Spray and Stretch Technique Versus Strain Counter Strain in Patients With Non Specific Low Back Pain

Comparative Effect of Spray and Stretch Technique Versus Strain Counter Strain on Hamstring Muscles for Pain , Disability and Mobility in Patients With Non Specific Low Back Pain

Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Non specific low back pain is posteriorly occurring that is located between lower rib margin and gluteal fold. It is exacerbated by sustained back postures, back movements or back muscle imbalances. The aim of study is to find out which technique whether Spray and stretch technique or strain Counter strain works better in reducing pain ,improving movement ,and decreasing disability caused by tight hamstring muscles in people with non specific low Back Pain.

Study Overview

• Status: Recruiting
• Conditions: Low Back Pain
• Intervention / Treatment: Other: Spray and stretch technique on Hamstring Muscle; Other: Strain and counter strain technique on hamstring muscle

Detailed Description

This double blinded randomized Clinical Trial will be conducted at Ibne Siena Hospital MULTAN through consecutive sampling technique on 30 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with spray and stretch technique and Group B will be treated with strain counter technique at the frequency of 2 sets with 5 repetitions and thrice a week. Outcome measures will be conducted through NPRS, ODI, AKE ,PKET and SLR before treatment and after 4 weeks. Data will be analyzed during SPSS software version 26. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non parametric test will be used within a group or between two groups.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Samrood Akram, PhD*; Phone Number: 03324806143; Email: samrood.akram@riphah.edu.pk
• Study Contact Backup: Name: Amna Zia, PhD*; Phone Number: 03244686993; Email: amna.zia@kemu.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Multan, Punjab Province, Pakistan
      • Recruiting
      • Ibne sina hospital and research institute.
      • Contact: Sajad Rasheed, MS-OMPT; Phone Number: 0300 6309825; Email: sajidch71@hotmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• AGE(35 to 50)

  • Gender (both male and female)
  • Negative lasegue test
  • Negative slump test
  • Negative prone instability test

Exclusion Criteria:

• Fracture or instability (4)

  • History of cancer
  • Inflammatory condition like ankylosing spondylitis
  • Neurological deficits like cauda equina syndrome or motor weakness
  • History of previous of previous lumber surgery
  • Pregnancy
  • Structural deformity like scoliosis
  • Herniated disc
  • Nerve compression
  • Spinal stenosis

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: Spray and stretch technique on Hamstrings muscle; The spray and stretch technique is a physical therapy method used to inactivate myofascial trigger points, reduce muscle spasms, and increase range of motion. It works by applying a vapocoolant spray to numb the skin, which interrupts the pain signal, allowing the therapist to safely stretch the muscle	Other: Spray and stretch technique on Hamstring Muscle; The participant will be positioned in a comfortable supine lying position on a treatment table in a quiet and suitable clinical environment. Before starting the intervention, the procedure will be explained to the participant in simple language, and verbal confirmation of comfort will be obtained. The affected lower limb will be exposed appropriately while ensuring privacy, modesty, and warmth through proper draping with towels or sheets. The participant will be instructed to relax the lower limb during the procedure. The hip will be maintained in a neutral position, and the knee will be kept straight or slightly flexed according to the participant's comfort before the stretching component begins. The therapist will first inspect the posterior thigh region to ensure that the skin is intact and suitable for vapocoolant application. The presence of any open wound, skin infection, rash, hypersens
Active Comparator: Strain and counter strain technique on Hamstring muscle; Strain-Counterstrain (SCS) is a gentle, hands-on physical therapy technique used to relieve low back pain by "resetting" the nervous system. By placing the body in specific, pain-free positions, it relaxes tight muscles, reduces muscle guarding, and improves mobility	Other: Strain and counter strain technique on hamstring muscle; identify the tender point Palpate the hamstring while the patient is prone or side lying locate the most tender point in belly of the muscle or near the ischial tuberosity Establish a pain scale and Ask the patient to rate the tenderness from 0 to 10 (10 being the most painful).Position of ease will be achieved by Flexing the patient's knee to about 70 to 90 degrees .Slightly abduct and externally rotate the leg to shorten the hamstring muscle (the position may vary depending on the muscle .The goal is to reduce tenderness by at least 70% .Hold the position and Maintain this position of comfort for 90 seconds Encourage the patient to relax during this time .Return the leg passively to a neutral position to avoid reactivating the trigger point .Palpate the tender point again and ask for a new pain rating.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric pain rate scale (NPRS)	Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale. Participants will rate their current low back pain from 0 to 10, where 0 indicates "no pain" and 10 indicates the "worst imaginable pain." The score will be recorded in points, with higher scores indicating greater pain intensity.	Baseline and after 4 weeks of intervention
Active knee extension	Hamstring flexibility will be assessed using the Active Knee Extension Test. The participant will lie in the supine position with the hip flexed to 90 degrees and will actively extend the knee as far as possible while maintaining the hip position. The knee extension angle will be measured in degrees using a goniometer. A smaller knee-flexion deficit indicates greater hamstring flexibility.Positive AKE (For males, a positive knee extension angle is >33.0°, whereas for females, it is >24)	Baseline and after 4 weeks of intervention
Passive knee extension test (PKET)	Hamstring flexibility will be assessed using the Passive Knee Extension Test. With the participant in the supine position and the hip maintained at 90 degrees of flexion, the examiner will passively extend the knee until resistance or discomfort is reached. The knee extension angle will be measured in degrees using a goniometer. A greater knee-extension angle indicates greater hamstring flexibility.	Baseline and after 4 weeks
Oswestry Disability Index	Low back pain-related disability will be assessed using the Oswestry Disability Index. The questionnaire contains 10 sections, with each section scored from 0 to 5. The total score will be converted into a percentage ranging from 0% to 100%, where higher scores indicate greater disability.	Baseline and after 4 weeks
Straight leg raise	Straight leg raise range of motion will be assessed with the participant in the supine position. The examiner will passively raise the participant's lower limb while maintaining the knee in extension until resistance or discomfort is reported. The hip-flexion angle will be measured in degrees using a goniometer. A greater angle indicates greater posterior-chain flexibility and straight leg raise range of motion.	Baseline and after 4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Amna Zia, PhD*, Riphah International University, Lahore; Principal Investigator: Zaib un Nisa, Riphah International University, Lahore

