The Effect of Remote Myofascial Release on Chronic Nonspecific Low Back Pain With Hamstrings Tightness.

CONTEXT: Anatomy trains theory states that performing techniques in any part of the superficial myofascial backline can remotely treat other parts of this pathway. Due to the connections of different parts of the superficial backline, it is possible to influence the hamstring by performing the technique in the lumbar area. As chronic nonspecific low back pain (LBP) may lead to or be caused by hamstring tightness, remote myofascial release (MFR) techniques using the superficial backline can help improve hamstring tightness. OBJECTIVE: This study aimed to evaluate the effect of remote MFR on hamstring tightness for those with chronic nonspecific LBP. DESIGN: Single-blind, parallel design. SETTING: The present study was performed at the clinical setting of Tarbiat Modares University in Iran. METHODS: This study included 40 participants (20 males and 20 females) who were 40.5 (5.3) years old with chronic nonspecific LBP and hamstring tightness. INTERVENTIONS: Participants were randomly divided into the lumbar MFR (remote area) and hamstring MFR groups. Participants underwent 4 sessions of MFR for 2 weeks. MAIN OUTCOME MEASURES: A passive knee-extension (PKE) test was used for muscle tightness evaluation 3 times. RESULTS: Repeated-measure analysis of variance test showed that after the lumbar and hamstring MFR, the PKE was significantly reduced in both legs: lumbar MFR (right knee: from 61.04° [2.17°] to 51.01° [4.11°], P ≤ .003 and left knee: from 63.02° [3.12°] to 52.09° [2.48°], P ≤ .004) and hamstring MFR (right knee: from 62.01° [4.32°] to 50.50° [7.18°], P ≤ .001 and left knee: from 63.11° [2.56°] to 51.32° [5.31°], P ≤ .002). Least Significant Difference (LSD) post hoc test results showed that the 2 groups were not significantly different after the MFR (P ≥ .05). Also, the intraclass correlation coefficient index showed that the PKE test has excellent reliability (intraclass correlation coefficient, .910 for the right limb and .915 for the left limb). The minimal detectable change at the 95% confidence interval indicated that a change greater than or equal to 6° is required to exceed the threshold of the error PKE test, respectively. CONCLUSION: The present study showed that the remote MFR technique to the lumbar region demonstrated the same significant results in decreasing hamstring tightness as was noted in hamstring MFR to both limbs in patients with chronic nonspecific LBP.

Changes in Hamstring Range of Motion After Neurodynamic Sciatic Sliders: A Critically Appraised Topic.

Clinical Scenario: Hamstring tightness is a common condition leading to dysfunctional or restricted movement that is often treated with stretching. Neurodynamics has been proposed as an alternative to stretching by targeting the neural system rather than muscle tissue. Focused Clinical Question: In an active population, what is the effect of using neurodynamic sliders compared with stretching on traditional measures of range of motion (ROM)? Summary of Key Findings: The authors of a well-designed study found that neurodynamic sliders were more effective than static stretching, while the authors of 2 less-well-designed studies reported no difference with static stretching or that proprioceptive neuromuscular facilitation stretching was more effective than neurodynamic sliders. Clinical Bottom Line: Evidence exists to support the use of neurodynamic sliders to increase measures of hamstring ROM in patients who present with limited hamstring flexibility; however, the effectiveness of neurodynamic sliders compared with traditional stretching is inconclusive. Strength of Recommendation: Grade B evidence exists that neurodynamic sliders perform as well as traditional stretching techniques at increasing measures of hamstring ROM in patients with limited hamstring flexibility.

Effects of Different Physical Therapy Interventions in Improving Flexibility in University Students with Hamstring Tightness - A Systematic Review and Network Meta-analysis.

