Connective Tissue Massage and Core Training in Mechanical Low Back Pain

This randomized controlled clinical trial will evaluate the effects of connective tissue massage (CTM) combined with core stabilization exercises (CSEs) on pain, functionality, endurance, and quality of life in patients with mechanical low back pain. A total of 29-30 participants aged 20 to 55 years who will be diagnosed with mechanical low back pain will be recruited. Participants will be randomized into two groups:

Experimental group: will receive core stabilization exercises plus connective tissue massage.

Control group: will receive only core stabilization exercises.

All interventions will be delivered under physiotherapist supervision in the physiotherapy and rehabilitation laboratories. The exercise program will include progressive core stabilization exercises performed twice per week for eight weeks, each session lasting approximately 50 minutes (10 minutes warm-up, 30 minutes core stabilization, 10 minutes cool-down). The experimental group will additionally receive 20 minutes of connective tissue massage twice per week during the same 8-week intervention period.

Outcome measures will include:

Pain: Visual Analog Scale (VAS).

Functionality: Oswestry Disability Index.

Endurance: Static and dynamic curl-up, static back endurance, and horizontal side bridge tests.

Lumbar mobility: Finger-to-floor distance.

Muscle strength: Manual muscle testing.

Quality of life: Short Form-36 (SF-36).

Instrumental activities of daily living: Lawton & Brody Instrumental ADL Scale.

Assessments will be performed at baseline and after the 8-week intervention period. The study will hypothesize that connective tissue massage combined with core stabilization exercises will provide greater improvements in pain relief, functional status, muscular endurance, and quality of life compared to core stabilization exercises alone.

The results will contribute evidence on whether connective tissue massage will offer an additional therapeutic benefit when integrated into a rehabilitation program for patients with mechanical low back pain.

Inclusion criteria

• Participants will be 20-55 years of age.
• Participants will have a clinician-confirmed diagnosis of mechanical low back pain and will be referred by specialists in Physical Medicine and Rehabilitation.
• Participants will have adequate cognitive ability to follow assessments and the treatment protocol and will agree to attend supervised sessions (2×/week for 8 weeks) and to perform daily home exercises.
• Participants will provide informed consent prior to any study procedures

Exclusion criteria

• Participants will be excluded if they have a history of lumbar spine surgery.
• Participants will be excluded for conditions affecting the lumbar region, including inflammatory arthritis, tumor, or infectious diseases.
• Participants will be excluded if they present congenital anomalies of the lumbosacral region or secondary orthopedic problems that could interfere with the study.
• Participants will be excluded if they have neurological disorders (e.g.,Parkinson's disease, Alzheimer's disease, multiple sclerosis) or systemic diseases such as diabetes mellitus.
• Any medical condition judged by the investigators to preclude safe participation or adherence to the protocol will lead to exclusion.