Evaluating Pain and Functional Outcomes of Active Release Technique Versus Strain-counter- Stain in Chronic Low Back Pain

Evaluating Pain and Functional Outcomes of Active Release Technique Versus Strain-counter- Stain in Chronic Low Back Pain .A Randomized Clinical Trial

clinical trial aims to compare the effects of Active Release Technique (ART) and Strain-Counter-Strain (SCS) on pain reduction and functional improvement in male patients aged 30-45 years with chronic low back pain (CLBP) persisting for at least 3-4 months. CLBP is a widespread and debilitating condition with significant impact on quality of life, healthcare costs, and work productivity. ART focuses on releasing myofascial adhesions and alleviating trigger points through manual pressure and movement, while SCS is a passive positional technique designed to reduce neuromuscular tension and restore range of motion.

A total of 40 participants will be randomly allocated into two equal groups (ART group and SCS group). Both groups will receive standardized baseline treatment including a hot pack and interferential current therapy, followed by their respective intervention protocols for 12 sessions over 4 weeks. Pain intensity will be measured using the Visual Analogue Scale (VAS), functional disability using the Quebec Back Pain Disability Scale (QBPDS), and functional limitation using the Oswestry Disability Index (ODI). Data will be analyzed using SPSS v25, applying paired and independent t-tests or their non-parametric equivalents, with a significance level of p < 0.05.

The study is expected to provide evidence-based insight into which intervention is more effective in improving pain and functional outcomes in CLBP. The findings may help guide clinical decision-making, contribute to treatment guidelines, and support cost-effective, patient-centered management approaches.

Study Overview

• Status: Completed
• Conditions: Low Back Pain
• Intervention / Treatment: Other: Strain Counter Strain; Other: Active Release Technique

Detailed Description

Chronic low back pain (CLBP) is a globally prevalent and debilitating condition that significantly impacts patients' functional capacity, quality of life, work productivity, and healthcare systems. Its multifactorial etiology, varied patient presentations, and inconsistent responses to treatment make CLBP a persistent therapeutic challenge. Non-pharmacological approaches such as Active Release Technique (ART) and Strain-Counter-Strain (SCS) have emerged as promising interventions, yet there is limited and inconsistent high-quality evidence comparing their effectiveness in CLBP management.

ART is a soft tissue manual therapy targeting myofascial adhesions, scar tissue, and trigger points. By applying specific manual pressure combined with patient movement, ART aims to restore normal muscle texture, reduce tension, and improve function. It is commonly used for pain associated with muscle tightness, restricted mobility, and neuromuscular dysfunction.

SCS is a passive positional release technique that reduces muscle spasm and tension by placing the affected muscle in a shortened position for a set duration, typically 90 seconds, followed by a gradual return to neutral. It works by reducing proprioceptive activity in muscle spindles, thereby alleviating pain and restoring motion.

This randomized clinical trial will recruit 40 male participants aged 30-45 years diagnosed with CLBP persisting for at least 3-4 months, with pain intensity ≥4/10 on the Visual Analogue Scale (VAS). Patients will be randomly allocated into two equal groups-Group A: ART and Group B: SCS-using a sealed card draw method. Both groups will receive a standardized pre-treatment protocol consisting of a 10-minute hot pack application to the lower back and 15 minutes of interferential current therapy.

Intervention Protocol:

ART Group: Application of ART techniques to the lumbar and gluteal regions with precise manual pressure and guided movements, 45 minutes per session, three sessions per week for four weeks.

SCS Group: Gentle passive positioning of targeted muscles into comfort, held for 90 seconds, then returned to neutral; 45 minutes per session, three sessions per week for four weeks.

Outcome Measures:

Pain Intensity - measured via VAS.

Functional Disability - assessed using the Quebec Back Pain Disability Scale (QBPDS).

Functional Limitation - assessed using the Oswestry Disability Index (ODI). Baseline measurements will be recorded before treatment and reassessed after completing the 12 sessions.

Data Analysis will be conducted using SPSS v25. Normality will be assessed with the Shapiro-Wilk test. Within-group comparisons will use paired t-tests (or Wilcoxon signed-rank tests for non-normal data), and between-group differences will be analyzed using independent t-tests (or Mann-Whitney U tests for non-normal data). Statistical significance will be set at p < 0.05.

Expected Contribution:

The study will provide comparative evidence on the efficacy of ART versus SCS in improving pain and function among CLBP patients. It will inform clinical decision-making, contribute to the development of evidence-based guidelines, and potentially influence cost-effective management strategies for CLBP. Furthermore, it will add to the body of literature on manual therapy interventions, supporting a patient-centered, biopsychosocial approach to musculoskeletal rehabilitation.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Rawalpindi, Punjab Province, Pakistan, 46000
      • Bilal Hospital Rawalpindi Physiotherapy Department

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patient will be diagnosed by the therapist.
• Individuals diagnosed with chronic low back pain persisting for at least 3-4 months.
• Patients aged 30-45 years.
• Only men will be included in this study
• Pain intensity of at least 4/10 on the Visual Analogue Scale (VAS)

Exclusion Criteria:Patients with a history of spinal surgery or significant spinal conditions (e.g., fractures, tumors, infections).

• Individuals with neurological disorders like cauda equine, radiculopathy and spinal stenosis affecting the lower back or lower extremities.
• Pregnant women or individuals with contraindications to ART or strain-counter-strain therapy.
• Patients unable to provide informed consent or adhere to treatment protocols.

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
Active Comparator: Strain Counterstrain; Technique: Gentle, passive positioning of affected muscles to reduce pain and dysfunction.; Positioning held for 90 seconds followed by slow return to a neutral position.; Treatment Duration: 12 sessions over 4 weeks (3 sessions per week, 45-minute sessions	Other: Strain Counter Strain; Technique: Gentle, passive positioning of affected muscles to reduce pain and dysfunction.; Positioning held for 90 seconds followed by slow return to a neutral position.; Treatment Duration: 12 sessions over 4 weeks (3 sessions per week, 45-minute sessions). both group warm up inclunding a 10 minute hot pack and 15 minute interferantial therapy before the main treatment
Active Comparator: Active Release Technique; Technique: Active Release Technique (ART) will be applied using precise manual pressure and movement to release myofascial adhesions in the lumbar and gluteal regions.; Treatment Time: Each session will last 45 minutes, focusing on targeted muscle groups.; Treatment Duration: 12 sessions over 4 weeks (3 sessions per week, 45-minute sessions)	Other: Active Release Technique; Technique: Active Release Technique (ART) will be applied using precise manual pressure and movement to release myofascial adhesions in the lumbar and gluteal regions.; Treatment Time: Each session will last 45 minutes, focusing on targeted muscle groups.; Treatment Duration: 12 sessions over 4 weeks (3 sessions per week, 45-minute sessions).both group warm up inclunding a 10 minute hot pack and 15 minute interferantial therapy before the main treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual analogue scale	pain intensity	fram enlloment to the end of treatment it 4 week
Oswerty disability index	functional limitation	fram enlloment to the end of treatment it 4 week
Quebec back pain disability	functional disability	fram enlloment to the end of treatment it 4 week

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): May 5, 2025
• Primary Completion (Actual): August 5, 2025
• Study Completion (Actual): August 15, 2025

Study Registration Dates

• First Submitted: February 11, 2026
• First Submitted That Met QC Criteria: February 11, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: IUII/RERC/ADT/2025/04/170

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