Hamstring Viscoelasticity and Low Back Pain

Is Hamstring Muscle Application of Different Physiotherapy Interventions Effective on Hamstring Viscoelasticity and Low Back Pain in Elite Adolescent Rowers Experiencing Low Back Pain? A Prospective Randomized Single-blind Study

Low back pain (LBP) is a prevalent issue among adolescent rowers, particularly males aged 14 to 16 years, with a high lifetime prevalence (94%) and point prevalence (65%). One of the mechanisms of lower back pain in rowing athletes is about the elasticity, stiffness and tone of the hamstring muscle. Current literature shows that stretching exercises, strengthening exercises and kinesiotaping affects hamstring viscoelasticity in various ways. Stretching exercises affect hamstring muscle tone and elasticity, strengthening exercises affect muscle stiffness and kinesiotaping affects muscle tone. While the effects of each of these interventions on viscoelastic properties individually are examined in the literature, studies comparing the effects of changes in viscoelastic properties caused by these interventions on low back pain, athletic disability index and athletic performance in rowers and their superiority among each other are lacking. The goal of this study is to change the viscoelasticity of the hamstring muscles and examine its effect on low back pain, disability index and athletic performance.

Volunteer male elite rowing athletes between the ages of 14 and 18 who score 3/10 or higher on the Numeric Pain Rating Scale at the time of activity will be included in the study. Signed voluntary consent will be obtained from participants and their legal representatives. Participants will be divided into three groups. Study groups will be as follows: a) ballistic hamstring stretching exercise b) hamstring extender exercise c) kinesiotaping

The investigator administering the treatment and the investigator performing the evaluations will be different. The evaluator will not know about the interventions that the participants received.

Athletes will be asked to reach the floor by leaning over in the standing posture without knee flexion. When they feel the tension in hamstring muscle groups, athletes will be requested to make small rebounding motion at degrees between 3°-5° for half a minute.

Athletes will lie on his back. Then, athletes will be asked to do 90 degrees of knee and hip flexion at the same time. Finally, the athletes is expected to perform slow repetitive knee extension to the point of maximal possible extension. According to Askling et al. and Aspetar protocol, it will be applied 12 repetitions and 3 sets.

Kinesio taping will be applied to the hamstring muscle in the direction of inhibition with a Y-shaped and 25% tension force.

The tones of muscle is described by frequency of muscle or oscillation frequency (Hz). It will be examined by the MyotonPro, Tallinn, Estonia.

The tones of muscle is described by frequency of muscle or oscillation frequency (Hz). It will be examined by the MyotonPro, Tallinn, Estonia.

Stiffness of muscle is described by reaction to contraction or forces from outside of tissue that may cause the original form to deteriorate. It will be examined by the MyotonPro, Tallinn, Estonia.

Stiffness of muscle is described by reaction to contraction or forces from outside of tissue that may cause the original form to deteriorate. It will be examined by the MyotonPro, Tallinn, Estonia.

The elasticity of a muscle is described by a logarithmic reduction of tissue's normal amplitude. It is more related with the dissipation of mechanical energy that arises between the deformation of the tissue and its recovery. It is a biomechanical feature of tissue that is called as elasticity. It will be examined by the MyotonPro, Tallinn, Estonia.

The elasticity of a muscle is described by a logarithmic reduction of tissue's normal amplitude. It is more related with the dissipation of mechanical energy that arises between the deformation of the tissue and its recovery. It is a biomechanical feature of tissue that is called as elasticity. It will be examined by the MyotonPro, Tallinn, Estonia.

The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable").

Inclusion Criteria: Being between ages 14 and 18 and male gender Having been rowing at an elite level for at least one year with a professional team Having pain 3/10 or higher on NPRS Participating to the study in a voluntary basis. Exclusion Criteria: Having limitation in lower extremity range of motion that limits completion of interventions Having a musculoskeletal injury involving the lower extremity in the last 6 months. Having undergone a operation in the last 6 months. Failing to complete any of interventions. Wanting to quit from study.

Noormohammadpour P, Hosseini Khezri A, Farahbakhsh F, Mansournia MA, Smuck M, Kordi R. Reliability and Validity of Athletes Disability Index Questionnaire. Clin J Sport Med. 2018 Mar;28(2):159-167. doi: 10.1097/JSM.0000000000000414.

Ng L, Caneiro JP, Campbell A, Smith A, Burnett A, O'Sullivan P. Cognitive functional approach to manage low back pain in male adolescent rowers: a randomised controlled trial. Br J Sports Med. 2015 Sep;49(17):1125-31. doi: 10.1136/bjsports-2014-093984. Epub 2015 Jan 24.

Yu S, Lin L, Liang H, Lin M, Deng W, Zhan X, Fu X, Liu C. Gender difference in effects of proprioceptive neuromuscular facilitation stretching on flexibility and stiffness of hamstring muscle. Front Physiol. 2022 Jul 22;13:918176. doi: 10.3389/fphys.2022.918176. eCollection 2022.

Almuzaini KS, Fleck SJ. Modification of the standing long jump test enhances ability to predict anaerobic performance. J Strength Cond Res. 2008 Jul;22(4):1265-72. doi: 10.1519/JSC.0b013e3181739838.

Severini G, Holland D, Drumgoole A, Delahunt E, Ditroilo M. Kinematic and electromyographic analysis of the Askling L-Protocol for hamstring training. Scand J Med Sci Sports. 2018 Dec;28(12):2536-2546. doi: 10.1111/sms.13288. Epub 2018 Sep 26.

Askling CM, Tengvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014 Apr;48(7):532-9. doi: 10.1136/bjsports-2013-093214.

van Dyk N, Bahr R, Burnett AF, Whiteley R, Bakken A, Mosler A, Farooq A, Witvrouw E. A comprehensive strength testing protocol offers no clinical value in predicting risk of hamstring injury: a prospective cohort study of 413 professional football players. Br J Sports Med. 2017 Dec;51(23):1695-1702. doi: 10.1136/bjsports-2017-097754. Epub 2017 Jul 29.