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.

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.

Inclusion Criteria:

• students in Physical Education (18-25 years old)
• with non-specific LBP (defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds), the pain of at least 3 months duration, without radiation to legs
• without a surgical history due to spinal problems
• didn't previously continue the hamstring stretches exercises
• with hamstring muscle shortness

Exclusion Criteria:

• spinal pathology (eg, tumor, infection, fracture, inflammatory disease
• disc herniation and leg length discrepancy over 1cm
• pregnancy
• nerve root compromise
• previous spinal surgery
• major surgery scheduled during treatment or follow-up period
• presence of any contraindication to exercise
• medically verified chronic back disorde
• menstrual pain