Hamstring Tightness, Low Back Pain
Conditions
Keywords
foam roller, Self-myofascial release, Neurodynamic sliding, Hamstring flexibility, Low back pain, Crossover trial
Brief summary
This randomized crossover pilot clinical trial evaluated the effects of two self-administered physiotherapy techniques in people with hamstring tightness and a history of non-specific low back pain. Participants were randomly assigned to one of two treatment sequences. One sequence performed self-myofascial release using a foam roller first, followed by a one-month washout period, and then performed a self-administered neurodynamic sliding technique. The other sequence performed the neurodynamic sliding technique first, followed by a one-month washout period, and then performed the foam roller intervention. The main objective of the study was to compare the effects of both interventions on hamstring flexibility. Secondary outcomes included active knee extension range of motion, dynamic balance, pressure pain threshold, hamstring and gluteus maximus strength, and low back pain intensity.
Detailed description
Low back pain is a common musculoskeletal condition, and hamstring tightness has been proposed as a potential contributing factor due to its influence on pelvic and lumbar biomechanics. Different physiotherapy interventions may be used to improve hamstring flexibility, including self-myofascial release with a foam roller and neurodynamic sliding techniques. This study was designed as a randomized, crossover, pilot clinical trial with two active interventions. Participants were people with hamstring tightness and a history of recurrent or chronic non-specific low back pain. Eligible participants were randomly assigned to one of two intervention sequences. In one sequence, participants first performed self-myofascial release using a foam roller on the hamstring muscles. After a one-month washout period, they then performed the self-administered neurodynamic sliding technique. In the other sequence, participants first performed the self-administered neurodynamic sliding technique. After a one-month washout period, they then performed the self-myofascial release intervention using a foam roller. The foam roller intervention consisted of bilateral self-myofascial release of the hamstring muscles for 2 minutes per leg over three consecutive days. The neurodynamic sliding intervention consisted of a seated self-administered neurodynamic sliding technique over three consecutive days, with 3 sets of 20 repetitions and 20 seconds of rest between sets. Assessments were performed before and after each intervention period. The primary outcome was hamstring flexibility measured using the Straight Leg Raising test. Secondary outcomes included hamstring flexibility measured using the Active Knee Extension test, dynamic balance assessed with the Y-Balance Test, pressure pain threshold over myofascial trigger points, isometric strength of the hamstrings and gluteus maximus, and low back pain intensity measured with the Numeric Pain Rating Scale.
Interventions
OTHERSelf-Myofascial Release Using a Foam Roller
Participants will perform bilateral self-myofascial release of the hamstring muscles using a foam roller. The technique will be performed for 2 minutes per leg over three consecutive days.
OTHERSelf-Administered Neurodynamic Sliding Technique
Participants will perform a seated self-administered neurodynamic sliding technique over three consecutive days. The intervention will consist of 3 sets of 20 repetitions, with 20 seconds of rest between sets.
Sponsors
Universidad Pontificia de Salamanca
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The outcomes assessor will be masked to the intervention sequence assigned to each participant. Due to the nature of the interventions, participants and the physiotherapist supervising the interventions cannot be masked.
Intervention model description
Participants will be randomly assigned to one of two intervention sequences. In one sequence, participants will first perform self-myofascial release using a foam roller, followed by a one-month washout period, and then perform the self-administered neurodynamic sliding technique. In the other sequence, participants will first perform the self-administered neurodynamic sliding technique, followed by a one-month washout period, and then perform self-myofascial release using a foam roller.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Men and women aged 16 years or older. * History of non-specific low back pain during the previous three months and/or recurrent or chronic non-specific low back pain. * Limited hamstring flexibility, defined as hamstring tightness with 75 degrees or less of hip flexion with knee extension during the Straight Leg Raise test. * No previous surgery involving the spine or lower limb. * No hamstring stretching exercises performed in the weeks prior to participation. * Ability and willingness to provide informed consent. * Availability to perform both self-administered physiotherapy techniques according to the study protocol.
Exclusion criteria
* Pregnancy or breastfeeding. * History of hamstring muscle or tendon injury during the previous year. * Lumbar or lower-limb neurological deficits. * Lower-limb length discrepancy. * Specific spinal pathology, including tumor, infection, fracture, or inflammatory disease. * History of lumbar disc herniation. * History of whiplash injury. * Any contraindication to physical exercise. * Menstrual pain at the time of assessment or intervention. * Scheduled surgery during the intervention or follow-up period. * History of cardiac disease. * Incomplete or incorrectly completed questionnaires or missing assessment data. * Refusal to complete part or all of the study intervention. * Development of a low back pain episode during the study intervention.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Hamstring Flexibility Measured With the Straight Leg Raise Test | Baseline of each intervention period, 24 hours after completing each intervention, and 7 days after each intervention | Hamstring flexibility will be assessed using the Straight Leg Raise test. The test will be performed with the participant in the supine position, and hip flexion range of motion will be measured in degrees using a goniometer. Higher values indicate greater hamstring flexibility. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Hamstring Flexibility Measured With the Active Knee Extension Test | Baseline of each intervention period, 24 hours after completing each intervention, and 7 days after each intervention | Hamstring flexibility will be assessed using the Active Knee Extension test. The knee extension angle will be measured in degrees using a goniometer, with the hip positioned at 90 degrees of flexion. |
| Change in Dynamic Balance Measured With the Y-Balance Test | Baseline of each intervention period, 24 hours after completing each intervention, and 7 days after each intervention | Dynamic balance will be assessed using the Y-Balance Test. Reach distances in the anterior, posteromedial, and posterolateral directions will be recorded in centimeters and normalized to lower limb length. |
| Change in Pressure Pain Threshold | Baseline of each intervention period, 24 hours after completing each intervention, and 7 days after each intervention | Isometric strength of the hamstring muscles and gluteus maximus will be assessed using a handheld dynamometer. Values will be recorded in Newtons, with higher values indicating greater muscle strength. |
| Change in Low Back Pain Intensity | Baseline of each intervention period, 24 hours after completing each intervention, and 7 days after each intervention | Low back pain intensity will be assessed using the Numeric Pain Rating Scale, ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. |
Countries
Spain
Contacts
CONTACTSara Perpiña Martínez, PT, PhD
PRINCIPAL_INVESTIGATORSara Perpiña Martínez, PT, PhD
Pontifical University of Salamanca
Outcome results
None listed