Comparing the Therapeutic Impact of Strain-Counterstrain and Exercise on Low Back Myofascial Pain Syndrome: A Randomized Trial

Ghada Mohamed Rashad Koura,1 Ahmed Mohamed Fathi Elshiwi,2 Mohamed Naeem Selim,3 Amani Abdu Mohammed Asiri,4 Reem Hadi Jowaied Alqahtani,5 Doaa Ayoub Elimy,6 Mohammed Abdullah Alshehri,7 Hani Hassan Alnakhli,1 Sultan Mofreh Assiri,8 Fuzail Ahmad,9 Irshad Ahmad1 1Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia; 2Consultant & Head of Physical Therapy Department, Saudi German Hospital, Aseer, Saudi Arabia; 3Basic Sciences Department, Faculty of Physical Therapy, Beni Suef University, Beni Suef, Egypt; 4Physical Therapy Department, Saudi German Hospital, Aseer, Saudi Arabia; 5Eradh Physical Therapy Center, Aseer, Saudi Arabia; 6Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 7Department of Physiotherapy, Abha International Private Hospital, Abha, Saudi Arabia; 8Department of Physical Therapy, Muhayel General Hospital, Asir Health Affairs, Ministry of Health, Abha, Saudi Arabia; 9Respiratory Care Department, College of Applied Sciences, Almaarefa University, Dirirya, Riyadh, Saudi ArabiaCorrespondence: Irshad Ahmad, Email [email protected]: Background: Strain-Counterstrain (SCS) therapy is a manual therapeutic technique used to treat myofascial pain by addressing tender points through passive positioning. Despite anecdotal evidence, limited peer-reviewed research supports its efficacy in chronic low back pain (LBP). This study evaluates the effects of SCS combined with exercise on pain severity, lumbar range of motion (ROM), and functional disability in patients with chronic LBP.Methods: A randomized controlled trial was conducted with 30 participants aged 45– 55 years, divided into Group A (SCS + Exercise) and Group B (Exercise Only). Outcome measures included pain intensity, lumbar ROM (flexion, extension, side bending), and functional disability (Oswestry Disability Index). Assessments were conducted at baseline and after four weeks of intervention. MANOVA was performed to evaluate group, time, and interaction effects, with detailed univariate follow-ups and effect sizes. Reliability of ROM measurements was ensured using intraclass correlation coefficients (ICC > 0.90).Results: MANOVA revealed statistically significant group, time, and interaction effects for all outcomes (Wilks’ Lambda = 0.065, F (6, 51) = 91.34, p < 0.001). Pain severity decreased by 26.7% in Group A compared to 5.2% in Group B (F (1, 56) = 65.78, p < 0.001, partial η² = 0.77). Lumbar ROM improved significantly in Group A for flexion (10.9%), extension (20.3%), and right-side bending (17.7%) (p < 0.001, partial η² = 0.68– 0.74), with no significant improvement in left-side bending. Functional disability scores reduced by 25.2% in Group A versus 2.3% in Group B (F (1, 56) = 53.45, p < 0.001, partial η² = 0.73).Conclusion: SCS therapy combined with exercise significantly reduces pain, improves lumbar ROM, and enhances functional capacity in patients with chronic LBP compared to exercise alone. These findings highlight SCS as a promising adjunctive treatment for managing chronic musculoskeletal pain. Future studies should investigate long-term outcomes and further refine treatment protocols.Keywords: low back pain, myofascial pain syndrome, strain-counter-strain, myofascial trigger points