Publications and helpful links

General Publications

• Shipton EA. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther. 2018 Dec;7(2):127-137. doi: 10.1007/s40122-018-0105-x. Epub 2018 Sep 18.
• Koura G, Hamada H, Mohamed YE, Balbaa AA, El-Nassag BA, Baghdadi ARJHM. Impact of strain-counterstrain on treatment of acute nonspecific low back pain: a single-blind randomized controlled trial. 2020;22(1):42-9.
• Seif HE, Alenazi A, Hassan SM, Kachanathu SJ, Hafez ARJOJoT, Rehabilitation. The effect of stretching hamstring, gastrocnemius, iliopsoas and back muscles on pain and functional activities in patients with chronic low back pain: a randomized clinical trial. 2015;3(4):139-45.
• Gou Y, Lei H, Chen X, Wang X. The effects of hamstring stretching exercises on pain intensity and function in low back pain patients: A systematic review with meta-analysis of randomized controlled trials. SAGE Open Med. 2024 Jul 29;12:20503121241252251. doi: 10.1177/20503121241252251. eCollection 2024.
• Haile G, Hailemariam TT, Haile TG. Effectiveness of Ultrasound Therapy on the Management of Chronic Non-Specific Low Back Pain: A Systematic Review. J Pain Res. 2021 May 17;14:1251-1257. doi: 10.2147/JPR.S277574. eCollection 2021.
• Riaz SA, Usman MJPJoR. Effect of Static Stretching of Hamstring on Non-Specific Low Back Pain. 2023;12(1):43-51.
• Dobija L, Pereira B, Cohen-Aknine G, Roren A, Dupeyron A, Coudeyre E. Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain. Heliyon. 2023 Sep 4;9(9):e19753. doi: 10.1016/j.heliyon.2023.e19753. eCollection 2023 Sep.
• Ahmed J, Anwar K, Sajjad AGJRJoHS. Effects of strain counter strain technique in treatment of chronic mechanical low back pain: a randomized controlled trail. 2021;3(2):85-91
• Hariharasudhan R, Balamurugan JJSjosm. A randomized double-blinded study of effectiveness of strain counter-strain technique and muscle energy technique in reducing pain and disability in subjects with mechanical low back pain. 2014;14(2):83-8.
• Ellythy MAJBFPT. Efficacy of muscle energy technique versus strain counter strain on low back dysfunction. 2012;17(2):29-35.

Study record dates

Study Major Dates

• Study Start (Actual): June 20, 2026
• Primary Completion (Estimated): August 20, 2026
• Study Completion (Estimated): September 20, 2026

Study Registration Dates

• First Submitted: July 21, 2026
• First Submitted That Met QC Criteria: July 27, 2026
• First Posted (Actual): July 28, 2026

Study Record Updates

• Last Update Posted (Actual): July 28, 2026
• Last Update Submitted That Met QC Criteria: July 27, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: low back pain; mobility; strain counter strain technique
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: REC/RCR & AHS/25/0135 Nisa

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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