The aim of the present study was to identify the different interventions for hamstring flexibility among university students with hamstring tightness and to determine the better treatment method. Design: Systematic review and network meta-analysis. An electronic search of the databases: Medline, Pubmed, Cochrane, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) was conducted. A total of 11 articles were included in the review. Of these articles, 02 were case-control studies, 02 were interventional pre-post studies and 07 were RCTs. The 07 RCTs were included for network meta-analysis. The findings of the initial network meta-analysis (NMA) which compared control i.e., no intervention with other interventions revealed that all the physical therapy interventions: stretching, electrotherapy combined with stretching, massage, dry needling and neurodynamic exercises combined with stretching and neurodynamics alone were superior to control. Since most studies included stretching as an intervention, a second NMA was conducted to compare the different physical therapy interventions with stretching. The results suggested that US-guided neuromodulation (WMD: -5.80, CI: -12.11, 0.51) had large effects on hamstring flexibility compared to stretching and stretching combined with electrotherapy i.e., cryotherapy and ultrasound (WMD: 0.25, CI: -1.14 to 1.64), MET (WMD: 3.10, CI: -3.28 to 9.48) and massage (WMD: 8.05, CI: -11.90 to 27.18) were inferior to stretching. To further investigate the effects of these interventions three meta-analysis were performed. The results revealed that stretching was more effective (SMD 2.27, 95% 0.72 to 3.81, p < 0.01) compared to control (no intervention). Neurodynamic exercises combined with stretching and neurodynamics alone were found to be superior to stretching alone ((SMD -0.69, 95% -1.35 to -0.03, p < 0.01) and stretching combined with electrotherapy was not significantly better than stretching alone ((SMD -0.07, 95% -1.00 to 0.87, p=0.88). Neurodynamic exercises combined with stretching and neurodynamics alone showed to be superior to the other physical therapy interventions in improving hamstring flexibility for hamstring tightness among university students, however, the reliability of the evidence is low.

Lumbar and Cervical Concurrent Muscle Activity Analysis During Hamstring Length Testing to Design a Customized Treatment Plan: An Observational Cross-Sectional Study.

BACKGROUND:  Hamstring length plays a significant role in a spectrum of clinical entities, from injury prevention and gait dysfunction to posture correction. Evidence suggests that the prevalence of hamstring tightness (HT)/reduced length is increasing. Despite the number of available tests and treatment protocols, HT is still a functional diagnosis. This study's primary goal is to evaluate concurrent muscle (CM) usage during these testing procedures to design a unique, customized treatment protocol. METHODS: The study was conducted in two stages. In phase 1, Active Straight Leg Raise (ASLR), Active Total Knee Extension (ATKE), and Active Seated Total Knee Extension (ASTKE) were carried out. Next, two pressure gauges (PGs) were placed to align with the natural lumbar and cervical curvatures while testing ASLR and ATKE. After analyzing the results for pressure gauge placement, phase 2 data were collected for tests ASLR and ATKE with PG. RESULTS: The results of ASLR and ATKE, both with and without PG, indicate a high prevalence rate, whereas the results of ASTKE show no prevalence. Changes in the PG values indicate CM usage. Dichotomization revealed that participants with normal test scores (non-HT group) had increased usage of CM work. Positive and negative changes in PG indicate the involved CM group. CONCLUSION(S): In regular practice, most healthcare professionals and fitness trainers prefer ASTKE due to the ease of the testing procedure. Directing co-professionals on their choice of tests is challenging, whereas providing knowledge about CM use paves the way for creating customized treatment plans.

A Comparison of the Effectiveness of Neurodynamic Sliding Technique and Self-Myofascial Release Technique for Reducing Hamstring Tightness in Healthy Individuals: A Prospective Study.

BACKGROUND: Hamstring tightness is prevalent among college-going students aged 18-25 years, leading to an increased risk of recurrent injury, reduced athletic performance, post-exercise soreness, and decreased coordination. Myofascial release and neurodynamic sliding technique are two interventions used to alleviate this issue. Myofascial release is a concept that involves pain originating from the muscle and fascia. The neurodynamic sliding technique is a method of producing sliding movement of neural structures relative to their mechanical interfaces. METHODS: This study involved 70 individuals with hamstring tightness who met the inclusion and exclusion criteria. Participants were assigned to Group A or Group B using a convenient sampling method. Group A received neurodynamic sliding technique treatment, while Group B received a self-myofascial release. Both interventions were administered for two months. The outcome measures used in this study were active knee extension and lower extremity functional scale, which were evaluated before and after the intervention. RESULTS AND IMPLICATIONS: Within-group comparisons indicated that both Group A and Group B showed significant improvements in hamstring flexibility. Between-group comparisons of active knee extension (AKE) and lower extremity functional scale (LEFS) immediately after the intervention showed statistically significant results. These findings suggest that both the neurodynamic sliding technique and self-myofascial release are effective in improving hamstring flexibility. This study has implications for clinical practice, as both interventions may be used to address hamstring tightness. CONCLUSION: Our study found that both the neurodynamic sliding technique and self-myofascial release can improve hamstring flexibility. However, the neurodynamic sliding technique was found to be more effective than self-myofascial release. Further research is necessary to determine the optimal protocol for these interventions and their effectiveness in clinical populations with hamstring tightness or injury.

