Reducing Lower Back Pain Using the Muscle Energy Technique Versus Transcutaneous Electrical Nerve Stimulation


Working from home for a long time during the Covid-19 pandemic led to many complaints of musculoskeletal disorders, such as lower back pain. This is caused by stress or spasm in the back muscles which makes the stability of the abdominal and lower back muscles decrease. Treatments include the muscle energy technique (MET) and transcutaneous electrical nerve stimulation (TENS). MET can reduce pain through the provision of post-isometric relaxation stimulation, stimulating the proprioception and neurophysiology, and causing a hypoalgesic effect in the lower back area, while TENS blocks pain-conducting nerves. Studies have not yet determined conclusively which treatment is most effective. In this literature review, relevant articles published from 2015-2020 were found by searching in Google Scholar and PubMed. The keywords used included low back pain, muscle energy technique and transcutaneous electrical nerve stimulation. The population, intervention, comparison group, outcome and study design were considered in the selection of the articles. There were 6 journal articles that met the research criteria, namely 3 that examined the MET intervention and 3 for the TENS intervention. The results showed that MET with a dose of 3-5x/session can reduce pain after the second day, while TENS, when placed locally, can take roughly a month to reduce lower back pain. The findings showed that MET is more effective in reducing lower back pain than TENS.

Keywords: low back pain, muscle energy technique, transcutaneous electrical nerve stimulation

[1] E. Widianawati, A. Khorioni, B. Yoni, S. Nugroho, W. Ratna Wulan, and A. Khoironi, “The ergonomics Design of Work-From-Home Facility during COVID-19 Outbreak in Indonesia and Its Implications for Musculoskeletal.,” Pakistan Journal of Medical & Sciences. vol. 14, no. 4, pp. 1619–1622, 2020.

[2] N. Susanti, Hartiyah, and D. Kuntowato, “Hubungan Berdiri Lama Dengan Keluhan Nyeri Punggung Bawah Miogenik Pada Pekerja Kasir Di Surakarta.,” Jurnal Pena Medika. vol. 5, no. 1, pp. 60–70, 2015.

[3] J. Natosba and J. Jaji, “Pengaruh Posisi Ergonomis terhadap Kejadian Low Back Pain. Pada Penenun Songket di Kampung BNI 46.,” Jurnal Keperawatan Sriwijaya. vol. 3, no. 2, pp. 8–16, 2016.

[4] H.F. Aeni and A. Awaludin, “Hubungan Sikap Kerja Duduk dengan Keluhan Nyeri Punggung Bawah pada Pekerja yang Menggunakan Komputer.,” Jurnal Kesehatan. vol. 8, no. 1, pp. 887–894, 2017.

[5] F. Andini, “Risk Factors of Low Back Pain in Worker.,” Jurnal Majority. vol. 6, no. 1, p. 2015.

[6] N.T. Wulandari and L. Zaidah, “Hubungan Usia dan Durasi Lama Duduk dengan Keluhan Nyeri Punggung Bawah pada Pembatik di Kampung Batik Giriloyo.,” Jurnal Ilmiah Fisioterapi. vol. 2, no. 02, pp. 82–83, 2019.

[7] I. Fuaedi, “Penatalaksanaan Fisioterapi Pada Piriformis Syndrome Sinistra Di RSUD Sukoharjo,” (2013).

[8] V.D. Patel, C. Eapen, Z. Ceepee, and R. Kamath, “Effect of muscle energy technique with and without strain-counterstrain technique in acute low back pain-A randomized clinical trial.,” Hong Kong Physiotherapy Journal. vol. 38, no. 1, pp. 41–51, 2018.

[9] N.M. Yuliadarwati, G.M. Sari, T. Wardani, et al., “Pengaruh Muscle Energy Tehnique Terhadap Ibu Pascaseksio Sesaria.,” pp. 14–19, 2016.

