Journal of Paramedical Sciences & Rehabilitation

Journal of Paramedical Sciences & Rehabilitation

The Effect of Eight Weeks of Motor Control Exercises and Myofascial Release on the Range of Motion of the Lumbar Spine and Disability in People with Non-Specific Chronic Low Back Pain

Document Type : Original Article

Authors
S Jamali Brayjani 1
M.H Alizadeh 2
N Rahnama 3
1 Department of Sports Injuries and Corrective Exercises, Faculty of Sports and Health Sciences, University of Tehran, Kish International Campus, Iran
2 Department of Sports Injuries and Corrective Exercises, Faculty of Sports and Health Sciences, University of Tehran, Tehran, Iran
3 Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, University of Isfahan, Isfahan, Iran
10.22038/jpsr.2025.85161.2678
Abstract
Purpose:
Low back pain is a major health problem worldwide with a clear social and economic impact and is a leading cause of years of disability and work absence. The purpose of the present study is the effect of eight weeks of motor control exercises and myofascial release on the range of motion of the lumbar spine and disability in people with non-specific chronic low back pain.
Methods:
The current study is of quasi-experimental type. In this study, 16 men with non-specific chronic low back pain diagnosed by a neurosurgeon were selected in a purposeful and accessible way and were randomly and equally divided into two experimental groups (age 30.2±6.1years, body mass index 23.7±3.7 kg/m2) and control (age 26.2±4.8 years, body mass index 25.6±5.4 kg/m2) the experimental group performed motor control exercises and myofascial release three times a week for a period of eight weeks, and the control group performed motor control exercises similar to the experimental group during the same period of time. The range of motion of the lumbar spine (Modified – Modified Schober Test) and disability (Oswestry Disability Index) of participants was evaluated before and after eight weeks of training. Data analysis was done using repeated measures analysis of variance and Bonferroni's post hoc test at a five percent error level and using SPSS software version 26.
Results
Movement control exercises with and without myofascial release have caused a significant increase in the amount of range of motion of the lumbar spine and significant reduction in the severity of disability of the subjects, after training compared to before training (p<0.001). range of motion of the lumbar spine and severity of disability was not significantly different between the control and experimental groups (p>0.05). Also, there was no significant difference between the control and experimental groups in range of motion of the lumbar spine and severity of disability changes before and after training (p>0.05).
Conclusion:
According to the findings of the present study, it can be concluded that motor control exercises with and without myofascial release can improve the of range of motion of the lumbar spine and reduction in the severity of disability in people with non-specific chronic low back pain. although the effect of motor control exercises and myofascial release on the range of motion of the lumbar spine and reduction in the severity of disability was more than motor control exercises alone, but the amount of this effect was not significant. Therefore, it is possible that both protocols can be suggested as a useful method for the rehabilitation of people with non-specific chronic low back pain.
Keywords
Chronic Low Back Pain
Motor Control
Myofascial Release
Range of Motion
Disability
  1. Bevan S. Economic impact of musculoskeletal disorders (MSDs) on work in Europe. Best Pract Res Clin Rheumatol 2015; 29(3): 356-373.
  2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1545-1602.
  3. Reid KJ, Harker J, Bala MM, Kellen E, et al. Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Curr Med Res Opin 2011; 27(2): 449-462
  4. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8(1): 8-20.
  5. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003; 12(2): 149-165
  6. Quittan M. Management of back pain. Disabil Rehabil 2002; 24(8): 423-434
  7. Koes BW, van Tulder M, Christine Lin CW, Macedo LG, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010; 19(12): 2075-2094.
  8. Hashemi L, Webster BS, Clancy EA, Courtney TK. Length of disability and cost of work-related musculoskeletal disorders of the upper extremity. J Occup Environ Med 1998; 40(3): 261-269.
  9. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006, 332(7555): 1430-1434.
  10. Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, et al. Symptoms of depression and risk of new episodes of Low Back pain: a systematic review and meta-analysis: depression and risk of Low Back pain. Arthritis Care Res 2015; 67(11): 1591-1603.
  11. Sezgin M, Hasanefendioğlu EZ, Sungur MA, Incel NA, et al. Sleep quality in patients with chronic low back pain: a cross-sectional study assesing its relations with pain, functional status and quality of life. J Back Musculoskelet Rehabil 2015; 28(3): 433-41
  12. Bahouq H, Allali F, Rkain H, Hmamouchi I, Hajjaj-Hassouni N. Prevalence and severity of insomnia in chronic low back pain patients. Rheumatol Int 2013; 33(5): 1277–1281.
  13. Chen Y, Campbell P, Strauss VY, Foster NE, et al. Trajectories and predictors of the longterm course of low back pain: Cohort study with 5-year followup. Pain 2018; 159(2): 252–260.
