The Somatic Connection  |   July 2014
Myofascial Release Increases Effectiveness in Management of Chronic Low Back Pain
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   July 2014
Myofascial Release Increases Effectiveness in Management of Chronic Low Back Pain
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 586-587. doi:
The Journal of the American Osteopathic Association, July 2014, Vol. 114, 586-587. doi:
Ajimsha MS, Daniel B, Chithra S. Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. J Bodyw Mov Ther. 2014;18(2):273-281. doi:10.1016/j.jbmt.2013.05.007.  
Myofascial release (MFR) is one of the more frequently applied and studied osteopathic manipulative treatment techniques. A recently published study by Ajimsha et al showed that specific back exercise plus MFR manual therapy was more effective than specific back exercise plus sham therapy in the management of chronic low back pain. In the study, carried out in India, 80 nursing professionals aged 20 to 40 years who had a primary diagnosis of chronic low back pain (low back pain ⩾3 months) were recruited. Exclusion criteria were conditions possibly adversely affected by MFR. 
Outcome measures included scores on the Pain Rating Index, as determined using the McGill Pain Questionnaire, and the Quebec Back Pain Disability Scale, which measures one's ability to perform activities of daily living. Measures were taken at baseline, 8 weeks, and 12 weeks after the first intervention. 
Participants were randomly assigned to 1 of 2 groups: an MFR group or a sham MFR group (ie, control group). Participants received an MFR protocol or a sham MFR protocol, as well as specific back exercises for chronic low back pain, 3 times per week for 8 weeks. Each session was 60 minutes in duration, with 40 minutes allocated for the intervention and 20 minutes allocated for specific back exercises. All participants watched the same 15-minute video that oriented them to the specific back exercise program. 
On the basis of the authors' descriptions, the MFR used in the study appeared to be slightly more firm than that usually administered by osteopathic physicians. Specifically, longer durations of firm elbow, hand, and finger pressure were applied. For the sham MFR in the control group, the same areas of the body were contacted for the same amount of time, with the therapist gently placing his or her hand over the same areas to which manual therapy was applied in the MFR group. 
Results showed that outcome measures in both groups were comparable at baseline. At 8 weeks, outcomes in both groups had improved, but the MFR group showed statistically significantly more improvement on both outcome measures. Beneficial effects were also present at 12 weeks (4 weeks after intervention ceased). 
This study showed “light touch” to be an effective sham therapy. However, in osteopathic research, light touch has been shown to have effects.1 I believe the difference in outcomes is a result of the way osteopathic palpatory skills and manipulative treatment are taught and applied. Osteopathic manipulative treatment curriculum emphasizes observing continuous palpatory feedback as one assesses musculoskeletal structures. Mentally, the osteopathic physician cannot help but be aware of, and respond to, the quality of the tissues contacted. This perceptive response, coupled with the body-mind-spirit aspect of osteopathic medical philosophy that further heightens awareness, probably conveys nonspecific effects when applied in research protocols. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (, or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (
Noll DR, Degenhardt BF, Morley TFet al. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2. doi:10.1186/1750-4732-4-2. [CrossRef] [PubMed]