The Correlation between Hamstring Tightness and Low Back Pain in Seated Workers Ahmed Radwan PT, DPT, PhD Thomas A. Crist, PhD

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1 The Correlation between Hamstring Tightness and Low Back Pain in Seated Workers Ahmed Radwan PT, DPT, PhD Thomas A. Crist, PhD

2 Ahmed Radwan, PT, DPT, Ph.D. Associate Professor Physical Therapy Program Thomas A. Crist, Ph.D. Professor Physical Therapy Program Copyright 2015 Ahmed Radwan and Thomas A. Crist

3 Anatomy of the Hamstrings

4 Description of the Hamstrings Three long muscles that move the hip and knee joints Located from medial to lateral: Semimembranosus Semitendinosus Biceps femoris Actions: Extend the thigh at the hip Flex the leg at the knee Medially and laterally rotate leg when knee is bent

5

6 Copyright 2007 Raymond A. Long

7

8 Attachments of the Hamstrings Proximally, attach to the pelvis at the ischial tuberosity Distally, attach to the tibia and fibula Also attached to the sacrotuberous ligament Resists anterior displacement of the sacrum Indirectly attached to the lower back muscles and fascia Extensors of the spine superficial and deep groups

9 Copyright 2014 Wolters Klower

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11 Lower back muscles and fascia Sacrotuberous ligament Tendon of biceps femoris

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13 Copyright 2014 Wolters Klower

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15 Transversospinalis muscles Erector spinae muscles

16 Copyright 2014 Wolters Klower

17 Lateral Medial

18 Sciatic Nerve

19

20

21 Mechanics of the Hamstrings We know what the hamstrings do, right?

22 Do they affect sacro-iliac joint stability?

23 Lumbar Curvature Normal curvature (lumbar lordotic angle) when standing is degrees When sitting, lordosis is 50% less on average than in standing position Pelvis tilts posteriorly and hamstrings tighten

24 Copyright 2014 Wolters Klower

25 Copyright Jason Martuscello

26 Could tightness affect all of these angles? Pelvic tilt angle (7-15 ) A. Lumbar lordotic curve (50 ) B. Lumbosacral angle (140 ) C. Sacral angle (30 ) D. Pelvic angle (30 ) Neutral pelvic position ASIS & pubic symphysis are on the same plane

27 Pathomechanics of Hamstring Tightness

28 Lumbar-pelvic Rhythm

29 Effect of Pelvic Tilting on Lumbar Spine Curvature

30 Correlation between Hamstring Tightness and LBP

31

32 Correlation between Tightness and Mechanical LBP Radwan et al. (2014) evaluated the relationship between hamstring tightness and LBP The authors examined hamstring flexibility in 72 seated workers with history of LBP All participants in the study had tight hamstrings

33 Measurement of Hamstring Tightness

34 Correlation between Tightness and Mechanical LBP Additionally, participants presented significant intrasubject differences in hamstring flexibility All dominant lower extremities were significantly more flexible than the non-dominant sides There was a significant mean difference of two degrees

35 Correlation between Tightness and Mechanical LBP Scores were positively and significantly correlated with the extent of their back discomfort as reported by Oswestry scores Similarly, Halbertsma et al. (2001) confirmed the presence of hamstring tightness in patients with nonspecific LBP when assessed during passive straight-leg raising tests

36 Oswestry Score Correlations to Hamstring Tightness Values Y= * x Values of Right and Left Lower Extremity Tightness

37 SIJ is a Six-degree of Freedom Joint Average active movement of degrees

38 SI Dysfunction is a Major Cause of LBP

39 Stretching Tight Hamstrings With Ease

40 Creeping Phenomenon

41 Anterior Tilting of Pelvis + Hip Flexion + Knee Extension for Seconds

42 References Baumgartner, D., Zemp, R., List, R., Stoop, M., Naxera, J., Elsig, J.P., & Lorenzetti, S. (2012). The spinal curvature of three different sitting positions analyzed in an open MRI scanner. The Scientific World Journal, 2012, 1-7. Cher, D., Polly, D., & Berven, S. (2014). Sacroiliac joint pain: burden of disease. Medical Devices (Auckland, N.Z.), 7, Duenwald, S., Vanderby, R., & Lakes, R. (2009). Viscoelastic relaxation and recovery of tendon. Annals of Biomedical Engineering, 37(6), Halbertsma, J.P.K., Goeken, L.N.H., Hof, A.L., Groothoff, J.W., & Eisma, W.H. (2001). Extensibility and stiffness of the hamstrings in patients with nonspecific low back pain. Archives of Physical Medicine Rehabilitation, 82, Hall S.J. (2007). Chapter 9. The Biomechanics of the Human Spine. In Hall S.J. (Eds.), Basic Biomechanics, 5e. Kennedy, C., Kassab, O., Gilkey, D., Linnel, S., & Morris, D. (2008). Psychosocial factors and low back pain among college students. Journal of American College Health, 57, Lim, K.-I., Nam, H.-C., & Jung, K.-S. (2014). Effects on hamstring muscle extensibility, muscle activity, and balance of different stretching techniques. Journal of Physical Therapy Science, 26(2), Long, M.J., Small, J.M., Dinsay, J.M., and Watkins, R.G. (1997). Lumbar lordosis. Effects of sitting and standing. Spine, 22(21), Neumann, D. (2010). Kinesiology of the musculoskeletal system: Foundations for rehabilitation (2nd ed.). St. Louis, Mo.: Mosby/Elsevier. Patel, A.T., & Ogle, A.A. (2000). Diagnosis and management of acute low back pain. American Family Physician, 61,

43 References Radwan, A., Bigney, K.A., Buonomo, H.N., Jarmak, M.W., Moats, S.M., Ross, J.K., Tatarevic, E., & Tomko, M.A. (2014). Evaluation of intra-subject difference in hamstring flexibility in patients with low back pain: An exploratory study. Journal of Back and Musculoskeletal Rehabilitation, [Epub ahead of print]. Rodriguez, P.L., Santonja, F.M., Lopez-Minarro, P. A., Sainz de Baranda, P., & Yuste J.L. (2008). Effect of physical education stretching programme on sit-and-reach score in schoolchildren. Science & Sports, 23, Tenney, H.R., Boyle, K.L., and DeBord, A. (2013). Influence of hamstring and abdominal muscle activation on a positive Ober s test in people with lumbopelvic pain. Physiotherapy Canada, 65(1), 4-11.

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