Integrated Neuromuscular Inhibition Versus Instrument Assisted Soft Tissue Mobilization in Chronic Back Pain

Study Overview
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Brief Summary
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this study will be conducted to identify the difference between the effect of integrated neuromuscular inhibition technique and instrument assisted soft tissue mobilization on back pain, pain threshold, back rang of motion ,back proprioception and back disability in chronic non specific low back pain

Official Title
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Integrated Neuromuscular Inhibition Technique Versus Instrument Assisted Soft Tissue Mobilization in Patients With Chronic Non Specific Low Back Pain

Conditions
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Chronic Non Specific Low Back Pain

Intervention / Treatment
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* Other: Experimental: Group A: integrated neuromuscular inhibition technique
* Other: Experimental: Group B :Instrument assissted soft tissue mobilization
* Other: control group C conventional physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 1. The patient's age ranged from 18 to 30 years.(Geogre et al, 2021) 2. Patients with low back pain for more than 3 months (pain felt between T12 and the gluteal fold). 3. Patient with chronic low back pain 4. Normal body mass index from 18 -25kg/m2. Exclusion Criteria: The subjects will be excluded if they have any of the followings: Lumbar discogenic lesions or any inflammatory arthritis, tumors, infection involving the lumbar spine. Patients with decreased range of motion secondary to congenital anomalies, muscular contracture, or bony block. Previous lumbar or hip surgery or trauma. Any hip structural abnormality such as malformations, impingements and degeneration. Patients With cognitive impairments that would limit their participation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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
Interventional Model Description: integrated neuromuscular inhibition technique and conventional physical therapy instrument assisted soft tissue mobilization technique and conventional physical therapy conventional physical therapy only
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A: integrated neuromuscular inhibition technique<br>Group A: patient will receive integrated neuromuscular inhibition technique and conventional physical therapy program for 3 sessions /week over 4 weeks periods | Other: Experimental: Group A: integrated neuromuscular inhibition technique<br>* will receive integrated neuromuscular inhibition in addition to conventional treatment,INIT which included IC, SCS, and MET for the low back region for the quadratus lumborum( QL) and erector spinae (ES) muscles<br>* Other names: technique;|
| Experimental: Group B :Instrument assissted soft tissue mobilization<br>Group B : patient will receive Instrument assissted soft tissue mobilization technique and conventional physical therapy program for 3 sessions /week over 4 weeks periods | Other: Experimental: Group B :Instrument assissted soft tissue mobilization<br>* IASTM performed on lumbar posterior muscle erector spinae (iliocostalis, longissimus), and quadratus lumborum(QL) The IASTM treatment was applied for approximately 20-seconds in a direction parallel to the muscle fibers being treated with the instrument at a 45° angle. Followed immediately by treating the muscles in a direction perpendicular to the muscle fibers with the instrument at a 45° angle for an additional 20-seconds, resulting in a total treatment time of approximately 40 seconds.<br>* Other names: instrument;|
| Active Comparator: Group C:conventional physical therapy<br>Group C: patient will receive conventional physical therapy only in the form of ( stretch for hamstring ,illiopoaps ,low back muscle and strenghtning for abdominal ,back muscles and side support exercise and quadriped exercise) | Other: control group C conventional physical therapy<br>* . The control group will applied general exercise. General exercise were applied with stretching exercises and stationary bicycling for 10-15 minutes14, 15) . Three sets of fifteen repetitions will performed, with rest times of 1 minute between sets during 4 weeks.<br>* Other names: exercise;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in lumber proprioception | change in lumbar proprioception will be measured by dual inclinometer for 3 group pre-and post-treatment | Evaluation will be performed priod to the first treatment session :as a baseline measure,and at least treatment session (after 4 weeks)as a post-treatment measure | 
| chang in pain pressure threshold | change in lower back pain threshold will be measured by pressure algometer for 3 group pre-and post-treatment | Evaluation will be performed priod to the first treatment session :as a baseline measure,and at least treatment session (after 4 weeks)as a post-treatment measure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| chang in lumbar rang of motion(ROM) | lumbar ROM will be measured by dual inclinometer pre-treatment and post treatment | Evaluation will be performed priod to the first treatment session :as a baseline measure,and at least treatment session (after 4 weeks)as a post-treatment measure | 
| functional disability oFlumbar spine | functional disability will be measured by The Arabic version of Oswestry Disability Index.(ODI) | Evaluation will be performed priod to the first treatment session :as a baseline measure,and at least treatment session (after 4 weeks)as a post-treatment measure | 
| pain level of lumbar spine | pain level will be measured by visual analoge scale(VAS) | Evaluation will be performed priod to the first treatment session :as a baseline measure,and at least treatment session (after 4 weeks)as a post-treatment measure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic non specific low back pain, integrated nouromuscular inhibition technique, instrument assisted soft tissue mobilization technique