Effect of Strain Counter Strain Technique in Treatment of Lower Back Myofascial Pain Syndrome

Study Overview
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Brief Summary
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This study aims to investigate the impact of impact of strain counterstrain technique on pain, lumbar range of motion and functional impairment in patients with lower back Myofascial pain syndrome.

Detailed Description
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Myofascial Pain Syndrome (MPS) is a prevalent form of musculoskeletal pain that impedes everyday activities and reduces productivity.Those who experience difficulties with regional pain frequently report myofascial pain. According to statistics, between 85% and 93% of patients who attend specialized pain treatment facilities and between 21% and 30% of people with regional pain who visit a general medical clinic also have it.Trigger points, which are hyperirritable tender spots in palpably tense bands of skeletal muscles, are what define it. These spots can cause referred pain patterns, painfully limited range of motion, stiffness, muscle fatigue, and autonomic dysfunction. Numerous clinical therapies as well as training regimens have been developed to combat trigger points. Strain counterstrain technique (SCS), is one of several manual methods for trigger points, which is a passive method that opens shortened tissues and reduces musculoskeletal pain. It may be possible to activate the Golgi tendon organ, which relaxes tense and tight muscles, by positioning shortened and painful tissues in a comfortable way, which would result in a reduction in the sensitivity of the trigger point. Hence, the purpose of this study is to ascertain how SCS affects pain, ROM, and functional disability in individuals suffering from lower back myofascial pain syndrome.

Official Title
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Effect of Strain Counter Strain Technique in Treatment of Lower Back Myofascial Pain Syndrome: a Randomized Controlled Clinical Trial

Conditions
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Lower Back Myofascial Pain Syndrome

Intervention / Treatment
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* Other: strain counter strain technique
* Other: physical therapy exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patients age from 20 to 40 years for both genders. Patients (office worker) with mechanical back pain for 3 months ago and has not been diagnose as a specific disease or spinal abnormality. Patients suffering from active MTrPS in lower back muscle. According to the Oswestry Low Back Pain Disability Questionnaire, patients suffered moderate disability care (20-40%). Patients capable of doing ROM assessment of Lumbar Spine (flexion, extension, as well as side binding) within the limit of pain. Exclusion Criteria: Neurological, systemic illness and infectious diseases such as rheumatologic diseases, tumor. Psychiatric/mental deficit. Patients who had a previous surgical history (within 6 months) were also excluded prior to the baseline assessment. Vertebral compression fracture Pregnancy and lactation. Existing lower limb symptoms. Activity intolerance due to cardiopulmonary disease.

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

Sexes Eligible for Study
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All

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
Interventional Model Description: strain counter strain technique and physical therapy exercises
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: strain counter strain technique<br>the patients will receive strain counter strain technique plus physical therapy exercises three times a week for four weeks | Other: strain counter strain technique<br>* It will be done in accordance with the technique principles in which the therapist will locate trigger point, and then find a position of comfort or mobile point (at least a 70% decrease in tenderness),monitored the tender point, holding the position o f comfort for 90 seconds, It will be conducted three times per session, for twelve sessions three times per week every other day over the course of a month.<br>Other: physical therapy exercises<br>* Physical therapy exercises for twelve sessions, three times a week, over the course of a month. Exercises will include: stretching exercises for the hamstring, calf muscles, and back muscles. strengthening exercises for back muscles and abdominal muscles.<br>|
| Active Comparator: physical therapy exercises<br>the patients will receive physical therapy exercise three times a week for four week | Other: physical therapy exercises<br>* Physical therapy exercises for twelve sessions, three times a week, over the course of a month. Exercises will include: stretching exercises for the hamstring, calf muscles, and back muscles. strengthening exercises for back muscles and abdominal muscles.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | A Visual Analogue Scale (VAS) will be used by the patient to mark his or her level of pain, usually 10 cm long, ranging from no pain or discomfort (zero) to the worst pain that the patient can possibly feel. | up to four weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| range of motion assessment | inclinometer will be used to assess lumbar flexion, extension and side bending | up to four weeks | 
| functional impairment | Arabic version of Oswestry Disability Index will be used for assessment of functional disability | up to four weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Low back Pain, Myofascial pain syndrome, Strain counter strain technique, trigger point