Clinical trial NCT04156776: Comparison of MET and AIS on Erector Spinae Muscle in Low Back Pain
Official title: Comparison Of Muscle Energy Technique And Active Isolated Stretching On Erector Spinae Muscle In The Management Of Mechanical Low Back Pain
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mechanical Low Back Pain
Keywords: Active Isolated Stretching
Muscle Energy Technique
Mechanical Low Back Pain
Lead sponsor: Riphah International University
Sponsor class: OTHER
First posted: 2019-11-07
Enrollment: 57
Sex: ALL
Minimum age (years): 35
Maximum age (years): 55
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Group A (MET) and Group B (AIS)
Primary purpose: TREATMENT

Brief 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.

Eligibility criteria: Inclusion Criteria:

* Patients having acute mechanical LBP.
* Patients having restricted ROM.

Exclusion Criteria:

* Patients with ankylosing spondylitis.
* Patient undergone any spinal surgery.
* Patient having scoliosis.
* Patient with tumor.
* Patient with Rheumatoid Arthritis and other systemic diseases.
* Immobile/ Bed ridden patients.
* Patients with cognitive Problems. 8. Patients having vertebral compression fracture. 9. Patients with slump test positive.

Primary outcomes:
measure: Erector Spinae Muscle Length through Measuring Tape
timeFrame: 4th week
measure: Oswestry Disability Index (ODI)
timeFrame: 4th week
measure: Numeric Pain Rating Scale (NPRS)
timeFrame: 4th week
Secondary outcomes:
measure: Lumbar Spine ROM through Inclinometer
timeFrame: 4th week
Other outcomes:
Locations:
city: Islamabad
country: Pakistan
facility: Riphah International University
Study officials:
affiliation: Riphah International University
name: Abdul Ghafoor Sajjad, Phd*
role: PRINCIPAL_INVESTIGATOR
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