Positional release technique in the management of low back pain: A systematic review and meta-analysis

This systematic review aimed to evaluate the effects of positional release technique (PRT) on clinically relevant outcomes in the management of low back pain (LBP) of any type and duration.

An electronic database search for trials was conducted on CINAHL (EBSCOhost), EMBASE (Ovid), PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), Osteopathic Medicine Digital Repository, Science Direct, Scopus, and Google Scholar from inception until July 31st, 2021. Two independent reviewers screened the retrieved citations against pre-defined eligibility criteria. Quality assessment was performed using the PEDro scale and the strength of the overall evidence was evaluated using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.

3276 citations were retrieved out of which 18 trials (14 with high risk of bias) involving 918 adults with LBP were included. Low certainty evidence indicated that muscle energy technique (MET) was superior to PRT at improving activity limitation (MD = 1.8, CI = 0.7 to 2.8) and lumbar extension (MD = -0.15, CI = -0.3 to -0.01). Very low certainty evidence indicated that PRT plus conventional physiotherapy (CPT) was superior to CPT at improving back pain intensity (MD = -1.7, CI = -2.4 to -1.0), activity limitation (MD = -6.3, CI = -11.5 to -1.0) and lumbar extension (SMD = 2.8, CI = 0.4 to 5.2). Sensitivity analyses confirmed these findings.

Currently, there is very low certainty evidence that PRT is superior at improving LBP intensity, activity limitation and range of motion when used in combination with other treatments but not when utilized as a stand-alone treatment for LBP. Future RCTs with a low risk of bias are very likely to change these findings.

PROSPERO-CRD42019129758).