Distance electrotherapy versus low pulsed electromagnetic field in the treatment of lower back myofascial syndrome: A randomized control trial
Main Article Content
Keywords
Distance electrotherapy, Lower back myofascial syndrome, Low pulsed electromagnetic field, Traditional physical therapy.
Abstract
Background: The impact of low back pain is about 60% - 90% of the working-age population in the industrial society. Myofascial pain syndrome is characterized by shortening of the muscles with increased tone and associated with trigger points that aggravated during the activity of daily living.
Objective: To compare the effects of distance electrotherapy versus low pulsed electromagnetic fields on the treatment of lower back myofascial syndrome.
Methods: The 60 participants in this randomized, double-blinded, pre-post experimental study with lower back myofascial syndrome ranged in age from 30 to 50. The participants were classified into three groups at random and the three groups received the same traditional physical therapyprogram; group (A) (n = 20), which received distance electrotherapy, group (B) (n = 20),which received low
pulsed electromagnetic field and group (C) (n=20) which received traditional physical therapy alone. Visual analog scale (VAS), Oswestry disability Questionnaire (ODQ) and the inclinometer were used to quantify pain intensity, functional disability and lumbar range of motion (ROM) for flexion and extension respectively, at the baseline and four weeks following therapy.
Results: Within-group comparisons revealed statistically significant improvements (P<0.05) in all outcome measures across all groups. All outcome measures for all groups showed a significant improvement in the between-group comparisons (P<0.05), with the distance electrotherapy group improving more than the low pulsed electromagnetic group.
Conclusion: Lower back myofascial syndrome can be effectively treated with distance electrotherapy, low pulsed electromagnetic field and traditional physical therapy, with distance electrotherapy being superior to both of these treatments.
References
1. Simons DG, Travell JG. Myofascial origins of low back pain: 1. Principles of diagnosis and treatment. Postgraduate Medicine. 1983; 73(2): 66-77.
2. Lavelle ED, Lavelle W, Smith H S. Myofascial trigger points. Anesthesiology clinics. 2007; 25(4):841-851.
3. Gerwin RD. A review of myofascial pain and fibromyalgia–factors that promote their persistence. AcupunctureMedicine.2005; 23(3):
121-134.
4. Pearce JMS. Myofascial pain, fibromyalgia or fibrositis?. European neurology.2004;52(2): 67- 72.
5. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Current Pain and Headache Reports.2012; 16(5): 439-444.
6. Hains G. Locating and treating low back pain of myofascial origin by ischemic compression. The Journal of the Canadian Chiropractic Association. 2002; 46(4): 257-267.
7. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. Journal of Manual & Manipulative
Therap. 2006;14(4): 203-221.
8. Hazlewood CF, Markov MS, Kostarakis P. Magnetic fields for relief of myofascial and/or low back pain through trigger points.
In Proceedings of Forth International Workshop Biological effects of electromagnetic fields . 2006 October; Vol. 475, 483.
9. MarkovMS. Expanding use of pulsed electromagnetic field therapies. Electromagnetic biology and medicine. 2007; 26(3): 257-274.
10. Thomas AW, GrahamK, Prato FS, McKayJ, Forster PM, Moulin DE, ChariS. A randomized, double-blind, placebo-controlled clinical trial
using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain. Pain Research and Management. 2007; 12(4): 249- 258.
11. Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Therapeutic effects of peripheral repetitive magnetic stimulation on
myofascial pain syndrome. Clinical neurophysiology. 2003; 114(2): 350-358.
12. EMBITRON Ltd.VAS-07 [internet], accessed on 2023 February 4, Available fromhttps://www.embitron.cz/en/vas-07/.
13. RajfurJ, PasternokM, RajfurK, Walewicz K, Fras B, BolachB, Taradaj J. Efficacy of selected electrical therapies on chronic low back pain: a comparative clinical pilot study. Medical Science Monitor. 2017; 23: 85-100.
