Body Posture, Joint Mobility, and Trunk Muscle Endurance Related to Lower Back Pain in Tennis Players

Completed

• Conditions: Low Back Pain

• Registration Number: NCT06890845
• Lead Sponsor: Józef Piłsudski University of Physical Education

Brief Summary

The aim of this study was to determine the significance of the impact of external factors (self-evaluation of the subjects) and internal factors, including the range of motion in the spine and hip joints, trunk muscle endurance and body posture of tennis players, on the occurrence and severity of low back pain.

Detailed Description

The aim of the study was to compare tennis players with and without lower back pain (LBP) and individuals not engaged in asymmetric sports without LBP in terms of spinal flexion, extension, lateral bending range of motion, hip joint flexion, extension, internal and external rotation, modified seat and reach test results, trunk muscle endurance, body posture parameters, and survey information regarding training volume and stretching exercises. Identifying significant differences between participants with and without LBP could provide indications for modifying rehabilitation programs for amateur tennis players with LBP or for introducing preventive exercises targeting factors significantly influencing the occurrence of LBP in this population. Prior to the study, participants provided written consent and were informed of their right to withdraw from the study at any time.

Study Timeline

• Study Start: 2022-04-01
• Primary Completion: 2022-11-30
• Study Completion: 2022-11-30
• Status Verified: 2024-07
• Study First Submitted: 2025-03-17
• Study First Submitted QC: 2025-03-17
• Last Update Submitted: 2025-03-17
• Study First Posted: 2025-03-24
• Last Update Posted: 2025-03-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 106

Inclusion Criteria

• provided written consent to participate in the study

For Study Group:

• playing tennis at least 3 times per week for the past 2 years
• experiencing back pain in the last 6 months that prevented playing tennis

For Comprarison Group I:

• playing tennis at least 3 times per week for the past 2 years
• no lower back pain (confirmed via survey) in the last 6 months that would have prevented playing tennis

For Comparison Group II:

• no lower back pain (confirmed via survey)
• regular physical activity at least 3 times a week
• no participation in asymmetrical sports

Exclusion Criteria

• lack of written consent to participate in the study,
• history of surgical procedures involving the spine or torso,
• severe musculoskeletal pathologies in the medical history, such as previous cancers in the torso area, vertebral fractures, structural scoliosis,
• inability to assume the required test positions.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Hip range of motion	Baseline	The hip range of motion was measured using a digital inclinometer. During hip rotation measurement, the subject lay prone with the pelvis stabilized by a strap. The tested hip was in a neutral position with the knee flexed to 90 degrees. The inclinometer was zeroed along the tibial axis when the tibial plateau was parallel to the ground. The range of motion was the angular difference between the initial and final positions.; For flexion, the subject lay supine with the non-tested lower limb stabilized. The inclinometer was zeroed parallel to the ground. The final position was where the thigh could no longer move further into flexion.; For extension, the subject .lay supine with the pelvis at the edge of the table. The subject maximally flexed both hips. The subject held the non-tested lower limb with both hands. On the tested side, the lower limb hung freely off the table. The inclinometer was zeroed on a surface parallel to the ground, and in the final position of the test.
Spine range of motion	Baseline	The measurement was conducted using a Baseline bubble inclinometer. For flexion, the patient stood in a relaxed position. The spinous processes of Th12 and S1 were palpated and marked. The inclinometer was zeroed at Th12, and the patient executed a full forward bend. The same was repeated at S1. The lumbar flexion range was the difference between readings at Th12 and S1.; For extension, the patient also stood relaxed. Before measuring, the patient performed three maximum lumbar extensions. The inclinometer was zeroed at Th12, and the patient executed a maximum extension. The same procedure was repeated at S1. The lumbar extension range was the difference between readings at Th12 and S1.; For lateral trunk flexion, the measurement was the distance between a point on the lateral thigh, where the tip of the third finger reached in a relaxed standing position, and a point on the thigh/shin after performing maximum lateral flexion.
Modified sit and reach test	Baseline	To perform the test, the subject sat on the examination table in such a way that one lower limb rested on the floor with the knee flexed at 90 degrees, while the other limb was placed on the table with the knee joint extended. The subject positioned their hands in front of them, thumbs joined and palms facing down. With elbows fully extended, the subject reached as far forward as possible, placing their hands on the table. The distance from the tip of the third finger to the heel line was measured. Positive results indicated that the tip of the third finger extended beyond the heel line, while negative results indicated that it was positioned before the heel line.
Body posture	Baseline	Posture assessment was conducted using the Diers Formetric 4D system, a non-invasive method with proven accuracy and reproducibility. This system employs surface topography for three-dimensional mapping of the subject's torso.; The measurement followed the manufacturer's methodology. The subject stood 2 meters from the projector and camera, with foot placement marked on the treadmill. The back and neck were exposed, and undergarments adjusted to reveal the upper gluteal cleft. The subject assumed a relaxed standing position without posture correction. The examiner adjusted the projector height so that the central reference stripe aligned with the lower angle of the scapula. The device performed 12 scans in 6 seconds (2 Hz). The Diers software analyzed approximately 50,000 points on the subject's back, presenting a three-dimensional model of the spine with posture parameters.
Trunk muscle endurance	Baseline	The protocol for assessing trunk muscle endurance was based on the McGill et al. (1999) method. \[McGill, S. M., Childs, A., \& Liebenson, C. (1999). Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Archives of Physical Medicine and Rehabilitation, 80(8), 941-944. https://doi.org/10.1016/s0003-9993(99)90087-4\]

Secondary Outcome Measures

Name	Time	Method
Oswestry Disability Index	Baseline	The survey assessed the level of pain and disability associated with LBP.
Custom survey for individuals not playing tennis	Baseline	The survey covered spinal pain, health status, physical activity, and the presence of chronic diseases
Custom survey for tennis players	Baseline	The survey covered training volume, engagement in general conditioning and stretching exercises, presence of chronic diseases, history of injuries, and the level of spinal pain

Trial Locations

Locations (1)

Mirai Clinic; 🇵🇱 Warsaw, Poland