Active Mobilization of Hamstring for Non-specific Low Back Pain and Musculoskeletal Discomfort During Prolonged Sitting
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Hip flexion is a normal part of everyday functional activities, including walking and
      sitting. The length of the hamstring influences on movement of the pelvis during hip flexion,
      consequently influencing lumbar lordosis. In most activities, the hamstring muscles are
      active and it is necessary to keep them at normal length. Sitting posture is responsible for
      the loss of the natural curvature of the lumbar spine, because the hip flexion and pelvic
      extension flatten the lumbar vertebrae (i.e., lumbopelvic rhythm). Furthermore tightened
      hamstring increases posterior pelvic tilt and reduces lumbar lordosis, which can tend to low
      back pain (LBP). Stretching exercises play an important role in both the prevention and
      treatment of LBP. One important option will be exercise protocol which will combine the
      active hamstring flexibility exercises with hip flexion mobilization and the development of
      the habit of correct hip flexion technique, protecting the lower spine.

      The aim of this RCT is to present a protocol for evaluating the effect of 8-week active
      hamstring flexibility exercises with hip flexion mobilization in reducing LBP and perceived
      musculoskeletal discomfort during prolonged sitting in young adults with non-specific LBP.
    

Detailed description: 
      Background:

      Limited lower extremity muscle flexibility, such as hamstring, iliopsoas, quadriceps, and
      limited hip range of motion are risk factors for low back pain (LBP) in young people. LBP has
      increased by 49.8-50.7% over the last twenty years which highlighted the increase in the
      dominance of LBP especially among young people. Flexibility is an essential factor in
      physical fitness, which has a significant role in the functional development of the
      musculoskeletal system and the optimization of muscle work. To prevent pain or perceived
      musculoskeletal discomfort, various flexibility exercises including exercise stretches of the
      hamstring muscles have been recommended. Improving the hip flexion technique requires hip
      power and stability in the lumbar spine. In hamstring flexibility training, we should create
      an opportunity to practice movement and develop correct patterns using the hip flexion and
      extension pattern while maintaining the stability of the lumbar spine. Keeping the torso
      straight while working the hips and knees is one of the basic principles of protecting the
      spine in the lumbar region. Maintaining a neutral lower spine protects passive tissues and
      allows for better mobilization of the hips. Stretching exercises play an important role in
      both the prevention and treatment of LBP. One important option will be exercise protocol
      which will combine the active hamstring flexibility exercises with hip flexion mobilization
      and the development of the habit of correct hip flexion technique, protecting the lower
      spine.

      Objective:

      This randomized controlled trial aims to investigate the effect of a 8-week intervention
      involving active hamstring flexibility exercises with hip flexion mobilization on reducing
      low back pain (LBP) and perceived musculoskeletal discomfort during prolonged sitting in
      young adults with non-specific LBP.

      Methods:

      This will be a single-blind, randomized controlled trial with pre and post-intervention
      assessment. Participants were recruited from Physical Education Faculty students and randomly
      assigned to either the experimental group (hamstring stretching exercises) or the control
      group (no intervention). The hamstring stretching exercises group will be held five a week,
      20 min per session for 8 weeks. The primary outcomes will be average pain intensity (Visual
      Analogue Scale, VAS), functional disability (Oswestry Disability Index), perceived
      musculoskeletal discomfort during prolonged sitting (Borg scale) , and the global perceived
      improvement (The Global Perceived Effect, 7-point Likert scale). Secondary outcome will be
      flexibility of the hamstring (SLR test).

      Expected outcomes:

      The findings of this study might provide information about a 8-week intervention involving
      active hamstring flexibility exercises with hip flexion mobilization on reduction of LBP and
      musculoskeletal discomfort during prolonged sitting in young adults. These results might
      highlight the importance of incorporating targeted flexibility exercises in the management of
      non-specific LBP, particularly in individuals with a sedentary lifestyle. Further research is
      warranted to explore the long-term effects and applicability of these interventions in larger
      populations.
    

Intervention name(s): Active hamstring flexibility exercises with hip flexion mobilization
Intervention type(s): Behavioral
Intervention description(s): 8 weeks x 5 times per week for 20 min. In the experimental intervention, the exercise program will be based on participant education, home-based individual exercises, and regular group meetings for check-ups by a physiotherapist according to a precise set schedule.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: exercise; treatment; spine; posture; students; pain; hamstring muscles