The Effect of Remote Myofascial Release on Chronic Nonspecific Low Back Pain With Hamstrings Tightness.

CONTEXT: Anatomy trains theory states that performing techniques in any part of the superficial myofascial backline can remotely treat other parts of this pathway. Due to the connections of different parts of the superficial backline, it is possible to influence the hamstring by performing the technique in the lumbar area. As chronic nonspecific low back pain (LBP) may lead to or be caused by hamstring tightness, remote myofascial release (MFR) techniques using the superficial backline can help improve hamstring tightness. OBJECTIVE: This study aimed to evaluate the effect of remote MFR on hamstring tightness for those with chronic nonspecific LBP. DESIGN: Single-blind, parallel design. SETTING: The present study was performed at the clinical setting of Tarbiat Modares University in Iran. METHODS: This study included 40 participants (20 males and 20 females) who were 40.5 (5.3) years old with chronic nonspecific LBP and hamstring tightness. INTERVENTIONS: Participants were randomly divided into the lumbar MFR (remote area) and hamstring MFR groups. Participants underwent 4 sessions of MFR for 2 weeks. MAIN OUTCOME MEASURES: A passive knee-extension (PKE) test was used for muscle tightness evaluation 3 times. RESULTS: Repeated-measure analysis of variance test showed that after the lumbar and hamstring MFR, the PKE was significantly reduced in both legs: lumbar MFR (right knee: from 61.04° [2.17°] to 51.01° [4.11°], P ≤ .003 and left knee: from 63.02° [3.12°] to 52.09° [2.48°], P ≤ .004) and hamstring MFR (right knee: from 62.01° [4.32°] to 50.50° [7.18°], P ≤ .001 and left knee: from 63.11° [2.56°] to 51.32° [5.31°], P ≤ .002). Least Significant Difference (LSD) post hoc test results showed that the 2 groups were not significantly different after the MFR (P ≥ .05). Also, the intraclass correlation coefficient index showed that the PKE test has excellent reliability (intraclass correlation coefficient, .910 for the right limb and .915 for the left limb). The minimal detectable change at the 95% confidence interval indicated that a change greater than or equal to 6° is required to exceed the threshold of the error PKE test, respectively. CONCLUSION: The present study showed that the remote MFR technique to the lumbar region demonstrated the same significant results in decreasing hamstring tightness as was noted in hamstring MFR to both limbs in patients with chronic nonspecific LBP.

Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial.

Objective: The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP. Methods: For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16). Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs. Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations. Results: The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other (F1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 = 1.48, P = .230, 95% confidence interval) (effect size = 0.22). Conclusion: The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP.

The effect of transcutaneous electrical nerve stimulation on pain and electrical stimulation muscle thickness in patients with non-specific chronic low back pain-based ultrasonographic evaluation.

Aim: The existing mechanisms of transcutaneous electrical nerve stimulation (TENS) focuses more on the effect of neural tissue. This study investigated the effect of TENS on the thickness of the erector spinae muscles and reducing pain. Patients & methods: 56 individuals with low back pain participated in this single-blind, pre/post-test study. For 2 weeks, participants underwent ten sessions of TENS. The ultrasound evaluations examined the thickness of the erector spinae muscle, and the visual analog scale measured the severity of low back pain. Results: There was a decrease in pain score and muscle thickness after the interventions (p ≤ 0.004). There was also a strong correlation between reducing pain and decreasing muscle thickness (R = 0.709; p = 0.000). Conclusion: Following TENS in the lumbar, in addition to reducing pain, the thickness of the erector spinae muscles also decreased. Clinical Trial Registration: IRCT20200423047173N1 (ClinicalTrials.gov).

Low back pain is one of the common problems in different societies, which can greatly impact people's social performance. Therefore, safe treatment methods must be used to relieve low back pain quickly. The TENS device is a safe electrical device available that can be used in the early stages of low back pain. The results of the present study on 20 people with low back pain showed that the use of this device, in addition to reducing low back pain, also affects the structure of the muscles in the back area and can help people improve their performance.

Evaluation of Lumbar Myofascial Release Effects on Lumbar Flexion Angle and Pelvic Inclination Angle in Patients with Non-Specific Low Back Pain.

