Back Pain Clinical Trial
Official title:
Effect of Increased Relative Stiffness of Lumbar Spine on Hamstrings Muscle Stretching in Individuals With History of Low Back Pain Suspected to Have a Clinical Lumbar Instability
The purpose of this study is to investigate the effect of lumbopelvic stabilization on hamstrings muscle stretching in individuals with history of low back pain suspected to have a clinical lumbar instability.
The participants between the age of 20 and 40 years with history of low back pain will be
recruited from Mahidol University using a poster posted at Faculty of Physical Therapy. All
participants will be explained the purposes, advantages, disadvantages and procedures of the
study by the researcher. The participant will be asked to sign an informed consent if the
participants are willing to participate in this study.
After obtaining the written informed consent, the researcher, who works in musculoskeletal
system including low back pain for 7 years and has received 3 training sessions on clinical
observation of aberrant movement, will perform 2 clinical tests including clinical
observation of aberrant movement patterns and passive straight leg raising test to identify
clinical lumbar instability, and measure hamstrings muscle length using clinical motion
analysis system. The researcher will also screen for exclusion criteria using a check list.
For those who are qualified for the study, the participants will be asked to fill out the
demographic data and physical activity questionnaire. The researcher will perform additional
clinical examination including modified Thomas test, back extensor muscle strength test
assessed by a handheld dynamometer, Trendelenburg's test and lumbar stability test. After
clinical tests, lumbopelvic, pelvic, and lumbar range of motions during an active forward
bend task will be measured by using the clinical motion analysis system. These outcome
measures will be assessed for baseline (Pre-1). After baseline data collection, the
participants will be divided into 2 groups; lumbopelvic stiffening group (LS) or lumbopelvic
relaxing group (LR) by randomly generated code in a concealed envelope.
The participants in LS group will stretch the hamstrings muscle in standing position with
lumbopelvic stabilization. Fifteen percent of the body weight will be used to standardize
stretching force. This force will be controlled by visual feedback from load cell. During
stretching protocol, the participants will be instructed to face the hydraulic table with the
hips square, maintain trunk straight up and look straight ahead. Researcher commands "during
adjusting the bed up, please tense the lower back rigid". After that, hydraulic bed will be
lifted up until force reaches 15 percent of the body weight. Participant will perform 30
seconds/repetition for 4 repetitions with 15 seconds rest between repetitions. To ensure that
participant correctly performs lumbopelvic stabilization, the researcher will palpate at ASIS
and iliac crest to check pelvic motion during hamstrings muscle stretching. Pelvic motion
indicates loss of lumbopelvic stabilization. Participant will be asked to re-perform another
repetition. Our protocol is based on a previous study by DePino et al., 2000. Participant
will perform 30 seconds/repetition for 4 repetitions with 15 seconds rest between
repetitions. The investigators use 30 seconds because a systematic review suggests that 30
seconds is the most effective dose for hamstrings muscle stretching.
For the participants in LR group, the participants will be instructed to face the hydraulic
table with the hips square, maintain trunk straight up and look straight ahead. The
researcher commands "During adjusting the bed up, please relax the lower back". The hydraulic
bed will be lifted up until force reaches 15 percent of the body weight. Participant will
perform 30 seconds/repetition for 4 repetitions with 15 seconds rest between repetitions.
After the intervention, the participants will be reassessed for hamstrings muscle length
test, lumbar motion, pelvic motion and total lumbopelvic motion (Post-1). Because this study
uses a cross-over study design, participants will be asked to maintain the usual physical
activity for 2 days as a wash-out period. Then, the participants will be re-assessed for
baseline data (Pre-2), and cross-over to another stretching group (LS changes to LR, while LR
changes to LS). After completion of intervention, the participants will be re-assessed for
post-intervention (Post-2). These to determine the effectiveness of lumbopelvic stabilization
during hamstrings stretching in standing.
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