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

Low back pain (LBP) is a condition characterized by fatigue, discomfort in the lumbosacral area, and a most common cause of disability . Low Back Pain (LBP) is defined as tiredness, discomfort or pain in the lower back region, radiating to lower extremities unilaterally or bilaterally. Low back pain is a bit common issue that most of the population experience sooner or later in their lives .

Low back pain (LBP) is featured as pain and discomfort in the area between the costal margin and the inferior gluteal folds, with or without referred leg pain. Non-specific low back pain is the most common back pain, it is estimated that 70-80% of the entire population has experienced non-specific low back pain in their lifetime.

Nonspecific low back pain (LBP) is usually defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds. It is the commonest musculoskeletal condition in the adult population and its prevalence amounts to 84%. Furthermore, it limits the activity of the affected population by 30.8% monthly and 38% every year. Consequently, CLBP poses a substantial economic burden on healthcare, social, and welfare systems.

Only 15% of non-specific low back pain can be identified, while the remaining 85% are non-specific. Sixty to eighty percent of LBP patients report pain or disability a year later, and up to 40% report chronic pain. However, understanding the specific etiology of chronic nonspecific LBP remains elusive because it results from a variety of factors that can interact with each other.

The diagnosis of Low Back Pain is divided into two, namely Specific and Non-specific Low Back Pain, In Specific Low Back Pain, there are certain pathophysiological mechanisms that cause symptoms such as infections of the spine, hernia nucleus pulposus, osteoporosis, rheumatoid arthritis, fractures, and tumors. In contrast to non-specific low back pain, where it is generally said that 80-90% of non-specific causes of low back pain are mechanical, and based on this percentage, 65-70% have no specific cause.

Additionally, LBP restricts occupational activities and is among the main causes of absenteeism. So, it leads to high costs of health care and decreases productivity. Various factors contribute to the development of chronic LBP. Physical factors, such as reduced muscle strength and endurance are prognostic factors for chronic LBP. The occupational load carriage has the potential to alter the carrier's body posture and may lead to greater forward trunk lean.

Besides, the presence and experience of nonspecific LBP could be affected by psychosocial factors, including anxiety and depression. These factors strongly influence the pain intensity during activity and degree of disability in patients with chronic nonspecific LBP. Apart from load carriage, other factors are also associated with LBP in these populations including a lack of physical fitness, higher fat mass, and long periods of sitting.

Pain is the main symptom and account for disability and lack of work participation. Physiological testing shows reduced lumbar flexibility and flexion-relaxation, poorer static balance , poorer proprioception and spinal segment stability, and lower physical fitness and health-related quality of life (HRQoL) in patients with NLBP .

Quadratus lumborum (QL) is a deep trunk muscle, and its tightness can trigger symptoms of significant low back tightness and discomfort. Recurrent episodes (lasting more than 3 months) are common presentations of nonspecific LBP usually accompanied by limitation of movement, long-term disability, and decreased quality of life.