A 12-week randomized controlled trial of active mobilization of hamstring for non-specific low back pain and musculoskeletal discomfort during prolonged sitting among young people: Study protocol

A 12-week randomized controlled trial of active mobilization of hamstring for non-specific low back pain and musculoskeletal discomfort during prolonged sitting among young people: Study protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A 12-week randomized controlled trial of active mobilization of hamstring for non-specific low back pain and musculoskeletal discomfort during prolonged sitting among young people: Study protocol Marta Łabęcka, Magdalena Plandowska, Aleksandra Truszczyńska-Baszak, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4281536/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction This randomized controlled trial aims to investigate the effect of a 12-week intervention involving active hamstring flexibility exercises with hip flexion mobilization on reducing low back pain (LBP) and perceived musculoskeletal discomfort during prolonged sitting in young adults. Methods Participants were recruited from Physical Education Faculty students and randomly assigned to either the experimental group (hamstring flexibility exercises) or the control group (no intervention). The primary outcome measures will be average pain intensity, functional disability, and perceived musculoskeletal discomfort during prolonged sitting. Secondary outcome measures will be satisfaction with the intervention and flexibility of the hamstring. Results A total of 44 participants will fulfill the inclusion criteria and will be completed the study. The results will demonstrate changes in average pain intensity, functional disability, perceived musculoskeletal discomfort during prolonged sitting, and the global perceived improvement in the experimental group compared to the control group. Additionally, in the experimental group, the level of satisfaction with the intervention and possible changes in the flexibility of the hamstring will be presented. Conclusions As an increase in LBP frequency is observed, it seems justified to research to determine the effect of feasible and effective interventions in addressing LBP and perceived musculoskeletal discomfort in young people. The findings of this study might provide information about a 12-week intervention involving active hamstring flexibility exercises with hip flexion mobilization on reduction of LBP and musculoskeletal discomfort during prolonged sitting in young adults. We hope this study will help to develop ergonomic recommendations for young people with LBP. Exercise Treatment Spine Posture Students Pain Hamstring muscles Introduction Decreased flexibility of muscles, poor posture, prolonged sitting, fatigue resulting in exertion, lumbosacral overload, and increased muscle fiber tone lead to an imbalance in the lumbo-pelvic rhythm [ 1 , 2 , 3 ]. Four muscle groups support and keep the pelvis in its natural position, including the erector spine, hamstrings, gluteus maximus, abdominals, and hip flexors [ 4 , 5 ]. The lack of weakening of central stabilization will force the musculoskeletal system to activate other stabilization mechanisms in areas distant from the spine, such as hyperactivity of the hamstrings [ 1 , 6 ]. Limited lower extremity muscle flexibility, such as hamstring, iliopsoas, quadriceps, and limited hip range of motion are risk factors for LBP [ 7 ]. LBP has increased by 49.8–50.7% over the last twenty years, highlighting the increase in LBP's dominance, especially among young people [ 8 ]. Muscle flexibility is an essential factor in physical fitness [ 9 ]. The length of the hamstring influences on movement of the pelvis during hip flexion, consequently influencing lumbar lordosis [ 10 , 11 , 12 ]. In most activities, the hamstring muscles are active and it is necessary to keep them at normal length. Hamstring flexibility training should create an opportunity to practice movement and develop correct patterns using the hip flexion and extension pattern while maintaining the stability of the lumbar spine. Keeping the torso straight while working the hips and knees is one of the basic principles of protecting the spine in the lumbar region [ 13 ]. Flexibility exercises play an important role in both the prevention and treatment of LBP [ 3 , 14 ]. One important option will be exercise protocol which will combine the active hamstring flexibility exercises with hip flexion mobilization and the development of the habit of correct hip flexion technique, protecting the lower spine. The aim of this study is to present a protocol for evaluating the effect of 12-week active hamstring flexibility exercises with hip flexion mobilization in reducing LBP and perceived musculoskeletal discomfort during prolonged sitting in young adults. Methods Study setting and design This will be a single-blind, randomized controlled trial with pre and post-intervention assessment. The study protocol was approved by the Senate Commission of Research Studies Ethics Józef Piłsudski University of Physical Education in Warsaw [SKE 01–05/2023] and registered on ClinicalTrials.gov [NCT05995145]. The protocol was prepared according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines [ 15 ] and is in compliance with the latest version of the Helsinki Declaration [ 16 ]. Written informed consent for participation will be obtained from all the participants involved in the study. The study is being conducted at the Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland. Results will be reported as stated in the Consolidated Standards of Reporting Trials (CONSORT) statement [ 17 ]. Study Population The participants will be recruited according to the inclusion criteria: (1) students in Physical Education (18 − 25 years old), (2) with non-specific LBP (defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds), the pain of at least 3 months duration, without radiation to legs, (3) without a surgical history due to spinal problems, (4) didn't previously continue the hamstring stretches exercises, (5) with hamstring muscle shortness. The exclusion criteria are (1) spinal pathology (eg, tumor, infection, fracture, inflammatory disease), (2) disc herniation and leg length discrepancy over 1cm, (3) pregnancy, (4) nerve root compromise, (5) previous spinal surgery, (6) major surgery scheduled during treatment or follow-up period, (7) presence of any contraindication to exercise, (8) medically verified chronic