Low Back PainNCT07729774
Spray and Stretch Technique Versus Strain Counter Strain in Patients With Non Specific Low Back Pain
A study testing Spray and stretch technique on Hamstring Muscle and Strain and counter strain technique on hamstring muscle in people with Low Back Pain, run by Riphah International University at 1 site in Pakistan.
Trial summary
Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Read more about this study
- Who is it for?
- Ages 35 to 50 years
- Conditions the study is for
- Low Back Pain
- What is being tested?
- Spray and stretch technique on Hamstring Muscle and Strain and counter strain technique on hamstring muscle
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 sitePakistan
- Study dates
- 20 Jun 2026to 20 Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 35 to 50 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- AGE(35 to 50)
- Gender (both male and female)
- Negative lasegue test
- Negative slump test
- Negative prone instability test
Who cannot join
- Fracture or instability (4)
- History of cancer
- Inflammatory condition like ankylosing spondylitis
- Neurological deficits like cauda equina syndrome or motor weakness
- History of previous of previous lumber surgery
- Pregnancy
Show all 10Show fewer
- Structural deformity like scoliosis
- Herniated disc
- Nerve compression
- Spinal stenosis
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Ibne sina hospital and research institute.
Multan, Punjab Province
Sajad Rasheed, MS-OMPT, 0300 6309825, sajidch71@hotmail.com
About this study
Official title: Comparative Effect of Spray and Stretch Technique Versus Strain Counter Strain on Hamstring Muscles for Pain , Disability and Mobility in Patients With Non Specific Low Back Pain
Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Non specific low back pain is posteriorly occurring that is located between lower rib margin and gluteal fold. It is exacerbated by sustained back postures, back movements or back muscle imbalances. The aim of study is to find out which technique whether Spray and stretch technique or strain Counter strain works better in reducing pain ,improving movement ,and decreasing disability caused by tight hamstring muscles in people with non specific low Back Pain.
Read the detailed description
This double blinded randomized Clinical Trial will be conducted at Ibne Siena Hospital MULTAN through consecutive sampling technique on 30 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with spray and stretch technique and Group B will be treated with strain counter technique at the frequency of 2 sets with 5 repetitions and thrice a week. Outcome measures will be conducted through NPRS, ODI, AKE ,PKET and SLR before treatment and after 4 weeks. Data will be analyzed during SPSS software version 26. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non parametric test will be used within a group or between two groups.
- Conditions
- Low Back Pain
- Being tested
- Spray and stretch technique on Hamstring Muscle, Strain and counter strain technique on hamstring muscle
- Keywords
- low back pain, strain counter strain technique, mobility
- Medical subject headings
- Low Back Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Spray and stretch technique on Hamstring MuscleOther
The participant will be positioned in a comfortable supine lying position on a treatment table in a quiet and suitable clinical environment. Before starting the intervention, the procedure will be explained to the participant in simple language, and verbal confirmation of comfort will be obtained. The affected lower limb will be exposed appropriately while ensuring privacy, modesty, and warmth through proper draping with towels or sheets. The participant will be instructed to relax the lower limb during the procedure. The hip will be maintained in a neutral position, and the knee will be kept straight or slightly flexed according to the participant's comfort before the stretching component begins.
The therapist will first inspect the posterior thigh region to ensure that the skin is intact and suitable for vapocoolant application. The presence of any open wound, skin infection, rash, hypersens
Strain and counter strain technique on hamstring muscleOther
identify the tender point Palpate the hamstring while the patient is prone or side lying locate the most tender point in belly of the muscle or near the ischial tuberosity Establish a pain scale and Ask the patient to rate the tenderness from 0 to 10 (10 being the most painful).Position of ease will be achieved by Flexing the patient's knee to about 70 to 90 degrees .Slightly abduct and externally rotate the leg to shorten the hamstring muscle (the position may vary depending on the muscle .The goal is to reduce tenderness by at least 70% .Hold the position and Maintain this position of comfort for 90 seconds Encourage the patient to relax during this time .Return the leg passively to a neutral position to avoid reactivating the trigger point .Palpate the tender point again and ask for a new pain rating.
| Study group | Role | What they receive |
|---|---|---|
| Spray and stretch technique on Hamstrings muscle | Experimental | The spray and stretch technique is a physical therapy method used to inactivate myofascial trigger points, reduce muscle spasms, and increase range of motion. It works by applying a vapocoolant spray to numb the skin, which interrupts the pain signal, allowing the therapist to safely stretch the muscle Receives: Other: Spray and stretch technique on Hamstring Muscle |
| Strain and counter strain technique on Hamstring muscle | Active comparator | Strain-Counterstrain (SCS) is a gentle, hands-on physical therapy technique used to relieve low back pain by "resetting" the nervous system. By placing the body in specific, pain-free positions, it relaxes tight muscles, reduces muscle guarding, and improves mobility Receives: Other: Strain and counter strain technique on hamstring muscle |
What is being measured
The primary outcome is the main question the study is designed to answer.
