EC Microbiology

Background: Low back pain (LBP) is the highly prevalent musculoskeletal condition, and causes activity limitations resulting in reduced productivity and high medical expenditure. Muscle Energy Technique (MET) is a therapeutic technique that has the potential to be successful in LBP, although the evidence for this notion is still inconclusive. The effectiveness of the muscular energy technique on pain intensity and disability for individuals with chronic low back pain was evaluated in published studies through this systematic review of the literature.

Methods: Pub Med, Scopus, Science Direct, The Cochrane Library, Ovid, Clinicaltrials.gov, and Embase were searched until October 30, 2022. Randomized controlled studies reporting on the effectiveness of muscles energy technique on pain intensity and disability for chronic low back patients were included. Information related to demographics, number and duration of treatment, MET protocol, assessment tools used for pain and disability, and key findings were extracted. The PEDro classification scale was used to assess the methodological quality of studies.

Results: 17 research studies (including 817 participants) were retrieved and included for qualitative analysis. The studies published between 2011 and 2022 were retrieved, and the sample size ranged from 10 to one hundred twenty-five participants. The age of the subjects ranged between 18 - 60 years, and interventions were done between 2 days to 12 weeks. Of the included 17 studies, 05 were from Egypt, 04 were from India, 2 each from Iran, Nigeria and one each from Brazil, Poland, Thailand and Pakistan. In comparison to other interventions or the control groups, MET was found to significantly, although modestly, decrease the severity of pain and reduce functional disability in patients with chronic LBP. Most of the included studies had moderate to high study quality.

Conclusion: In patients with CLBP, MET alone as well as in conjunction with other interventions was found to be beneficial in reducing pain intensity, improving lumbar spine range of motion, and decreasing the degree of functional disability.

Keywords: Muscle Energy Technique; Chronic Pain; Low Back Pain; Functional Disability

