Evaluating Pain and Functional Outcomes of Active Release Technique Versus Strain-counter- Stain in Chronic Low Back Pain

Chronic low back pain (CLBP) is a globally prevalent and debilitating condition that significantly impacts patients' functional capacity, quality of life, work productivity, and healthcare systems. Its multifactorial etiology, varied patient presentations, and inconsistent responses to treatment make CLBP a persistent therapeutic challenge. Non-pharmacological approaches such as Active Release Technique (ART) and Strain-Counter-Strain (SCS) have emerged as promising interventions, yet there is limited and inconsistent high-quality evidence comparing their effectiveness in CLBP management.

ART is a soft tissue manual therapy targeting myofascial adhesions, scar tissue, and trigger points. By applying specific manual pressure combined with patient movement, ART aims to restore normal muscle texture, reduce tension, and improve function. It is commonly used for pain associated with muscle tightness, restricted mobility, and neuromuscular dysfunction.

SCS is a passive positional release technique that reduces muscle spasm and tension by placing the affected muscle in a shortened position for a set duration, typically 90 seconds, followed by a gradual return to neutral. It works by reducing proprioceptive activity in muscle spindles, thereby alleviating pain and restoring motion.

This randomized clinical trial will recruit 40 male participants aged 30-45 years diagnosed with CLBP persisting for at least 3-4 months, with pain intensity ≥4/10 on the Visual Analogue Scale (VAS). Patients will be randomly allocated into two equal groups-Group A: ART and Group B: SCS-using a sealed card draw method. Both groups will receive a standardized pre-treatment protocol consisting of a 10-minute hot pack application to the lower back and 15 minutes of interferential current therapy.

Intervention Protocol:

ART Group: Application of ART techniques to the lumbar and gluteal regions with precise manual pressure and guided movements, 45 minutes per session, three sessions per week for four weeks.

SCS Group: Gentle passive positioning of targeted muscles into comfort, held for 90 seconds, then returned to neutral; 45 minutes per session, three sessions per week for four weeks.

Outcome Measures:

Pain Intensity - measured via VAS.

Functional Disability - assessed using the Quebec Back Pain Disability Scale (QBPDS).

Functional Limitation - assessed using the Oswestry Disability Index (ODI). Baseline measurements will be recorded before treatment and reassessed after completing the 12 sessions.

Data Analysis will be conducted using SPSS v25. Normality will be assessed with the Shapiro-Wilk test. Within-group comparisons will use paired t-tests (or Wilcoxon signed-rank tests for non-normal data), and between-group differences will be analyzed using independent t-tests (or Mann-Whitney U tests for non-normal data). Statistical significance will be set at p < 0.05.

Expected Contribution:

The study will provide comparative evidence on the efficacy of ART versus SCS in improving pain and function among CLBP patients. It will inform clinical decision-making, contribute to the development of evidence-based guidelines, and potentially influence cost-effective management strategies for CLBP. Furthermore, it will add to the body of literature on manual therapy interventions, supporting a patient-centered, biopsychosocial approach to musculoskeletal rehabilitation.