Numeric pain rate scale (NPRS)
Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale. Participants will rate their current low back pain from 0 to 10, where 0 indicates "no pain" and 10 indicates the "worst imaginable pain." The score will be recorded in points, with higher scores indicating greater pain intensity.
Measured: Baseline and after 4 weeks of intervention
Active knee extension
Hamstring flexibility will be assessed using the Active Knee Extension Test. The participant will lie in the supine position with the hip flexed to 90 degrees and will actively extend the knee as far as possible while maintaining the hip position. The knee extension angle will be measured in degrees using a goniometer. A smaller knee-flexion deficit indicates greater hamstring flexibility.Positive AKE (For males, a positive knee extension angle is >33.0°, whereas for females, it is >24)
Measured: Baseline and after 4 weeks of intervention
Passive knee extension test (PKET)
Hamstring flexibility will be assessed using the Passive Knee Extension Test. With the participant in the supine position and the hip maintained at 90 degrees of flexion, the examiner will passively extend the knee until resistance or discomfort is reached. The knee extension angle will be measured in degrees using a goniometer. A greater knee-extension angle indicates greater hamstring flexibility.
Measured: Baseline and after 4 weeks
Oswestry Disability Index
Low back pain-related disability will be assessed using the Oswestry Disability Index. The questionnaire contains 10 sections, with each section scored from 0 to 5. The total score will be converted into a percentage ranging from 0% to 100%, where higher scores indicate greater disability.
Measured: Baseline and after 4 weeks
Straight leg raise
Straight leg raise range of motion will be assessed with the participant in the supine position. The examiner will passively raise the participant's lower limb while maintaining the knee in extension until resistance or discomfort is reported. The hip-flexion angle will be measured in degrees using a goniometer. A greater angle indicates greater posterior-chain flexibility and straight leg raise range of motion.
Measured: Baseline and after 4 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Jul 2026
- Study start20 Jun 2026
- Primary completion20 Aug 2026 (estimated)
- Study completion20 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Low Back PainStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Amna Zia, PhD*, Principal investigator, Riphah International University, LahoreZaib un Nisa, Principal investigator, Riphah International University, Lahore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07729774
- Sponsor's protocol ID
- REC/RCR & AHS/25/0135 Nisa
- Status last verified
- Jul 2026
- First submitted
- 21 Jul 2026
- Last updated
- 28 Jul 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Koura G, Hamada H, Mohamed YE, Balbaa AA, El-Nassag BA, Baghdadi ARJHM. Impact of strain-counterstrain on treatment of acute nonspecific low back pain: a single-blind randomized controlled trial. 2020;22(1):42-9.
Seif HE, Alenazi A, Hassan SM, Kachanathu SJ, Hafez ARJOJoT, Rehabilitation. The effect of stretching hamstring, gastrocnemius, iliopsoas and back muscles on pain and functional activities in patients with chronic low back pain: a randomized clinical trial. 2015;3(4):139-45.
Shipton EA. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther. 2018 Dec;7(2):127-137. doi: 10.1007/s40122-018-0105-x. Epub 2018 Sep 18.
PubMed 30229473Gou Y, Lei H, Chen X, Wang X. The effects of hamstring stretching exercises on pain intensity and function in low back pain patients: A systematic review with meta-analysis of randomized controlled trials. SAGE Open Med. 2024 Jul 29;12:20503121241252251. doi: 10.1177/20503121241252251. eCollection 2024.
PubMed 39086556Haile G, Hailemariam TT, Haile TG. Effectiveness of Ultrasound Therapy on the Management of Chronic Non-Specific Low Back Pain: A Systematic Review. J Pain Res. 2021 May 17;14:1251-1257. doi: 10.2147/JPR.S277574. eCollection 2021.
PubMed 34040429Riaz SA, Usman MJPJoR. Effect of Static Stretching of Hamstring on Non-Specific Low Back Pain. 2023;12(1):43-51.
Dobija L, Pereira B, Cohen-Aknine G, Roren A, Dupeyron A, Coudeyre E. Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain. Heliyon. 2023 Sep 4;9(9):e19753. doi: 10.1016/j.heliyon.2023.e19753. eCollection 2023 Sep.
PubMed 37810115Ahmed J, Anwar K, Sajjad AGJRJoHS. Effects of strain counter strain technique in treatment of chronic mechanical low back pain: a randomized controlled trail. 2021;3(2):85-91
Hariharasudhan R, Balamurugan JJSjosm. A randomized double-blinded study of effectiveness of strain counter-strain technique and muscle energy technique in reducing pain and disability in subjects with mechanical low back pain. 2014;14(2):83-8.