Background: Many studies have shown that changes in lumbar flexion angle and the pelvic inclination angle can be affected by the shortening of the lumbar muscles, which can cause low back pain. Decreased lumbar flexion angle and pelvic inclination angle can cause or exacerbate low back pain by disrupting the lumbo-pelvic rhythm. Purpose: This study aimed to use myofascial release techniques as a specialized treatment on muscle tissue to cause muscles to reach the optimal length and improve lumbar flexion angle and pelvic inclination angle, and thus improve low-back pain. Setting: Non-specific low back pain patients, Tarbiat Modares University, Iran. Participants: 30 chronic non-specific low back pain participants were randomly assigned into two groups. Research Design: This is a randomized control trial. Interventions: The myofascial release group (n=15) underwent 4 sessions of myofascial release treatment based on Myer's techniques, and the control group (n=15) underwent 10 sessions of routine electrotherapy for two weeks. Main Outcome Measures: Before starting the intervention and after the last treatment session, both groups were evaluated by the lumbar flexion angle with a flexible ruler, calculating the pelvic inclination angle by a trigonometric formula, and VAS measured the pain score of the participants. Results: The results of the paired t test showed that, after treatment in both groups, the severity of pain and lumbar flexion angle changed significantly (p ≤ .001). However, the pelvic inclination angle was changed considerably only in the myofascial release group, and we did not see significant changes in the control group (p = .082). Also, the independent sample t test results to examine the between-group changes showed that changes in the myofascial release group were significantly different from the control group (p ≤ .000). Also, the effect size shows the large effect of the myofascial release technique compared to the control group (effect size ≥ 1.85). Conclusion: The present study results showed that myofascial release techniques in patients with low back pain could help decrease pain intensity and increase lumbar flexion and pelvic inclination angle. Based on the present study results, myofascial release can be a treatment to correct posture in patients with chronic non-specific, low back pain. Due to the prevalence of the COVID-19 pandemic, it was not possible to evaluate the long-term effects of treatment.

Comparative effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low back pain.

OBJECTIVES: Low back pain is a major health issue in most industrialized countries. Lumbar fascia is supported as a potential source of pain in the lumbar region. Myofascial release is a manual therapeutic approach that focuses on restoring altered soft tissue function. On the other hand, one of the most commonly used physical therapy methods for low back pain is electrotherapy. The purpose of this study was to compare the effect of lumbar Myofascial release and electrotherapy on clinical outcomes of Non-specific low back pain and elastic modulus of lumbar myofascial tissue. DESIGN: Randomized, clinical trial. SETTING: Outpatient Low back pain clinic. SUBJECTS: 32 subjects with low back pain. INTERVENTIONS: Subjects were randomized into the myofascial release group (n = 16) and electrotherapy group(n = 16). Subjects in the myofascial release group received 4 sessions of myofascial release in the lumbar region, and the electrotherapy group received 10 sessions of electrotherapy. MAIN MEASURES: Low back pain severity, and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment. RESULTS: An independent sample T-test was used to compare baseline variables in both groups (p > 0.05) (effect size≥0.83), Paired T-test was used to compare within-group changes after performing myofascial release and electrotherapy (p ≤ 0.023) (effect size≥0.56), and the GLM Anova test was used to Comparison of Changes in the Elastic Modulus of the Lumbar Spine and Low Back Pain between-group (F (10,21) = 12.10, P < 0.0005) (effect size = 0.86). CONCLUSION: The improvements in the outcome measures suggest that lumbar myofascial release may be effective in subjects with non-specific low back pain. Data suggest that the elastic modulus of lumbar fascia and the severity of low back pain are directly linked. Decreasing the elastic modulus after myofascial release can directly affect reducing low back pain.

The effect of aerobic and resistance exercise training on the health related quality of life, physical function, and muscle strength among hemodialysis patients with Type 2 diabetes.

INTRODUCTION: Diabetic patients who undergo hemodialysis commonly suffer from reduction of both exercise capacity and muscle strength. These factors may have a negative effect on health related quality of life (HRQoL) and physical function. We investigated the effect of aerobic and resistance exercise training on the HRQoL, physical function, and muscle strength among hemodialysis patients with Type 2 diabetes. METHODS: Twenty-eight diabetic patients who were on hemodialysis in the Milad Hospital (Tehran, Iran) were recruited for the study. Subjects were randomized into control (n = 13) and exercise training groups (n = 15). The exercise training group performed combined aerobic and resistance exercise training at moderate intensity (11-15/20 on the Borg scale) during hemodialysis treatment, 3 times a week for 8 weeks. The primary outcomes consisted of physical function measured by a 6-min walk test (6MWT), HR-QoL measured by the Short Form Health Survey (SF-36), and lower limb muscle strength measured using a hand-held Digital Dynamometer. RESULTS: The 6MWT distance increased significantly in the exercise training group (36%). Bilateral hip flexor strength (right, 24.5%; left, 30.4%) and abductor strength (right, 27.6%; left, 25.2%) decreased significantly in the non-exercising control group but no significant change was found in the exercise group (P > 0.05). There were no significant changes in any of the 8 generic subscales of HR-QoL neither in the exercise training group nor controls following an 8- week study. CONCLUSIONS: 8 weeks of combined aerobic-resistance exercise training among diabetic hemodialysis patients seem to be effective in improvement of physical function and lower limb muscle strength.