  14. Linton SJ, Flink IK, Vlaeyen JWS. Understanding the etiology of chronic pain from a psychological perspective. Phys Ther 2018; 98(5): 315-324.
  15. O'Sullivan PB, Caneiro JP, O'Keeffe M, Smith A, et al. Cognitive functional therapy: An integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther 2018; 98(5): 408-423.
  16. Moseley GL, Hodges PW. Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: a risk factor for chronic trouble? Behav Neurosci 2006; 120(2): 474-476.
  17. Jacobs JV, Henry SM, Nagle KJ. People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments. Behav Neurosci 2009; 123(2): 455-458.
  18. Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J 2006; 15(5): 668-676.
  19. Comerford MJ, Mottram SL. Movement and stability dysfunction – contemporary developments. Man Ther 2001; 6(1): 15-26
  20. Correia JP, Oliveira R, Vaz JR, Silva L, Pezarat-Correia P. Trunk muscle activation, fatigue and low back pain in tennis players. J Sci Med Sport 2016; 19(4): 311-316.
  21. Shen FH, Samartzis D, Andersson GB. Nonsurgical management of acute and chronic low back pain. J Am Acad Orthop Surg 2006; 14(8): 477-487.
  22. Middelkoop MV, Rubinstein SM, Kuijpers T, Verhagen AP, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 2011; 20(1):19-39.
  23. Qaseem A, Wilt TJ, McLean RM, Forciea MA, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166(7): 514-530.
  24. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: An updated overview. Eur Spine J 2018; 27(11): 2791-2803.
  25. Chou R, Qaseem A, Snow V, Casey D, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147(7):478-491.
  26. Hayden JA, Ellis J, Ogilvie R, Stewart AS, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother 2021; 67(4): 252-262.
  27. Lin I, Wiles L, Waller R, Goucke R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2020; 54(2): 79-86.
  28. Macedo LG, Maher CG, Hancock MJ, Kamper SJ, et al. Predicting response to motor control exercises and graded activity for patients with low back pain: preplanned secondary analysis of a randomized controlled trial. Phys Ther 2014; 94(11): 1543-1554.
  29. Zhang C, Li Y, Zhong Y, Feng C, et al. Effectiveness of motor control exercise on non-specific chronic low back pain, disability and core muscle morphological characteristics: a meta-analysis of randomized controlled trials. Eur J Phy Rehabi Med 2021; 57(5): 793-806.
  30. Saragiotto BT, Maher CG, Yamato TP, Costa LO, et al. Motor control exercise for nonspecific low back pain: a cochrane review. Spine 2016; 41(16): 1284-1295.
  31. Byström MG, Rasmussen-Barr E, Grooten WJ. Motor Control Exercises Reduces Pain and Disability in Chronic and Recurrent Low Back Pain: A Meta-Analysis. Spine 2013; 38(6): E350-E358.
  32. Schleip R, Ja¨ger H, Klingler W. What is ‘fascia’? A review of different nomenclatures. J Bodyw Mov Ther 2012; 16(4): 496-502.
  33. Tozzi P. Selected fascial aspects of osteopathic practice. Journal of Bodywork and Movement Therapies 2012; 16(4): 503-519.
  34. Stecco C, Gagey O, Belloni A, Pozzuoli A, et al. Anatomy of the deep fascia of the upper limb. Second part: study of innervation. J Morphologie 2007; 91(292): 38-43.
  35. Gatton ML, Pearcy MJ, Pettet GJ, Evans JH. A three-dimensional mathematical model of the thoracolumbar fascia and an estimate of its biomechanical effect. J Biomech 2010; 43(14): 2792-2797.
  36. de las Penas CF, Cleland J, Dommerholt J. Manual therapy for musculoskeletal pain syndromes: An evidence-and clinical-informed approach. Elsevier Health Sciences; 2015.
  37. Kuruma H, Takei H, Nitta O, Furukawa Y, et al. Effects of Myofascial Release and Stretching Technique on Range of Motion and Reaction Time. J Phys Ther Sci 2013; 25(2): 169-171.
  38. Ünal M, Evcik E, Kocatürk M, Algun ZC. Investigating the effects of myofascial induction therapy techniques on pain, function and quality of life in patients with chronic low back pain. J Bodyw Mov Ther 2020; 24(4): 188-195.
  39. Arguisuelas MD, Lisón JF, Doménech-Fernández J, Martínez-Hurtado I, et al. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. J Clin Biomech 2019; 63:  27-33.
  40.  Lee DW, Shin HK, Kim KS. Effects of dynamic myofascial release on trunk mobility and standing balance in persons with chronic nonspecific low back pain. Phys ther rehabil sci 2019; 8(2): 74-78.
  41. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J 2008; 8(1): 1-7.
  42. Jamali Brayjani S, Alizadeh MH, Rahnama N. The Effect of Eight Weeks of Motor Control Exercises and Myofascial Release on Muscular Endurance of the Central Part of Body in People with Non-Specific Chronic Low Back Pain. J Paramed Sci Rehabil 2024; 13(3): 7-20.
