Effect of Tecar Therapy on Pain and Functional Disability in Patients with Chronic Non-specific Low Back Pain

³ Social Determinants of the Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

*Corresponding author: Rozita Hedayati, Department of Physiotherapy, Semnan University of Medical Sciences, Semnan, Iran. Email: rosehed@yahoo.com

EXTENDED ABSTRACT

Background

Chronic non-specific low back pain (CNLBP) is pain between the lower rib margins and the inferior gluteal folds that persists for at least 12 weeks without a specific identifiable cause and is commonly accompanied by painful limitation of movement [1,2]. It affects adults across a wide age range, with substantial lifetime and annual prevalence, and can markedly reduce quality of life and participation in employment [3, 4]. Numerous treatments have been used for CNLBP, including medication, exercise, manual therapy, traction, orthoses, transcutaneous electrical nerve stimulation, laser, and other physical modalities, although no single approach has consistently shown definitive superiority [5, 6]. Tecar therapy, a relatively recent modality for musculoskeletal disorders, applies high-frequency electromagnetic current, typically in the 0.3-1.2 MHz range [7]. Its proposed effects include deep tissue heating, increased circulation and metabolism, reduced muscle spasm, and analgesia that may be partly related to endorphin release [8-10]. Clinical studies have reported potential benefits of radiofrequency-based therapy for pain, flexibility, and musculoskeletal function [11-14]. Tecar can be delivered through capacitive and resistive modes, which are intended to target tissues of different impedance and depth [15]. Previous studies have suggested pain reduction in musculoskeletal conditions, including low back pain [18, 19], but controlled clinical evidence in CNLBP remains limited. Therefore, the present study evaluated the short-term and one-month effects of Tecar therapy, added to routine physiotherapy, on pain intensity and functional disability in patients with CNLBP.

Methods

This double-blind clinical trial was conducted among adults with CNLBP who attended the physiotherapy clinic of the School of Rehabilitation, Hamadan University of Medical Sciences, from June to December 2023. Eligible participants were men and women aged 20-60 years with non-specific low back pain for at least 12 weeks, no documented discopathy or disc herniation, and a baseline visual analog scale (VAS) pain score of 4-7. Patients with contraindications to Tecar therapy, active vertebral fracture, previous spinal surgery, rheumatologic or systemic disease affecting pain perception, recent local injection, or recent physiotherapy were excluded. Convenience sampling was used, followed by randomized permuted-block allocation. The planned sample was 32 patients in two groups of 16; the baseline table reports complete data for 15 treatment and 13 placebo participants. The treatment group received 10 sessions over two weeks (five sessions per week) consisting of routine physiotherapy plus active Tecar therapy. Tecar treatment included 10 minutes of capacitive therapy at 600 kHz followed by 10 minutes of resistive therapy at 450 kHz over the lumbar paraspinal region. Routine physiotherapy included 20 minutes of low-frequency TENS at 5 Hz with a 300-microsecond pulse duration, 15 minutes of infrared treatment, lumbar-pelvic stabilization exercises, and paraspinal stretching [23]. The placebo group received the same routine physiotherapy with placebo Tecar therapy. Pain was assessed using the 100-mm VAS [24], and functional disability was evaluated with the Oswestry Disability Index (ODI), scored from 0 to 100 [25, 26]. Outcomes were measured before treatment, immediately after the 10th session, and one month later. Statistical analysis was performed in SPSS version 22 using normality testing, independent or nonparametric comparisons as appropriate, chi-square tests for categorical data, and repeated-measures analysis. Statistical significance was defined as P<0.05. The study was approved by the Ethics Committee of Semnan University of Medical Sciences (IR.SEMUMS.REC.1401.190) and registered in the Iranian Registry of Clinical Trials (IRCT20221101056358N1).

Results

Baseline demographic characteristics did not differ significantly between the treatment and placebo groups (all P>0.05). In the analyzed baseline table, the treatment group included 15 patients and the placebo group 13 patients. Mean age was 40.27±9.83 years in the treatment group and 46.00±11.47 years in the placebo group; mean body mass index was 24.79±4.01 and 24.59±4.70 kg/m², respectively. Pain intensity decreased significantly within both groups after treatment and at one-month follow-up (both within-group P<0.001). In the Tecar group, mean VAS decreased from 5.83±0.98 before treatment to 2.43±1.03 immediately after treatment and was 3.03±1.23 at one month. In the placebo group, the corresponding values were 5.77±1.15, 3.65±1.65, and 3.08±1.62. The two groups were comparable at baseline (P=0.943). Immediately after the 10th session, pain was significantly lower in the Tecar group than in the placebo group (P=0.034), whereas the between-group difference was no longer significant at one month (P=0.888). In the repeated-measures covariance model for pain, the time-by-group interaction was significant (F=6.113, P=0.021, effect size=0.196), while the overall group effect was not significant (P=0.145).

Table 2. Pain intensity and functional disability before treatment, after the intervention, and one month later in the Tecar therapy and placebo groups.

Functional disability showed a similar short-term pattern. Mean ODI in the Tecar group decreased from 25.60±8.36 before treatment to 12.93±5.95 immediately after treatment and 13.33±5.49 one month later. In the placebo group, ODI decreased from 28.77±10.41 to 20.00±8.08 and 16.46±7.75, respectively. Within-group reductions were significant after treatment and at one month in both groups (all P<0.001). The between-group comparison was not significant at baseline (P=0.380), became significant immediately after the intervention (P=0.013), and was not significant at one-month follow-up (P=0.224). In the adjusted repeated-measures covariance analysis of disability, the time-by-group interaction did not reach statistical significance (F=3.86, P=0.061); the baseline disability value was significant (P=0.038), while the main group effect was not significant (P=0.073). Thus, the unadjusted mid-treatment comparison showed a greater immediate improvement in the Tecar group, but the adjusted model did not demonstrate a statistically significant differential trajectory for disability. These findings were broadly consistent with earlier reports of pain or functional improvement with Tecar-related interventions [18, 19, 27-30]. The authors suggested that the lack of a maintained between-group difference at one month may relate to the short treatment and follow-up periods.

Conclusion

Adding Tecar therapy to routine physiotherapy produced greater short-term reductions in pain intensity and unadjusted functional disability than placebo Tecar plus the same routine treatment in patients with CNLBP. Both groups improved over time, and the between-group differences were not statistically significant at the one-month follow-up. The study therefore supports Tecar therapy as a potentially useful short-term adjunct for reducing pain and improving functional disability in CNLBP, while emphasizing that durability of benefit was not demonstrated over the available follow-up. The authors also noted that the findings should not be generalized to other age groups, specific or acute low back pain, or lumbar radiculopathy, and that longer follow-up studies are needed.

Keywords: Functional Disability, Low Back Pain, Tecar Therapy

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