[10] S. Zuhri and M. Rustanti, “Beda Efektivitas Elektroakupunktur Dengan Tens Terhadap Nyeri Dan Fleksibilitas Lumbal Pada Pasien Nyeri Punggung Bawah Myogenik.,” Jurnal Keterapian Fisik. vol. 2, no. 2, pp. 93–102, 2017.

[11] C. Ghasemi, A. Amiri, J. Sarrafzadeh, M. Dadgoo, and N. Maroufi, “Comparison of the effects of craniosacral therapy, muscle energy technique, and sensorimotor training on non-specific chronic low back pain.,” Anaesthesia, Pain and Intensive Care. vol. 24, no. 5, pp. 532–543, 2020.

[12] P. Rishi and B. Arora, “Impact of Muscle Energy Technique Along With Supervised. Exercise Program Over Muscle Energy Technique on Quadratus Lumborum and Iliopsoas on Pain and Functional Disability in Chronic Non Specific Low Back Pain.,” International Journal of Physiotherapy and Research. vol. 6, no. 3, pp. 2748–2753, 2018.

[13] T. Garaud, C. Gervais, B. Szekely, M. Michel-Cherqui, J.F. Dreyfus, and M. Fischler, “Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation.,” Medicine (United States). vol. 97, no. 52, p. 2018.

[14] F.M. Alyazedi, S. Khan, A. Hassan Al Ghamdi, N. Al-Toriri, and S. Shamsi, “Effect of Ultrasound and Exercise together and TENS alone in the Management of Chronic back pain.,” vol. 4, no. 5, pp. 110–114, 2015.

[15] C.M. Verruch, A.R. Fréz, and G.R.F. Bertolini, “Comparative analysis between three forms of application of transcutaneous electrical nerve stimulation and its effect in college students with non-specific low back pain.,” Brazilian Journal Of Pain. vol. 2, no. 2, pp. 132–136, 2019.

[16] L. Kinteki, Zumrotin, and T.B. Santoso, “Pengaruh Kinesio Tapping dan Muscle Energy Technique Terhadap Penurunan Nyeri Myofascial Pain Syndrome Otot Upper Trapezius Pada Penjahit Di Adieva Konveksi - UMS ETD-db,” (2018).

[17] P.F. Jarzem, E.J. Harvey, N. Arcaro, and J. Kaczorowski, “Transcutaneous electrical nerve stimulation [TENS] for chronic low back pain.,” Journal of Musculoskeletal Pain. vol. 13, no. 2, pp. 3–9, 2015.

[18] Y. Lu, H. Dong, Y. Gao, et al., “A feed-forward spinal cord glycinergic neural circuit gates mechanical allodynia.,” Journal of Clinical Investigation. vol. 123, no. 9, pp. 4050–4062, 2013.

[19] H. Mufidati and Setiawan, “Efektifitas Pemberian Terapi Ultrasound Dan Transcutaneus Electrical Nerve Stimulation Dengan Ultrasound Dan Mobilisasi Saraf Terhadap Pengurangan Nyeri Pada Pasien Carpal Tunnel Syndrome,” (2014).

[20] F.M. Alyazedi, S. Khan, A. Hassan Al Ghamdi, N. Al-Toriri, and S. Shamsi, “Effect of Ultrasound and Exercise together and TENS alone in the Management of Chronic back pain.,” IOSR Journal of Nursing and Health Science. vol. 4, no. 5, pp. 110–114, 2015.

[21] C.C. Chen and M.I. Johnson, “Differential Frequency Effects of Strong Nonpainful Transcutaneous Electrical Nerve Stimulation on Experimentally Induced Ischemic Pain in Healthy Human Participants.,” Clinical Journal of Pain. vol. 27, no. 5, pp. 434–441, 2011.

[22] P.E.O. Gonçalves, M. Milanez, R.L.G. Flumignan, J. Machado, T.P. Navarro, and L. de L. Cisneros, “Transcutaneous Electric Nerve Stimulation on Ischemic Rest Pain in Inpatients: Randomised Trial.,” Revista da Associação Médica Brasileira. vol. 67, no. 2, pp. 213–217, 2021.