A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.

BACKGROUND: Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH. OBJECTIVE: The purpose of this study was to compare the effect of dry needling (DN) and ischemic compression (IC) on the headache symptoms as well as MTrP-related features in subjects with CeH originating from MTrPs of the SCM muscle using a sonographic method. METHODS: A total of 29 female subjects aged 35.34 ± 12.19 on average with a clinical diagnosis of CeH originating from MTrP in the SCM muscle were randomly divided into the DN, IC, and control groups. Both DN and IC groups received 4 treatment sessions. Headache intensity, duration, frequency, MTrP elastic modulus, MTrP area, and pressure pain threshold (PPT) were assessed 2 weeks before and after treatments. RESULTS: In both DN and IC groups, a significant improvement was found in the headache intensity, duration, frequency, PPT, and MTrP area (P< 0.05). No significant differences were observed between DN and IC (P> 0.05). Pearson correlation revealed a significant correlation between headache intensity and the MTrP elastic modulus (P< 0.05). CONCLUSIONS: Both interventions could reduce headache symptoms, PPT, and MTrP area. Neither intervention was found to be superior to the other in short-term follow-up. IC may be preferred since it has fewer unwanted side effects compared to DN. Based on the data, it may be concluded that some MTrP biomechanical features such as stiffness may influence the produced headache symptoms.

Novel method to measure active myofascial trigger point stiffness using ultrasound imaging.

INTRODUCTION: Myofascial trigger points (MTrPs) are one of the most common and important causes of musculoskeletal pain. Ultrasound is a useful modality in examining musculoskeletal disorders. By applying compressive stress and observing changes in ultrasound images, the elastic modulus (Young's modulus) can be calculated. Our objective was to develop a novel method to distinguish MTrPs from normal tissues. METHODS: A total of 29 subjects with MTrP in the sternocleidomastoid muscle were assessed. A force gauge was attached to a transducer to obtain stress levels. To obtain strain, images were recorded in both with stress and without stress states. By dividing the stress level by the measured strain, the elastic modulus was determined. RESULTS: Elastic modulus in MTrPs and the normal part of the muscle were measured to be 13379.57 ± 1069.75Pa and 7078.24 ± 482.92Pa, respectively (P = 0.001). This indicated that MTrPs were stiffer than normal parts of the muscle. CONCLUSION: This study presents a new method for the quantitative measurement of the elastic modulus of MTrP, thereby distinguishing MTrPs from normal adjacent muscular tissue, with more simplicity and lower cost, compared to other ultrasound methods.

Effect of ischemic compression for cervicogenic headache and elastic behavior of active trigger point in the sternocleidomastoid muscle using ultrasound imaging.

OBJECTIVES: To investigate the effect of ischemic compression on clinical outcomes of a cervicogenic headache and elastic behavior of myofascial trigger points. DESIGN: Randomized, controlled trial. SETTING: Outpatient headache clinic. SUBJECTS: 19 subjects with a cervicogenic headache originating from myofascial trigger point within the sternocleidomastoid muscle. INTERVENTIONS: Subjects were randomized in treatment group (n = 9) and control group (n = 10). Subjects in the treatment group received 4 sessions of ischemic compression in the myofascial trigger point region. MAIN MEASURES: Headache intensity, frequency, and duration, trigger point elastic modulus, trigger point area, pressure tolerance, and pressure pain threshold were assessed before and after treatment. RESULTS: Subjects in the treatment group compared with those in control group showed significant improvements in headache intensity (P = 0.002), headache frequency (P = 0.005), headache duration (P = 0.015), pressure tolerance (P < 0.001), pressure pain threshold (P = 0.039), and myofascial trigger point area (P = 0.017). Changes in myofascial trigger point elastic modulus did not reach a significant level (P > 0.05). CONCLUSION: The improvements in outcome measures suggest that ischemic compression may be effective in subjects with a cervicogenic headache associated with a myofascial trigger point in the sternocleidomastoid muscle. Data suggests that biomechanical properties of MTrP and severity of headache symptoms are not directly linked, and other mechanisms could be more influential in contributing to symptoms.