14. Facci LM, Nowotny JP, Tormem F, Trevisani VFM. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Medical Journal. 2011; 129(4): 206-216.
15. Lin YP, SuYH, Chin SF, Chou YC, Chia WT. Light-emitting diode photobiomodulation therapy for non-specific low back pain in working
nurses: A single-center, double-blind, prospective, randomized controlled trial. Medicine. 2020; 99(32): e21611.
16. El Shiwi AMF. Effectof magnetic field in treatment of lower back myofascial painsyndrome: A randomized controlled trial. Egyptian Journal of Occupational Medicine. 2014; 38(1): 95-109.
17. Marc A. Pain measurement. P. Prithvi Ray: pain medicine a comprehensive review, Mosby, Los Angeles, California, USA. 2001;36-37.
18. Davidson M, Keating J. Oswestry disability questionnaire (ODQ). Australian Journal of Physiotherapy. 2005; 51(4):270.
19. Williams R, Binkley J, Bloch R, Goldsmith CH, Minuk T. Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Physical therapy. 1993; 73(1): 26-37.
20. Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential
therapy for acute low back pain.Spine (Phila Pa 1976). 2004; 29(20): 2207-2216.
21. Lee M, Song C, Jo Y, Ha D, Han D. The effects of core muscle release technique on lumbar spine deformation and low back pain.The Journal of Physical Therapy Science. 2015; 27(5): 1519- 1522.
22. WernersR., Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and
massage in the management of low back pain in a primary care setting. Spine (Phila Pa 1976).1999; 24(15): 1579-1584.
23. Johnson MI, Tabasam GA. single-blind placebocontrolled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects. Clinical physiology and functional imaging journal. 2002; 22(3): 187-196.
24. MelzackR ,Wall PD. Pain Mechanisms: A New Theory: A gate control system modulates sensory input from the skin before it evokes pain perception and response. Science. 1965; 150(3699): 971-979.
25. Fulop AM, Dhimmer S, Deluca JR, Johanson DD, Lenz RV, Patel KB, Enwemeka CS. A metaanalysis of the efficacy of laser phototherapy on pain relief. Clinical journal of pain.2010; 26(8): 729-736.
26. Tantawy SA, Kamel DM, Abdelbasset WK, Nambi G. A randomized controlled trial investigating the impact of interferential therapy
on pain, range of motion and quality of life in patients with chronic non-specific low back pain. Archives of the Balkan Medical Union.
2020; 55(1): 47-54.
27. Elshiwi AM, Hamada HA, Mosaad D, Ragab I. MA., Koura GM., Alrawaili, S. M. Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial. Brazilian journal of physical therapy. 2019; 23(3): 244-249.
28. Lee PB, Kim YC., Lim YJ, Lee CJ, Choi SS, Park SH, Lee SC. Efficacy of pulsed electromagnetic therapy for chronic lower back pain: a
randomized, double-blind, placebo-controlled study. Journal of International Medical Research. 2006; 34(2): 160-167.
29. OkeKI,Umebese PFA. Evaluation of the efficacy of pulsed electromagnetic therapy in the treatment of back pain: a randomized controlled trial in a tertiary hospital in Nigeria. West indian medical journal. 2013; 62(3): 205-209.
30. Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L. Low-amplitude, extremely low frequency magnetic fields for they treatment of osteoarthritic knees: A double-blind clinical study. Alternative therapies in health and medicine. 2001; 7(5): 54-64.
31. Hinman MR, Ford J, Heyl H. Effects of static magnets on chronic knee pain and physical function: a double-blind study. Alternative
therapies in health and medicine. 2002; 8(4): 50.
32. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. Journal of neurophysiology. 2013; 109(1): 5-12.
33. Malmivuo J, Plonsey R. Bioelectromagnetism: principles and applications of bioelectric and biomagnetic fields. Oxford University Press, USA.1995.
