Foam Roller Versus Self-Performed Neurodynamic Sliding in People With Hamstring Tightness and Low Back Pain History

Effects of Self-Myofascial Release With Foam Roller Versus Self-Performed Neurodynamic Sliding on Hamstring Flexibility in People With Hamstring Tightness and a History of Low Back Pain: A Randomized Pilot Clinical Trial

This randomized crossover pilot clinical trial evaluated the effects of two self-administered physiotherapy techniques in people with hamstring tightness and a history of non-specific low back pain.

Participants were randomly assigned to one of two treatment sequences. One sequence performed self-myofascial release using a foam roller first, followed by a one-month washout period, and then performed a self-administered neurodynamic sliding technique. The other sequence performed the neurodynamic sliding technique first, followed by a one-month washout period, and then performed the foam roller intervention.

The main objective of the study was to compare the effects of both interventions on hamstring flexibility. Secondary outcomes included active knee extension range of motion, dynamic balance, pressure pain threshold, hamstring and gluteus maximus strength, and low back pain intensity.

Low back pain is a common musculoskeletal condition, and hamstring tightness has been proposed as a potential contributing factor due to its influence on pelvic and lumbar biomechanics. Different physiotherapy interventions may be used to improve hamstring flexibility, including self-myofascial release with a foam roller and neurodynamic sliding techniques.

This study was designed as a randomized, crossover, pilot clinical trial with two active interventions. Participants were people with hamstring tightness and a history of recurrent or chronic non-specific low back pain. Eligible participants were randomly assigned to one of two intervention sequences.

In one sequence, participants first performed self-myofascial release using a foam roller on the hamstring muscles. After a one-month washout period, they then performed the self-administered neurodynamic sliding technique. In the other sequence, participants first performed the self-administered neurodynamic sliding technique. After a one-month washout period, they then performed the self-myofascial release intervention using a foam roller.

The foam roller intervention consisted of bilateral self-myofascial release of the hamstring muscles for 2 minutes per leg over three consecutive days. The neurodynamic sliding intervention consisted of a seated self-administered neurodynamic sliding technique over three consecutive days, with 3 sets of 20 repetitions and 20 seconds of rest between sets.

Assessments were performed before and after each intervention period. The primary outcome was hamstring flexibility measured using the Straight Leg Raising test. Secondary outcomes included hamstring flexibility measured using the Active Knee Extension test, dynamic balance assessed with the Y-Balance Test, pressure pain threshold over myofascial trigger points, isometric strength of the hamstrings and gluteus maximus, and low back pain intensity measured with the Numeric Pain Rating Scale.

Inclusion Criteria:

• Men and women aged 16 years or older.
• History of non-specific low back pain during the previous three months and/or recurrent or chronic non-specific low back pain.
• Limited hamstring flexibility, defined as hamstring tightness with 75 degrees or less of hip flexion with knee extension during the Straight Leg Raise test.
• No previous surgery involving the spine or lower limb.
• No hamstring stretching exercises performed in the weeks prior to participation.
• Ability and willingness to provide informed consent.
• Availability to perform both self-administered physiotherapy techniques according to the study protocol.

Exclusion Criteria:

• Pregnancy or breastfeeding.
• History of hamstring muscle or tendon injury during the previous year.
• Lumbar or lower-limb neurological deficits.
• Lower-limb length discrepancy.
• Specific spinal pathology, including tumor, infection, fracture, or inflammatory disease.
• History of lumbar disc herniation.
• History of whiplash injury.
• Any contraindication to physical exercise.
• Menstrual pain at the time of assessment or intervention.
• Scheduled surgery during the intervention or follow-up period.
• History of cardiac disease.
• Incomplete or incorrectly completed questionnaires or missing assessment data.
• Refusal to complete part or all of the study intervention.
• Development of a low back pain episode during the study intervention.