Effect of Superficial Back Line Relaxation Technique on Hamstring Flexibility in Non Specific Low Back Pain Patients

Not Applicable

Completed

• Conditions: Low Back Pain, Mechanical; Hamstring Flexibility
• Interventions: Other: Superficial back line relaxation (SMIT & CCFE); Other: Conventional physical therapy

• Registration Number: NCT06406894
• Lead Sponsor: Riphah International University

Brief Summary

Current study aim to evaluate the effect of Superficial back line relaxation techniques (SMIT along with CCFE) In Non Specific Low back Pain Patients in order to improve pain and hamstring flexibility.

And To find out the association between sub occipital muscle inhibition technique (SMIT) and cranial cervical flexion exercise (CCFE) in nonspecific low back pain patients with hamstring tightness.

The study aims to enhance the functional status and posture of patients suffering from nonspecific low back pain due to hamstring tightness, thereby enhancing patient efficiency in performing ADLS and IADLS.

Detailed Description

According to recent studies, hamstring tightness gets better as a result of sub occipital muscle inhibition technique, and cranial cervical flexion exercise that improve hamstring flexibility. SMIT is an approach of releasing fascia by application of pressure on sub occipital area. The myofascia relaxes as tone of suboccipital muscle declines that results in reduction in hamstring tone effectively.This is so because the superficial back line of dura matter connects hamstring with sub occipital muscles and neurological system runs through it. In SMIT superficial back line relaxes. While this approach helps suboccipital muscles release degree tension between occiput and axis.

The premise behind CCFE is that cervical spine's dura matter and suboccipital muscle fascia are connected by soft tissue while superficial back line of myofascial chain connects the neck to lower extremity. If tone of suboccipital muscle is reduced,the tone of knee flexors gets minimize and degree of hip flexion gets increase that results in increasing hamstring flexibility. Previous study showed that CCFE restores hamstring flexibility by relaxing superficial back line. While SMI and CCFE represents passive and active exercise program, respectively are equally effective in immediate enhancement of hamstring flexibility.

This study divide in to two groups. Group A ( experimental group) and Group B ( control group). Group A will receive manual technique superficial back line relaxation technique includes (Suboccpital muscle inhibition along with cranial cervical flexion Exercise) with conventional therapy.While group B will receive only conventional therapy include hot pack (lumber region) with low back exercises such as stretching exercise (knee to chest, Pelvis bridging, Cat and camel stretch).

Current study aims to pin point combine effect of SMIT along with CCFE in people with hamstring tightness. Additionally this study will evaluate the immediate and long term effect of SMIT and CCFE on patients with non- specific low back pain by comparing direct and indirect approaches for hamstring flexibility. The study aims to enhance the functional status and posture of patients suffering from nonspecific low back pain due to hamstring tightness, thereby enhancing patient efficiency in performing ADLS and IADLS.

Study Timeline

• Study Start: 2024-03-01
• Study First Submitted: 2024-05-06
• Study First Submitted QC: 2024-05-06
• Study First Posted: 2024-05-09
• Primary Completion: 2024-06-01
• Study Completion: 2024-06-01
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-19
• Last Update Posted: 2024-11-22

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 44

Inclusion Criteria

• Patients with chronic low back pain associate with hamstring tightness.
• Unilateral or bilateral short hamstring syndrome
• 3 to 6 points in numeric pain rating scale(NPRS).
• Active knee extension more than 20°.
• Presence of hamstring tightness with Popliteal angle more than 30 degree.
• Angle in SLR test should be less than 80°

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Exclusion Criteria

• History of cervical spine surgery and neck trauma.
• Cervical and lumber spinal deformity, Herniated disc or protrusions, Spinal stenosis.
• Muscle tendon injuries of the hamstring.
• History of vascular disease in head and neck.
• Visual swelling in the region of hamstring muscle.
• Progressive neurological deficit.
• Fractures in cervical and lumber spine.
• Past and current history of vertigo and dizziness.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
superficial back line relaxation	Superficial back line relaxation (SMIT & CCFE)	suboccipital muscle inhibition, cranial cervical flexion exercise
Conventional physical therapy	Conventional physical therapy	hot packs, muscle stretching exercise of lowerlimb ( Pelvic bridging, knee to chest, Cat and camel stretch)

Primary Outcome Measures

Name	Time	Method
Active knee extension test	3rd week	Changes from baseline knee extension range was taken with help of goniometer. This test was performed to assess the hamstring muscle's flexibility.The length of the hamstring muscles was determined by measuring the angle of knee extension in degrees. This test has a 99% reliability rate when used to measure hamstring flexibility
Politeal angle ( Hip flexion with knee extension range)	3rd week	Changes from baseline popliteal angle was taken with help of goniometer. The hamstring-popliteal angle measures hamstring flexibility by bending the hip and stretching the knee. It's passive and accurate, with a 98% reliability value. Adult popliteal angles typically fall between 80 and 90 degrees. If leg cannot reach this angle, stiffness may be present.
Straight leg raise SLR (Hip flexion ROM)	3rd week	Changes from baseline hip flexion ROM was taken with help of goniometer. Patient lies supine throughout the SLR test, and the assessor raises the subject's right leg. Patient should keep their leg straight during the evaluation. If the therapist senses resistance or the patient complains of pain, the therapist should halt and use goniometry to determine the angle of the lower leg and hip. The therapist need to be vigilance while measuring the angle to make sure the patient's ankle or pelvis does not rotate. This test's reliability for determining hamstring flexibility is 92%.
Modified Sit and Reach test	3rd week	Common test of flexibility that evaluates the hamstring and lower back muscles' flexibility is the sit and reach test.The greatest distance a person can extend forward while seated in a fixed position is measured, and this is used to evaluate the stability of the patient.The sit-and-reach test's reliability rate for hamstring flexibility is 96%.

Secondary Outcome Measures

Name	Time	Method
Oswestry Disability Index (ODI)	3rd week	(ODI) is a widely used tool for measuring low back pain, assessing impairment in daily activities. It uses a questionnaire with 10 multiple-choice questions.Each question contains six possible answers, ranging from 0 to 5, indicating a person's ability to perform specific tasks. ODI has a 96% reliability rate.
Numeric pain rating scale(NPRS)	3rd week	Changes from baseline NPRS is a one-dimensional assessment of adult pain severity, where participants rate their discomfort using a segmented numeric version (0-10 integers) of the VAS. NPRS has a 96% reliability rate and an 85% validity rate..

Trial Locations

Locations (1)

Railway General hospital; 🇵🇰 Rawalpindi, Punjab, Pakistan