back disorders, (9) menstrual pain. The necessary minimum total number of subjects (n = 44) was obtained using the G*power program assuming of medium-sized effect (d = 0.50) at a significance level of 0.05 and statistical power of 0.85. The sample will be increased by 10% to compensate for possible dropouts (overall sample = 48 participants). Randomization Participants meeting the inclusion criteria will be randomized to one of 2 groups: the experimental (hamstring flexibility exercises) or the control (without any intervention). The randomization will be designed by a researcher external to the study using a Microsoft Excel software random number generator, before the beginning of the main study. Randomization will be stratified according to age and the frequency of LBP. Concealed allocation will be achieved using opaque envelopes. After the baseline assessment, one of the researchers responsible for the intervention will open the sealed envelope to identify the group to which the participant was allocated. Blinding Single-blind will be used. All pre- and post-treatment assessments will be performed by an evaluator who is blind to the group. The statistician performing the statistical analysis will also be blinded to the allocation and treatment of groups. Due to the nature of exercise interventions, it will not be possible to blind the participants. Intervention Protocol Participants will be randomly assigned to the experimental group (with active hamstring flexibility exercises) or the control group (without any intervention). Experimental group The hamstring flexibility exercises program will be conducted five times a week, 20 min per session, for 12 weeks. The exercises will be supervised by an experienced physiotherapist with five years of clinical experience. The intervention will be divided into two parts. The first part will include exercises with a massage foam roller. For the roller massage, the participants will have to sit on a mat with a roller placed under the leg (Table 1 ). The participants will have to move up and down to massage their thighs between the buttock and the knee. The roller massage will be performed for 5 min. The second part will include exercises of active hamstring flexibility exercises with hip flexion mobilization and the development of the habit of correct hip flexion technique, protecting the lower spine. The exercise protocol will include three exercises (Table 1 ). The session will consist of 3 sets of each exercise and the position will be maintained for a minimum of 30 seconds and relaxing time (30 s) for the hamstring muscles between sets and exercises. The level of difficulty (level of hip flexion) is self-regulated by the participant based on the level of physical condition [ 18 ]. Equipment used in the active hamstring flexibility exercises program will consist of a massage foam roller and a gym mat. In the experimental intervention, the exercise program will be based on participant education, home-based individual exercises, and regular group meetings for check-ups by a physiotherapist according to a precise set schedule. The first week of the treatment will consist of 4 full days of participants education and home exercise instruction. Sessions will supplement with information about the basic anatomy of the lower spine and advice, including postural instructions and practical demonstrations of lifting, pushing, pulling, and other daily actions. Other weeks of the intervention will be dedicated to individually prescribed home exercises. The first check-up with the physiotherapist will be after 2 weeks from the start of the exercise to check the correct execution and regularity. The next check-up with the physiotherapist will be after 4 weeks when the physiotherapist will recheck the current exercises. The participants will record their exercise frequency in a previously prepared diary-record sheet. Control group Participants assigned to the control group will receive an educational booklet containing information on low back pain, the anatomy of the spine and its relation to the muscular chain, and care during daily life activities. The control group will perform their regular baseline activities without the addition of a specific lower extremity flexibility program. Participants will also be contacted weekly by email and/or telephone. Participants will be asked to continue their daily routine and received neither physical therapy treatment programs nor other medical care. The control group participants participating in the evaluation session will recommend being included in the same hamstring stretches training conducted by the intervention group after the study will be completed. Assessment Participants who fulfilled the eligibility criteria and agreed to participate and sign a written informed consent form will be included in the study prior to the assessment. A blinded assessor- physiotherapist with five years of clinical experience will evaluate the qualifying criteria. A baseline assessment will be conducted before participants are randomly assigned to groups. Outcome assessment will be collected at the baseline of the study and immediately after the 12-week intervention. Pre-Intervention data collection sheet Before random assignment, participants will receive the survey containing questions about age, gender, current physical activity (number of training days and hours per week, sports discipline), past illnesses, injuries, surgeries due to spinal ailments, treatment related to LBP, and confirmed body posture defects. A questionnaire will also be used to collect data about the experience of LBP within the last three months. Individuals who will respond positively (“yes”) to the question „Have you experienced low back pain for the last three months” will answer the question in the frequency of LBP (rarely, few times per week, often or constantly), the types of situations in which LBP occurred or increased. Outcome Measures Primary outcome measures (average pain intensity, functional disability, perceived musculoskeletal discomfort during prolonged sitting) will be collected at baseline and immediately after the 12-week intervention, and the global perceived improvement, assessed only after the 12-week intervention. Secondary outcome measure (flexibility of the hamstring) will be collected after the 12-week intervention. Table 2 shows the distribution of the different measures across the time points during the study. Primary outcome measures 1. Pain Intensity The Visual Analogue Scale (VAS) will be used to assess average pain intensity graded from 0 (no pain) up to 10 (unbearable pain). Mild pain or no pain will be defined as VAS 0–3, moderate pain as VAS 4–6, and severe pain as VAS 7–10 [ 19 ]. Participants will be asked to rate their maximum pain intensity from the last 3 months. 