The association of hamstring tightness with lumbar lordosis and trunk flexibility in healthy individuals: gender analysis.

Objectives: The purpose of this study was to investigate if there is a relation between hamstring tightness and lumbar lordosis as well as trunk flexibility based on gender differences and to analyze the differences in hamstring tightness, lumber lordosis and trunk flexibility in healthy adults. Methods: One hundred young healthy adults were recruited and distributed into 2 equal groups according to gender: group A (female group) and group B (male group). Hamstring tightness (HT) was measured by Active Knee Extension (AKE) test and Straight Leg Raise (SLR) test, the angle of lumbar lordosis was measured with a flexible ruler from standing position and trunk flexion flexibility (TFF) was measured by Fingertip-to-Floor Test. Results: There was a significant correlation between TFF and both measures of HT (SLR, p = 0.001; AKE, p = 0.001) in females. While, there was a non-significant correlation in males (SLR, p = 0.900; AKE, p = 0.717). Moreover, there was a non-significant correlation between lumbar lordosis and HT measures in both groups as (p > 0.05). Furthermore, there were significant differences between males and females in hamstring flexibility, TFF and lumbar lordosis as (p < 0.05). Conclusion: Gender differences in the relationship between hamstring tightness and trunk flexion flexibility are significant. However, there was no significant difference between males and females in the relationship between hamstring tightness and lumbar lordosis.

Throwing Shoulder Range of Motion and Hamstring Flexibility in Adolescent Baseball Players: A Pilot Study.

Overhead throwing athletes with limited hamstring flexibility should be counseled appropriately regarding their risk for shoulder injury. Baseball players should stretch and prepare their bodies to throw to reduce the compensatory mechanisms that may occur from hamstring stiffness. We aim to identify the association between the contralateral hamstring-popliteal angle and throwing shoulder total range of motion (ROM) in high school baseball players. Fifteen high school varsity baseball players (ages 14-18 years old) volunteered for this observational study. All the athletes played five times a week and played different positions. Bilateral hamstring and throwing shoulder total ROMs were measured using a goniometer by the same examiner. Three examiners determined the maximum ROM by joint end feel for each measurement to ensure quality control. Contralateral hamstring flexibility was measured using the popliteal angle test. These measurements were compared to the throwing shoulder total ROM to determine the presence of an association. The relationship between the contralateral hamstring flexibility and throwing shoulder total ROM was determined using a linear regression analysis. The correlation coefficient (r) was +0.3928, indicating a positive linear relationship. We conclude that higher contralateral hamstring-popliteal angles may cause a compensatory increase in throwing shoulder total ROM. We highlight the role hamstring stiffness may play in shoulder injury development in adolescent baseball players.

Lower-Limb Range of Motion Predicts Sagittal Spinal Misalignments in Children: A Case-Control Study.

