Hamstring Elongation Quantified Using Ultrasonography During the Straight Leg Raise Test in Individuals With Low Back Pain

The relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific chronic low back pain

BACKGROUND

Low back pain is a common health issue, and such pains are often associated with muscle tightness. Understanding the link between lower back pain and tight lower extremity muscles is essential for effective pain management and enhanced quality of life.

OBJECTIVE

The objective of this study was to investigate the relationship between lower extremity muscle tightness and pain and disability in individuals with non-specific low back pain (NSLBP).

METHODS

A total of 52 individuals with NSLBP were enrolled in this cross-sectional study. Lower extremity muscle tightness was assessed using various clinical tests, including the Active Knee Extension Test, Active Straight Leg Raise, Ober Test, and Modified Thomas Test. Pain intensity and disability were evaluated using the Visual Analog Scale and the Oswestry Disability Index, respectively. Statistical analyses were conducted to assess the correlation between muscle tightness, pain, and disability.

RESULTS

The study found weak to moderate negative correlations between lower extremity muscle tightness and both pain intensity and disability in individuals with NSLBP (r: -0.287 to -0.526, p < 0.05). Dominant and non-dominant extremities exhibited differences in muscle flexibility, with the dominant extremity showing greater flexibility (p < 0.05).

CONCLUSIONS

In individuals with NSLBP, lower extremity muscle tightness is closely related to pain severity and disability. These findings suggest that lower extremity muscle tightness plays a significant role in the severity of low back pain and disabilities. Additionally, the observed flexibility difference between dominant and non-dominant extremities warrants further investigation for more personalized treatment approaches.

Immediate effect of passive hamstring stretching on flexibility and relationship with psychosocial factors in people with chronic low back pain

Background

Hamstring muscle tightness contributes to disability in people with chronic low back pain (CLBP). HM stretching improves flexibility in healthy individuals, but the immediate effect of stretching is unknown in people with CLBP. Moreover, the stretching effect could be influenced by psychosocial factors.

Objectives

To evaluate the immediate effect of passive HM stretching on flexibility in people with CLBP and the relationships between psychosocial factors and change in hamstring flexibility.

Design

Non-randomized, pilot trial.

Method

One minute of passive stretching was performed in 90 people with CLBP. Change in Active Knee Extension and Straight Leg Raise angles (digital inclinometer), and Fingertips-to-Floor distance (measuring tape) were measured before and immediately after stretching. Correlations between change in flexibility and baseline Fear-Avoidance Beliefs Questionnaire (FABQ) and Hospital Anxiety and Depression Scale (HADS) scores were analyzed.

Results

Hamstring flexibility improved significantly after stretching; Active Knee Extension mean difference was 4° (95% CI, 2.4 to 5.1; p < 0.001, right ES = 0.24, left ES = 0.23); Straight Leg Raise mean difference was 7° (95% CI, 5.5 to 8.6, p < 0.001, right ES = 0.44, left ES = 0.42), Fingertips-to-Floor mean difference was 2 cm (95% CI, 1.7 to 3.0, p < 0.001, ES = 0.20). No correlation was found between improvement in any of the hamstring flexibility measurements and FABQ or HADS scores (p > 0.05).

Conclusions

Passive hamstring stretching induced an immediate, statistically significantly improvement in hamstring flexibility, but only the change in Straight Leg Raise amplitude was clinically important. Psychosocial factors were not related to improvements in flexibility after hamstring stretching.

Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise

Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.

Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer)

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.

Comparisons of hamstring flexibility between individuals with and without low back pain: systematic review with meta-analysis

Background: There is no robust evidence on the contribution of reduced hamstring flexibility to the development of low back pain (LBP) in cohort studies.Purpose: To investigate whether individuals with LBP have impaired hamstring flexibility and stiffness and what measures have been used to compare hamstring flexibility and stiffness between individuals with and without LBP.Methods: A systematic literature search was undertaken in PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, and Cochrane databases from inception to April 2018. The GRADE system was used to determine the quality of evidence for each measure evaluated in meta-analysis.Results: Respectively, seventeen and two studies having acceptable methodological quality were analyzed with regard to hamstring flexibility and stiffness. Four measures were identified for hamstring flexibility and five for stiffness. Meta-analyses were undertaken in straight leg raising (SLR), sit and reach and knee extension in 90° hip flexion for hamstring flexibility and for hamstring stiffness measures of stiffness at 50° SLR and gradient of stiffness from 20° to 50° SLR (M_e-grad). Significantly reduced hamstring flexibility or increased stiffness (P < .05) was detected in SLR, 90/90 knee extension and M_e-grad. However, the validity of measures for hamstring flexibility was problematic and GRADE scores for all measures in the meta-analyses were very low.Conclusion: There have been four measures for hamstring flexibility and five for stiffness to evaluate individuals with and without LBP. It was impossible to conclude whether individuals with LBP have impaired hamstring flexibility and stiffness due to very low quality of evidence for meta-analyses.

A systematic review on quantifiable physical risk factors for non-specific adolescent low back pain

PURPOSE

The aim of this systematic review was to analyze the results of studies on quantifiable physical risk factors (beyond questionnaires) for adolescent low back pain (LBP).

METHODS

A systematic search was conducted in Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro and PsycINFO. Cross-sectional, prospective and retrospective English language studies on LBP in adolescents aged 10 to 18 years were included.

RESULTS

Twenty-two mostly cross-sectional studies were included. Trunk muscle endurance in particular seemed to be associated with adolescent LBP, while a possible association of trunk muscle strength and spinal flexibility was less clear.

CONCLUSION

There is a need for prospective studies on quantifiable physical risk factors for adolescent LBP. Such studies should focus on back and abdominal muscle endurance, possibly in combination with sagittal spinal mobility, sagittal postural alignment and neurodynamics as possible modifiable risk factors for LBP.