Objective:
To evaluate the effectiveness of adding Myofascial Release Technique (MRT) to Clinical Pilates in adults with chronic non-specific low back pain (CNSLBP).
Hypothesis:
MRT combined with Pilates will lead to greater improvements in pain, functional disability, and soft tissue mobility compared to Pilates alone.
Design \& Intervention:
Randomized controlled trial. Participants (18-45 years) will be randomly assigned to:
MRT + Clinical Pilates Clinical Pilates only for 6 weeks (2 sessions/week).
Outcomes:
Primary: Pain (VAS), ultrasonographic thickness (multifidus \& thoracolumbar fascia) Secondary: Disability (ODI), lumbar mobility, balance
Eligibility:
Adults with CNSLBP ≥3 months; excluding spinal surgery, rheumatic disease, and pregnancy.
Chronic non-specific low back pain lasting at least 3 months
No clinical signs of nerve root compression or neurological deficit
Aged 18-45 years
No physical therapy or manual therapy for low back pain in the last 1 month
Systemic, neurological, or orthopedic conditions limiting exercise participation
Lumbar radiculopathy or severe spinal pathology
History of lumbar spine surgery
Unhealed fracture or recent surgical intervention
Parallel
Myofascial Release Technique (MRT)
Other interventionMyofascial Release Technique (MRT) will be applied manually to the lumbar and thoracolumbar regions to improve fascial mobility, reduce soft tissue restrictions, and decrease pain. The technique will be delivered for 6 weeks, 2 sessions per week, by a trained physiotherapist.
Sham Myofascial Release Technique
Other interventionSham Myofascial Release Technique will be applied to the lumbar and thoracolumbar regions using light manual contact without therapeutic pressure or specific myofascial release techniques. The intervention is designed to mimic the real treatment in terms of time and therapist contact, but without producing physiological therapeutic effects. It will be administered for 6 weeks, 2 sessions per week by a trained physiotherapist.
Clinical Pilates Exercise
Other interventionThe Clinical Pilates program will focus on trunk stabilization, core muscle activation, postural control, flexibility, and functional movement training. Exercises will be individually tailored and progressed according to participant tolerance. The program will be administered for 6 weeks, 2 sessions per week under physiotherapist supervision.
Pain Intensity (VAS)
Pain intensity will be measured using a 10-cm Visual Analog Scale (VAS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Participants will mark their current pain level on the scale.
Multifidus and Thoracolumbar Fascia Thickness
Muscle and fascia thickness will be measured using ultrasonography to evaluate changes in soft tissue properties in the lumbar region.
Functional Disability (Oswestry Disability Index - ODI)
Disability related to low back pain will be assessed using the Oswestry Disability Index (ODI), a validated questionnaire measuring functional limitations in daily activities.
Lumbar Mobility (Modified Schober Test)
Lumbar flexion mobility will be measured using the Modified Schober Test, which evaluates changes in lumbar spine flexibility.
Dynamic Balance (Y-Balance Test)
Dynamic balance will be assessed using the Y-Balance Test to evaluate functional stability and postural control.
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