Effects of Muscle Energy Technique and Pilates Exercises on Pain and Physical Function in Patients With Nonspecific Low Back Pain

Effects of Muscle Energy Technique and Pilates Exercises on Pain and Physical Function in Patients With Nonspecific Low Back Pain: A Randomized Clinical Trial

This randomized clinical trial aimed to compare the effects of Muscle Energy Techniques (METs) and Pilates exercises on pain and physical function in individuals with nonspecific low back pain. A total of 72 participants aged between 20 and 50 years were recruited from the University of Lahore Teaching Hospital, Lahore. Participants were randomly allocated into two groups: one group received Muscle Energy Techniques and the other group performed Pilates exercises. Each intervention session lasted 60 minutes, conducted four days per week for six weeks. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), while physical function was evaluated using the Roland Morris Disability Questionnaire (RMDQ). The results were analyzed to determine the comparative effectiveness of the two interventions in reducing pain and improving functional ability among patients with nonspecific low back pain.

Study Overview

• Status: Completed
• Conditions: Nonspecific Low Back Pain
• Intervention / Treatment: Other: Muscle Energy Technique; Behavioral: Pilates Exercises

Detailed Description

Nonspecific low back pain (NSLBP) is one of the most common musculoskeletal conditions affecting adults and is characterized by pain in the lumbar region without a specific underlying pathology such as disc herniation, fracture, or spinal stenosis. It can significantly affect daily functioning and quality of life.

Muscle Energy Techniques (METs) are manual therapy procedures in which the patient actively contracts a muscle against a controlled resistance applied by the therapist, followed by relaxation and stretching to improve muscle flexibility and joint mobility. Pilates exercises are structured exercises designed to strengthen the core muscles, improve posture, increase flexibility, and enhance body awareness.

This randomized clinical trial was conducted to compare the effectiveness of Muscle Energy Techniques and Pilates exercises in reducing pain and improving physical function in individuals with nonspecific low back pain. Seventy-two participants were recruited and randomly assigned into two groups. Group A received Muscle Energy Techniques, while Group B performed Pilates exercises. Both groups underwent 60-minute treatment sessions, four times per week for six weeks.

Pain intensity was measured using the Numeric Pain Rating Scale (NPRS), and physical function was assessed using the Roland Morris Disability Questionnaire (RMDQ). Statistical analysis was conducted using SPSS version 27. Independent t-tests were used for between-group comparisons and repeated ANOVA was applied for within-group analysis.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Lahore, Pakistan
    • University of Lahore

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Individuals aged 20-50 years
• Both males and females
• Pain lasting for at least 2-3 months
• Pain score greater than 3 on Numeric Pain Rating Scale
• Participants who had not received physiotherapy treatment for low back pain

Exclusion Criteria:

• History of lumbar radiculopathy
• Use of painkiller medications
• Spinal pathologies such as prolapsed disc, spinal stenosis, spondylolisthesis, vertebral fractures, or spinal infections
• Systemic diseases such as rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, or malignancy
• Pregnant women
• Neurological conditions such as stroke or multiple sclerosis

Heart conditions or psychological disorders

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: Muscle Energy Technique Group; Participants in this group received Muscle Energy Techniques including post-isometric relaxation and reciprocal inhibition techniques targeting the iliopsoas, quadratus lumborum, and erector spinae muscles. Each treatment session lasted 60 minutes and was conducted four times per week for six weeks.	Other: Muscle Energy Technique; Muscle Energy Technique is a manual therapy intervention where the patient performs voluntary muscle contractions against therapist resistance followed by stretching to improve muscle flexibility, reduce pain, and enhance joint mobility.
Active Comparator: Pilates Exercise Group; Participants in this group performed a structured Pilates exercise program including core strengthening, flexibility exercises, and postural control activities for 60 minutes per session, four times per week for six weeks.	Behavioral: Pilates Exercises; Pilates exercises are structured physical exercises focusing on core muscle strengthening, flexibility, posture improvement, and body awareness to enhance functional movement and reduce musculoskeletal pain.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 (no pain) to 10 (worst imaginable pain).	Baseline and after 6 weeks of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Physical Function	Physical function was measured using the Roland Morris Disability Questionnaire (RMDQ), which includes 24 items assessing functional disability related to low back pain.	Baseline and after 6 weeks of intervention

Collaborators and Investigators

• Sponsor: University of Lahore
• Collaborators: University of Lahore Hospital (ULH)

