Hamstring Viscoelasticity and Low Back Pain

Study Overview
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Brief Summary
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Low back pain (LBP) is a prevalent issue among adolescent rowers, particularly males aged 14 to 16 years, with a high lifetime prevalence (94%) and point prevalence (65%). One of the mechanisms of lower back pain in rowing athletes is about the elasticity, stiffness and tone of the hamstring muscle. Current literature shows that stretching exercises, strengthening exercises and kinesiotaping affects hamstring viscoelasticity in various ways. Stretching exercises affect hamstring muscle tone and elasticity, strengthening exercises affect muscle stiffness and kinesiotaping affects muscle tone. While the effects of each of these interventions on viscoelastic properties individually are examined in the literature, studies comparing the effects of changes in viscoelastic properties caused by these interventions on low back pain, athletic disability index and athletic performance in rowers and their superiority among each other are lacking. The goal of this study is to change the viscoelasticity of the hamstring muscles and examine its effect on low back pain, disability index and athletic performance.

Detailed Description
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Volunteer male elite rowing athletes between the ages of 14 and 18 who score 3/10 or higher on the Numeric Pain Rating Scale at the time of activity will be included in the study. Signed voluntary consent will be obtained from participants and their legal representatives. Participants will be divided into three groups. Study groups will be as follows: a) ballistic hamstring stretching exercise b) hamstring extender exercise c) kinesiotaping

Official Title
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Is Hamstring Muscle Application of Different Physiotherapy Interventions Effective on Hamstring Viscoelasticity and Low Back Pain in Elite Adolescent Rowers Experiencing Low Back Pain? A Prospective Randomized Single-blind Study

Conditions
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Low Back Pain, Athletic Injuries

Intervention / Treatment
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* Other: Ballistic Stretching Exercise
* Other: Extender Exercise
* Other: Kinesiotaping


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being between ages 14 and 18 and male gender Having been rowing at an elite level for at least one year with a professional team Having pain 3/10 or higher on NPRS Participating to the study in a voluntary basis. Exclusion Criteria: Having limitation in lower extremity range of motion that limits completion of interventions Having a musculoskeletal injury involving the lower extremity in the last 6 months. Having undergone a operation in the last 6 months. Failing to complete any of interventions. Wanting to quit from study.

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be divided into three groups with equal numbers by computer randomization method.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Ballistic Stretching Exercise<br>Athletes will be asked to reach the floor by leaning over in the standing posture without knee flexion. When they feel the tension in hamstring muscle groups, athletes will be requested to make small rebounding motion at degrees between 3°-5° for half a minute. | Other: Ballistic Stretching Exercise<br>* It will be applied 4 times a week for 6 weeks and before starting on-water training.<br>|
| Active Comparator: Extender Exercise<br>Athletes will lie on his back. Then, athletes will be asked to do 90 degrees of knee and hip flexion at the same time. Finally, the athletes is expected to perform slow repetitive knee extension to the point of maximal possible extension. According to Askling et al. and Aspetar protocol, it will be applied 12 repetitions and 3 sets. | Other: Extender Exercise<br>* It will be applied 4 times a week for 6 weeks and before starting on-water training.<br>|
| Active Comparator: Kinesiotaping<br>Kinesio taping will be applied to the hamstring muscle in the direction of inhibition with a Y-shaped and 25% tension force. | Other: Kinesiotaping<br>* It will be applied 4 times a week for 6 weeks and before starting on-water training.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of Biceps Femoris Muscle | The tones of muscle is described by frequency of muscle or oscillation frequency (Hz). It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline frequency at 6 weeks | 
| Frequency of Semitendinosus Muscle | The tones of muscle is described by frequency of muscle or oscillation frequency (Hz). It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline frequency at 6 weeks | 
| Stiffness of Biceps Femoris Muscle | Stiffness of muscle is described by reaction to contraction or forces from outside of tissue that may cause the original form to deteriorate. It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline stiffness at 6 weeks | 
| Stiffness of Semitendinosus Muscle | Stiffness of muscle is described by reaction to contraction or forces from outside of tissue that may cause the original form to deteriorate. It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline stiffness at 6 weeks | 
| Decrement of Biceps Femoris Muscle | The elasticity of a muscle is described by a logarithmic reduction of tissue's normal amplitude. It is more related with the dissipation of mechanical energy that arises between the deformation of the tissue and its recovery. It is a biomechanical feature of tissue that is called as elasticity. It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline decrement at 6 weeks | 
| Decrement of Semitendinosus Muscle | The elasticity of a muscle is described by a logarithmic reduction of tissue's normal amplitude. It is more related with the dissipation of mechanical energy that arises between the deformation of the tissue and its recovery. It is a biomechanical feature of tissue that is called as elasticity. It will be examined by the MyotonPro, Tallinn, Estonia. | change from baseline decrement at 6 weeks | 
| Numeric Pain Rating Scale (NPRS) | The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable). | change from baseline pain at the time of activity at 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Standing Long Jump Test (SLJT) | It is a horizontal jump test that measures anaerobic performance. | change from baseline performance level at 6 weeks | 
| 2K-rowing test | It is an ergometer test that measures 2,000 meter rowing time as a gold standard. | change from baseline performance time at 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ballistic Stretching, Athletic Tape, Eccentric Exercise, Low Back Pain, Athletic Performance