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06 June 2023 : Case report  Netherlands

Unlocking Pain Relief for Chronic Low Back Pain: The Potential of the 4xT Method® – A Dual Case Study Analysis

Unusual setting of medical care

Robbert N. van Amstel ORCID logo1ABDEF*, Karl Noten2DEF

DOI: 10.12659/AJCR.939284

Am J Case Rep 2023; 24:e939284



BACKGROUND: The 4xT method is a therapeutic approach involving 10 sequential steps. The 4xT method uses the steps test, trigger, tape, and train, sequentially executed until the patient can train with an acceptable level of pain. The report aimed to evaluate the effectiveness of 4xT therapy in managing chronic nonspecific low back pain (LBP) after the first treatment and after 6 weeks of therapy by measuring changes in range of motion (ROM) and pain levels using the numeric rating scale (pain NRS).

CASE REPORT: After the first treatment, patient 1 (42-year-old woman with 16 years of LBP, having a profession requiring standing) improved substantially in ROM, increasing flexion from 57° to 104° and extension from 5° to 21°. The pain NRS during flexion decreased from 8 to 0 (after step 6), and during extension, it decreased from 6 to 0 (after step 7). Similarly, patient 2 (43-year-old man with 13 weeks of LBP, having a sedentary occupation) showed ROM improvements, increasing extension from 16° to 25° and flexion from 58° to 101°. After step 8, pain NRS during extension decreased from 7 to 1, and during flexion, it decreased from 6 to 2 (after step 3). Pain further reduced to NRS0 after training. After 6 weeks of 4xT therapy, LBP improved, and mobility substantially increased in both patients.

CONCLUSIONS: The 4xT method was effective in reducing pain and improving mobility in 2 LBP patients after initial treatment and 6 weeks of therapy. Further research is necessary to validate these results in larger populations.

Keywords: Low Back Pain, Physical Therapy Modalities, Back Muscles, Range of Motion, Articular, Spine, Fascia

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923