The goal of this clinical trial is to learn if two common physical therapy approaches, used alone or together, can help reduce pain and improve daily function in adults with nonspecific low back pain. Nonspecific low back pain means low back pain without a clear medical cause.
The main questions this study aims to answer are:
1. Does hands-on pressure to painful muscle spots (called myofascial trigger point therapy) help lower low back pain? 2. Does a guided exercise program that focuses on how muscles work together help lower low back pain? 3. Does combining hands-on therapy with exercise work better than using either approach alone?
Researchers will compare three groups to see which approach leads to greater improvement. One group will receive hands-on trigger point therapy, one group will do a specific exercise program, and one group will receive both treatments.
Participants will:
* Be assigned to one of the three treatment groups by chance * Receive treatment twice a week for four weeks * Complete simple assessments before treatment starts, after the first treatment session, and after the final session
The results of this study may help physical therapists choose better noninvasive treatment options for people with nonspecific low back pain.
Adults aged 18 to 65 years
Nonspecific low back pain lasting longer than 6 weeks
Average low back pain intensity of 3 or higher on a 0-10 Numeric Pain Rating Scale
Presence of at least 6 myofascial trigger points identified across bilateral target muscles
Currently pregnant
Diagnosed spondylolisthesis or vertebral compression fracture
Known malignancy or history of cancer affecting the spine
Previous lumbar spine surgery
Parallel
Myofascial Trigger Point Manual Compression
Other interventionThis intervention consists of noninvasive hands-on manual pressure applied by a licensed physical therapist to identified myofascial trigger points associated with nonspecific low back pain. Treatment sessions are provided twice per week over a four-week period. Manual compression is applied using standardized clinical procedures at an intensity tolerated by the participant. The selection of trigger points follows predefined criteria to ensure consistency across treatment sessions. This intervention is noninvasive and does not involve the use of any drugs or medical devices.
Myofascial Chain-Based Specific Exercise
Other interventionThis intervention is a supervised, noninvasive exercise program delivered by a licensed physical therapist. Participants attend exercise sessions twice per week for four weeks. The program focuses on movement control and muscle function within targeted myofascial chains and is tailored based on functional muscle performance. Exercise selection and progression follow standardized clinical criteria to promote safe and consistent implementation. This intervention is noninvasive and does not involve the use of any drugs or medical devices.
Pain Intensity
Pain intensity is assessed using the Numeric Pain Rating Scale (NPRS). Participants rate their current low back pain on an 11-point scale ranging from 0 (no pain) to 10 (worst pain imaginable). Lower scores indicate less pain.
Functional performance
Functional performance is assessed using the Patient-Specific Functional Scale (PSFS). Participants identify activities limited by low back pain and rate their ability to perform each activity on a scale from 0 (unable to perform) to 10 (able to perform without difficulty). Higher scores indicate better function.
Low Back Pain-Related Disability
Disability related to low back pain is assessed using the Oswestry Disability Index (ODI). The ODI measures the impact of low back pain on daily activities, with higher scores indicating greater disability. The Oswestry Disability Index (ODI) was used in this study to assess the level of disability in individuals with low back pain. The ODI consists of ten items designed to quantify the impact of low back pain on activities of daily living. Each item includes six statements, scored from 0 to 5, with 0 indicating no pain, no difficulty, and no functional limitation, and 5 indicating severe pain or disability that prevents the performance of the activity. The total score is calculated as a percentage, with 0% representing no disability and \*\*100% representing the highest level of disability.
Myofascial Chain Extensibility
Myofascial chain extensibility is assessed using standardized extensibility tests targeting three myofascial chains: the Superficial Back Line, Front Functional Line, and Back Functional Line. Superficial Back Line extensibility is assessed using a standing forward-bending test, with the distance between the fingertips and the ground measured in centimeters. Front Functional Line extensibility is assessed using a lunge-based trunk rotation test, with trunk rotation angle measured in degrees. Back Functional Line extensibility is assessed using a kneeling side-bending posture, with thoracolumbar side-bending angle measured in degrees using a goniometer.
Myofascial Chain Endurance
Myofascial chain endurance is assessed using standardized endurance tests targeting three myofascial chains: the Superficial Back Line, Front Functional Line, and Back Functional Line. Superficial Back Line endurance is assessed using a modified Sorensen test, in which participants maintain a horizontal trunk position until voluntary fatigue occurs, without the presence of pain or compensatory movement. Front Functional Line endurance is assessed using a supine abdominal curl-up endurance test with lower-limb adduction, with time recorded until voluntary fatigue occurs, without pain or compensatory movement. Back Functional Line endurance is assessed using a modified quadruped endurance test, with participants maintaining simultaneous upper- and lower-limb elevation until voluntary fatigue occurs, without pain or compensatory movement.
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