2. Functional Disability The Revised Oswestry Low Back Pain Disability Index (ODI) will be used to assess the level of functional disabilities of participants resulting from LBP. The questionnaire consists of 10 items related to different aspects of function regarding activities of daily living. Each item will be scored from 0 to 5, with higher values representing greater disability. The total score will be multiplied by 2 and expressed as a percentage [ 20 ]. 3. Perceived musculoskeletal discomfort during prolonged sitting The Borg CR-10 scale will be used to assess the perceived musculoskeletal discomfort during 1 hour of sitting named as prolonged sitting. The Borg CR-10 scale is presented in such a way that test subjects can indicate in which parts of the body feel discomfort (i.e. neck, shoulder, upper back, lower back, hip/thigh, and knee) and the degree of discomfort they feel (on a scale from 0 to 10, 0 being no discomfort and 10 being extremely uncomfortable) [ 21 ]. The scale and body chart were determined according to a standardized Nordic questionnaire [ 22 ]. 4. The global perceived improvement The Global Perceived Effect (GPE) will be used to assess the global perceived improvement. The investigator will ask the student to rate, on a numerical scale, how much their condition has improved or deteriorated since some predefined time point: 1 = completely recovered, 2 = much improved, 3 = slightly improved, 4 = not changed, 5 = slightly worsened, 6 = much worsened and 7 = worse than ever. These ratings will be dichotomized into “improved” (GPE scores 1–2) and “not improved” (GPE scores 3 to 7) [ 23 ]. Secondary Outcome Measures 1. Flexibility of the hamstring The flexibility of the hamstring will be assessed through the SLR. The SLR is a passive test performed unilaterally. The criterion score of hamstring extensibility will be the maximum angle (degree) read from the goniometer at the point of maximum hip flexion. Angles will be recorded to the nearest degree for each leg. Two trials will give for each leg and the average of the two trials on each side will use for subsequent analysis [ 24 ]. A subject`s hamstring muscles will be considered tight (in a shortened position) if there was an SLR of ≤ 70 degrees [ 25 ]. Procedure The purpose of the study and research procedures will be explained to the participants. The pre-screening will address the specific inclusion and exclusion criteria for the study, basic demographic data, and the frequency of LBP. Participants who meet the inclusion criteria will be invited to attend a baseline assessment at the Regional Centre for Research and Development in Biala Podlaska. All the tests will be performed during morning hours in the laboratory room. At the baseline assessment session, participants will be requested to complete the VAS, ODI and the Borg-10 scale. After completion of the baseline assessment, participants will be randomly assigned into one of two groups (experimental group or control), and simultaneous implementation of the exercise program will commence. After 12 weeks, all assessment measures for all participants will be repeated in the same way as baseline measurements. Statistical Analysis The normality of the distributions will be checked using the Shapiro–Wilk test. Data will be presented as mean ± SD where appropriate. For variables that do not meet the criteria of normality of distribution, data will be presented as medians and quartile ranges. Lavene's test will be conducted to verify the homogeneity of variances. The chi-square test will be used for categorical variables. The Mann–Whitney U test will be used to compare the groups. The mixed-design ANOVA with two factors (intervention, time) will be used. Tukey’s post hoc test will be used for detailed comparisons. Effect sizes will be assessed by partial eta squared (ANOVA) or the Glass rank-biserial correlation coefficient (the Mann–Whitney U test). The significance level will be set at p < 0.05. Discussion Flexibility exercises play an important role in both the prevention and treatment of LBP [ 3 , 14 ]. Previously, a direct correlation between hamstring hyperactive strain and the severity of LBP has been reported [ 7 ]. In contrast to other randomized control trials, our study has been designed to investigate the effect of active hamstring flexibility exercises and education in the correct hip flexion technique, protecting the lower spine, on reduced LBP and perceived musculoskeletal discomfort during prolonged sitting. We believe that, with improving hip flexion technique, there will be an improvement in pain. Moreover, suggested exercises may be more effective for pain and disability because exercises are focused on hip mobility and stability of the lower back. If our hypothesis is proven, this may increase the treatment options for people with LBP. In 2019, the world faced the unforeseen COVID-19 pandemic, the effects of which adversely affected the health of the entire world population. Undoubtedly, the pandemic has contributed to the intensification of risk factors resulting in LBP. In the current situation, an intervention based on scientific evidence seems to be extremely important, which will allow us to mitigate the effects of the unusual phenomenon of the pandemic, by reducing the frequency and intensity of LBP. To the best of our knowledge, this problem has not yet been fully explored, especially among young people with LBP, and requires immediate attention to obtaining the best available evidence and assessing the effectiveness of planned interventions. Conclusions The findings of this study might provide information about a 12-week intervention involving active hamstring flexibility exercises on reduction of LBP and musculoskeletal discomfort during prolonged sitting in young adults. We hope this study will help to develop ergonomic recommendations for young people with LBP. Declarations Funding : This work was supported by the Ministry of Education and Science in the years 2023-2024 under the University Research Project at Józef Piłsudski University of Physical Education in Warsaw, development of an effective intervention to reduce low back pain and musculoskeletal discomfort caused by prolonged sitting in young people” [3/BN/UPB/2023]. Conflicts of interest/Competing interests : There are no conflicts of interest to declare. Ethics approval : The study was approved by the Senate Commission of Research studies Ethics Józef Piłsudski University of Physical Education in Warsaw [SKE 01-05/2023]. Written informed consent for participation will be obtained from all the students involved in the study. Consent to participate : Informed consent was obtained from all individual participants included in the study. Consent for publication : Not applicable. Availability of data and material : Not applicable. Code availability : Not applicable. 