Ellythy MAJBFPT. Efficacy of muscle energy technique versus strain counter strain on low back dysfunction. 2012;17(2):29-35.
Study at a glance
From the registry record, last updated by the sponsor on 28 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Effect of Spray and Stretch Technique Versus Strain Counter Strain on Hamstring Muscles for Pain , Disability and Mobility in Patients With Non Specific Low Back Pain
- ClinicalTrials.gov ID
- NCT07729774
- Acronym / sponsor ID
- REC/RCR & AHS/25/0135 Nisa
- Conditions
- Low Back Pain
- Keywords
- low back pain, strain counter strain technique, mobility
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 30 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 20 Jun 2026 (actual)
- Primary completion
- 20 Aug 2026 (estimated)
- Study completion
- 20 Sep 2026 (estimated)
- First posted
- 28 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Non-specific low back pain refers to pain in the lower back region that cannot be attributed to a specific identifiable pathology such as infection, tumor, osteoporosis, lumbar disc herniation, spinal stenosis or fracture. It is the most common type of low back pain, accounting for about 85-90% of cases. Non specific low back pain is posteriorly occurring that is located between lower rib margin and gluteal fold. It is exacerbated by sustained back postures, back movements or back muscle imbalances. The aim of study is to find out which technique whether Spray and stretch technique or strain Counter strain works better in reducing pain ,improving movement ,and decreasing disability caused by tight hamstring muscles in people with non specific low Back Pain.
Detailed description
This double blinded randomized Clinical Trial will be conducted at Ibne Siena Hospital MULTAN through consecutive sampling technique on 30 patients which will be allocated using simple random sampling through sealed opaque enveloped into Group A and Group B. Group A will be treated with spray and stretch technique and Group B will be treated with strain counter technique at the frequency of 2 sets with 5 repetitions and thrice a week. Outcome measures will be conducted through NPRS, ODI, AKE ,PKET and SLR before treatment and after 4 weeks. Data will be analyzed during SPSS software version 26. After assessing normality of data by Shapiro-wilk test, it will be decided either parametric or non parametric test will be used within a group or between two groups.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Spray and stretch technique on Hamstrings muscle | Experimental | Other: Spray and stretch technique on Hamstring MuscleThe spray and stretch technique is a physical therapy method used to inactivate myofascial trigger points, reduce muscle spasms, and increase range of motion. It works by applying a vapocoolant spray to numb the skin, which interrupts the pain signal, allowing the therapist to safely stretch the muscle |
| Strain and counter strain technique on Hamstring muscle | Active comparator | Other: Strain and counter strain technique on hamstring muscleStrain-Counterstrain (SCS) is a gentle, hands-on physical therapy technique used to relieve low back pain by "resetting" the nervous system. By placing the body in specific, pain-free positions, it relaxes tight muscles, reduces muscle guarding, and improves mobility |
Who may qualify
- Ages
- 35 to 50 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- AGE(35 to 50)
Key exclusion criteria (10 listed)
- Fracture or instability (4)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Spray and stretch technique on Hamstring MuscleThe participant will be positioned in a comfortable supine lying position on a treatment table in a quiet and suitable clinical environment. Before starting the intervention, the procedure will be explained to the participant in simple language, and verbal confirmation of comfort will be obtained. The affected lower limb will be exposed appropriately while ensuring privacy, modesty, and warmth through proper draping with towels or sheets. The participant will be instructed to relax the lower limb during the procedure. The hip will be maintained in a neutral position, and the knee will be kept straight or slightly flexed according to the participant's comfort before the stretching component begins. The therapist will first inspect the posterior thigh region to ensure that the skin is intact and suitable for vapocoolant application. The presence of any open wound, skin infection, rash, hypersens | Other | Spray and stretch technique on Hamstrings muscle |
| Strain and counter strain technique on hamstring muscleidentify the tender point Palpate the hamstring while the patient is prone or side lying locate the most tender point in belly of the muscle or near the ischial tuberosity Establish a pain scale and Ask the patient to rate the tenderness from 0 to 10 (10 being the most painful).Position of ease will be achieved by Flexing the patient's knee to about 70 to 90 degrees .Slightly abduct and externally rotate the leg to shorten the hamstring muscle (the position may vary depending on the muscle .The goal is to reduce tenderness by at least 70% .Hold the position and Maintain this position of comfort for 90 seconds Encourage the patient to relax during this time .Return the leg passively to a neutral position to avoid reactivating the trigger point .Palpate the tender point again and ask for a new pain rating. | Other | Strain and counter strain technique on Hamstring muscle |
Primary outcome
Numeric pain rate scale (NPRS)
Time frame: Baseline and after 4 weeks of intervention
Pain intensity will be assessed using the 11-point Numeric Pain Rating Scale. Participants will rate their current low back pain from 0 to 10, where 0 indicates "no pain" and 10 indicates the "worst imaginable pain." The score will be recorded in points, with higher scores indicating greater pain intensity.
