{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T03:38:55Z","timestamp":1790307535024,"version":"4.1.0"},"reference-count":94,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. Methods: A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. Results: Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p &lt; 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p &lt; 0.05), but not for EQ-5D-3L. Conclusions: The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.<\/jats:p>","DOI":"10.3390\/life14010007","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T03:51:45Z","timestamp":1703044305000},"page":"7","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method\u00ae and Exercise Therapy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4641-0094","authenticated-orcid":false,"given":"Robbert van","family":"Amstel","sequence":"first","affiliation":[{"name":"Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands"},{"name":"Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Noten","sequence":"additional","affiliation":[{"name":"Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, 2000 Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vaes","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation Science and Physical Therapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.berh.2015.03.002","article-title":"The management of musculoskeletal disorders in the workplace","volume":"29","author":"Madan","year":"2015","journal-title":"Best Pract. 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