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BMC Musculoskelet Disord 22:1-8. https://doi.org/10.1186/s12891-021-04159-y Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4281536","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":292309885,"identity":"b38b2d5d-b641-49ae-86e2-97f3058e8040","order_by":0,"name":"Marta Łabęcka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYPACCwYDBgZmBoYKBgb2BgYGCaCQDB7ljGA1EC1nGBh4DkC08BCnhbGNCC267WefP/jBICFvzt782ODnPLvEHgbmg7d5GO7g1GJ2Jt2wsYdBwnBnzzHjxN5tyUAtbMnWPAzPcGs5kMbYwMMgwbjhRg7zAd5tzLn7GXjMpHkYDuPWcv4ZY+MfBgn7DfffMB/8O6c+t4eB/xt+LTfSGJuBtiRuuMHDnMzbcBiohYeNgJZnjLNlDCSSd/akGRvLHDte38PMZmw5xwCPX86nMXx8U2Fju5398GPJNzXVxjzszQ9vvKm4I4dLCwQYIHOYwSIH8OvABsjQMgpGwSgYBcMVAAAuo1Ev1TLqxQAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Marta","middleName":"","lastName":"Łabęcka","suffix":""},{"id":292309886,"identity":"c0829ec4-e3b5-43d1-ad73-a2557018428c","order_by":1,"name":"Magdalena Plandowska","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Plandowska","suffix":""},{"id":292309887,"identity":"3b55f824-5d27-4fd3-8090-f85b1ff8e375","order_by":2,"name":"Aleksandra Truszczyńska-Baszak","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Aleksandra","middleName":"","lastName":"Truszczyńska-Baszak","suffix":""},{"id":292309888,"identity":"96aed291-69dc-4e07-a20b-3cc56956bd8f","order_by":3,"name":"Reza Rajabi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Reza","middleName":"","lastName":"Rajabi","suffix":""},{"id":292309889,"identity":"82507e71-32f3-4668-94b4-e5120319096a","order_by":4,"name":"Maciej Płaszewski","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Maciej","middleName":"","lastName":"Płaszewski","suffix":""},{"id":292309890,"identity":"a14caa42-9128-49f6-8a93-dbee07e18681","order_by":5,"name":"Dorota Różańska","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Dorota","middleName":"","lastName":"Różańska","suffix":""}],"badges":[],"createdAt":"2024-04-17 11:21:16","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4281536/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4281536/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55066009,"identity":"7779d172-f1c5-4062-be6a-4178e911a50f","added_by":"auto","created_at":"2024-04-22 04:27:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":293052,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4281536/v1/c17c9b43-adf3-4eb4-8985-dec2d78e4569.pdf"},{"id":55065545,"identity":"273964f9-d88e-4500-95ce-73bf42becc5c","added_by":"auto","created_at":"2024-04-22 04:11:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":898905,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4281536/v1/3ff492fbd53d236b4e120a32.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA 12-week randomized controlled trial of active mobilization of hamstring for non-specific low back pain and musculoskeletal discomfort during prolonged sitting among young people: Study protocol\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDecreased flexibility of muscles, poor posture, prolonged sitting, fatigue resulting in exertion, lumbosacral overload, and increased muscle fiber tone lead to an imbalance in the lumbo-pelvic rhythm [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Four muscle groups support and keep the pelvis in its natural position, including the erector spine, hamstrings, gluteus maximus, abdominals, and hip flexors [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The lack of weakening of central stabilization will force the musculoskeletal system to activate other stabilization mechanisms in areas distant from the spine, such as hyperactivity of the hamstrings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLimited lower extremity muscle flexibility, such as hamstring, iliopsoas, quadriceps, and limited hip range of motion are risk factors for LBP [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. LBP has increased by 49.8\u0026ndash;50.7% over the last twenty years, highlighting the increase in LBP's dominance, especially among young people [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMuscle flexibility is an essential factor in physical fitness [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The length of the hamstring influences on movement of the pelvis during hip flexion, consequently influencing lumbar lordosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In most activities, the hamstring muscles are active and it is necessary to keep them at normal length. Hamstring flexibility training should create an opportunity to practice movement and develop correct patterns using the hip flexion and extension pattern while maintaining the stability of the lumbar spine. Keeping the torso straight while working the hips and knees is one of the basic principles of protecting the spine in the lumbar region [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFlexibility exercises play an important role in both the prevention and treatment of LBP [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. One important option will be exercise protocol which will combine the active hamstring flexibility exercises with hip flexion mobilization and the development of the habit of correct hip flexion technique, protecting the lower spine.