Myofascial Release for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

Abstract

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial.Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP.Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated.Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = −0.37, 95% CI (−0.67, −0.08), I2 = 46%, P = 0.01] and physical function [SMD = −0.43, 95% CI (−0.75, −0.12), I2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (−0.38, 0.64), I2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (−0.49, 1.64), I2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (−0.75, 0.69), I2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (−0.09, 2.13), I2 = 92%, P = 0.07] and mental health [SMD = −0.06, 95% CI (−0.83, 0.71), I2 = 73%, P = 0.88].Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.

The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

“…Firstly, the implementation of RCTs on patient education in the future should strictly follow the Consolidated Standards of Reporting Trials (CONSORT) statement to improve the quality of research ( 82 ). Secondly, researchers should complete registration at a standard clinical study center before starting a clinical study, and complete study protocols should be published to reduce publication bias ( 83 ). Finally, clinical studies should extend the duration of follow-up and increase the frequency of follow-up to assess the long-term efficacy of interventions.…”

Immediate effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: A factorial randomized trial

“…MRT is underlined by mechanisms that are not fully understood [35,36], however, it seems to induce fibroblasts to upregulate the production of anti-inflammatory cytokines and growth factors [37]; and (1.3) Effects: MRT shows mixed results for treating painful (often chronic) musculoskeletal conditions [33,34,38] as it reduces pain and improves function in patients with cLBP [39] while reducing disability, but not pain, in patients with LBP [40]…”

“…Herein, we provide an overview about the definition, mechanisms, and effects of three manual techniques frequently used in the osteopathic field: (1) Myofascial release technique (MRT) : (1.1) Definition : MRT uses pressure and stretch with low load and long duration (which are adjusted based on palpatory feedback) to release myofascial tissues [33, 34]; (1.2) Mechanisms : MRT is underlined by mechanisms that are not fully understood [35, 36], however, it seems to induce fibroblasts to upregulate the production of anti-inflammatory cytokines and growth factors [37]; and (1.3) Effects : MRT shows mixed results for treating painful (often chronic) musculoskeletal conditions [33, 34, 38] as it reduces pain and improves function in patients with cLBP [39] while reducing disability, but not pain, in patients with LBP [40]; (2) Muscle energy technique (MET) : (2.1) Definition : MET involves instructing the patient to voluntarily contract muscles into a controlled direction against the therapist counter-pressure [41]; (2.2) Mechanisms : MET has unclear mechanisms of action with some speculating changes in proprioception, inflammation, and fluid circulation [42] and others emphasising post-isometric relaxation and reciprocal inhibition [43]; and (2.3) Effects : MET is effective in improving pain, disability, and range of motion in symptomatic and asymptomatic subjects, specifically in chronic MSDs like cLBP [43]; and (3) Soft tissue technique (STT) : (3.1) Definition : STT applies stretch, traction and/or deep pressure to soft tissues [32]; herein, we used repeated, slow, and deep pressure gliding strokes applied with the thumb alongside the muscle fibres, which is a STT that is similar to muscle stripping massage [44–46]; (3.2) Mechanisms : STT (or therapeutic massage, respectively) might work through mechanotransduction [47, 48] albeit other biomechanical, physiological, neurological, and psychological mechanisms are not to be disregarded [49, 50]; and (3.3) Effects : STT (or massage therapy, respectively) benefits patients with LBP [51, 52] and improves pain and function in patients with cLBP in the short-term [50].…”

The short-term effect of a myofascial protocol versus light touch applied to the cervical spine towards the prevention of balance disorders in the elderly: protocol of a randomised controlled trial

“…However, there is no consensus on the frequency or number of treatments necessary with MFR, regardless of the reason for which they are used, for example: chronic low back pain, fibromyalgia, functional capacities… [39,40]. Whatever the modality of application (massage or osteopathic manual therapy) or location (lower limb or trunk) it seems that only one MFR session have a limited or even non-existent effect on balance [41,42] while recent studies have shown that two sessions can [43,44].…”