Temporal Recovery Patterns and Clinically Meaningful Change in Pain, Lumbar Mobility, and Disability Among Patients with Lumbar Myofascial Pain Syndrome Receiving McKenzie-Based Rehabilitation: A Secondary Analysis of a Randomized Trial

Abstract

Background: Lumbar myofascial pain syndrome is commonly associated with persistent pain, restricted spinal mobility, and functional disability. Conventional trial reporting often emphasizes statistical differences between interventions, but this may not clarify when recovery occurs or whether pain, mobility, and disability improve at similar rates. Objective: To evaluate temporal recovery patterns and clinically meaningful change in pain intensity, lumbar mobility, hip flexion, and disability among patients with lumbar myofascial pain syndrome receiving McKenzie-based rehabilitation. Methods: This secondary analysis used data from a single-blinded randomized trial including 70 adults allocated to adjunctive Graston technique with McKenzie extension protocol or McKenzie extension protocol alone. Outcomes included Visual Analogue Scale pain score, Oswestry Disability Index, lumbar flexion, lumbar extension, right and left lateral flexion, and hip flexion measured at baseline, 6 weeks, and 12 weeks. Absolute change, percentage improvement, Friedman tests, Mann–Whitney U tests, and effect-size gradients were used to interpret recovery patterns. Results: At 12 weeks, adjunctive Graston plus McKenzie rehabilitation produced greater improvement than McKenzie alone in pain reduction (65.4% vs 44.7%), ODI reduction (59.7% vs 50.5%), lumbar flexion (32.4% vs 16.8%), lumbar extension (93.0% vs 71.1%), right lateral flexion (65.4% vs 33.9%), left lateral flexion (128.8% vs 110.2%), and hip flexion (9.2% vs 4.5%). Mobility outcomes showed the largest between-group effect sizes, while disability recovery was delayed relative to pain and range-of-motion gains. Conclusion: Recovery following McKenzie-based rehabilitation was clinically multidimensional and time-dependent. Adjunctive Graston technique appeared to enhance pain and mobility recovery, whereas disability improvement emerged more gradually over 12 weeks.