\u003c/p\u003e \u003cp\u003eThe aim of this study is to present a protocol for evaluating the effect of 12-week active hamstring flexibility exercises with hip flexion mobilization in reducing LBP and perceived musculoskeletal discomfort during prolonged sitting in young adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy setting and design\u003c/h2\u003e\n \u003cp\u003eThis will be a single-blind, randomized controlled trial with pre and post-intervention assessment. The study protocol was approved by the Senate Commission of Research Studies Ethics J\u0026oacute;zef Piłsudski University of Physical Education in Warsaw [SKE 01\u0026ndash;05/2023] and registered on ClinicalTrials.gov [NCT05995145]. The protocol was prepared according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e] and is in compliance with the latest version of the Helsinki Declaration [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. Written informed consent for participation will be obtained from all the participants involved in the study. The study is being conducted at the Faculty of Physical Education and Health, Jozef Pilsudski University of Physical Education in Warsaw, Biala Podlaska, Poland. Results will be reported as stated in the Consolidated Standards of Reporting Trials (CONSORT) statement [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Population\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe participants will be recruited according to the inclusion criteria: (1) students in Physical Education (18\u0026thinsp;\u0026minus;\u0026thinsp;25 years old), (2) with non-specific LBP (defined as pain and discomfort localized below the costal margin and above the inferior gluteal folds), the pain of at least 3 months duration, without radiation to legs, (3) without a surgical history due to spinal problems, (4) didn\u0026apos;t previously continue the hamstring stretches exercises, (5) with hamstring muscle shortness.\u003c/p\u003e\n \u003cp\u003eThe exclusion criteria are (1) spinal pathology (eg, tumor, infection, fracture, inflammatory disease), (2) disc herniation and leg length discrepancy over 1cm, (3) pregnancy, (4) nerve root compromise, (5) previous spinal surgery, (6) major surgery scheduled during treatment or follow-up period, (7) presence of any contraindication to exercise, (8) medically verified chronic back disorders, (9) menstrual pain.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eThe necessary minimum total number of subjects (n\u0026thinsp;=\u0026thinsp;44) was obtained using the G*power program assuming of medium-sized effect (d\u0026thinsp;=\u0026thinsp;0.50) at a significance level of 0.05 and statistical power of 0.85. The sample will be increased by 10% to compensate for possible dropouts (overall sample\u0026thinsp;=\u0026thinsp;48 participants).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eRandomization\u003c/h2\u003e\n \u003cp\u003eParticipants meeting the inclusion criteria will be randomized to one of 2 groups: the experimental (hamstring flexibility exercises) or the control (without any intervention). The randomization will be designed by a researcher external to the study using a Microsoft Excel software random number generator, before the beginning of the main study. Randomization will be stratified according to age and the frequency of LBP. Concealed allocation will be achieved using opaque envelopes. After the baseline assessment, one of the researchers responsible for the intervention will open the sealed envelope to identify the group to which the participant was allocated.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eBlinding\u003c/h2\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eSingle-blind will be used. All pre- and post-treatment assessments will be performed by an evaluator who is blind to the group. The statistician performing the statistical analysis will also be blinded to the allocation and treatment of groups. Due to the nature of exercise interventions, it will not be possible to blind the participants.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eIntervention Protocol\u003c/h2\u003e\n \u003cp\u003eParticipants will be randomly assigned to the experimental group (with active hamstring flexibility exercises) or the control group (without any intervention).\u003c/p\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003eExperimental group\u003c/h2\u003e\n \u003cp\u003eThe hamstring flexibility exercises program will be conducted five times a week, 20 min per session, for 12 weeks. The exercises will be supervised by an experienced physiotherapist with five years of clinical experience.\u003c/p\u003e\n \u003cp\u003eThe intervention will be divided into two parts. The first part will include exercises with a massage foam roller. For the roller massage, the participants will have to sit on a mat with a roller placed under the leg (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The participants will have to move up and down to massage their thighs between the buttock and the knee. The roller massage will be performed for 5 min. The second part will include exercises of active hamstring flexibility exercises with hip flexion mobilization and the development of the habit of correct hip flexion technique, protecting the lower spine. The exercise protocol will include three exercises (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The session will consist of 3 sets of each exercise and the position will be maintained for a minimum of 30 seconds and relaxing time (30 s) for the hamstring muscles between sets and exercises. The level of difficulty (level of hip flexion) is self-regulated by the participant based on the level of physical condition [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Equipment used in the active hamstring flexibility exercises program will consist of a massage foam roller and a gym mat.\u003c/p\u003e\n \u003cp\u003eIn the experimental intervention, the exercise program will be based on participant education, home-based individual exercises, and regular group meetings for check-ups by a physiotherapist according to a precise set schedule.\u003c/p\u003e\n \u003cp\u003eThe first week of the treatment will consist of 4 full days of participants education and home exercise instruction. Sessions will supplement with information about the basic anatomy of the lower spine and advice, including postural instructions and practical demonstrations of lifting, pushing, pulling, and other daily actions. Other weeks of the intervention will be dedicated to individually prescribed home exercises.\u003c/p\u003e\n \u003cp\u003eThe first check-up with the physiotherapist will be after 2 weeks from the start of the exercise to check the correct execution and regularity. The next check-up with the physiotherapist will be after 4 weeks when the physiotherapist will recheck the current exercises. The participants will record their exercise frequency in a previously prepared diary-record sheet.