Dry Needling Versus Cyriax Technique on Pain, Paraesthesia and Functional Disability in Patients With Chronic Low Back Pain

NCT ID: NCT07089472

Last Updated: 2025-07-28

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 80 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-11-25
• Study Completion Date: 2025-07-19

Brief Summary

This study is designed to compare the effectiveness of two physiotherapy techniques-Dry Needling and the Cyriax Technique-in people suffering from chronic low back pain (CLBP) that radiates to the outer thigh, a condition commonly known as meralgia paresthetica.

Meralgia paresthetica occurs when a nerve called the lateral femoral cutaneous nerve (LFCN) gets compressed, leading to pain, numbness, tingling, or burning sensations in the front or side of the thigh. Many patients also experience difficulty in performing daily activities because of these symptoms.

Dry Needling is a modern treatment where fine, sterile needles are inserted into specific muscles to relieve tension and improve nerve function. It is believed to release natural pain-relieving chemicals and reduce inflammation.

On the other hand, the Cyriax Technique is a manual therapy approach involving deep friction massage and gentle mobilizations targeted at the affected nerve area to reduce pressure and pain.

In this study, 80 participants between the ages of 30 and 50 years, who have had low back pain for more than three months and symptoms of nerve entrapment in the thigh, will be randomly divided into two groups. One group will receive Dry Needling therapy, and the other will receive Cyriax treatment. Both groups will also receive standard physiotherapy, including heat therapy, muscle stimulation, and stretching exercises. Treatment will continue for 8 weeks (2 sessions per week).

The aim is to evaluate and compare changes in pain, tingling/numbness (paraesthesia), and daily life functioning using recognized clinical tools such as the Visual Analogue Scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), and the Roland-Morris Disability Questionnaire (RMDQ). Data will be collected at the beginning, and then again after 2, 4, and 8 weeks.

This research will help determine which therapy-Dry Needling or Cyriax-is more effective in treating patients with this type of nerve-related back and thigh pain. The findings may guide physiotherapists and healthcare providers in choosing the most suitable treatment for managing meralgia paresthetica in chronic low back pain.

Detailed Description

Chronic low back pain (CLBP) with radiating symptoms to the anterolateral thigh, often due to meralgia paresthetica (MP), represents a complex clinical presentation with both musculoskeletal and neuropathic components. MP results from entrapment or irritation of the lateral femoral cutaneous nerve (LFCN), leading to symptoms such as numbness, tingling, burning sensations, and pain in the outer thigh. These symptoms can significantly impair quality of life and physical functioning.

This randomized controlled trial aims to compare two physiotherapeutic interventions-Dry Needling (DN) and the Cyriax Technique-with respect to their impact on pain relief, reduction of paraesthesia, and improvement in functional disability among patients with MP secondary to CLBP.

Participants will be screened based on strict inclusion and exclusion criteria. Eligible participants will be adults aged 30-50 years, diagnosed with CLBP lasting more than three months and exhibiting characteristic symptoms of MP. Exclusion criteria include prior spinal surgery, coagulopathies, serious neurological disorders, or contraindications to dry needling.

After obtaining informed consent, participants will be randomly allocated to either the experimental group (DN) or control group (Cyriax) using computer-generated randomization. Both groups will receive 16 treatment sessions over 8 weeks (2 sessions per week), in addition to standard physiotherapy consisting of heat therapy, electrical muscle stimulation, and targeted exercises.

The dry needling group will receive intramuscular stimulation along the anatomical route of the LFCN, targeting muscles including piriformis, psoas major, iliacus, tensor fasciae latae, vastus lateralis, and sartorius. Aseptic technique using solid filiform needles will be followed, with each needle retained in situ for 15 minutes per session.

The Cyriax group will receive deep transverse friction massage along the LFCN pathway, focused around the anterior superior iliac spine (ASIS), with repeated mobilizations aimed at releasing nerve entrapment and relieving local tissue tension.

Blinding will be maintained at the assessor level to reduce bias. Outcomes will be evaluated using standardized tools:

Visual Analogue Scale (VAS) for pain intensity,

Neuropathic Pain Symptom Inventory (NPSI) for paraesthesia,

Roland-Morris Disability Questionnaire (RMDQ) for functional disability.

These assessments will be conducted at baseline, 2nd, 4th, and 8th weeks of the intervention period. The study is powered at 80% with a 95% confidence interval to detect statistically significant between-group differences. Statistical analysis will be performed using SPSS, with ANOVA applied for both intra- and inter-group comparisons.

This trial is expected to provide clinically meaningful insights into which physiotherapy technique yields better therapeutic outcomes in MP associated with chronic low back pain. It will also contribute to evidence-based practice by addressing a gap in the comparative literature for these two commonly used interventions in musculoskeletal and peripheral nerve-related pain management.

