Comparison of Post Facilitation Stretch Versus Reciprocal Inhibition in Quadratus Lumborum Syndrome: a Randomized Controlled Trial

This study is a randomised control trial and the purpose of this study is to determine the effects Post facilitation stretch versus reciprocal inhibition on pain, lumbar range of motion, apparent leg length discrepancy and lumbar lordotic angle in Quadratus Lumborum Syndrome.

Study Overview

• Status: Recruiting
• Conditions: Quadratus Lumborum Syndrome
• Intervention / Treatment: Other: Post Facilitation Stretch; Other: Conventional Physical Therapy; Other: Reciprocal Inhibition

Detailed Description

The purpose of this study is to determine the difference between Post facilitation, stretch versus reciprocal inhibition on pain, lumbar range of motion, apparent leg length discrepancy and lumber lordotic angle in Quadratus Lumborum Syndrome.

The individual of Age 18-35 years among both genders, who experiences pain of 3 ≤ on NPRS from at least 3 months and whose pain decreases on supine lying; along with any two of the following findings positive of quadratus lumborum on physical examination i.e., Taut bands, Local tenderness, Patient's pain recognition, Pain referral to greater trochanter, Local twitch response & Jump sign will be recruited in the study as patients of Quadratus lumborum syndrome.

Pain levels will be assessed using the Numeric Pain Rating Scale (NPRS). Inclinometer will be used for measuring lumber ranges. To assess apparent leg length discrepancy measuring tape will be used. The lumbar lordotic angle will be measured using 60 cm flexible ruler. Participants of interest would be approached and explained about the research. Informed written consent will be taken. It is a non-blinded study and randomization will be done through sealed envelope. Both groups will receive conventional intervention. Additionally, Group A will receive quadratus lumborum post facilitation stretches while Group B will receive Reciprocal inhibition. Baseline and post intervention scores would be recorded for both groups.

• Study Type: Interventional
• Enrollment (Estimated): 42
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Aqsa Ayaz, MS-MSKPT*; Phone Number: 03365765782; Email: aqsaayaz77@gmail.com

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan, 46000
      • Recruiting
      • Foundation University College of Physical Therapy
      • Contact: Qurat ul Ain Saeed, MS-OMPT,PHD*; Phone Number: 03315562889; Email: quratulain.saeed@fui.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18-35 years
• Both genders
• Having pain of ≤ 8 on NPRS from at least 3 months
• Pain decreases on supine lying

• Any two of the following findings positive of unilateral quadratus lumborum on physical examination:

  1. Taut bands
  2. Local tenderness
  3. Patient's pain recognition
  4. Pain referral to greater trochanter
  5. Local twitch response

Exclusion criteria:

• Painful isometric muscle testing of hip flexors, abductors, adductors, and extensors
• Previous surgery of lower limb
• Centralization/peripheralization
• Lower back trauma
• Positive SLR
• Radiculopathy
• Fracture/surgery of pelvic and/or hip region
• Diagnosed fibromyalgia or other rheumatic diseases.
• Lactating women
• Intrauterine device
• Pregnant women
• Use of psychiatric medications

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PFS Group; Group A along with Post facilitation stretch of quadratus lumborum will a comprehensive therapeutic regimen that includes a 10-minute session of hot pack therapy specifically targeted at the low back region. In addition to this, participants will receive trigger point release therapy to alleviate muscle tension. The treatment plan also incorporates a tailored exercise protocol designed to enhance back health and strength. This protocol includes: Back isometric exercises; Bridging exercises; Cat and camel stretches; Prone press-ups; Abductor strengthening exercises	Other: Post Facilitation Stretch; The patient is placed in the lateral decubitus position with the affected side up and a Dutchman's roll or pillow under the iliac crest. Positioned at the edge of the table, the patient's inferior leg is flexed with the foot at the table's edge. The patient grasps the headpiece of the table with the superior hand, allowing the superior leg to drop off the back of the table.The therapist stands behind the patient, providing support to prevent posterior pelvic rotation with their thigh behind the pelvis. The cephalad hand grasps the top of the iliac crest and applies a caudad force, while the caudad hand gently guides the affected leg without generating force.The patient "hikes" the hip against the resistance from the therapist's cephalad hand, creating an isometric contraction for 5-10 seconds. The patient then relaxes, followed by a rapid stretch held for 10 seconds until the next barrier is reached. This procedure is repeated 3-5 times.; Other: Conventional Physical Therapy; A comprehensive therapeutic regimen that includes a 10-minute session of hot pack therapy specifically targeted at the low back region. In addition to this, participants will receive trigger point release therapy to alleviate muscle tension.The treatment plan also incorporates a tailored exercise protocol designed to enhance back health and strength. This protocol includes: Back isometric exercises; Bridging exercises; Cat and camel stretches; Prone press-ups; Abductor strengthening exercises
Experimental: RI Group; Group B along with Reciprocal inhibition of quadratus lumborum will a comprehensive therapeutic regimen that includes a 10-minute session of hot pack therapy specifically targeted at the low back region. In addition to this, participants will receive trigger point release therapy to alleviate muscle tension. The treatment plan also incorporates a tailored exercise protocol designed to enhance back health and strength. This protocol includes: Back isometric exercises; Bridging exercises; Cat and camel stretches; Prone press-ups; Abductor strengthening exercises	Other: Conventional Physical Therapy; A comprehensive therapeutic regimen that includes a 10-minute session of hot pack therapy specifically targeted at the low back region. In addition to this, participants will receive trigger point release therapy to alleviate muscle tension.The treatment plan also incorporates a tailored exercise protocol designed to enhance back health and strength. This protocol includes: Back isometric exercises; Bridging exercises; Cat and camel stretches; Prone press-ups; Abductor strengthening exercises; Other: Reciprocal Inhibition; The patient is placed in the lateral decubitus position with the affected side up and a Dutchman's roll or pillow under the iliac crest. Positioned at the edge of the table, the patient's inferior leg is flexed with the foot at the table's edge. The patient grasps the headpiece of the table with the superior hand, allowing the superior leg to drop off the back of the table.The therapist stands behind the patient, providing support to prevent posterior pelvic rotation with their thigh behind the pelvis. The cephalad hand grasps the top of the iliac crest and applies a caudad force, while the caudad hand gently guides the affected leg without generating force.The patient "hikes" the hip against the resistance from the therapist's cephalad hand, creating an isometric contraction for 5-10 seconds. The patient then relaxes, followed by a rapid stretch held for 10 seconds until the next barrier is reached. This procedure is repeated 3-5 times.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity	Pain is assessed by using numeric main rating scale comparing pre and post pain intensity. This is 11- point numeric scale ranges from '0' representing one pain extreme (e.g., "no pain") to '10' representing the other pain extreme	2 weeks
Lumbar Range of Motion (ROM)	It will measured using inclinometer	2 weeks
Leg Length Discrepancy (LLD)	Measure the distance between the anterior superior iliac spine (ASIS) and the medial malleolus.This method, referred to as the "direct" clinical method for measuring LLD, provides the apparent leg length discrepancy.	2 weeks
Lumbar Lordotic Angle	It will be measured using Flexible Ruler	2 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2023
• Primary Completion (Estimated): January 15, 2025
• Study Completion (Estimated): January 30, 2025

Study Registration Dates

• First Submitted: July 30, 2024
• First Submitted That Met QC Criteria: July 30, 2024
• First Posted (Actual): August 2, 2024

Study Record Updates

• Last Update Posted (Actual): August 2, 2024
• Last Update Submitted That Met QC Criteria: July 30, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: FUI/CTR/2024/22

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No