Comparison of corticosteroid injection & extracorporeal shock wave therapy efficacy in distal trigger point of quadratus lumborum muscle

Abstract

Low back pain is a common health issue in many countries. Myofascial pain syndrome of quadratus lumborum muscle may cause low back pain which is resistant to routine medical treatments. Trigger point treatment methods include non-surgical treatments such as NSAIDs, prevention form vigorous activity, and using physical methods such as shockwave therapy. Materials and methods: In this single-blind simple randomized clinical trial, 54 patients with chronic low back pain with trigger point on quadratus lumborum muscle referring to physical medicine and rehabilitation clinic were investigated. After matching age, gender, severity of trigger points, patients were divided into two groups using simple randomization with A and B pockets. Patients in group A underwent Extracorporeal shock wave therapy (ESWT) and patient in group B received local corticosteroid injection (Injection group). Study variables (including VAS, Oswestry score, pressure-pain threshold and quality of life) were measured before intervention, one week and one month after intervention. Results: In either treatment groups quality of life, VAS, Oswestry score, and pressure-pain threshold improved toward one week after intervention (P<0/001). A significant difference was observed one month after intervention in IG group in terms of VAS, pressure-pain threshold and Oswestry Score (P<0/001). In ESWT group, a significant difference was observed in quality of life, VAS, Oswestry score, and pressure-pain threshold one month after intervention (P<0.05). The inter-group comparison one week after treatment indicated that corticosteroid injection group recorded statistically significant higher improvement of ODI, VAS and PPT scores than the ESWT group (All P value<0.05). Despite, the ESWT group experienced higher improvement in quality of life as measured by SF-36 score one week after treatment, it was not statistically significant (P>0.05). ESWT group recorded statistically significant higher improvement of ODI and quality of life than the IG at 4th week post treatment evaluation (P<0.05). Despite, the ESWT group experienced higher improvement in PPT and VAS at 4th week post treatment evaluation, it was not statistically significant (P>0.05).