effect of superficial back line relaxation technique on hamstring flexibility in non specific low back pain patients

Conditions: Low Back Pain, Mechanical; Hamstring Flexibility

Summary: current study aim to evaluate the effect of superficial back line relaxation techniques (smit along with ccfe) in non specific low back pain patients in order to improve pain and hamstring flexibility. and to find out the association between sub occipital muscle inhibition technique (smit) and cranial cervical flexion exercise (ccfe) in nonspecific low back pain patients with hamstring tightness. the study aims to enhance the functional status and posture of patients suffering from nonspecific low back pain due to hamstring tightness, thereby enhancing patient efficiency in performing adls and iadls.

according to recent studies, hamstring tightness gets better as a result of sub occipital muscle inhibition technique, and cranial cervical flexion exercise that improve hamstring flexibility. smit is an approach of releasing fascia by application of pressure on sub occipital area. the myofascia relaxes as tone of suboccipital muscle declines that results in reduction in hamstring tone effectively.this is so because the superficial back line of dura matter connects hamstring with sub occipital muscles and neurological system runs through it. in smit superficial back line relaxes. while this approach helps suboccipital muscles release degree tension between occiput and axis. the premise behind ccfe is that cervical spine's dura matter and suboccipital muscle fascia are connected by soft tissue while superficial back line of myofascial chain connects the neck to lower extremity. if tone of suboccipital muscle is reduced,the tone of knee flexors gets minimize and degree of hip flexion gets increase that results in increasing hamstring flexibility. previous study showed that ccfe restores hamstring flexibility by relaxing superficial back line. while smi and ccfe represents passive and active exercise program, respectively are equally effective in immediate enhancement of hamstring flexibility. this study divide in to two groups. group a ( experimental group) and group b ( control group). group a will receive manual technique superficial back line relaxation technique includes (suboccpital muscle inhibition along with cranial cervical flexion exercise) with conventional therapy.while group b will receive only conventional therapy include hot pack (lumber region) with low back exercises such as stretching exercise (knee to chest, pelvis bridging, cat and camel stretch). current study aims to pin point combine effect of smit along with ccfe in people with hamstring tightness. additionally this study will evaluate the immediate and long term effect of smit and ccfe on patients with non- specific low back pain by comparing direct and indirect approaches for hamstring flexibility. the study aims to enhance the functional status and posture of patients suffering from nonspecific low back pain due to hamstring tightness, thereby enhancing patient efficiency in performing adls and iadls.

Eligibility criteria:
inclusion criteria: * patients with chronic low back pain associate with hamstring tightness. * unilateral or bilateral short hamstring syndrome * 3 to 6 points in numeric pain rating scale(nprs). * active knee extension more than 20°. * presence of hamstring tightness with popliteal angle more than 30 degree. * angle in slr test should be less than 80° exclusion criteria: * history of cervical spine surgery and neck trauma. * cervical and lumber spinal deformity, herniated disc or protrusions, spinal stenosis. * muscle tendon injuries of the hamstring. * history of vascular disease in head and neck. * visual swelling in the region of hamstring muscle. * progressive neurological deficit. * fractures in cervical and lumber spine. * past and current history of vertigo and dizziness.

Keywords: hamstring flexibility backache suboccipital muscle inhibition technique cranial cervical flexion exercise