Effect of muscle energy technique with and without strain-counterstrain technique in acute low back pain - A randomized clinical trial.
Vivek Dineshbhai Patel, Charu Eapen, Zulfeequer Ceepee and 1 others
PMID 30930578WHAT IT FOUND
Adding strain-counterstrain to muscle energy technique did not improve pain, disability or lumbar motion more than muscle energy technique alone after the second session.
Both groups improved, but there was no significant difference between them.
Key findings
01After the second treatment session, pain, disability and lumbar motion improved within both groups, but there was no significant difference between muscle energy technique alone and muscle energy technique plus strain-counterstrain.
02Immediately after the first treatment session, pain improved in both groups; lumbar flexion improved significantly only in the group that also received strain-counterstrain, while extension did not improve in either group.
03Between-group comparisons showed no significant difference for pain, motion or disability after the first or second session.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only two treatment sessions were given, and follow-up stopped after the second session, so longer-term effects were not measured. The treating physiotherapist was not blinded to group. Patients' pain medications were not controlled. The strain-counterstrain procedure did not follow the general treatment guidelines recommended by its proponents. Only 25 participants were assigned to each group. Lost follow-up was handled by intention-to-treat analysis, but the number lost is not stated in the text. Both groups received active manual therapy, so the trial cannot show whether either treatment was better than no manual therapy.
Declared interests
The authors declared no conflict of interest. Partial financial support was provided by Manipal Academy of Higher Education.
The easy way to misread this
Do not conclude that strain-counterstrain adds benefit because lumbar flexion improved after the first session in the combined group. The main between-group comparison showed no significant difference for pain, disability or motion after the first or second session, and the combined group received both treatments, so any single component's contribution cannot be separated.