The exclusion criteria were: Oswestry Disability Index score less than 10, history of spinal surgery or fracture or diagnosis with an inflammatory disorder or fibromyalgia. Patients were also excluded if assessment suggested that they were experiencing lumbar radiculopathy (Wilk, 2004). All participants were given the same general advice, which was to continue using medication Adriamycin datasheet as prescribed

by their medical practitioner and to remain active (March et al 2004), but to avoid activities that aggravated their low back pain. All participants were instructed in a standardised exercise program and issued with a printed handout to reinforce the verbal instructions. The handout is available as an e-addendum (see Appendix 1). The exercise program consisted of three exercises that are commonly prescribed by physiotherapists for clients with low back pain: sidelying abdominal bracing (intended to activate deep abdominal stabilisers) (Richardson et al 1999), alternate knee-to-chest holds (Nicholas et al 2007), and side-to-side lumbar rotation (Olson 2007). Correct performance of side-lying abdominal Trametinib mw bracing was assessed

clinically by observing for a slight drawing-in of the lower abdominal wall below the umbilicus which is consistent with activation of the transversus abdominis muscle (Richardson et al 1999). Participants were asked to perform the exercises in a range that did not increase their pain, twice a day during the intervention period. The exercises were not progressed during the intervention period. Participants in the experimental group attended twice a week for two consecutive weeks and received Strain-Counterstrain treatment and review of the standardised exercises. Strain-Counterstrain treatment involved passive positioning of a participant, with varying degrees of spinal flexion/extension, lateral flexion and rotation, such that there was a two-thirds reduction in tenderness at a monitored digitally tender point (Jones et al 1995). This was determined by having participants rate their tenderness to palpation at digitally tender points on a numerical

pain scale where 10 represented initial tenderness next and 0 no tenderness. In addition to reported tenderness with intermittent probing, perceived tissue tension was used to guide the experimenter to the appropriate passive position (Jones et al 1995). The participant was passively maintained at this point by the experimenter for approximately 90 seconds, with intermittent probing at 30-sec intervals to ensure correct positioning, before being slowly and passively returned to a neutral position (Jones et al 1995, Kusunose and Wendorff, 1990, Kusunose, 1993). Treatment of a digitally tender point was considered successful if tenderness reduced by 70% or more (Kusunose, 1993, Kusunose and Wendorff, 1990).