Chronic low back pain (CLBP) significantly impacts patients’ quality of life. While fascial release therapy is widely used, its comprehensive efficacy remains underexplored.
Objective
This study aimed to evaluate the effects of fascial release therapy combined with routine care on CLBP patients over 8 weeks.
Methods
This retrospective cohort study analyzed 90 CLBP patients (2021–2025), divided into the fascial release therapy group (n = 45) and the conventional rehabilitation group (n = 45). Outcomes included pain intensity [numerical rating scale (NRS)], disability [Roland–Morris disability questionnaire (RMDQ)], balance [timed up and go (TUG)], psychological status [depression, anxiety, and stress scale—21 items (DASS-21)], quality of life [12-item short form survey (SF-12)], and exercise compliance [exercise adherence rating scale (EARS)].
Results
The fascial release therapy group demonstrated significantly greater improvements than the conventional group in all measures: lower NRS (1.92 ± 0.83 vs 4.51 ± 1.22) and RMDQ scores (4.83 ± 2.34 vs 9.72 ± 3.52); reduced depression, anxiety, and stress (DASS-21); better physical (48.54 ± 5.11 vs 41.83 ± 5.93) and mental (52.34 ± 5.79 vs 46.51 ± 6.32) health (SF-12); improved balance (TUG: 7.21 ± 1.13 s vs 9.42 ± 1.63 s); and higher exercise compliance (16.52 ± 2.94 vs 11.82 ± 3.53). All between-group differences were statistically significant (P < 0.05).
Conclusion
In this study, fascial release therapy, combined with conventional care, was associated with multidimensional clinical improvements in patients with CLBP, particularly in pain relief, functional recovery, psychological status, and exercise adherence. These findings suggest that the combined intervention may offer comprehensive benefits. However, due to limitations in the study design, the results should be interpreted as evidence of association. Causal inferences require further validation through prospective, randomized controlled trials.
AdhikariS. P.DevR.ShresthaJ. N. (2020). Cross-cultural adaptation, validity, and reliability of the Nepali version of the exercise adherence rating scale: A methodological study. Health and Quality of Life Outcomes, 18(1), 328. https://doi.org/10.1186/s12955-020-01588-6
2.
AlfalogyE.MahfouzS.ElmedanyS.HaririN.FallatahS. (n.d.). Chronic low back pain: Prevalence, impact on quality of life, and predictors of future disability. Cureus, 15(9), e45760.
3.
AlhowimelA. S.AlotaibiM. A.AlenaziA. M.AlqahtaniB. A.AlshehriM. A.AlamamD.AlodaibiF. A. (2021). Psychosocial predictors of pain and disability outcomes in people with chronic low back pain treated conservatively by guideline-based intervention: A systematic review. Journal of Multidisciplinary Healthcare, 14, 3549–3559. https://doi.org/10.2147/JMDH.S343494
4.
AliA. M.AlkhameesA. A.HoriH.KimY.KunugiH. (2021). The depression anxiety stress scale 21: Development and validation of the depression anxiety stress scale 8-item in psychiatric patients and the general public for easier mental health measurement in a post COVID-19 world. International Journal of Environmental Research and Public Health, 18(19), 10142. https://doi.org/10.3390/ijerph181910142
5.
AliA. S.DarwishM. H.ShalabyN. M.AbbasR. L.SoubhyH. Z. (2021). Efficacy of core stability versus task oriented trainings on balance in ataxic persons with multiple sclerosis. A single blinded randomized controlled trial. Multiple Sclerosis and Related Disorders, 50, 102866. https://doi.org/10.1016/j.msard.2021.102866
6.
ArensmanR. M.PistersM. F.KloekC. J. J.KoppenaalT.VeenhofC.OsteloR. J. W. G. (2024). Exploring the association between adherence to home-based exercise recommendations and recovery of nonspecific low back pain: A prospective cohort study. BMC Musculoskeletal Disorders, 25(1), 614. https://doi.org/10.1186/s12891-024-07705-6
7.
BianchiM.RossettiniG.CerritelliF.EstevesJ. E. (2025). Insights into how manual therapists incorporate the biopsychosocial-enactive model in the care of individuals with CLBP: A qualitative study. Chiropractic & Manual Therapies, 33(1), 7. https://doi.org/10.1186/s12998-025-00574-3
8.
