4. Discussion
tightness, low back pain, sacroiliac joint dysfunction, pain
HEAT, BENDING, SACROILIAC JOINT DYSFUNCTION
In our research, the same MT protocol was applied with and without the application of a TECAR high-frequency current to investigate whether the simultaneous application of the two methods could be more effective, compared to the individual application of MT, in the treatment of symptoms in people with CNSLBP. Modern TECAR devices are widely accepted in clinical practice, allowing the simultaneous application of high-frequency current with special electrodes, along with therapeutic applications, such as manipulation, mobilization, or therapeutic exercise. However, their efficacy has not been proven in clinical studies. Research data surrounding the applications of TECAR both in the treatment of CNSLBP [The mechanisms to achieve analgesia are known. In manual therapy, the therapeutic manipulations are able, through the mobilization of the tissues and stimulation of the sensory receptors, to block the noxious stimuli of the pain receptors and simultaneously increase the local circulation, the temperature, and the local metabolism at the cellular level [On the other hand, the high-frequency current emitted by a TECAR device produces an intense thermal effect at different tissue levels (muscles, tendons, cartilage, joints, and bones). Generating this deep heat through radio frequency emission has been shown to greatly increase cellular metabolism and provide intense analgesic effects and healing action, which leads to reduced recovery time [The study was conducted on the assumption that the simultaneous emission of the high-frequency current with another means such as the therapeutic manipulations of the care provider combines the therapeutic effects of manual therapy with the effect of deep heat and possibly enhances the analgesic effect. By maintaining consistent conditions throughout the application of the ΜΤ protocol, both with and without the application of TECAR therapy, and at the same time by ensuring sample homogeneity in terms of initial measurements and demographic characteristics, any distinction between the groups can be attributed to the cumulative impact of the MT and TECAR therapeutic means.The results of this research show that the application of the same MT protocol using a conventional capacitive and a resistive electrode bracelet further improved the pain of participants. The NPRS score improved significantly in both intervention groups compared to the control group in the second week, while this difference was maintained at the one-month follow-up (Our results agree with those of Tashiro et al. [Corresponding differences between the groups were also noted in the RMDQ score. Both intervention groups showed statistically significant differences compared to the control group from the second week. These differences remained statistically significant during the one-month follow-up measurement. A difference was also found from the second week between the two intervention groups with the MT + TECAR group showing an improvement in the score compared to the initial measurement by 51.91% (6.1 points decrease) compared to the MT group which improved by 36.4% (4.15 points decrease). However, the differences between the two intervention groups appeared statistically significant only at the one-month follow-up with bigger mean differences between groups at the one-month follow-up related to the second week (3.05 and 2.6, respectively). This fact can be partially explained by the generally lower levels of pain experienced after the intervention by the participants of the MT + TECAR group compared to the participants of the MT group, which is also reflected by the results of the NPRS score. The difference between the two intervention groups at the one-month follow-up is also clinically significant. According to Ostelo et al. [Regarding the PPT values of the L4-L5 paraspinal intervertebral space on the right side, statistically significant differences were detected between the two intervention groups and the control group in the second week, while at the one-month follow-up, differences were detected only between the MT + TECAR group and the control group. A possible explanation is the greater increase in the PPT value noted in the MT + TECAR group compared to the other two groups. It appears that even if the difference between the two intervention groups in the second week did not appear statistically significant, the improvement in the MT + TECAR group was maintained at high levels one month later in contrast to the MT group. This possibly explains why the MT group did not show statistically significant differences compared to the control group at the one-month follow-up (Concerning the L4-L5 paraspinal intervertebral space PPT on the left side, in the second week, differences were detected between the two intervention groups as well as between the MT + TECAR group and the control group, which remained statistically significant during the one-month follow-up (Regarding the sacroiliac joint PPT on both the right and left sides, the only differences noted in the second week were between the MT + TECAR group and the control group. In fact, these differences remained statistically significant during the one-month follow-up, which means that the improvement noted in the participants of the MT + TECAR group (shown numerically in The improvements observed in the PPT values in both the L4-L5 paraspinal intervertebral space and the sacroiliac joint in the participants of the MT + TECAR group appear to be due to the combined effect of MT and TECAR. It is possible that the combination of mechanical (MT) and thermal (TECAR) effects at the same time increased the PPT values more effectively and for a longer period.Regarding the quadratus lumborum muscle PPT, both on the right and left sides, differences between the groups were detected in the second week between the two intervention groups and the control group, while these differences remained statistically significant at the one-month follow-up. However, although Finally, the results of the FTF test score showed that it improved significantly in both intervention groups compared to the control group in the second week, while this difference was maintained at the one-month follow-up (This study had several limitations. The fact that neither participants nor care providers were blinded to the aims of the study was a threat. The small number of participants in combination with a short follow-up period was also a significant limitation of this research. Another limitation concerns the selection of the FTF test. This test is affected by a number of factors such as hamstring tightness or sacroiliac joint dysfunction, while it is limited to measure only the trunk bending movement without taking into account the rest of the movements. However, the FTF test was chosen because of its high reliability in people with low back pain (ICC = 0.99), as well as its ease of use [