Welling Aarti, Kage Vijay, Gurudut Peeyoosha, Nadaf Rubeen, Hulmani Soumya, G Nithisha, Chabada Nisha, Math Shivashri
KLE Institute of Physiotherapy, Belagavi, India.
KAHER, Dr. Prabhakar Kore Basic Science Research Centre, Jawaharlal Nehru Medical College, Belagavi, India.
Eur Spine J. 2025 Aug 25. doi: 10.1007/s00586-025-09279-w.
Non- specific low back pain (NSLBP) is a common musculoskeletal disorder that leads to disability. Its development has been associated with inflammatory responses including cytokines such as TNF-α. Various management approaches, including manual therapy and exercise therapy to treat NSLBP. Manual therapy including myofascial release (MFR) has shown to reduce the pain and improve soft tissue flexibility and mobility. It was therefore hypothesized that three-dimensional MFR (3D-MFR) would reduce TNF-α levels in individuals with NSLBP. This present study aimed to investigate the effect of three-dimensional myofascial release (3D-MFR) on inflammation as indicated by TNF-α level, as well as on pain intensity and quality of life in individuals with NSLBP.
A double-blinded randomized controlled trial was conducted over a 6 month period in the tertiary care centre. 40 participants aged 18-50 years with a clinical diagnosis of nonspecific low back pain. Participants were randomly allocated into two groups using a computer-generated randomization sequence with allocation concealed through sealed opaque envelopes, one receiving 3D-MFR and the other a sham group intervention, both over 4 weeks. Outcomes included concentration of TNF-α level (in blood and urine), Visual Analogue Scale (VAS) scores for pain intensity and Modified Oswestry Disability Index (MODI) scores for quality of life assessed before and after the intervention.
Post-intervention, the blood TNF-α in 3D-MFR group (p = 0.001; CI- LL = 5.62, UL = 14.69) compared to the Sham group (p = 0.85; CI- LL = 9.97, UL = 20.09) and urine TNF-α levels in 3D-MFR group (p = 0.003; CI- LL = 0.61, UL = 1.33) compared to the Sham group (p = 0.744; CI- LL = 1.36, UL = 2.63). VAS scores in 3D- MFR group (p < 0.001; CI- LL = 2.2, UL = 3.39) versus the Sham group (p = 0.001; CI- LL = 4.06, UL = 5.31), MODI scores for 3D-MFR group (p < 0.001; CI- LL = 23.69, UL = 34.09) compared to the Sham group (p < 0.001; CI- LL = 37.65, UL = 49.4).
This study concludes that three-dimensional myofascial release effectively reduces inflammation and pain intensity, while improving quality of life in individuals with Non-specific low back pain. These findings support the integration of fascia-based manual therapy into multidisciplinary approaches for managing low back pain.
非特异性下腰痛（NSLBP）是一种常见的导致残疾的肌肉骨骼疾病。其发病与包括细胞因子如肿瘤坏死因子-α（TNF-α）在内的炎症反应有关。多种治疗方法，包括手法治疗和运动疗法，被用于治疗NSLBP。包括肌筋膜松解术（MFR）在内的手法治疗已被证明可以减轻疼痛并改善软组织的柔韧性和活动度。因此，有人推测三维肌筋膜松解术（3D-MFR）可以降低NSLBP患者的TNF-α水平。本研究旨在探讨三维肌筋膜松解术（3D-MFR）对以TNF-α水平为指标的炎症的影响，以及对NSLBP患者疼痛强度和生活质量的影响。
在一家三级护理中心进行了一项为期6个月的双盲随机对照试验。40名年龄在18至50岁之间、临床诊断为非特异性下腰痛的参与者。使用计算机生成的随机序列将参与者随机分为两组，通过密封不透明信封进行分配隐藏，一组接受3D-MFR治疗，另一组接受假治疗组干预，均为期4周。观察指标包括干预前后TNF-α水平（血液和尿液中）的浓度、疼痛强度的视觉模拟评分（VAS）以及生活质量的改良奥斯威斯利残疾指数（MODI）评分。
干预后，3D-MFR组的血液TNF-α水平（p = 0.001；可信区间下限LL = 5.62，上限UL = 14.69）与假治疗组（p = 0.85；可信区间下限LL = 9.97，上限UL = 20.09）相比，3D-MFR组的尿液TNF-α水平（p = 0.003；可信区间下限LL = 0.61，上限UL = 1.33）与假治疗组（p = 0.744；可信区间下限LL = 1.36，上限UL = 2.63）相比。3D-MFR组的VAS评分（p < 0.001；可信区间下限LL = 2.2，上限UL = 3.39）与假治疗组（p = 0.001；可信区间下限LL = 4.06，上限UL = 5.31）相比，3D-MFR组的MODI评分（p < 0.001；可信区间下限LL = 23.69，上限UL = 34.09）与假治疗组（p < 0.001；可信区间下限LL = 37.65，上限UL = 49.4）相比。
本研究得出结论，三维肌筋膜松解术能有效减轻炎症和疼痛强度，同时改善非特异性下腰痛患者的生活质量。这些发现支持将基于筋膜的手法治疗纳入多学科方法来管理下腰痛。