The main objective of this study was to determine lower-limb range of motion (ROM) as a risk factor associated with sagittal spinal misalignments in children. Two hundred and one children (10.9 ± 0.7 years old) from five different primary schools were recruited for this retrospective case-control study. Anthropometric variables, sagittal spinal alignment in habitual everyday postures, and lower-limb ROM, such as ankle dorsiflexion with the knee flexed (ADF-KF), hip extension with the knee relaxed (HE), and hip flexion with the knee extended (HF-KE) were measured. Multivariate and univariate analyses revealed differences between the means of HE and HF-KE ROM, and the thoracic and lumbar curves (p ≤ 0.034; η2 ≥ 0.052). The HE (p ≤ 0.028; OR ≥ 1.066) predicted sagittal thoracic misalignment in the slump sitting (SSP) and relaxed standing (RSP) postures in males and the sagittal lumbar misalignment in the RSP in female children; while HF-KE (p ≤ 0.006; OR ≥ 1.089) predicted sagittal thoracic misalignment in the maximum trunk forward flexion posture (MTFP) and sagittal lumbar misalignment in SSP and MTFP in males. In this study, the reference values for restricted HE and HF-KE were significantly associated with sagittal spinal misalignment in male children but not for the ankle ROM. Physical education teachers should include stretching exercises in the ISQUIOS programme to increase the extensibility of the iliopsoas (HE) and hamstrings (HF-KE) and prevent sagittal spinal misalignments in habitual everyday postures.

Effectiveness of Mulligan's Two-Leg Rotation Versus Muscle Energy Technique in Subjects With Hamstring Tightness.

Background Hamstring stiffness has been growing more common, but is often neglected. The hamstring muscle complex is the key and most commonly involved muscle group for stiffness, and the younger generation is particularly susceptible. The tightness causes a limited range of motion and associated consequences. The purpose of this study is to look for the efficacy of Mulligan's two-leg rotation (TLR) and muscle energy technique (MET). Methods To evaluate TLR against MET, an intervention with a duration of six days per week was planned. Modified Oswestry disability questionnaire (MODQ), active knee extension (AKE), lumbar range of motion (LROM), and numerical pain rating scale (NPRS) were used as outcome measures. The duration of the study was six months. It is a pre and post-interventional type of study. Result Statistical analysis was done by using descriptive and inferential statistics using Student's paired and unpaired t-tests. The Statistical Package for Social Sciences (SPSS) version 27 (IBM Corp., Armonk, NY, USA) was used. A p-value <0.05 was considered significant. Both the treatment protocol were beneficial for the patients but TLR yields a more significant reduction in tightness and pain than MET. Conclusion The results after the data analysis show that TLR should be utilized for individuals with hamstring tightness because it exhibited a significant reduction in tightness and pain when compared to MET.

Balance highly influences flexibility measured by the toe-touch test.

Flexibility evaluation is a standard assessment in clinical and in sports settings. The Toe-touch test (TTT) is a common assessment tool to evaluate posterior muscular chain flexibility, but the test procedure implies a balance demand. The objective of the study was to verify the hypothesis that the balance demand during the TTT may affect the flexibility measured by the test. Twenty healthy, active young adults participated in the present study. Toe-touch test outcome (the linear finger to toe distance), Center of Pressure (CP) and sagittal plane joint angles were compared under two balance conditions: (1) standard TTT (ST) and (2) minimised postural demand (MPD) during TTT (using a device that restrained the participant against a forward fall). Then, ST was re-tested to verify a possible effect of motor learning on TTT outcome. Compared to ST, MPD showed an improvement of 73% in test outcome, greater flexion of the ankle, greater total body flexion, and a forward displacement of the CP. Re-test of ST showed indications of motor learning with a different balance strategy compared to the first trial in the same condition. The test outcome showed significant negative correlations with CP position in ST (weak correlation), in the re-test (strong correlation) and when the conditions were combined (moderate correlation). In conclusion, TTT outcome was highly affected by balance performance. Maximum range of motion during ST was a fraction of the range obtained when balance demand was minimized.

Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study.

PURPOSE: To assess the effect of extracorporeal shock wave therapy (ESWT) for healthy participants with hamstring tightness. MATERIALS AND METHODS: This study was performed at a university rehabilitation hospital. Twenty nine healthy adults with hamstring tightness were enrolled and randomly allocated into four groups (ESWT, stretching exercise, ESWT with stretching exercise, and control). The effects of individual treatments were compared by the finger-to-floor test and popliteal angle. RESULTS: The ESWT group, stretching exercise group and ESWT with stretching exercise group had decreased finger-to-floor distances and right popliteal angles immediately after intervention, compared with the control group (p<0.05). At 4 weeks after completion of the interventions, finger-to-floor distances and the right popliteal angle in only the ESWT with stretching exercise group showed a significant improvement, compared with the control group (p=0.008 and 0.023). CONCLUSION: While ESWT and stretching both reduced hamstring tightness immediately after interventions, only ESWT with stretching exercise maintained the significantly improved relief of hamstring tightness significantly after 4 weeks.