Conditions

Meralgia Paresthetica; Chronic Low-back Pain (cLBP)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Dry Needling Group

Participants in this group will receive dry needling therapy targeting muscles along the route of the lateral femoral cutaneous nerve (LFCN), including the piriformis, iliacus, tensor fascia latae, vastus lateralis, and sartorius. Each session will involve needle insertion (90 sec-2 mins) with retention for 15 minutes. Sessions will be conducted twice a week for 8 weeks (total 16 sessions). Standard physiotherapy (hot pack, EMS, stretching) will be provided alongside.

Group Type: EXPERIMENTAL

Dry Needling Therapy

Intervention Type: BEHAVIORAL

Dry needling will be applied along the lateral femoral cutaneous nerve (LFCN) pathway, targeting muscles such as piriformis, iliacus, tensor fascia latae, vastus lateralis, and sartorius. Sterile solid filiform needles (0.25x30mm and 0.30x50mm) will be inserted for 90 seconds to 2 minutes using a cone technique and retained in situ for 15 minutes. Sessions will occur twice weekly for 8 weeks, with standard physiotherapy (hot pack, EMS, and guided stretches) administered alongside.

Cyriax Technique Group

Participants in this group will receive the Cyriax technique (deep transverse friction massage and nerve mobilization) applied along the LFCN pathway near the anterior superior iliac spine (ASIS). Each session will involve 3-5 repetitions of mobilization, with 10-15 second holds. Sessions will be conducted twice a week for 8 weeks (total 16 sessions). Standard physiotherapy (hot pack, EMS, stretching) will be provided alongside.

Group Type: ACTIVE_COMPARATOR

Cyriax Technique

Intervention Type: BEHAVIORAL

The Cyriax technique involves deep friction massage and mobilization of the lateral femoral cutaneous nerve (LFCN) near the anterior superior iliac spine (ASIS). Using the "pinch and roll" and deep pressure technique, therapists will apply sustained pressure along the nerve path in 3-5 repetitions per session, holding each for 10-15 seconds. Sessions will occur twice weekly for 8 weeks, alongside standard physiotherapy modalities and exercises.

Interventions

Dry Needling Therapy

Dry needling will be applied along the lateral femoral cutaneous nerve (LFCN) pathway, targeting muscles such as piriformis, iliacus, tensor fascia latae, vastus lateralis, and sartorius. Sterile solid filiform needles (0.25x30mm and 0.30x50mm) will be inserted for 90 seconds to 2 minutes using a cone technique and retained in situ for 15 minutes. Sessions will occur twice weekly for 8 weeks, with standard physiotherapy (hot pack, EMS, and guided stretches) administered alongside.

Intervention Type: BEHAVIORAL

Cyriax Technique

The Cyriax technique involves deep friction massage and mobilization of the lateral femoral cutaneous nerve (LFCN) near the anterior superior iliac spine (ASIS). Using the "pinch and roll" and deep pressure technique, therapists will apply sustained pressure along the nerve path in 3-5 repetitions per session, holding each for 10-15 seconds. Sessions will occur twice weekly for 8 weeks, alongside standard physiotherapy modalities and exercises.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Diagnosed with chronic low back pain (time to onset ≥ 3 months) (Erbay, 2002).
• Roland Morris Disability Questionnaire score ≥ 4 (Lara-Palomo et al., 2022).
• CLBP radiating to Anterolateral thigh with symptoms of numbness tingling (de Ruiter et al., 2023).

Exclusion Criteria

• Patients with sensory and/or coagulation disorders (Lara-Palomo et al., 2022).
• A history of spinal surgery, heart complications, concurrent severe central or peripheral nervous system disease (de Ruiter et al., 2023).
• Epilepsy, needle phobia, serious pathologies that can be the main cause of chronic low back pain other than meralgia parasthetica (Lara-Palomo et al., 2022).

• Minimum Eligible Age: 30 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Lahore

OTHER

Sponsor Role: lead

Responsible Party

Faisal Javaid

Student

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

The University of Lahore Teaching Hospital

Lahore, , Pakistan

Countries

Pakistan

References

de Ruiter GCW, Oosterhuis JWA, Vissers TFH, Kloet A. Unusual causes for meralgia paresthetica: systematic review of the literature and single center experience. Neurosurg Rev. 2023 May 6;46(1):107. doi: 10.1007/s10143-023-02023-2.

Reference Type: BACKGROUND

PMID: 37148363 (View on PubMed)

Other Identifiers

Rec-UOL-/504/08/24

Identifier Type: -

Identifier Source: org_study_id