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003eControl group\u003c/h2\u003e\n \u003cp\u003eParticipants assigned to the control group will receive an educational booklet containing information on low back pain, the anatomy of the spine and its relation to the muscular chain, and care during daily life activities. The control group will perform their regular baseline activities without the addition of a specific lower extremity flexibility program. Participants will also be contacted weekly by email and/or telephone. Participants will be asked to continue their daily routine and received neither physical therapy treatment programs nor other medical care.\u003c/p\u003e\n \u003cp\u003eThe control group participants participating in the evaluation session will recommend being included in the same hamstring stretches training conducted by the intervention group after the study will be completed.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eAssessment\u003c/h2\u003e\n \u003cp\u003eParticipants who fulfilled the eligibility criteria and agreed to participate and sign a written informed consent form will be included in the study prior to the assessment. A blinded assessor- physiotherapist with five years of clinical experience will evaluate the qualifying criteria. A baseline assessment will be conducted before participants are randomly assigned to groups. Outcome assessment will be collected at the baseline of the study and immediately after the 12-week intervention.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003ePre-Intervention data collection sheet\u003c/h2\u003e\n \u003cp\u003eBefore random assignment, participants will receive the survey containing questions about age, gender, current physical activity (number of training days and hours per week, sports discipline), past illnesses, injuries, surgeries due to spinal ailments, treatment related to LBP, and confirmed body posture defects. A questionnaire will also be used to collect data about the experience of LBP within the last three months. Individuals who will respond positively (\u0026ldquo;yes\u0026rdquo;) to the question \u0026bdquo;Have you experienced low back pain for the last three months\u0026rdquo; will answer the question in the frequency of LBP (rarely, few times per week, often or constantly), the types of situations in which LBP occurred or increased.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eOutcome Measures\u003c/h2\u003e\n \u003cp\u003ePrimary outcome measures (average pain intensity, functional disability, perceived musculoskeletal discomfort during prolonged sitting) will be collected at baseline and immediately after the 12-week intervention, and the global perceived improvement, assessed only after the 12-week intervention. Secondary outcome measure (flexibility of the hamstring) will be collected after the 12-week intervention. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of the different measures across the time points during the study.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ePrimary outcome measures\u003c/em\u003e\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e1. Pain Intensity\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eThe Visual Analogue Scale (VAS) will be used to assess average pain intensity graded from 0 (no pain) up to 10 (unbearable pain). Mild pain or no pain will be defined as VAS 0\u0026ndash;3, moderate pain as VAS 4\u0026ndash;6, and severe pain as VAS 7\u0026ndash;10 [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Participants will be asked to rate their maximum pain intensity from the last 3 months.\u003c/p\u003e\n \u003cp\u003e2. Functional Disability\u003c/p\u003e\n \u003cp\u003eThe Revised Oswestry Low Back Pain Disability Index (ODI) will be used to assess the level of functional disabilities of participants resulting from LBP. The questionnaire consists of 10 items related to different aspects of function regarding activities of daily living. Each item will be scored from 0 to 5, with higher values representing greater disability. The total score will be multiplied by 2 and expressed as a percentage [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e3. Perceived musculoskeletal discomfort during prolonged sitting\u003c/p\u003e\n \u003cp\u003eThe Borg CR-10 scale will be used to assess the perceived musculoskeletal discomfort during 1 hour of sitting named as prolonged sitting. The Borg CR-10 scale is presented in such a way that test subjects can indicate in which parts of the body feel discomfort (i.e. neck, shoulder, upper back, lower back, hip/thigh, and knee) and the degree of discomfort they feel (on a scale from 0 to 10, 0 being no discomfort and 10 being extremely uncomfortable) [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The scale and body chart were determined according to a standardized Nordic questionnaire [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e4. The global perceived improvement\u003c/p\u003e\n \u003cp\u003eThe Global Perceived Effect (GPE) will be used to assess the global perceived improvement. The investigator will ask the student to rate, on a numerical scale, how much their condition has improved or deteriorated since some predefined time point: 1\u0026thinsp;=\u0026thinsp;completely recovered, 2\u0026thinsp;=\u0026thinsp;much improved, 3\u0026thinsp;=\u0026thinsp;slightly improved, 4\u0026thinsp;=\u0026thinsp;not changed, 5\u0026thinsp;=\u0026thinsp;slightly worsened, 6\u0026thinsp;=\u0026thinsp;much worsened and 7\u0026thinsp;=\u0026thinsp;worse than ever. These ratings will be dichotomized into \u0026ldquo;improved\u0026rdquo; (GPE scores 1\u0026ndash;2) and \u0026ldquo;not improved\u0026rdquo; (GPE scores 3 to 7) [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSecondary Outcome Measures\u003c/em\u003e\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e1. Flexibility of the hamstring\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003eThe flexibility of the hamstring will be assessed through the SLR. The SLR is a passive test performed unilaterally. The criterion score of hamstring extensibility will be the maximum angle (degree) read from the goniometer at the point of maximum hip flexion. Angles will be recorded to the nearest degree for each leg. Two trials will give for each leg and the average of the two trials on each side will use for subsequent analysis [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. A subject`s hamstring muscles will be considered tight (in a shortened position) if there was an SLR of \u0026le;\u0026thinsp;70 degrees [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eProcedure\u003c/h2\u003e\n \u003cp\u003eThe purpose of the study and research procedures will be explained to the participants. The pre-screening will address the specific inclusion and exclusion criteria for the study, basic demographic data, and the frequency of LBP. Participants who meet the inclusion criteria will be invited to attend a baseline assessment at the Regional Centre for Research and Development in Biala Podlaska. All the tests will be performed during morning hours in the laboratory room.