The goal of this clinical trial is to determine whether a combination of passive and active hamstring stretching (PAS) is more effective than passive stretching alone (PS) in improving flexibility in patients with chronic low back pain (CLBP).
The main questions it aims to answer are:
Does PAS lead to greater improvements in active flexibility compared to PS? Does PAS provide additional benefits in passive flexibility, hamstring stiffness, and pelvic tilt? Researchers will compare the PAS group and the PS group to see if combining passive and active stretching results in greater improvements in flexibility and movement control.
Participants will:
Perform either PAS or PS stretching exercises as assigned. Undergo measurements of flexibility, hamstring stiffness, and pelvic tilt before and after the intervention.
Answer a question about their perceived change in flexibility following the intervention.
This study aims to improve rehabilitation strategies for people with CLBP, helping them achieve better movement and pain relief.
Male or female patients aged between 18 and 65 years
Suffering from low-back pain for at least 3 months
Presenting with hamstring flexibility deficit (Straight Leg Raise <85°, Fingertip-to-Floor distance >5 cm)
Patients with radicular pain
Disc inflammation (MODIC Type 1)
Other relevant pathologies (neurological, cardiovascular, respiratory, or oncological diseases)
Significant surgical history (e.g., lumbar arthrodesis, knee or hip arthroplasty)
Parallel
Passive-active stretching (PAS)
Other interventionPassive-active stretching (PAS) combines conventional passive stretching with active exercises designed to activate muscles that promote hamstring elongation. On the other hand, passive stretching (PS) is a commonly administered intervention to improve hamstring flexibility.
Passive hamstring stretching
Other interventionParticipants will receive one minute of passive hamstring stretching applied three times for each lower limb, with a 30-second rest time between stretches.
Active Knee Extension (AKE)
The Active Knee Extension (AKE) angle will be evaluated at baseline and immediately after the intervention. The mean value of the two measurements taken before the intervention will be compared with the mean value of two measurements taken immediately after the intervention. The change in AKE values of the less flexible lower limb, expressed as a percentage relative to the initial value, will be used to compare the effect between the PS and PAS groups. The participants will extend the tested knee as much as possible while keeping their thigh vertical against a plastic stick placed along the anterior surface of their thigh (maintaining 90° hip flexion). The rater will position the EasyAngle® digital inclinometer on the tibial crest, just below the tibial tuberosity, to record the maximal knee extension angle.
Fingertip-to-Floor distance (FTF)
The FTF distance will be evaluated at baseline and immediately after the intervention. The mean value of the two measurements taken before the intervention will be compared with the mean value of two measurements taken immediately after the intervention. The change in FTF values, expressed as a percentage relative to the initial value, will be used to compare the effect between the PS and PAS groups. The FTF measurement will be conducted in the standard manner by measuring the distance between the fingertips and the floor using a measuring tape at the end of the forward bending range, with knees fully extended.
Pelvic tilt angle
The pelvic tilt angle will be measured at baseline and immediately after the intervention. The mean value of the two measurements taken before the intervention will be compared with the mean value of two measurements taken immediately after the intervention. The change in pelvic tilt angle values, expressed as a percentage relative to the initial value, will be used to compare the effect between the PS and PAS groups. The EasyAngle® inclinometer will be placed on the sacrum to measure the sagittal plane angle between the pelvis position in the erect standing posture and its position at the end of forward trunk bending, as in the FTF measurement.
Straight Leg Raise (SLR) angle
The SLR angle will be evaluated at baseline and immediately after the intervention. The mean value of the two measurements taken before the intervention will be compared with the mean value of two measurements taken immediately after the intervention. The change in SLR angle values of the less flexible lower limb, expressed as a percentage relative to the initial value, will be used to compare the effect between the PS and PAS groups. The rater will raise the participant's lower limb with the knee fully extended until the first sensation of stretch or pain is felt. The angle will then be recorded using the EasyAngle® digital inclinometer, which will be secured with a Velcro strap to the lateral side of the lower limb at the level of the tibial tuberosity.
Hamstring stiffness
Hamstring stiffness during the SLR maneuver will be measured at baseline and immediately after the intervention. The mean value of the two measurements taken before the intervention will be compared with the mean value of two measurements taken immediately after the intervention. The change in hamstring stiffness of the less flexible lower limb, expressed as a percentage relative to the initial value, will be used to compare the effect between the PS and PAS groups. The pulling force applied during the SLR maneuver will be recorded in Newtons using the EasyForce® digital dynamometer.
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