Positional Release With/Without Exercise for Chronic LBP (LBP)

Evaluating the Effectiveness of Positional Release Technique With and Without Therapeutic Exercises for Chronic Low Back Pain Management

Chronic low back pain (CLBP) presents a significant therapeutic challenge due to its multifactorial nature and high recurrence rate. While manual therapy techniques like Positional Release Technique (PRT) are commonly employed to modulate pain and improve tissue function, there is a growing consensus in rehabilitation that their effects may be transient if not coupled with active strategies to address underlying impairments. Therapeutic exercises (TE) form a cornerstone of CLBP management by aiming to restore strength, endurance, and neuromuscular control. However, the specific additive benefit of combining a passive, indirect technique like PRT with a structured TE program remains an area for empirical investigation. This study, therefore, sought to compare the clinical effectiveness of an integrated approach using PRT alongside TE against the application of PRT alone, hypothesizing that the combined intervention. would yield superior outcomes in pain reduction and functional improvement for individuals with CLBP.

Study Overview

• Status: Completed
• Conditions: Back Disorder
• Intervention / Treatment: Other: PRT with exercises; Other: PRT Without exercises

Detailed Description

Background & Rationale:

Chronic low back pain (CLBP) is complex and prone to recurrence, making its management difficult. Clinicians often use passive manual therapies like the Positional Release Technique (PRT) to reduce pain. However, evidence suggests that passive treatments alone may not provide long-term relief unless combined with active interventions. Therapeutic exercise (TE) is a fundamental active approach that targets core deficits in strength and motor control. The key question is whether adding TE to PRT offers a significant advantage over PRT used in isolation.

Aim:

This study aimed to directly compare the clinical effectiveness of a combined treatment (PRT + TE) versus PRT alone in managing CLBP, with the hypothesis that the combined approach would be superior.

Methodology:

A randomized controlled trial was conducted with 60 participants diagnosed with CLBP (pain duration ≥3 months), aged 20-65. They were recruited from a single physiotherapy center. Participants with specific spinal pathologies (e.g., fractures, disc abnormalities) were excluded. They were randomly divided into two groups:

Group A (Experimental): Received PRT combined with a structured Therapeutic Exercise program.

Group B (Control): Received PRT alone.

Outcome Measures:

Effectiveness was assessed using standardized tools measured before and after the treatment period:

Pain Intensity: Visual Analogue Scale (VAS). Functional Disability: Roland-Morris Questionnaire (RMQ). Muscular Performance: A curl-up test for abdominal endurance.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Palestinian Territories
  • West Bank
    • Bethlehem, West Bank, Palestinian Territories, 3600700
      • Palestine Ahliya University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants aged 20-65 years.
• Clinical diagnosis of chronic low back pain (CLBP).
• Positive Faber (Patrick's) test.
• Positive Slump test.
• A pain intensity score of ≥3 on the Visual Analogue Scale (VAS).
• Symptoms presenting with or without referred leg pain.

Exclusion Criteria:

• Diagnosis of spondylolisthesis, disc disease, osteoporosis, or other significant bone disease.
• History of vertebral fractures.
• History of spinal surgery.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: arm 1- Group A (PRT): Positional Release Technique with exercises; Group A (n=30) underwent a 12-session program over four weeks. Each 40-minute session combined two 30-minute positional release procedures with three 10-minute therapeutic exercise modules.	Other: PRT with exercises; Postional release technique with exercises.
Experimental: arm 2- Group A (PRT): Positional Release Technique without exercises; Group B received 12 treatment sessions over four weeks (three sessions/week), each consisting of two positional release procedures totaling 30 minutes.	Other: PRT Without exercises; Postional release technique without exercises.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VAS	A validated, single-item scale used to measure subjective pain intensity. Patients mark a point on a 10-cm line anchored by "no pain" (0) and "worst pain imaginable" (10). The score is the measured distance in cm/mm, providing a quantitative pain rating.	4 weeks
RMQ	The Roland-Morris Disability Questionnaire (RMQ) is a widely used, self-administered, health status measure designed to assess physical function and disability specifically related to low back pain. It consists of 24 yes/no statements derived from the Sickness Impact Profile, each describing a specific activity limitation due to back pain (e.g., "I walk more slowly because of my back"). The total score (0-24) is the sum of items marked "yes," with a higher score indicating greater disability. It is valued for its brevity, ease of use, and responsiveness to clinical change.	4 weeks
Endurance	An endurance test is a performance-based assessment that measures the ability of specific muscle groups (particularly the trunk stabilizers: back extensors, flexors, and lateral musculature) to maintain a submaximal contraction or a fixed posture against gravity over time. Common examples used in low back pain research include the prone plank (trunk flexors), Sorensen/Biering-Sørensen test (back extensors), and side plank (lateral stabilizers). The outcome is the time (in seconds) the position can be held until failure, providing an objective measure of muscular stamina.	4 weeks

Collaborators and Investigators

• Sponsor: Palestine Ahliya University

Publications and helpful links

General Publications

• https://doi.org/10.1056/NEJMcp2032396

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): September 30, 2024
• Study Completion (Actual): October 30, 2024

Study Registration Dates

• First Submitted: January 24, 2026
• First Submitted That Met QC Criteria: January 30, 2026
• First Posted (Actual): February 5, 2026

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: January 30, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: LBP; PRT; Exercies
• Additional Relevant MeSH Terms: Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Enzymes; Enzymes and Coenzymes; Transferases; Glycosyltransferases; Pentosyltransferases; Exercise; Hypoxanthine Phosphoribosyltransferase
• Other Study ID Numbers: PAU

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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