1. Ahmed UA., et al. “Effects of dynamic stabilization exercises and muscle energy technique on selected biopsychosocial outcomes for patients with chronic non-specific low back pain: a double-blind randomized controlled trial”. Scandinavian Journal of Pain 3 (2021): 495-511.
2. Gk S., et al. “Effectiveness of muscle energy technique in patients with nonspecific low back pain: a systematic review with meta-analysis”. European Journal of Physical and Rehabilitation Medicine (2022).
3. Szulc P., et al. “Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain”. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 21 (2015): 2918-2932.
4. Hoy D., et al. “The global burden of low back pain: estimates from the Global Burden of Disease 2010 study”. Annals of the Rheumatic Diseases 6 (2014): 968-974.
5. Wu A., et al. “Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017”. Annals of Translational Medicine 6 (2020): 299.
6. D’hooge R., et al. “Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle functional MRI”. The Clinical Journal of Pain 3 (2013): 187-194.
7. Hartvigsen J., et al. “What low back pain is and why we need to pay attention”. Lancet London England 10137 (2018): 2356-2367.
8. Foster NE., et al. “Prevention and treatment of low back pain: evidence, challenges, and promising directions”. Lancet London England 10137 (2018): 2368-2383.
9. Campbell P., et al. “Conceptual overlap of psychological constructs in low back pain”. Pain 9 (2013): 1783-1791.
10. Knobloch K., et al. “Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias”. Journal of Cranio-Maxillofacial Surgery 2 (2011): 91-92.
11. De Morton NA. “The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study”. Australian Journal of Physiotherapy 2 (2009): 129-133.
12. Ak A Sra A As O. “Comparative effects of muscle energy technique and core stability exercise in the management of patients with non-specific chronic low back pain”. Low Back Pain (2017): 8.
13. Ellythy MA. “Efficacy of muscle energy technique versus myofascial release on function outcome measures in patients with chronic low back pain”. Bulletin of Faculty of Physical Therapy 1 (2012): 51-57.
14. Ellythy MA. “Efficacy of muscle energy technique versus strain counter strain on low back dysfunction”. Bulletin of Faculty of Physical Therapy 2 (2012): 29-35.
15. Tubassam S., et al. “Effectiveness of Muscle Energy Technique Versus Strain Counter Strain Technique on Trigger Points of Quadratus Lumborum among Low Back Pain Patients”. Pakistan Journal of Medical and Health Sciences 8 (2021): 2451-2453.
16. Gendy M., et al. “Pilate mat exercise versus muscle energy technique on chronic non specific low back pain”. International Journal of Health Sciences 6 (2022): 3570-3583.
17. Dhinkaran M., et al. “Comparative Analysis of Muscle Energy Technique and Conventional Physiotherapy in Treatment of Sacroiliac Joint Dysfunction”. The Indian Journal of Physiotherapy and Occupational Therapy 4 (2011): 127-130.
18. Bindra S., et al. “A Study on the Efficacy of Muscle Energy Technique as Compared to Conventional Therapsy in Chronic Low Back Pain Due to Sacroiliac Joint Dysfunction”. The Indian Journal of Physiotherapy and Occupational Therapy 1 (2012).
19. Bhosale SV and Burungale M. “Effectiveness of Myofascial Release, Muscle Energy Technique and Stretching of Quadrartus Lumborum Muscle in Patients with Non-Specific Low Back Pain”. Journal of Ecophysiology and Occupational Health (2021): 132-141.
20. Sturion LA., et al. “Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial”. South African Journal of Physiotherapy 1 (2020): 1420.
21. Patel SY., et al. “Comparison of Neural Tissue Mobilization and Muscle Energy Technique on Hamstring Tightness in Chronic Low Back Pain”. Medico Legal Update 2 (2020): 375-379.
22. Fahmy E., et al. “Efficacy of spinal extension exercise program versus muscle energy technique in treatment of chronic mechanical low back pain”. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery 1 (2019): 77.
23. Elshinnawy AM., et al. “The effect of Muscle Energy Techniques versus cross (X) technique kinesio taping to treat chronic low back dysfunction”. International Journal of Therapy and Rehabilitation 2 (2019): 1-8.
24. Ghasemi C., et al. “Comparative study of muscle energy technique, craniosacral therapy, and sensorimotor training effects on postural control in patients with nonspecific chronic low back pain”. Journal of Family Medicine and Primary Care 2 (2020): 978-984.
25. Ghasemi C., et al. “Comparison of the effects of craniosacral therapy, muscle energy technique, and sensorimotor training on non-specific chronic low back pain”. Anaesthesia, Pain and Intensive Care 5 (2020): 532-543.
26. Wahyuddin W., et al. “Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study”. Hong Kong Physiotherapy Journal: Official Publication of the Hong Kong Physiotherapy Association Limited = Wu li Chih Liao 2 (2020): 109-119.
27. Majid K and Truumees E. “Epidemiology and Natural History of Low Back Pain”. Seminars in Spine Surgery 2 (2008): 87-92.
28. Shigaki L., et al. “Effects of Holding an External Load on the Standing Balance of Older and Younger Adults with and Without Chronic Low Back Pain”. Journal of Manipulative and Physiological Therapeutics 4 (2017): 284-292.
29. Koes BW., et al. “An updated overview of clinical guidelines for the management of non-specific low back pain in primary care”. European Spine Journal 12 (2010): 2075-2094.
30. Qaseem A., et al. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians”. Annals of Internal Medicine7 (2017): 514-530.
31. Franke H., et al. “Muscle energy technique for non-specific low-back pain”. Cochrane Database of Systematic Reviews 2 (2015): CD009852.
32. Hamilton L., et al. “The effects of high-velocity, low-amplitude manipulation and muscle energy technique on suboccipital tenderness”. The International Journal of Osteopathic Medicine2 (2007): 42-49.
33. Herrington LL Chaitow. “Muscle Energy Techniques (third edition”.), Elsevier, Churchill-Livingstone, New York, NY (2006): 346. CD included, Price £42.99, ISBN: 10 0443101140. Man Ther - MAN THER (2008): 13.
34. Rubinstein SM., et al. “Spinal manipulative therapy for acute low-back pain”. Cochrane Database of Systematic Reviews 9 (2012): CD008880.
35. Coulter ID., et al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis”. The North American Spine Society Open Access Journal5 (2018): 866-879.
36. Zafereo J., et al. “Regional manual therapy and motor control exercise for chronic low back pain: a randomized clinical trial”. Journal of Manual and Manipulative Therapy4 (2018): 193-202.
37. Niemistö L., et al. “A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain”. Spine 19 (2003): 2185-2191.
38. Greenman’s Principles of Manual Medicine (Point (Lippincott Williams and Wilkins)) - PDF Drive (2022).