Effectiveness of ELDOA Stretching Combined With Standard Physiotherapy in Adults With Chronic Low Back Pain and Dural Hypomobility; A Randomized Controlled Trial.

Chronic low back pain (CLBP) is one of the leading causes of disability worldwide and is associated with persistent pain, reduced functional capacity, impaired quality of life, and substantial socioeconomic burden. Current clinical practice guidelines recommend non-pharmacological management, particularly exercise therapy and physiotherapy, as first-line treatment. Nevertheless, many individuals continue to experience pain and disability despite conventional rehabilitation.

Dural hypomobility has been suggested as a potential contributor to persistent low back pain. Restricted movement of the spinal dura mater may increase neural mechanosensitivity, alter neurodynamics, and contribute to pain during movement. The Slump Test is commonly used clinically to identify signs consistent with altered neural mobility or dural tension.

ELDOA (Étirements Longitudinaux avec Décoaptation Ostéo-Articulaire) is a specific therapeutic exercise technique developed to create targeted spinal decompression through fascial tensioning and segmental positioning. The technique aims to improve spinal alignment, fascial mobility, and neural tissue mobility while reducing mechanical stress on spinal structures. Although previous studies have demonstrated beneficial effects of ELDOA on pain and function in several musculoskeletal conditions, evidence regarding its effectiveness in adults with chronic low back pain accompanied by dural hypomobility is limited.

This study is designed as a single-blind randomized controlled trial. Eligible adults aged 20 to 45 years with chronic low back pain lasting at least three months and presenting with a positive Slump Test will be recruited. Participants will be randomly allocated into two groups. The experimental group will receive standard physiotherapy consisting of hot pack application, transcutaneous electrical nerve stimulation (TENS), manual therapy, and ELDOA stretching exercises. The control group will receive the same standard physiotherapy protocol without ELDOA. Both groups will receive treatment three times per week for six weeks.

The primary outcome will be pain intensity measured using the Numeric Pain Rating Scale (NPRS). Secondary outcomes will include disability measured by the Oswestry Disability Index (ODI) and dural mobility assessed using the Slump Test. Outcome measures will be recorded at baseline and after completion of the six-week intervention.

The study aims to determine whether adding ELDOA stretching to standard physiotherapy provides greater improvements in pain, disability, and dural mobility than standard physiotherapy alone. The results may contribute to evidence-based rehabilitation strategies for adults with chronic low back pain associated with dural hypomobility and help guide future physiotherapy practice.

Inclusion criteria

• Adults aged 20 to 45 years. Male or female participants. Chronic low back pain persisting for at least 3 months. Positive Slump Test indicating dural hypomobility. Localized mechanical low back pain. Able and willing to participate in the intervention program. Willing to provide written informed consent.

Exclusion criteria

• History of spinal surgery within the previous 12 months. Vertebral fracture, spinal tumor, spinal infection, or other serious spinal pathology.

Spondylolisthesis, ankylosing spondylitis, scoliosis, or kyphosis confirmed clinically or radiographically.

Pregnancy. Neurological deficits or progressive neurological disorders. Skin infection or open wounds in the lumbar region that contraindicate treatment.

Severe systemic disease that may interfere with participation. Current participation in another clinical trial or structured physiotherapy program for low back pain.