Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT05479266 |
Other study ID # |
RIPHAH/FR&AHS/Letter-0976 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
November 1, 2021 |
Est. completion date |
July 15, 2022 |
Study information
Verified date |
July 2022 |
Source |
Riphah International University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
The aim of this research is to compare the effects of Muscle Energy Techniques and Myofascial
Release on Lumbar Range of motion, pain and disability in patients of low back pain due to
Sacroiliac Joint Dysfunction, Randomized controlled trials were done at a private clinic, The
Health Professionals Bahria Town Phase 6, Islamabad. The Sample Size was 30. The subjects
were divided into two groups, 15 subjects in Interventional group A receiving conventional
physical therapy treatment alongside METs for hamstrings, iliopsoas and piriformis muscle
while the other 15 subjects in Interventional group B receiving conventional physical therapy
treatment with direct myofascial release of hamstrings, iliopsoas and piriformis muscle.
study duration was of 6 months. Samling technique applied was non.probability sampling. Only
females of age group 40-55 yrs having sacroiliac joint pain with limited lumbar range of
motion were reduced. Tools used in the study were Numeric Pain Rating Scale(NPRS), Modified
Oswestry Disability Index(MODI), Pelvic and bubble Inclinometer. Data was analyzed through
SPSS 21.
Description:
Sacroiliac joint is the most common source of low back pain affecting 70-85% of adults.
Accordingly, 13-30% of patients with lower back pain have Sacroiliac joint dysfunction. The
main mechanism for developing sacroiliac joint dysfunction includes different unidirectional
pelvic shear force along with repetitive torsional force and inflammation which produces not
only the lower back pain but also groin and gluteal pain. Muscle imbalances has also been
sighted as possible cause of pain. This theory states that the sacroiliac joint itself is
unaffected, but the musculature surrounding the sacroiliac joint is in form of dysfunction.
This muscular imbalance could limit the flexibility of muscle of low back pain and ultimately
begin a syndrome of chronic disuse culminating in decreased function and heightened pain. The
use of a combination of tests showed a high sensitivity and specificity to indicate the
presence of sacroiliac joint dysfunction that includes FABER, posterior shear and resisted
abduction pain provocation tests.
Treatment of sacroiliac joint pain is variable and no set method or protocol of treatment has
been found to be efficacious and reliable. Interventions to treat pain of SIJ dysfunction
includes Non-steroidal Anti-Inflammatory drugs(NSAIDs), physical therapy, corticosteroid
injections, osteopathic manipulations(manual medicine), radiofrequency denervation,
sacroiliac joint belts and surgery. Muscle Energy Techniques is the most commonly used manual
medicine techniques that depends on method of using low amplitude muscle contractions against
resistance thinking that it would improve vascular circulation and have a positive influence
on static and dynamic posture. this techniques was further modified by having patients use
their muscles in a controlled position against a counterforce. Muscle energy techniques have
several uses that can help increase muscle strength, increase range of motion(ROM) and
decrease edema.
Myofascial release techniques(MFR) are another manual medicine technique that is described as
'designed to stretch and reflexively release patterned soft tissue( particularly the muscles
and fascia) and joint related restrictions'. myofascial abnormalities may lead to connective
tissue fibrosis, increased tissue stiffness and further movement impairment which may lead to
low back pain chronicity.
In a study conducted by D. Sharma et al in 2014 on comparing the effects of muscle energy
techniques and mobilizations in treating sacroiliac joint dysfunction focusing on piriformis,
quadratus lumborum and erector spinae muscles, concluded that METs and mobilizations are both
effective in treating chronic low back pain due to sacroiliac joint dysfunction. Outcomes
were measured on first day and then after 1st and 2nd week from each subject, pain and
disability by Visual Analogue Scale and Modified Oswestry Disability Index
Questionnaire(MODI) In a randomized controlled trial conducted by Arguisuelas et al in 2017
for studying the effects of Myofascial release (MFR) for quadratus lumborum, psoas muscle,
thoracolumbar fascia and lumbar paravertebral muscles in Non-specific chronic low back pain ,
it was concluded that myofascial release therapy produced a significant improvement in both
pain and disability. Pain was measured by means of Short Form Mc Gill Pain Questionnaire
(SF-MPQ) and Visual Analogue scale and disability measured with Roland Morris Questionnaire.
In another study conducted by Sabah et al in 2019 concluded that muscle energy techniques for
iliopsoas, hamstrings, erector spinae and quadratus lumborum is an effective treatment for
decreasing anterior pelvic tilting angle and reducing pain in patients with chronic SIJ
dysfunction. The study findings revealed a statistical significant decrease of anterior
pelvic tilting angle in group A(p<0.001), also a significant decrease in pain in the 2 groups
compared with the pre-intervention values(p<0.001) In 2020, Faryal et al conducted a study in
peshawar, concluded that muscle energy technique targeting quadratus lumborum, iliopsoas and
piriformis muscle and maitland mobilizations are both effective in treating the chronic
sacroiliac joint dysfunction in terms of decreasing pain and disability when using
lumbopelvic stabilization exercises as an adjunct therapy with them.
In previous studies both muscle energy techniques and myofascial release therapy has been
proven to be effective in treating chronic low back pain due to sacroiliac joint dysfunction.
Currently to our knowledge there exists very weak evidence to which one technique can be
proved to be more effective than the other. The purpose of this study is to compare the
effects of both these therapies on pain and functional status in patients with sacroiliac
joint dysfunction in addition to conventional physical therapy treatment protocols.