BrandlA.EgnerC.ReerR.SchmidtT.SchleipR. (2023). Immediate effects of myofascial release treatment on lumbar microcirculation: A randomized, placebo-controlled trial. Journal of Clinical Medicine, 12(4), 1248. https://doi.org/10.3390/jcm12041248
9.
da TrindadeA. M. V.RezendeL. P.AraújoH. R. S.ParreiraR. B.OliveiraC. S. (2025). Instrumented functional mobility assessment in elderly patients following total knee arthroplasty: A retrospective longitudinal study using the timed up and go test. Life, 15(9), 1409. https://doi.org/10.3390/life15091409
10.
DarnallB. D.BurnsJ. W.HongJ.RoyA.SlaterK.Poupore-KingH.ZiadniM. S.YouD. S.JungC.CookK. F.LorigK.TianL.MackeyS. C. (2024). Empowered relief, cognitive behavioral therapy, and health education for people with chronic pain: A comparison of outcomes at 6-month follow-up for a randomized controlled trial. Pain Reports, 9(1), e1116. https://doi.org/10.1097/PR9.0000000000001116
11.
FerreiraM. L.de LucaK.HaileL. M.SteinmetzJ. D.CulbrethG. T.CrossM.KopecJ. A.FerreiraP. H.BlythF. M.BuchbinderR.HartvigsenJ.WuA.-M.SafiriS.WoolfA. D.CollinsG. S.OngK. L.VollsetS. E.SmithA. E.CruzJ. A., …MarchL. M. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: A systematic analysis of the global burden of disease study 2021. The Lancet Rheumatology, 5(6), e316–e329. https://doi.org/10.1016/S2665-9913(23)00098-X
12.
FrançaM. E. D.SinhorimL.MartinsD. F.SchleipR.Machado-PereiraN. A. M. M.de SouzaG. M.HorewiczV. V.SantosG. M. (2020). Manipulation of the fascial system applied during acute inflammation of the connective tissue of the thoracolumbar region affects transforming growth factor-β1 and interleukin-4 levels: Experimental study in mice. Frontiers in Physiology, 11, https://doi.org/10.3389/fphys.2020.587373
13.
GilanyiY. L.ShahB.CashinA. G.GibbsM. T.BellamyJ.DayR.McAuleyJ. H.JonesM. D. (2024). Barriers and enablers to exercise adherence in people with nonspecific chronic low back pain: A systematic review of qualitative evidence. Pain, 165(10), 2200–2214. https://doi.org/10.1097/j.pain.0000000000003234
14.
GilanyiY. L.WewegeM. A.ShahB.CashinA. G.WilliamsC. M.DavidsonS. R. E.McAuleyJ. H.JonesM. D. (2023). Exercise increases pain self-efficacy in adults with nonspecific chronic low back pain: A systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 53(6), 335–342. https://doi.org/10.2519/jospt.2023.11622
15.
HungK.-C.ChungH.-W.YuC. C.-W.LaiH.-C.SunF.-H. (2019). Effects of 8-week core training on core endurance and running economy. PLoS One, 14(3), e0213158. https://doi.org/10.1371/journal.pone.0213158
16.
IsajiY.SasakiD.OkuyamaK.KurasawaY.SuzukiK.KonY.KitagawaT. (2025). Therapeutic mechanisms of fascia manipulation: A scoping review. Journal of Back and Musculoskeletal Rehabilitation, 38(6), 1267–1276. https://doi.org/10.1177/10538127251341828
17.
KimY.ParkE. Y.LeeH. (2023). The effect of myofascial release in patients with breast cancer-related lymphedema: A cross-over randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 59(1), 85–93. https://doi.org/10.23736/S1973-9087.22.07698-5
18.
KodamaY.MasudaS.OhmoriT.KanamaruA.TanakaM.SakaguchiT.NakagawaM. (2023). Response to mechanical properties and physiological challenges of fascia: Diagnosis and rehabilitative therapeutic intervention for myofascial system disorders. Bioengineering, 10(4), 474. https://doi.org/10.3390/bioengineering10040474
19.
LenaO.GjiniE.TodriJ. (2025). Translation, cross-cultural adaptation, validity and reliability of the inaugural Albanian Roland-Morris disability questionnaire in Albanian population with low back pain. PLoS One, 20(7), e0325777. https://doi.org/10.1371/journal.pone.0325777
20.
LiY.ZouC.GuoW.HanF.FanT.ZangL.HuangG. (2024). Global burden of low back pain and its attributable risk factors from 1990 to 2021: A comprehensive analysis from the global burden of disease study 2021. Frontiers in Public Health, 12, 1480779.
