Impact of 3-dimensional myofascial release on tumor necrosis factor (TNF) alpha biomarker in nonspecific low back pain: a randomised controlled trial.

BACKGROUND: 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. METHODOLOGY: 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. RESULTS: 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). CONCLUSION: 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.