Active knee extension
Time frame: Baseline and after 4 weeks of intervention
Hamstring flexibility will be assessed using the Active Knee Extension Test. The participant will lie in the supine position with the hip flexed to 90 degrees and will actively extend the knee as far as possible while maintaining the hip position. The knee extension angle will be measured in degrees using a goniometer. A smaller knee-flexion deficit indicates greater hamstring flexibility.Positive AKE (For males, a positive knee extension angle is >33.0°, whereas for females, it is >24)
Passive knee extension test (PKET)
Time frame: Baseline and after 4 weeks
Hamstring flexibility will be assessed using the Passive Knee Extension Test. With the participant in the supine position and the hip maintained at 90 degrees of flexion, the examiner will passively extend the knee until resistance or discomfort is reached. The knee extension angle will be measured in degrees using a goniometer. A greater knee-extension angle indicates greater hamstring flexibility.
Oswestry Disability Index
Time frame: Baseline and after 4 weeks
Low back pain-related disability will be assessed using the Oswestry Disability Index. The questionnaire contains 10 sections, with each section scored from 0 to 5. The total score will be converted into a percentage ranging from 0% to 100%, where higher scores indicate greater disability.
Straight leg raise
Time frame: Baseline and after 4 weeks
Straight leg raise range of motion will be assessed with the participant in the supine position. The examiner will passively raise the participant's lower limb while maintaining the knee in extension until resistance or discomfort is reported. The hip-flexion angle will be measured in degrees using a goniometer. A greater angle indicates greater posterior-chain flexibility and straight leg raise range of motion.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Jul 2026.
- BackgroundKoura G, Hamada H, Mohamed YE, Balbaa AA, El-Nassag BA, Baghdadi ARJHM. Impact of strain-counterstrain on treatment of acute nonspecific low back pain: a single-blind randomized controlled trial. 2020;22(1):42-9.
- BackgroundSeif HE, Alenazi A, Hassan SM, Kachanathu SJ, Hafez ARJOJoT, Rehabilitation. The effect of stretching hamstring, gastrocnemius, iliopsoas and back muscles on pain and functional activities in patients with chronic low back pain: a randomized clinical trial. 2015;3(4):139-45.
- Background: PubMed 30229473Shipton EA. Physical Therapy Approaches in the Treatment of Low Back Pain. Pain Ther. 2018 Dec;7(2):127-137. doi: 10.1007/s40122-018-0105-x. Epub 2018 Sep 18.
- Background: PubMed 39086556Gou Y, Lei H, Chen X, Wang X. The effects of hamstring stretching exercises on pain intensity and function in low back pain patients: A systematic review with meta-analysis of randomized controlled trials. SAGE Open Med. 2024 Jul 29;12:20503121241252251. doi: 10.1177/20503121241252251. eCollection 2024.
- Background: PubMed 34040429Haile G, Hailemariam TT, Haile TG. Effectiveness of Ultrasound Therapy on the Management of Chronic Non-Specific Low Back Pain: A Systematic Review. J Pain Res. 2021 May 17;14:1251-1257. doi: 10.2147/JPR.S277574. eCollection 2021.
- BackgroundRiaz SA, Usman MJPJoR. Effect of Static Stretching of Hamstring on Non-Specific Low Back Pain. 2023;12(1):43-51.
- Background: PubMed 37810115Dobija L, Pereira B, Cohen-Aknine G, Roren A, Dupeyron A, Coudeyre E. Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain. Heliyon. 2023 Sep 4;9(9):e19753. doi: 10.1016/j.heliyon.2023.e19753. eCollection 2023 Sep.
- BackgroundAhmed J, Anwar K, Sajjad AGJRJoHS. Effects of strain counter strain technique in treatment of chronic mechanical low back pain: a randomized controlled trail. 2021;3(2):85-91
- BackgroundHariharasudhan R, Balamurugan JJSjosm. A randomized double-blinded study of effectiveness of strain counter-strain technique and muscle energy technique in reducing pain and disability in subjects with mechanical low back pain. 2014;14(2):83-8.
- BackgroundEllythy MAJBFPT. Efficacy of muscle energy technique versus strain counter strain on low back dysfunction. 2012;17(2):29-35.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Amna Zia, PhD* principal investigator
Riphah International University, Lahore
Zaib un Nisa principal investigator
Riphah International University, Lahore
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Spray and stretch technique on Hamstring Muscle and Strain and counter strain technique on hamstring muscle in people with Low Back Pain, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 28 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Amna Zia, PhD* (03244686993, amna.zia@kemu.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Numeric pain rate scale (NPRS) (time frame: Baseline and after 4 weeks of intervention). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07729774, which also lists 10 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jul 2026.