21.
LyndersC. (2019). The critical role of development of the transversus abdominis in the prevention and treatment of low back pain. HSS Journal, 15(3), 214–220. https://doi.org/10.1007/s11420-019-09717-8
22.
MathewJ.SinghS. B.GarisS.DiwanA. D. (2013). Backing up the stories: The psychological and social costs of chronic low-back pain. The International Journal of Spine Surgery, 7, e29–e38. https://doi.org/10.1016/j.ijsp.2013.02.001
23.
MikkonenJ.LuomajokiH.AiraksinenO.GoubertL.LeinonenV. (2023). Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: Randomized feasibility trial with two-month follow-up. BMC Musculoskeletal Disorders, 24(1), 354. https://doi.org/10.1186/s12891-023-06434-6
24.
Monclús-DíezG.Díaz-ArribasM. J.Fernández-de-las-PeñasC.KossonD.KołaczM.KobylarzM. D.Sánchez-JorgeS.Valera-CaleroJ. A. (2025). Prevalence of myofascial trigger points in patients with radiating and non-radiating low back pain: A systematic review. Biomedicines, 13(6), 1453. https://doi.org/10.3390/biomedicines13061453
25.
NicolV.VerdaguerC.DasteC.BisseriexH.LapeyreÉLefèvre-ColauM.-M.RannouF.RörenA.FacioneJ.NguyenC. (2023). Chronic low back pain: A narrative review of recent international guidelines for diagnosis and conservative treatment. Journal of Clinical Medicine, 12(4), 1685. https://doi.org/10.3390/jcm12041685
26.
NugentS. M.LovejoyT. I.ShullS.DobschaS. K.MorascoB. J. (2021). Associations of pain numeric rating scale scores collected during usual care with research administered patient reported pain outcomes. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 22(10), 2235–2241. https://doi.org/10.1093/pm/pnab110
27.
Otero-KettererE.Peñacoba-PuenteC.Ferreira Pinheiro-AraujoC.Valera-CaleroJ. A.Ortega-SantiagoR. (2022). Biopsychosocial factors for chronicity in individuals with non-specific low back pain: An umbrella review. International Journal of Environmental Research and Public Health, 19(16), 10145. https://doi.org/10.3390/ijerph191610145
28.
PereiraC. M.BrancoD.SalvadorD.DiasT. L.CarvalhoD.MatosM.RodriguesS.CalheirosJ. M.MarquesA. M.JonesF. (2025). Effects of a self-management program on adults with stroke: A quasi-experimental study. Healthcare (Basel, Switzerland), 13(5), 495.
29.
Pericot-MozoX.Suñer-SolerR.Reig-GarciaG.Patiño-MasóJ.Sitjar-SuñerM.Masià-PlanaA.Bertran-NoguerC. (2024). Quality of life in patients with chronic low back pain and differences by sex: A longitudinal study. Journal of Personalized Medicine, 14(5), 496. https://doi.org/10.3390/jpm14050496
30.
PianeseL.BordoniB. (n.d.). Beyond the biomedical model: A critical review of the approach to chronic pain and the proposal of an integrated functional model. Cureus, 17(6), e85717.
31.
QingzhiR. a. N.AoshuangL. I.HengwenC.JianmeiZ.BenxiangH. E. (2024). A randomized controlled trial of myofascial release therapy in patients with chronic nonspecific lower back pain. Chinese General Practice, 27(20), 2451.
32.
RathnayakeA. P. S.SparkesV.SheeranL. (2021). What is the effect of low back pain self-management interventions with exercise components added? A systematic review with meta-analysis. Musculoskeletal Science & Practice, 56, 102469. https://doi.org/10.1016/j.msksp.2021.102469
33.
RouraS.ÁlvarezG.SolàI.CerritelliF. (2021). Do manual therapies have a specific autonomic effect? An overview of systematic reviews. PLoS One, 16(12), e0260642. https://doi.org/10.1371/journal.pone.0260642
34.
ScholzC.SchmigalleP.PlessenC. Y.LieglG.VajkoczyP.PrasserF.RoseM.ObbariusA. (2024). The effect of self-management techniques on relevant outcomes in chronic low back pain: A systematic review and meta-analysis. European Journal of Pain, 28(4), 532–550. https://doi.org/10.1002/ejp.2221
35.
ShahC. H.BrownJ. D. (2020). Reliability and validity of the short-form 12 item version 2 (SF−12v2) health-related quality of life survey and disutilities associated with relevant conditions in the U.S. older adult population. Journal of Clinical Medicine, 9(3), 661. https://doi.org/10.3390/jcm9030661
36.