34. Moffett J, Fray LM, Kubat NJ. Activation of endogenous opioid gene expression in human keratinocytes and fibroblasts by pulsed
radiofrequency energy fields. Journal of Pain Research. 2012; 347-357.
35. Lisi AJ., Scheinowitz M, Saporito R, Onorato A. A pulsed electromagnetic field therapy device for non-specific low back pain: a pilot randomized controlled trial. Pain and therapy. 2019; 8 (1): 133-140.
36. Holcomb R. Biomagnetics in the treatment of human pain-past, present, future. Environmental media association. 1991; 8(2): 24-30.
37. Van Nguyen J, Marks R. Pulsed electromagnetic fields for treating osteo-arthritis. Physiotherapy. 2002; 88(8): 458-470.
38. Trock DH, Bollet AJ, Dyer Jr, RH, Fielding LP, Miner WK, Markoll R.A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. The Journal of rheumatology. 1993; 20(3):456-460.
39. Draper DO, Schulthies S, Sorvisto P, Hautala AM. Temperature changes in deep muscles of humans during ice and ultrasound therapies: an in vivo study. Journal of Orthopaedic& Sports Physical Therapy. 1995;21(3): 153-157.
40. Reed BV, Ashikaga T, Fleming BC, Zimny NJ. Effects of ultrasound and stretch on knee ligament extensibility. Journal of Orthopaedic& Sports Physical Therapy. 2000; 30(6): 341-347.
41. Khalil TM., AsfourSS., MartinezLM.,WalySM., RosomoffRS, Rosomoff HL. Stretching in the rehabilitation of low-back pain patients. Spine. 1992; 17(3): 311-317.
42. O'Sullivan PB, Phyty GDM, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain
with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997; 22(24): 2959- 2967.
43. Van Middelkoop M., Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal. 2011; 20 (1): 19-39.
44. Magnusson ML, Bishop JB, Hasselquist L, Spratt KF, Szpalski M, Pope MH. Range of motion and motion patterns in patients with low back pain before and after rehabilitation. Spine. 1998; 23(23):2631-2639.
45. Battié MC, Bigos SJ, Fisher LD, Spengler DM, Hansson TH, Nachemson AL, Wortley MD. The role of spinal flexibility in back pain complaints within industry: a prospective study. Spine. 1990;15(8): 768-773.
46. Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. The Tohoku journal of experimental medicine. 2020; 251(3): 193-206.
47. Sullivan MS, Shoaf LD, Riddle DL. The relationship of lumbar flexion to disability in patients with low back pain.Physical therapy.
2000; 80(3):240-250.
2. Lavelle ED, Lavelle W, Smith H S. Myofascial trigger points. Anesthesiology clinics. 2007; 25(4):841-851.
3. Gerwin RD. A review of myofascial pain and fibromyalgia–factors that promote their persistence. AcupunctureMedicine.2005; 23(3):
121-134.
4. Pearce JMS. Myofascial pain, fibromyalgia or fibrositis?. European neurology.2004;52(2): 67- 72.
5. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Current Pain and Headache Reports.2012; 16(5): 439-444.
6. Hains G. Locating and treating low back pain of myofascial origin by ischemic compression. The Journal of the Canadian Chiropractic Association. 2002; 46(4): 257-267.
7. Dommerholt J, Bron C, Franssen J. Myofascial trigger points: an evidence-informed review. Journal of Manual & Manipulative
Therap. 2006;14(4): 203-221.
8. Hazlewood CF, Markov MS, Kostarakis P. Magnetic fields for relief of myofascial and/or low back pain through trigger points.
In Proceedings of Forth International Workshop Biological effects of electromagnetic fields . 2006 October; Vol. 475, 483.
9. MarkovMS. Expanding use of pulsed electromagnetic field therapies. Electromagnetic biology and medicine. 2007; 26(3): 257-274.
10. Thomas AW, GrahamK, Prato FS, McKayJ, Forster PM, Moulin DE, ChariS. A randomized, double-blind, placebo-controlled clinical trial
using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain. Pain Research and Management. 2007; 12(4): 249- 258.
11. Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Therapeutic effects of peripheral repetitive magnetic stimulation on
myofascial pain syndrome. Clinical neurophysiology. 2003; 114(2): 350-358.
12. EMBITRON Ltd.VAS-07 [internet], accessed on 2023 February 4, Available fromhttps://www.embitron.cz/en/vas-07/.
13. RajfurJ, PasternokM, RajfurK, Walewicz K, Fras B, BolachB, Taradaj J. Efficacy of selected electrical therapies on chronic low back pain: a comparative clinical pilot study. Medical Science Monitor. 2017; 23: 85-100.
14. Facci LM, Nowotny JP, Tormem F, Trevisani VFM. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Medical Journal. 2011; 129(4): 206-216.
15. Lin YP, SuYH, Chin SF, Chou YC, Chia WT. Light-emitting diode photobiomodulation therapy for non-specific low back pain in working
nurses: A single-center, double-blind, prospective, randomized controlled trial. Medicine. 2020; 99(32): e21611.
16. El Shiwi AMF. Effectof magnetic field in treatment of lower back myofascial painsyndrome: A randomized controlled trial. Egyptian Journal of Occupational Medicine. 2014; 38(1): 95-109.
17. Marc A. Pain measurement. P. Prithvi Ray: pain medicine a comprehensive review, Mosby, Los Angeles, California, USA. 2001;36-37.
18. Davidson M, Keating J. Oswestry disability questionnaire (ODQ). Australian Journal of Physiotherapy. 2005; 51(4):270.
19. Williams R, Binkley J, Bloch R, Goldsmith CH, Minuk T. Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Physical therapy. 1993; 73(1): 26-37.
20. Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential
therapy for acute low back pain.Spine (Phila Pa 1976). 2004; 29(20): 2207-2216.
21. Lee M, Song C, Jo Y, Ha D, Han D. The effects of core muscle release technique on lumbar spine deformation and low back pain.The Journal of Physical Therapy Science. 2015; 27(5): 1519- 1522.
22. WernersR., Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and
massage in the management of low back pain in a primary care setting. Spine (Phila Pa 1976).1999; 24(15): 1579-1584.
23. Johnson MI, Tabasam GA. single-blind placebocontrolled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects. Clinical physiology and functional imaging journal. 2002; 22(3): 187-196.
24. MelzackR ,Wall PD. Pain Mechanisms: A New Theory: A gate control system modulates sensory input from the skin before it evokes pain perception and response. Science. 1965; 150(3699): 971-979.
25. Fulop AM, Dhimmer S, Deluca JR, Johanson DD, Lenz RV, Patel KB, Enwemeka CS. A metaanalysis of the efficacy of laser phototherapy on pain relief. Clinical journal of pain.2010; 26(8): 729-736.
26. Tantawy SA, Kamel DM, Abdelbasset WK, Nambi G. A randomized controlled trial investigating the impact of interferential therapy
on pain, range of motion and quality of life in patients with chronic non-specific low back pain. Archives of the Balkan Medical Union.
2020; 55(1): 47-54.
27. Elshiwi AM, Hamada HA, Mosaad D, Ragab I. MA., Koura GM., Alrawaili, S. M. Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial. Brazilian journal of physical therapy. 2019; 23(3): 244-249.
28. Lee PB, Kim YC., Lim YJ, Lee CJ, Choi SS, Park SH, Lee SC. Efficacy of pulsed electromagnetic therapy for chronic lower back pain: a
randomized, double-blind, placebo-controlled study. Journal of International Medical Research. 2006; 34(2): 160-167.
29. OkeKI,Umebese PFA. Evaluation of the efficacy of pulsed electromagnetic therapy in the treatment of back pain: a randomized controlled trial in a tertiary hospital in Nigeria. West indian medical journal. 2013; 62(3): 205-209.
30. Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L. Low-amplitude, extremely low frequency magnetic fields for they treatment of osteoarthritic knees: A double-blind clinical study. Alternative therapies in health and medicine. 2001; 7(5): 54-64.
31. Hinman MR, Ford J, Heyl H. Effects of static magnets on chronic knee pain and physical function: a double-blind study. Alternative
therapies in health and medicine. 2002; 8(4): 50.
32. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. Journal of neurophysiology. 2013; 109(1): 5-12.
33. Malmivuo J, Plonsey R. Bioelectromagnetism: principles and applications of bioelectric and biomagnetic fields. Oxford University Press, USA.1995.
34. Moffett J, Fray LM, Kubat NJ. Activation of endogenous opioid gene expression in human keratinocytes and fibroblasts by pulsed
radiofrequency energy fields. Journal of Pain Research. 2012; 347-357.
35. Lisi AJ., Scheinowitz M, Saporito R, Onorato A. A pulsed electromagnetic field therapy device for non-specific low back pain: a pilot randomized controlled trial. Pain and therapy. 2019; 8 (1): 133-140.
36. Holcomb R. Biomagnetics in the treatment of human pain-past, present, future. Environmental media association. 1991; 8(2): 24-30.
37. Van Nguyen J, Marks R. Pulsed electromagnetic fields for treating osteo-arthritis. Physiotherapy. 2002; 88(8): 458-470.
38. Trock DH, Bollet AJ, Dyer Jr, RH, Fielding LP, Miner WK, Markoll R.A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis. The Journal of rheumatology. 1993; 20(3):456-460.
39. Draper DO, Schulthies S, Sorvisto P, Hautala AM. Temperature changes in deep muscles of humans during ice and ultrasound therapies: an in vivo study. Journal of Orthopaedic& Sports Physical Therapy. 1995;21(3): 153-157.
40. Reed BV, Ashikaga T, Fleming BC, Zimny NJ. Effects of ultrasound and stretch on knee ligament extensibility. Journal of Orthopaedic& Sports Physical Therapy. 2000; 30(6): 341-347.
41. Khalil TM., AsfourSS., MartinezLM.,WalySM., RosomoffRS, Rosomoff HL. Stretching in the rehabilitation of low-back pain patients. Spine. 1992; 17(3): 311-317.
42. O'Sullivan PB, Phyty GDM, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain
with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997; 22(24): 2959- 2967.
43. Van Middelkoop M., Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal. 2011; 20 (1): 19-39.
44. Magnusson ML, Bishop JB, Hasselquist L, Spratt KF, Szpalski M, Pope MH. Range of motion and motion patterns in patients with low back pain before and after rehabilitation. Spine. 1998; 23(23):2631-2639.
45. Battié MC, Bigos SJ, Fisher LD, Spengler DM, Hansson TH, Nachemson AL, Wortley MD. The role of spinal flexibility in back pain complaints within industry: a prospective study. Spine. 1990;15(8): 768-773.
46. Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. The Tohoku journal of experimental medicine. 2020; 251(3): 193-206.
47. Sullivan MS, Shoaf LD, Riddle DL. The relationship of lumbar flexion to disability in patients with low back pain.Physical therapy.
2000; 80(3):240-250.
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Mar 13, 2023
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Yomna F. Ahmed, Ragaee Saeed Mahmoud, Sara S. El-Din, Alaa A. Ahmed, & Reham M. Abdelrahim. (2023). Distance electrotherapy versus low pulsed electromagnetic field in the treatment of lower back myofascial syndrome: A randomized control trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), 94-105. https://doi.org/10.47750/jptcp.2023.30.03.012
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Yomna F. Ahmed, Ragaee Saeed Mahmoud, Sara S. El-Din, Alaa A. Ahmed, & Reham M. Abdelrahim. (2023). Distance electrotherapy versus low pulsed electromagnetic field in the treatment of lower back myofascial syndrome: A randomized control trial. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), 94-105. https://doi.org/10.47750/jptcp.2023.30.03.012