Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain

This randomized controlled study investigated the comparative efficacy of two therapeutic approaches for acute and subacute low back pain: traditional Chinese acupuncture and stretching exercises based on the myofascial meridian system. The research was motivated by the observation that acupuncture meridians and myofascial lines show considerable anatomical overlap and clinical compatibility, especially between the Bladder meridian and the distribution of myofascial pain. The researchers recruited 81 participants with non-specific low back pain of up to three months' duration, excluding those with neurological deficits, inflammatory disease, or other systemic conditions. Participants were randomized into three groups: acupuncture (n = 27), myofascial meridian stretching (n = 27), and control (n = 27).

The acupuncture group received bilateral treatment at BL-57 (Chengshan) and BL-62 (Shenmai) on the Bladder meridian, applied for 20 minutes, three times per week for two weeks. The choice of these points was based on the correspondence between the Bladder meridian and the distribution of myofascial pain. The myofascial stretching group performed specific exercises targeting the superficial back line, including bilateral stretching of the plantar fascia, Achilles tendon, and hamstring muscles for 30 seconds with 30-second rest, in four sets, three times per week. The control group received only anti-inflammatory medication (etodolac 400 mg twice daily).

Assessments were conducted at baseline, week 2, and week 6, using multiple outcome measures. Pain was assessed with the Numerical Rating Scale (NRS), disability with the Roland-Morris Questionnaire (RMQ); deep abdominal muscle strength, lumbar extensor strength, and lumbar range of motion were also measured. Results demonstrated significant improvements in both intervention groups compared with controls. On pain assessment, the acupuncture group showed a mean reduction from 8 to 4 points on the NRS at week 2, while the stretching group dropped from 7 to 3 points and the control group remained at 5 points.

This difference was statistically significant between the acupuncture and control groups (p = 0.004). For functional disability, both intervention groups showed substantial RMQ improvements, with reductions of approximately 64% in the acupuncture group and 73% in the stretching group, compared with smaller improvement in the control group. Muscle strength also improved significantly. The Sorensen test, which assesses lumbar extensor strength, showed significant increases in both intervention groups during the first two weeks (p = 0.004 for acupuncture, p < 0.001 for stretching).

Deep abdominal muscle strength, measured by pressure biofeedback unit, also improved in both groups, with the stretching group showing particularly notable gains. Lumbar range of motion increased significantly in the meridian stretching group between baseline and week 2, exceeding the other groups (p = 0.009 vs acupuncture, p < 0.001 vs control). The researchers propose that mechanisms of action involve stimulation of interconnected fascial systems. For acupuncture, stimulation of Bladder meridian points may influence force transmission through the fascia, given that this meridian anatomically corresponds to the distribution of myofascial pain.

For stretching exercises, tension applied to the superficial back line may affect distant structures through fascial connections, improving proprioception, mechanoreception, and nociceptive modulation. Clinical implications are significant, suggesting that both acupuncture and specific meridian stretching exercises can offer effective alternatives to conventional treatments for acute low back pain. Both approaches showed benefits superior to anti-inflammatory use alone, with improvements observed in the first two weeks of treatment. The study presents important limitations, including a relatively small sample size, short follow-up period (6 weeks), and difficulty in adequately blinding the interventions.

In addition, the concomitant use of anti-inflammatory medication in all groups may have confounded results. The treatment duration (only 2 weeks) may have been insufficient to fully assess therapeutic effects.