Effects of myofascial techniques on pain, mobility and function in patients with low back pain: a double-blind, controlled and randomized trial

Abstract

Introduction: Low back pain is one of the most frequent causes of disability, with several associated etiologies. Osteopathic manipulative treatment is widely used to evaluate and manage musculoskeletal disorders. The aim of the study was to evaluate the immediate and late effects of 3 sessions of myofascial osteopathic techniques on pain intensity, posterior chain flexibility, lumbar mobility and level of disability in patients with chronic low back pain. Methods: 60 subjects of both genders, randomly divided into 3 experimental groups: healthy control (HC n = 20), low back pain control group (CG, n = 20) and treated low back pain group (TG, n = 20). Initially, the 3 groups were evaluated using the Visual Analogue Scale (VAS), Oswestry questionnaire, Wells bench and measurement of lateral spine tilt and fingertip-to-floor test. The TG was submitted to 3 sessions of myofascial techniques (lasting 40 minutes), 1x / week. The session consisted of the application of 6 myofascial techniques (thoracolumbar fascia, quadratus lumborum fascia, iliopsoas muscle stretching, quadratus lumborum stretching and iliolumbar ligaments). Subjects were reevaluated immediately after the first session, 7 days after the last session and one month after treatment completion (follow up). Results: There was an improvement in posterior chain flexibility (20.3 ± 7.4 cm pre to 26.3 ± 8 cm after 3 sessions), spinal mobility (fingertip-to-floor: 13.3 ± 11.33 cm pre to 4.8 ± 10.5 cm after 3 sessions), as well as pain intensity reduction (3.3 ± 1.9 cm pre to 1 ± 1.7 after 3 sessions) and reduction in the level of lumbar disability (15.8 ± 7.3 in the pre to 9.2 ± 8.6 after 3 sessions) for TG. In HC and CG there was no change in any of the variables. The results shown for TG remained even one month after the intervention. Conclusion: The osteopathic treatment protocol with myofascial techniques was effective for the treatment of low back pain.

Effects of Isolated Myofascial Release Therapy in Patients with Chronic Low Back Pain—A Systematic Review

“…Out of these participants, 192 were male and 225 were female, aged 18-60 years old, across all study groups. The studies were conducted in Spain [18,19], Brazil [20,21], and Poland [12,13]. Among all the qualified RCTs, five studies had a parallel design [12,13,[18][19][20], and one had a crossover design [21].…”

“…The studies were conducted in Spain [18,19], Brazil [20,21], and Poland [12,13]. Among all the qualified RCTs, five studies had a parallel design [12,13,[18][19][20], and one had a crossover design [21].…”

“…The studies were conducted in Spain [18,19], Brazil [20,21], and Poland [12,13]. Among all the qualified RCTs, five studies had a parallel design [12,13,[18][19][20], and one had a crossover design [21]. [12,13] or only one manual technique lasting 5 min (release of the TLF in a seated position with the patient active trunk flexion-extension movement) were applied [21].…”

“…Tissues in the area of the lumbosacral spine were manually released at various depths, starting from superficial tissues, such as skin and superficial layers of TLF [12,13,[18][19][20][21], iliolumbar ligaments [20], lumbar paravertebral muscles (e.g., erector spinae, ES) [12,13,18,19], and ending with deeper muscles, such as m. quadratus lumborum and m. iliopsoas [12,13,[18][19][20]. The authors also used different procedures in the control groups: without any intervention [12,13,20,21], using sham therapy-gently placing the therapist's hands on the same areas treated in the MFR group, without sliding, and maintaining only contact with the tissues [18,19]-or by asking patients only to perform the same active trunk movements that accompanied manual techniques performed in the experimental group, while renouncing the therapist's touch [21]. In the paper of Sakabe et al, an additional control group with healthy individuals was also examined [20].…”

“…The authors also used different procedures in the control groups: without any intervention [12,13,20,21], using sham therapy-gently placing the therapist's hands on the same areas treated in the MFR group, without sliding, and maintaining only contact with the tissues [18,19]-or by asking patients only to perform the same active trunk movements that accompanied manual techniques performed in the experimental group, while renouncing the therapist's touch [21]. In the paper of Sakabe et al, an additional control group with healthy individuals was also examined [20]. The included RCTs reported different outcomes, which encompassed pain intensity (assessed with SF-MPQ, VAS, NPRS), pain sensitivity (assessed with PPT), range of motion (assessed with Sit and Reach Test, FTF test, measurement of lateral spine inclinations), functional disability (assessed with RMQ, ODI), fear-avoidance beliefs (assessed with FABQ), muscle activity (assessed with sEMG), and postural stability (evaluated through posturography).…”