Myofascial Release Versus Conventional Exercise on Pain and Pain Sensitivity in Chronic Low Back Pain

Abstract

Chronic non-specific low back pain (CLBP) is a leading cause of disability, and it is unclear whether myofascial release (MFR) and exercise differ in their effects on pain and on pain sensitivity. This assessor-blinded randomized controlled trial compared MFR with conventional core-stabilization exercise in adults aged 20–40 years with CLBP and pain of at least 4 on the Numeric Pain Rating Scale (NPRS). Sixty-four participants were randomized to 24 supervised sessions of MFR or exercise over 8 weeks. The primary outcome was NPRS at week 8, analysed by intention-to-treat ANCOVA with multiple imputation. Secondary outcomes were local (lumbar) and remote (tibialis anterior) pressure pain thresholds (PPT), the Central Sensitization Inventory (CSI), the Pain Catastrophizing Scale (PCS) and responder status. Fifty-nine participants (92%) completed the trial. At week 8, pain was 1.10 points lower after MFR than after exercise (95% CI -1.86 to -0.35; p = 0.004; d = -0.74), and 90.0% versus 51.7% of participants achieved a clinically important improvement (number needed to treat 2.6). MFR increased local PPT by 54.2 kPa more than exercise (Bonferroni-adjusted p = 0.025), whereas exercise produced a modest increase in remote PPT; CSI and PCS improved similarly in both groups. The between-group difference in pain was no longer significant at the week-12 follow-up, and adverse events were mild in both groups. MFR provided greater short-term pain relief and local pain-threshold improvement than conventional exercise, suggesting a predominantly local mechanism; strategies to maintain its benefit warrant investigation.