Strain-Counterstrain therapy combined with exercise is not more effective than exercise alone on pain and disability in people with acute low back pain: a randomised trial

Question: Is Strain-Counterstrain treatment combined with exercise therapy more effective than exercise alone in reducing levels of pain and disability in people with acute low back pain? Design: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Participants: 89 (55 female) participants between 18 and 55 years experiencing acute low back pain were randomised to experimental (n = 44) and control (n = 45) groups. Intervention: Participants attended four treatments in two weeks. The experimental group received Strain-Counterstrain treatment and review of standardised exercises (abdominal bracing, knee to chest, and lumbar rotation). The control group performed the standardised exercises under supervision. Following the intervention period, all participants received exercise progression, manual therapy, and advice. Outcome measures: The primary outcome was the modified Oswestry low back pain disability questionnaire, measured at 2 weeks (ie, end of treatment), 6 weeks, and 28 weeks. Secondary outcome measures included the SF-36, visual analogue scale pain ratings, and a 7-point global rating of change. Results: The experimental intervention was not more effective than exercise alone in reducing levels of pain and disability. Mean between-group differences in change from baseline for the Oswestry Disability Index were 0 (95% Cl -6 to 7) after treatment, -1 (95% Cl -7 to 6) at 6 weeks, and 2 (95% Cl -4 to 8) at 28 weeks. Other outcomes did not differ significantly between groups. Conclusion: There is no advantage in providing Strain-Counterstrain treatment to patients with acute low back pain, although further studies could examine whether a subset of these patients can benefit from the treatment. Trial registration: ACTRN 12609000084280. [Lewis C, Souvlis T, Sterling M (2011) Strain-Counterstrain therapy combined with exercise is not more effective than exercise alone on pain and disability in people with acute low back pain: a randomised trial. Journal of Physiotherapy 57: 91-98]