Compare Bowen's Technique and Muscle Energy Technique on Hamstrings Tightness in Chronic Non-Specific Low Back Pain Patients

Hamstring muscles are well known for their immense tendency to tightness which is due to their multi-joint function, their tonic postural character, and considerable amount of tensional forces to which they are constantly submitted. The ability of the muscle to lengthen allowing one joint (or more than one joint) to move through the range of motion is due to the flexibility of the muscle. If a muscle has good flexibility it will allow muscle tissue to accommodate to imposed stress more easily and allows efficient and effective movement and will assist in preventing or minimizing injuries and enhance performance of the muscle.

The length of the hamstring muscles is considered to play an essential role in both the effectiveness and efficiency of fundamental human movements such as walking and running. Particularly in the field of rehabilitation, flexibility of the muscle is important in postural balance, complete maintenance of the range of motion of knees and hips, injury prevention and optimization of musculoskeletal function. Tight hamstrings have been involved in lumbar spine dysfunction and shows strong positive correlation between low back pain and reduced hamstring flexibility. Hamstring muscle tightness leads to decreased range of motion of lumber flexion and pelvic tilt. This can alter the biomechanics of lumbar spine and may lead to back pain. Mainly hamstrings flexibility may prevent acute and chronic musculoskeletal injuries, low backache problems, postural deviations, gait limitations and chances of fall.

Low back pain (LBP) is described as the pain located in the lower part of the spine (lumbo-sacral region), coming from this area and optionally radiating to one or both lower limbs. It occurs in a great amount of the population, in about 80% of people and it has a different intensity. Non-specific LBP (low back pain) is defined as low back pain not attributable to a known cause there is no pathology within the spine such as cancer, osteoporosis, trauma or fracture. It represents 90-95% of the cases of Low back pain. There are several factors which are responsible for development of Low back pain. Various factors include increased lumber lordosis, reduced abdominal muscle strength, and decreased back extensor muscle endurance, back extensor muscle flexibility, length of iliopsoas and hamstring muscle flexibility.

Muscle energy technique (MET) is a manual technique developed by osteopaths that is now used in much different manual therapy professions. It is gentle manual therapy technique for restricted motion of the spine and extremities and is an active technique where the patient, not the clinician, controls the corrective force.

One of the two techniques is 'Post-isometric relaxation technique (PIRT)' which uses controlled, voluntary isometric contractions up to 20% of a target muscle group. MET is claimed to be useful for lengthening a shortened muscle, improving range of motion at a joint and increasing drainage of fluid from peripheral regions. This approach which targets primarily the soft tissue is also known as 'active muscular relaxation'.