REACTIVE NEUROMUSCULAR TRAINING RESULTS IN IMMEDIATE AND LONG TERM IMPROVEMENTS IN MEASURES OF HAMSTRING FLEXIBILITY: A CASE REPORT.

BACKGROUND AND PURPOSE: Hamstring tightness is a common complaint among active individuals and patients are traditionally classified with tight hamstrings based on commonly accepted clinical exams including the active knee extension, active straight leg raise, and passive straight leg raise tests. Apparent hamstring tightness is a condition that is present in patients who have the perception of hamstring tightness and are classified with a tissue extensibility dysfunction but demonstrate immediate gains in hamstring range of motion following an intervention that does not address a tissue length dysfunction. Reactive neuromuscular training can be used as part of the evaluative process used to classify and treat patients with apparent hamstring tightness. The purpose of this case report was to identify, treat, and report the outcomes experienced when using a reactive neuromuscular training technique on a patient who was classified with hamstring inflexibility based on traditional testing methods. CASE DESCRIPTION: A 20 year-old female softball player presented with a chief complaint of hamstring tightness of more than four years duration. The patient tested positive for hamstring inflexibility based on traditional testing methods. The patient was then treated using a reactive neuromuscular training technique in which the patient resisted a manual anterior to posterior force at the abdomen, sternum and across the hips while simultaneously bending forward at the hips in an attempt to touch her toes. OUTCOMES: Following one reactive neuromuscular training treatment session the patient tested negative for hamstring inflexibility based on traditional testing methods and maintained those results at a five-week follow-up appointment. DISCUSSION: The subject in this case report demonstrated the effectiveness of reactive neuromuscular training in identifying and treating apparent hamstring tightness. Based on these findings, clinicians should consider using reactive neuromuscular training to properly classify and treat patients with a chief complaint of hamstring "tightness." LEVEL OF EVIDENCE: 4 (single case report).

A NOVEL APPROACH FOR THE REVERSAL OF CHRONIC APPARENT HAMSTRING TIGHTNESS: A CASE REPORT.

BACKGROUND AND PURPOSE: Movement dysfunction in the trunk and lower extremity (e.g., apparent hamstring tightness) may produce pain, as well as decrease range of motion, function, and performance in athletes. Novel treatments not frequently studied in the literature, such as Total Motion Release® (TMR®) and instrument-assisted soft -tissue mobilization (IASTM), have anecdotal claims of immediate, gross gains of mobility that far exceed conventionally reported results. The purpose of this case report was to examine the efficacy of TMR® in treating an apparent tissue tightness/extensibility dysfunction and to determine if IASTM would improve outcomes if TMR® techniques failed to produce maintained improvement. CASE DESCRIPTION: A 27-year old former competitive speed walker presented with a chronic history of bilateral pain and posterior leg tightness. The patient met the criteria for diagnosis of a bilateral tissue extensibility dysfunction in the posterior lower extremity and was treated with TMR® and IASTM (Técnica Gavilán®; Tracy, California, United States). OUTCOMES: After the first week of treatment, the patient increased her sit and reach by 5cm and her active straight leg raise (ASLR) by an average of 31.5 ° bilaterally. Following the second week of treatment, the patient experienced an additional increase in sit and reach and ASLR. At discharge, the patient displayed negative 90/90 Active Knee Extension, Tripod, and Slump tests bilaterally, normalized ASLR and a resolution of her complaints. Follow-up examinations completed at one month and three months post-discharge indicated maintenance of the outcomes without any additional interventions. DISCUSSION: The subject in this case report demonstrated the potential use of TMR® in classifying apparent hamstring tightness and provided evidence to support the use of TMR® and IASTM in addressing mobility deficits associated with hamstring inflexibility/tightness. Based on these findings, clinicians should consider the use of TMR® to improve classification and treatment of patients with a chief complaint of hamstring "tightness." LEVEL OF EVIDENCE: Level 4; single case report.