Non-Specific Chronic Low Back Pain Treatment Methods

Summary

In Turkish society, almost all people experience back pain. When this pain lasts longer than 3 months and is not related to any cause, it is called "non-specific chronic back pain". The source of back pain is often not known for sure. While it can be seen with some physical loads; since humans are biopsychosocial beings, it is possible to say that psychological factors can also cause this pain. Along with the pain, the quality of life and functionality of people are negatively affected. In order to avoid situations such as loss of work, loss of muscle strength or depression, treatment should be at the center of the individual and a multidisciplinary health team. Many treatment methods are used for back pain, these are pharmacological and non-pharmacological methods. One of the non-pharmacological methods is physical therapy. Physiotherapy methods also have many contents such as mobilization, relaxation, massage, electrotherapy. The physiotherapy methods to be used within the scope of this research include conventional treatment (TENS, US and Hot Pack) application. The Mulligan mobilization technique (Continuous Natural Apophyseal Gliding technique, which is the same as the natural gliding movement of the vertebrae) involves manual application. The relaxation technique involves deep-slow diaphragmatic breathing and the application of progressive relaxation exercise with verbal commands. Individuals between the ages of 18-60 who have been diagnosed with back pain that has not been caused by any reason and has lasted longer than 3 months will be included in the study. The study is planned to be conducted with 45 participants and they will be asked to fill out a "voluntary consent form" before participation. The study consists of 3 groups: conventional (control) group, mobilization group and relaxation group. Conventional treatment will be applied to each group and mobilization and relaxation techniques will be applied in addition to the group determined as a result of randomization. The treatment lasts 4 weeks in certain protocols. 3 evaluations will be made at the beginning, end and 3 months after the treatments. Demographic information, pain and perception questionnaires, shortness test, mobility test, quality of life questionnaire and joint range of motion measurement will be used within the scope of the evaluation.

Conditions

• Non-Specific Chronic Low Back Pain

Interventions

OTHER

Conventional Physical Therapy Group

Conventional physical therapy applied to patients consists of Transcutaneous Electrical Nerve Stimulation (TENS), Ultrasound (US) and Hot Pack. TENS will be applied for 20 minutes at a frequency of 100 hertz. US will be applied for 5 minutes at an intensity of 1.2-1.5 W/cm2. Hot Pack will be applied for 20 minutes. Treatment will be applied to the lumbar region. Application will be made 3 days a week for 4 weeks.

OTHER

Relaxation Techniques Group

The individual will be in a sitting or lying position without muscle tension, and progressive relaxation will be provided with verbal commands given for each body part in order. The patient is asked to place their hand on their abdomen and by applying light resistance, they are provided with the direction in which the breath will go. During diaphragmatic breathing, the person breathes deeply and slowly through the nose and out through the mouth for 5-7 seconds, holds it for 2 seconds and exhales for 6-8 seconds. During this time, the abdomen is inflated in 4 directions and care is taken to ensure that there is no auxiliary muscle activity. First, after taking a deep breath, the muscles are tensed, this tension is maintained for 5-7 seconds and then the muscles are relaxed (8-10 seconds). This application will be applied in 3 sets, with 5/6 repetitions and then returning to calm/normal breathing. The treatment will be applied 3 days a week and will last for 4 weeks.

OTHER

Mulligan Treatment Group

Application of the Technique: The direction of the technique will be shaped according to the direction of movement of the patient's pain. If the patient's pain occurs during flexion, flexion will be applied, if it occurs during extension, extension SNAGS will be applied. In the flexion SNAGS application, the physiotherapist places the mobilization belt at the patient's spina iliaca anterior superior (SIAS) level while the patient is sitting or standing. The physiotherapist places his hand, thumbs or the hypothenar part of the hand parallel to the spinous processes one level above the relevant segment. Then, he asks the patient to flex until he feels pain. The physiotherapist continues the flexion by applying force towards the cranium with his hand. After waiting for a while at the end point, the starting position is returned. During this time, the physiotherapist maintains the natural shift in the facet joint. If the pain does not disappear, the application is applied unilaterally.

Sponsors & Collaborators

• The Scientific and Technological Research Council of Turkey

  collaborator OTHER

• Istanbul Medipol University Hospital

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

60 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-09-02

Primary Completion

2026-06-02

Completion

2026-08-25

Countries

• Turkey (Türkiye)

Study Locations