Publications and helpful links

General Publications

• Lytras, D., Iakovidis, P., Sykaras, E., Kottaras, A., Kasimis, K., Myrogiannis, I., Barouxakis, A., & Tarfali, G. (2023). Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial. Aging clinical and experimental research, 35(12), 3059-3071.
• Li, W., Gong, Y., Liu, J., Guo, Y., Tang, H., Qin, S., Zhao, Y., Wang, S., Xu, Z., & Chen, B. (2021). Peripheral and central pathological mechanisms of chronic low back pain: a narrative review. Journal of pain research, 1483-1494.
• Kripa, S., & Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy, 26, 1-4.
• Kersten, R., Fikkers, J., Wolterbeek, N., Öner, F., & Van Gaalen, S. (2021). Are the Roland Morris Physical function Questionnaire and Oswestry Physical function Index interchangeable in patients after lumbar spinal fusion? Journal of Back and Musculoskeletal Rehabilitation, 34(4), 605-611.
• Kant, S., Urvashi, K. J., & Raman, R. K. (2024). Effectiveness of Core Stabilization Exercises vs. Traditional Physical Therapy for Chronic Low Back Pain. Journal of Contemporary Clinical Practice, 10, 279-287.
• Jenks, A., Hoekstra, T., van Tulder, M., Ostelo, R. W., Rubinstein, S. M., & Chiarotto, A. (2022). Roland-Morris physical function questionnaire, Oswestry physical function index, and Quebec back pain physical function scale: which has superior measurement properties in older adults with low back pain? Journal of Orthopaedic & Sports Physical Therapy, 52(7), 457-469.
• Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews(9).
• Goudman, L., Pilitsis, J., Billet, B., De Vos, R., Hanssens, K., Billot, M., Roulaud, M., Rigoard, P., & Moens, M. (2024). The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain. Anaesthesia, 79(2), 128-138.
• Frota, N. T., Fidelis-de-Paula-Gomes, C. A., Pontes-Silva, A., Pinheiro, J. S., de Jesus, S. F. C., Apahaza, G. H. S., da Silva Souza, C., Avila, M. A., & Dibai-Filho, A. V. (2022). 15-item Roland-Morris Physical function Questionnaire (RMDQ-15): structural and criterion validity on patients with chronic low back pain. BMC musculoskeletal disorders, 23(1), 978.
• Franks, J., Thwaites, C., & Morris, M. E. (2023). Pilates to improve core muscle activation in chronic low back pain: a systematic review. Healthcare,
• Erawan, T., Sudaryanto, S., & Nur, M. a. (2021). Effectiveness Combination Muscle Energy Technique and Strain Counterstrain Lumbar and Functional Changes to The Range of Motion in Patients With Non Specific Low Back Pain. Urban Health, 3(1), 1-10.
• Elahi, A. R., Seidi, F., & Karimi zadeh Ardakani, M. (2021). Effect of 8 Weeks of Selected Corrective Exercises on the Lumbar Lordosis Angle and LowerLimb Function in Non-Athlete Men with Lumbar Hyper Lordosis. Journal of Safety Promotion and Injury Prevention, 9(4), 304-314.
• El Gendy, M. H., Hekal, H. N., Kadah, M. A., Hussein, H. M., & Ewais, N. F. (2022). Pilate mat exercise versus muscle energy technique on chronic non specific low back pain. International Journal of Health Sciences, 6(S5), 3570-3583.
• Du, S., Liu, W., Cai, S., Hu, Y., & Dong, J. (2020). The efficacy of e-health in the self-management of chronic low back pain: a meta analysis. International journal of nursing studies, 106, 103507.
• Childress, M. A., & Stuek, S. J. (2020). Neck pain: initial evaluation and management. American family physician, 102(3), 150-156.
• Chiarotto, A., & Koes, B. W. (2022). Nonspecific low back pain. New England Journal of Medicine, 386(18), 1732-1740.
• Chauhan, P., Khare, K., Vachchani, K., & Kapoor, G. (2022). Effectiveness of muscle energy technique versus positional release therapy on range of motion and pain in non-specific low back pain. Indian Journal of Continuing Nursing Education, 23(1), 54-58.
• Bogduk, N. (2022). Clinical and Radiological Anatomy of the Lumbar Spine: Clinical and Radiological Anatomy of the Lumbar Spine-E-Book. Elsevier Health Sciences.
• Bhosale, S. V., & Burungale, M. (2022). Effectiveness of myofascial release, muscle energy technique and stretching of quadrartus lumborum muscle in patients with non-specific low back pain. J Ecophysiol Occup Health, 21, 132-141.
• Bento, T. P. F., dos Santos Genebra, C. V., Maciel, N. M., Cornelio, G. P., Simeão, S. F. A. P., & de Vitta, A. (2020). Low back pain and some associated factors: is there any difference between genders? Brazilian journal of physical therapy, 24(1), 79-87.
• Batıbay, S., Külcü, D. G., Kaleoğlu, Ö., & Mesci, N. (2021). Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain. Journal of Orthopaedic Science, 26(6), 979-985.
• Arul, J., & R, R. (2025). Effect of muscle energy technique versus Pilates on functional outcomes among physiotherapy students with non-specific neck pain. Bulletin of Faculty of Physical Therapy, 30(1), 8.
• Ali, A., Saleh, M., Abdelaraouf, N., & Elazizi, H. (2022). Effect of core stabilization exercises on lumbar lordotic angle in patients with lumbar disc degeneration. Physiotherapy Quarterly, 30(4), 87-95.
• Akram, A., Imtiaz, K., Maryem, S., Mahmood, W., Mahmood, T., & Babur, M. N. (2024). Comparison of Pilates exercises versus muscle energy technique with Kinesio taping in non-specific low back pain: a randomized controlled trial. Khyber Medical University Journal, 16(1), 3-9.
• Ahmed, U. A., Nadasan, T., Van Oosterwijck, J., & Maharaj, S. S. (2021). Effect of dynamic stabilisation exercise therapy enhanced with muscles energy technique on some selected patients outcomes and trunk muscles function in patients with chronic non-specific low back pain: a study protocol. European Journal of Physiotherapy, 23(6), 344-354.

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2025
• Primary Completion (Actual): September 25, 2025
• Study Completion (Actual): October 12, 2025

Study Registration Dates

• First Submitted: March 4, 2026
• First Submitted That Met QC Criteria: March 4, 2026
• First Posted (Actual): March 9, 2026

Study Record Updates

• Last Update Posted (Actual): March 9, 2026
• Last Update Submitted That Met QC Criteria: March 4, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Low Back Pain; Physical Therapy; Pain Management; Pilates Exercises
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Back Pain; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain; Agnosia; Therapeutics; Physical Therapy Modalities; Exercise Movement Techniques
• Other Study ID Numbers: UOL/IREB/25/09/0044

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because this study was conducted as an academic research project. The informed consent obtained from participants did not include provisions for public data sharing, and the dataset contains sensitive personal health information. Data will be stored securely and used only for academic and research purposes in accordance with institutional ethics approval

Drug and device information, study documents

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