Strain Counter Strain and Muscle Energy Technique in Non-specific Low Back Pain

Infact, there is evidence that NSLBP subjects show an increase in center of pressure (CoP) displacement and velocity; and proprioceptive deficits, probably as a consequence of pain . Studies have reported LBP patients show significantly lower hip abductor and extensor strength compared to healthy adults and show weakening of the hip abductor or weakening of the hip extensors.

Quadratus Lumborum (QL) is a major cause of LBP difficulties, which frequently results in active and latent MTrP. Chronic LBP has been associated with changes in trunk muscle responses and increased muscle fatigability. This postural response alters the biomechanics of the spine, with the hips adopting an increased bend, which triggers a concomitant increase in the activation of the musculature surrounding the lower back and hip extensors.

The QL muscle is important in body mechanics and lumbar spine stabilization. Poor body mechanics and posture affects body positioning and stresses quadratus lumborum muscle which ultimately leads to myofascial trigger points in muscle. Increasing load also brings with it changes in spinal curvatures in both females and males. These increases in forward lean and back muscle activation, in addition to changes in spinal curvature, can heighten the risk of developing low back pain (LBP).

NSLBP has no definitive pathology regarding what is causing the pain but has been theorized to be caused by factors including poor posture, impaired flexibility, previous history of injury, heavy lifting, mental stress, and obesity. The prevalence of non-specific LBP increases with age, presenting a worse clinical course and a greater probability of transition to chronicity.

Manual therapy is a common treatment for severe low back pain. The strength and endurance of the trunk muscles play a crucial role in reducing pain, enhancing stability, and maintaining spinal function. Various treatments have been proposed for alleviating LBP, such as stretching exercises , heat therapy , massage therapy, proprioceptive neuromuscular facilitation and myofascial release.

Despite the number of treatment modalities detailed in the physiotherapy literature, there is no single conclusive treatment that has demonstrated to be effective for treating low back pain. Whole body vibration (WBV) is currently increasing in popularity as a treatment modality for alleviating pain, enhancing muscle activities and improving health-related quality of life.

The muscle energy technique is an active technique requiring the participant to contribute in an accurately regulated manner to the voluntary contraction of the muscle of a subject against the counterforce of an operator. MET is a manual therapy that utilizes gentle muscle contractions of the patient to relax muscles, lengthen them, and restore normal joint motion. This technique was pioneered in 1948 by Fred Mitchell, Doctor of Osteopathic Medicine, to enhance musculoskeletal function by mobilizing joints and stretching tight muscles and fascia.

The objective of MET is to promote muscle relaxation and lengthening, consequently enhancing joint range of motion (ROM). It is generally recognized as a gentle manual therapy technique for addressing limited motion in the spine and extremities. Depending on the comparative acuteness of the scenario, the contraction is generally started from or short of a previously identified obstacle of resistance. The mechanisms by which MET generates enhanced ROM is still under study. MET's effectiveness in relaxing the impacted muscles is due to the Golgi tendon organs inhibiting motor activity. Thus the shortened tissues attain a greater degree of ease and extra movement. The SCS method is an indirect manipulative method for treating muscle trigger points as its therapy action moves away from the restrictive obstacles, i.e. towards ease.

The strain counter strain (SCS) technique is one of the effective osteopathic treatment methods. It is a passive positional intervention aimed at relieving musculoskeletal dysfunction and pain. It is achieved by putting the tissues in an optimal position of comfort (POC). POC's aim is to decrease tender point irritability and normalize the dysfunction related to tissue. It is established by the soft and atraumatic nature of SCS methods as a secure and efficient primary mode of action in the therapy of painful muscles and the joints that affect them.

Osteopathic techniques including SCS have been addressed in peer-reviewed literature showing success. The intervention to treat chronic low back pain using SCS method can be regarded as a type of manipulative spinal soft tissue therapy because the pelvis, sacrum, and lower limbs are used passively in degrees of flexion, expansion, lateral flexion, and rotation in the placement of the lumbar spine and sacral areas.

This study will offer a thorough comparison of SCS and MET that could offer insight into their mechanisms and inform optimal clinical decision-making for long-term management of NSLBP and can help to understand which mechanism offers superior outcomes or if they are equally effective.