  43. Tousignant M, Poulin L, Marchan S, Viau A, Place C. The Modified – Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: A study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change. Disabil Rehabil 2005; 27(10): 553-559.
  44. Fairbank JCT, Pynsent PB, The Oswestry disability index. J Spine 2000; 25(22):2940-2952.
  45. Payares K, Lugo LH, Morales V, Londono A. Validation in Colombia of the Oswestry Disability Questionnaire in Patients with Low Back Pain. J Spine 2011; 36(26): E1730-E1735.
  46. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: Translation and Validation Studies of the Iranian Versions. Spine 2006; 31(14): E454-E459
  47. Rodríguez RF, Bueno CA, Redondo IC, Costoso AT, et al. Best Exercise Options for Reducing Pain and Disability in Adults with Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther 2022; 52(8): 505-521.
  48. Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83(10):1406-1414.
  49. Richardson C, Hodges P, Hides J. Therapeutic exercise for lumbopelvic stabilization. A Motor Control Approach for the Treatment and Prevention of Low Back Pain. Edinburgh: Churchill Livingstone; 2004.
  50. Ibrahim AA, Akindele MO, Ganiyu SO, Bello B. Effects of motor control exercise and patient education program in the management of chronic low back pain among community-dwelling adults in rural Nigeria: a study protocol for a randomized clinical trial. Integr Med Res 2019; 8(2): 71-81.
  51. Castillo-Lozano R. Effects of lumbar motor control exercises in paddle-tennis players. Revista Andaluza de Medicina del Deporte. 2015; 8(4):184-185.
  52. Wu Z, Wang Y, Ye X, Chen Z, et al. Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Frontiers in Medicine 2021; 8: 697986.
  53. França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain-a comparative study. Clinics 2010; 65(10): 1013-1017.
  54. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003; 13(4): 371-379.
  55. O'Sullivan PB. Lumbar segmentalinstability': clinical presentation and specific stabilizing exercise management. Man Ther 2000; 5(1): 2-12.
  56. Hultman G, Nordin M, Saraste H, Ohlsen H. Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. J Spine Discord 1993; 6(2): 114-123.
  57. Grindrod S, Tofts P, Edwards R. Investigation of human skeletal muscle structure and composition by X-ray computerised tomography. Eur J Clin Invest 1983; 13(6): 465-468.
  58. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. Phys Ther 2006; 86(7): 1001-1012.
  59. Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Med hypotheses 2007; 68(1): 74-80.
  60. Langevin HM, Fox JR, Koptiuch C, Badger GJ, et al. Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC musculoskelet disord 2011; 12: 1-1.
  61. Barnes MF. The basic science of myofascial release: morphologic change in connective tissue. J Bodyw Mov Ther 1997; 1(4): 231-238.
  62. Woby SR, Urmston M, Watson PJ. Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients. Eur J Pain 2007; 11(7): 711-718.
  63. Mälkiä E, Ljunggren AE. Exercise programs for subjects with low back disorders. Scand J Med Sci Sports 1996; 6(2): 73-81.
  64. Macedo LG, Maher CG, Latimer J, McAuley JH. Motor Control Exercise for Persistent, Nonspecific Low Back Pain: A Systematic Review. Phys Ther 2009; 89(1): 9-25.
  65. Hides JA, Donelson R, Lee D, Prather H, et al. Convergence and divergence of exercise-based approaches that incorporate motor control for the management of low back pain. J Orthop Sports Phys Ther 2019; 49(6): 437-452.
  66. Comesaña AC, Vicente MD, Ferreira TD, del Mar Pérez-La Fuente M, et al. Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. J Bodyw Mov Ther 2017; 21(1): 197-204.
  67. Albright J, Allman R, Bonfiglio RP, Conill A, et al. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 2001; 81(10):1641-1674.
  68. Hong CZ. Pathophysiology of myofascial trigger point. Journal of the Formosan Medical Association= Taiwan yi zhi. 1996; 95(2): 93-104.
  69. Stanborough M. Direct release myofascial technique: an illustrated guide for practitioners. UK: Churchill Livingstone. 2004
  70. Ellythy MA. Efficacy of muscle energy technique versus myofascial release on function outcome measures in patients with chronic low back pain. Bull Fac Ph Th 2012; 17(1): 51-7.
  71. Samani M, Motealleh AR, Yazdani S, Abbasi L. Effects of myofascial release technique on pain and disability in patients with chronic lumbar disc herniation: a randomized trial. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2017; 27(04): 218-225.
  72. Aaberg E. Muscle mechanics. Human Kinetics; 2006: 216.
Journal of Paramedical Sciences & Rehabilitation
Volume 13, Issue 4
Winter 2025
Pages 30-43