SlaterA. M.BarclayS. J.GranfarR. M. S.PrattR. L. (2024). Fascia as a regulatory system in health and disease. Frontiers in Neurology, 15. https://doi.org/10.3389/fneur.2024.1458385
37.
SongJ.YimJ. (2025). Effects of self-myofascial release and dynamic neuromuscular stabilization exercises on pain, balance, muscle function, and the autonomic nervous system in women with chronic low back pain. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 31, e949985. https://doi.org/10.12659/MSM.949985
38.
Suarez-RodriguezV.FedeC.PirriC.PetrelliL.Loro-FerrerJ. F.Rodriguez-RuizD.De CaroR.SteccoC. (2022). Fascial innervation: A systematic review of the literature. International Journal of Molecular Sciences, 23(10), 5674. https://doi.org/10.3390/ijms23105674
39.
SunJ.ZhangH.HeH.WangR. (2005). Effects of SDS, PBS solutions upon fluorescence values of Dermatophagoides pterronyssinus radioallergosorbent test inhibition. Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K’o Hsueh Tsa Chih, 20(1), 27–29.
40.
Şenel TopaloğluE.BudakM.AtilganE.KurtH. (2025). Effect of myofascial release therapy applied to selective muscles on mobility and function in patients with temporomandibular dysfunction and co-occurring chronic low back pain: A randomized controlled trial. Medicine, 104(34), e44086. https://doi.org/10.1097/MD.0000000000044086
41.
TamartashH.BahrpeymaF.DizajiM. M. (n.d.). Effect of myofascial release technique on lumbar fascia thickness and low back pain: A clinical trial. Journal of Modern Rehabilitation. Retrieved 14 October 2025, from.
42.
TankhaH.GaskinsD.ShallcrossA.RothbergM.HuB.GuoN.RoseenE. J.DombrowskiS.BarJ.WarrenR.WilgusH.TateP.GoldfarbJ.DragoV. G.SaperR. (2024). Effectiveness of virtual yoga for chronic low back pain: A randomized clinical trial. JAMA Network Open, 7(11), e2442339. https://doi.org/10.1001/jamanetworkopen.2024.42339
43.
University of South Florida (with Stanford University & U.S. Army Medical Research and Development Command). (2025). Research on effectiveness of non-surgical spinal decompression therapy and outcomes with radiographic evaluation (Clinical Trial Registration No. NCT06525896). clinicaltrials.gov.
44.
van AmstelR. N.WeideG.WesselinkE. O.NotenK.JacobsK.Pool-GoudzwaardA. L.JaspersR. T. (2025). A review and empirical findings of fasciae and muscle interactions in low back pain. Frontiers in Physiology, 16, 1604459. https://doi.org/10.3389/fphys.2025.1604459
45.
WellingA.KageV.GurudutP.NadafR.HulmaniS.NithishaG.ChabadaN.MathS. (2025). Impact of 3-dimensional myofascial release on tumor necrosis factor (TNF) alpha biomarker in nonspecific low back pain: A randomised controlled trial. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 34, 12, 5488–5499. https://doi.org/10.1007/s00586-025-09279-w
46.
WongJ. J.TriccoA. C.CôtéP.LiangC. Y.LewisJ. A.BouckZ.RosellaL. C. (2022). Association between depressive symptoms or depression and health outcomes for low back pain: A systematic review and meta-analysis. Journal of General Internal Medicine, 37(5), 1233–1246. https://doi.org/10.1007/s11606-021-07079-8
47.
WuZ.WangY.YeX.ChenZ.ZhouR.YeZ.HuangJ.ZhuY.ChenG.XuX. (2021). Myofascial release for chronic low back pain: A systematic review and meta-analysis. Frontiers in Medicine, 8, 697986. https://doi.org/10.3389/fmed.2021.697986
48.
YangH.LiJ.ShanW.RenS.ChaiX.LuJ.YanH.LuY. (2025). The effect of different exercise modalities on older adults’ quality of life: An assessor-blinded randomized controlled trial. Scientific Reports, 15(1), 26177. https://doi.org/10.1038/s41598-025-11047-1
49.
ZhouW. B. S.MengJ.ZhangJ. (2021). Does low grade systemic inflammation have a role in chronic pain?Frontiers in Molecular Neuroscience, 14, 785214. https://doi.org/10.3389/fnmol.2021.785214
