Comparison of Passive and Active Application of Instrument-Assisted Soft Tissue Mobilization in Individuals with Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial

Abstract

Background: There is a lack of studies investigating the effects of instrument-assisted soft tissue mobilization on chronic low back pain, and the level of evidence is low. Objective: This study aimed to examine and compare the time-dependent effects of two different instrument-assisted soft tissue mobilization protocols in individuals with chronic nonspecific low back pain. Methods: This was a comparative study. Setting: University Physiotherapy and Rehabilitation department in Cyprus. Participants: Seventy-four patients with chronic nonspecific low back pain were randomized into two groups (Group 1 (n = 37) and Group 2 (n = 37)). Intervention: 6 sessions were implemented with the participants, twice weekly for 3 weeks. The same instrument-assisted soft tissue mobilization protocol (7-step) was applied to both groups, but in different positions (fixed prone vs. extended child pose and knee flexion-extension). Outcome Measures: Pain levels (visual analogue scale), spinal mobility (Modified Schober Test), flexibility (Sit and Reach Test, Maximal Hip Flexion Active Knee Extension Test, Active Knee Extension Test, Thoracolumbar Fascia Flexibility Test), muscle endurance of trunk extensors (The Biering-Sorenson Test), and disability (Oswestry Disability Index) were assessed. Results: The pain and disability values of both groups decreased, and their spinal mobility, spinal flexibility, hamstring flexibility, thoracolumbar fascia flexibility, and endurance values increased after the 1st and 6th interventions (P < .05). Intra-group comparisons revealed a significant improvement only in pain levels at rest in the group in which instrument-assisted soft tissue mobilization was applied during functional exercises (P < .05). Conclusion: Both instrument-assisted soft tissue mobilization methods instantly reduced levels of pain and disability and improved spinal mobility, flexibility, and trunk extensor endurance. Applying instrument-assisted soft tissue mobilization with functional exercises to individuals with chronic nonspecific low back pain is more effective in reducing pain levels at rest. Keywords: Low back pain, fascia, spine, soft tissue therapy, comparative study.