types of interventions will be applied for the patient<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pressure-pain threshold | Algometry device will be used to measure three thresholds' values: Tenderness threshold. Referred pain threshold. Pain tolerance threshold. | 45 hour session | 
| The Oswestry Disability Index | is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent functional disability, scoring from 0 to 50, the lower score the better | 45 minutes session | 
| Numerical pain scale | 0-10 the lower the better | 45 minutes session | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ROM of the back | an electrical goniometer will be used to measure the change in the back ROM | 45 minutes session |