\u003c/p\u003e\n \u003cp\u003eAt the baseline assessment session, participants will be requested to complete the VAS, ODI and the Borg-10 scale. After completion of the baseline assessment, participants will be randomly assigned into one of two groups (experimental group or control), and simultaneous implementation of the exercise program will commence. After 12 weeks, all assessment measures for all participants will be repeated in the same way as baseline measurements.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eThe normality of the distributions will be checked using the Shapiro\u0026ndash;Wilk test. Data will be presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD where appropriate. For variables that do not meet the criteria of normality of distribution, data will be presented as medians and quartile ranges. Lavene\u0026apos;s test will be conducted to verify the homogeneity of variances. The chi-square test will be used for categorical variables. The Mann\u0026ndash;Whitney U test will be used to compare the groups. The mixed-design ANOVA with two factors (intervention, time) will be used. Tukey\u0026rsquo;s post hoc test will be used for detailed comparisons. Effect sizes will be assessed by partial eta squared (ANOVA) or the Glass rank-biserial correlation coefficient (the Mann\u0026ndash;Whitney U test). The significance level will be set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFlexibility exercises play an important role in both the prevention and treatment of LBP [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Previously, a direct correlation between hamstring hyperactive strain and the severity of LBP has been reported [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In contrast to other randomized control trials, our study has been designed to investigate the effect of active hamstring flexibility exercises and education in the correct hip flexion technique, protecting the lower spine, on reduced LBP and perceived musculoskeletal discomfort during prolonged sitting. We believe that, with improving hip flexion technique, there will be an improvement in pain. Moreover, suggested exercises may be more effective for pain and disability because exercises are focused on hip mobility and stability of the lower back. If our hypothesis is proven, this may increase the treatment options for people with LBP.\u003c/p\u003e \u003cp\u003eIn 2019, the world faced the unforeseen COVID-19 pandemic, the effects of which adversely affected the health of the entire world population. Undoubtedly, the pandemic has contributed to the intensification of risk factors resulting in LBP. In the current situation, an intervention based on scientific evidence seems to be extremely important, which will allow us to mitigate the effects of the unusual phenomenon of the pandemic, by reducing the frequency and intensity of LBP. To the best of our knowledge, this problem has not yet been fully explored, especially among young people with LBP, and requires immediate attention to obtaining the best available evidence and assessing the effectiveness of planned interventions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study might provide information about a 12-week intervention involving active hamstring flexibility exercises on reduction of \u0026nbsp;LBP and musculoskeletal discomfort during prolonged sitting in young adults. We hope this study will help to develop ergonomic recommendations for young people with LBP.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This work was supported by the Ministry of Education and Science in the years 2023-2024 under the University Research Project at J\u0026oacute;zef Piłsudski University of Physical Education in Warsaw, development of an effective intervention to reduce low back pain and musculoskeletal discomfort caused by prolonged sitting in young people\u0026rdquo; [3/BN/UPB/2023].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e: There are no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: The study was approved by the Senate Commission of Research studies Ethics J\u0026oacute;zef Piłsudski University of Physical Education in Warsaw [SKE 01-05/2023]. Written informed consent for participation will be obtained from all the students involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGajdosik RL, Albert CR, Mitman JJ (1994) Influence of hamstring length on the standing position and flexion range of motion of the pelvic angle, lumbar angle, and thoracic angle. J Orthop Sports Phys Ther 20:213-219. https://doi.org/10.2519/jospt.1994.20.4.213\u003c/li\u003e\n\u003cli\u003eMasood K, Riaz H, Ghous M, Iqbal M (2020) Comparison between dynamic oscillatory stretch technique and static stretching in reduced hamstring flexibility in healthy population: A single blind randomized control trial. J Pak Med Assoc 70.1908-1912. https://doi.org/10.5455/JPMA.24472\u003c/li\u003e\n\u003cli\u003eLee I, Sim S, Jin S (2021) Hamstring stretching significantly changes the sitting biomechanics. Int J Ind Ergon 84:103163. https://doi.org/10.1016/j.ergon.2021.103163\u003c/li\u003e\n\u003cli\u003eNarouei S, Imai A, Akuzawa H, Hasebe K, Kaneoka K (2018) Hip and trunk muscles activity during nordic hamstring exercise. J Exerc Rehabil 14:231-238. https://doi.org/10.12965//jer.1835200.600\u003c/li\u003e\n\u003cli\u003eShamsi M, Shahsavari S, Safari A, Mirzaei M (2020) A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients. J Bodyw Mov Ther 24:15-20. https://doi.org/10.1016/j.jbmt.2020.02.001\u003c/li\u003e\n\u003cli\u003eCzaprowski D, Stoliński Ł, Tyrakowski M, Kozinoga M, Kotwicki T (2018) Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord 13:1-14. https://doi.org/10.1186/s13013-018-0151-5\u003c/li\u003e\n\u003cli\u003eSadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH (2017) Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskelet Disord 18:1-15. https://doi.org/10.1186/s12891-017-1534-0\u003c/li\u003e\n\u003cli\u003eFerreira ML, de Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, Kopec JA, Ferreira PH, Blyth FM, Buchbinder R (2023) Global, regional, and national burden of low back pain, 1990\u0026ndash;2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. \u003cem\u003eLancet Rheumatol \u003c/em\u003e5:316-329. https://doi.org/10.1016/S2665-9913(23)00098-X\u003c/li\u003e\n\u003cli\u003eFatima G, Qamar MM, Hassan JU, Basharat A (2017) Extended sitting can cause hamstring tightness. Saudi J Sports Med 17:110. https://doi.org/10.4103/sjsm.sjsm_5_17\u003c/li\u003e\n\u003cli\u003eCongdon R, Bohannon R, Tiberio D (2005) Intrinsic and imposed hamstring length influence posterior pelvic rotation during hip flexion. Clin Biomech (Bristol, Avon) 20:947-951. https://doi.org/10.1016/j.clinbiomech.2005.03.011\u003c/li\u003e\n\u003cli\u003eHey HWD, Teo AQA, Tan K-A, Ng LWN, Lau L-L, Liu K-PG, Wong H-K (2017) How the spine differs in standing and in sitting- important considerations for correction of spinal deformity. Spine J 17:799-806. https://doi.org/10.1016/j.spinee.2016.03.056\u003c/li\u003e\n\u003cli\u003eMoon JH, Jung J-H, Won YS, Cho H-Y (2017) Immediate effects of Graston Technique on hamstring muscle extensibility and pain intensity in patients with nonspecific low back pain. J Phys Ther Sci 29:224-227. https://doi.org/10.1589/jpts.29.224\u003c/li\u003e\n\u003cli\u003eMcGill SM, Hughson RL, Parks K (2000) Changes in lumbar lordosis modify the role of the extensor muscles. Clin Biomech 15:777-780. https://doi.org/10.1016/s0268-0033(00)00037-1\u003c/li\u003e\n\u003cli\u003eShariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM (2018) Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther 22:144-153. https://doi.org/10.1016/j.bjpt.2017.09.003\u003c/li\u003e\n\u003cli\u003eChan A-W, Tetzlaff JM, Altman DG, Laupacis A, G\u0026oslash;tzsche PC, Krleža-Jerić K, Hr\u0026oacute;bjartsson A, Mann H, Dickersin K, Berlin JA (2013) SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 158:200-207. https://doi.org/10.7326/0003-4819-158-3-201302050-00583\u003c/li\u003e\n\u003cli\u003eWorld Medical A (2004) Ethical principles for medical research involving human subjects, Declaration of Helsinki. http://www.wmanet/e/policy/b3 htm. 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Spine 25:2552. https://doi.org/10.1097/00007632-200010010-00025\u003c/li\u003e\n\u003cli\u003eBorg G (1990) Psychophysical scaling with applications in physical work and the perception of exertion. Scand J Work Environ Health 16:55-58. https://doi.org/10.5271/sjweh.1815\u003c/li\u003e\n\u003cli\u003eKuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-S\u0026oslash;rensen F, Andersson G, J\u0026oslash;rgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233-237. https://doi.org/10.1016/0003-6870(87)90010-x\u003c/li\u003e\n\u003cli\u003eMeisingset I, Stensdotter AK, Woodhouse A, Vasseljen O (2018) Predictors for global perceived effect after physiotherapy in patients with neck pain: an observational study. Physiotherapy 104:400-407. https://doi.org/10.1016/j.physio.2017.01.007\u003c/li\u003e\n\u003cli\u003eGo CW, Piuzzi NS (2019) Straight Leg Raise Test. StatPearls Publishing, Treasure Island\u003c/li\u003e\n\u003cli\u003ePesonen J, Shacklock M, Rantanen P, M\u0026auml;ki J, Karttunen L, Kankaanp\u0026auml;\u0026auml; M, Airaksinen O, Rade M (2021) Extending the straight leg raise test for improved clinical evaluation of sciatica: reliability of hip internal rotation or ankle dorsiflexion. BMC Musculoskelet Disord 22:1-8. https://doi.org/10.1186/s12891-021-04159-y\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Exercise, Treatment, Spine, Posture, Students, Pain, Hamstring muscles","lastPublishedDoi":"10.21203/rs.3.rs-4281536/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4281536/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction\u003c/p\u003e\n\u003cp\u003eThis randomized controlled trial aims to investigate the effect of a 12-week intervention involving active hamstring flexibility exercises with hip flexion mobilization on reducing low back pain (LBP) and perceived musculoskeletal discomfort during prolonged sitting in young adults.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eParticipants were recruited from Physical Education Faculty students and randomly assigned to either the experimental group (hamstring flexibility exercises) or the control group (no intervention). The primary outcome measures will be average pain intensity, functional disability, and perceived musculoskeletal discomfort during prolonged sitting. Secondary outcome measures will be satisfaction with the intervention and flexibility of the hamstring.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eA total of 44 participants will fulfill the inclusion criteria and will be completed the study. The results will demonstrate changes in average pain intensity, functional disability, perceived musculoskeletal discomfort during prolonged sitting, and the global perceived improvement in the experimental group compared to the control group. Additionally, in the experimental group, the level of satisfaction with the intervention and possible changes in the flexibility of the hamstring will be presented.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eAs an increase in LBP frequency is observed, it seems justified to research to determine the effect of feasible and effective interventions in addressing LBP and perceived musculoskeletal discomfort in young people. The findings of this study might provide information about a 12-week intervention involving active hamstring flexibility exercises with hip flexion mobilization on reduction of \u0026nbsp;LBP and musculoskeletal discomfort during prolonged sitting in young adults. We hope this study will help to develop ergonomic recommendations for young people with LBP.\u003c/p\u003e","manuscriptTitle":"A 12-week randomized controlled trial of active mobilization of hamstring for non-specific low back pain and musculoskeletal discomfort during prolonged sitting among young people: Study protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-22 04:10:54","doi":"10.21203/rs.3.rs-4281536/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6dddc0fa-5589-46a8-88a2-50df51e938b5","owner":[],"postedDate":"April 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-22T04:10:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-22 04:10:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4281536","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4281536","identity":"rs-4281536","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}