International Journal of
Therapies and Rehabilitation Research [E-ISSN: 2278-0343]
http://www.scopemed.org/?jid=12
Gopi et al., International Journal
IJTRR 2014, 3: 4 I doi: 10.5455/ijtrr.00000040
Original Article
Open Access
Correlation of hamstrings flexibility with age and gender in
subjects having chronic low back pain
Gopi S. Mistry 1, Neeta J. Vyas 2, Megha S. Sheth 3
1
*Gopi S. Mistry Post graduate student, SBB College of Physiotherapy, VS hospital,
Ahmedabad, E mail: [email protected]
2
Neeta J. Vyas. Principal, SBB College of Physiotherapy, VS Hospital, Ahmedabad,
E mail ID: [email protected]
3
Megha S. Sheth. Lecturer, SBB College of Physiotherapy, VS Hospital, Ahmedabad. E mail:
[email protected].
*Corresponding Author: [email protected]
Abstract
Aim of the study: Rehabilitation professionals routinely assess Hamstring muscle length (HML) in
persons with hamstring muscle injury, spinal cord injury, LBP or anterior knee pain without taking into
account age and gender, which may influence the development of hamstrings tightness. So this study is
intended to find out the correlation of hamstring flexibility for men and women of different age groups in
chronic LBP subjects. This information can be helpful for every physical therapist for examination and
treatment of LBP.
Methodology: A co-relational study was conducted with convenience sample of 80 participants with age
group 20-70 years having chronic LBP. Persons with previous history of knee injury, knee deformity and
fractures around knee joint and radiating pain were excluded. Hamstrings tightness was measured by
active knee extension test (AKET).
Results: Correlation analysis of age and hamstrings flexibility revealed a correlation coefficient r=-0.380,
p<0.001; indicating there is statistically significant weak negative correlation between the two variables.
Correlation analysis between age and hamstrings tightness for men revealed a correlation coefficient of
r=-0.526, p<0.001 indicating a statistically significant moderate negative correlation between the two
variables and for females revealed r=-0.219, p=0.174 indicating weak negative correlation between the
two variables which was statistically not significant.
Conclusion: There was statistically significant moderate to weak negative correlation found between
age and hamstrings flexibility for males and females.
Key words: hamstrings flexibility, age, gender, chronic low back pain, active knee extension test.
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
INTRODUCTION
between men and women, with women having
Chronic low back pain (LBP) is defined
greater HML than men.13 Furthermore, a
as back pain lasting more than 12 weeks.1
clinician could reason that hamstrings flexibility
Previous history of low back pain is often
would diminish with an increase in age. So the
predictive of future back problems2 and chronic
generalizations can be made about the effect of
cases represent a significant burden on the
gender and age on joint range of motion.
health care and compensation systems.3
Bell
Low back pain is among the leading
and
Hoshizaki
examined
the
relationship of age and gender on range of
motion
both developed and developing countries. It
reported a general decline in flexibility as age
affects
increased, with women having a greater range
more
population.
than
50%
of
the
general
1
of
17
joint
actions.13The
cause of occupational injury and disability in
authors
of motion than males throughout life. Akinpelu
There are several factors which are
AO did study to find out the influence of age on
responsible for development of LBP. Various
hamstrings tightness in apparently healthy
factors include
Nigerians and they found
increased lumber lordosis,
that hamstring
reduced abdominal muscle length and strength,
tightness is present in early childhood and
decreased back extensor muscle endurance,
increases with age.14
back extensor muscle flexibility, length of
Five studies reported HML values using
iliopsoas, hamstring muscle flexibility and body
popliteal angle in healthy adults .15,
composition.4,
Three of the 5 studies examined men within a
5, 6, 7
Of all these, reduction in
hamstrings flexibility was found to be one of the
narrow age range.16,
causes for development of low back pain.8
studies were done using healthy individuals and
Hamstring muscle tightness leads to decreased
the age as well as gender may be the
range of motion of lumber flexion and pelvic tilt.
influencing factor for the development of
This can alter the biomechanics of lumbar spine
hamstrings tightness which can be the cause for
9
17, 18
16,17,18,19
Most of the previous
and may lead to back pain. A study by Clare
the development of LBP. The current study was
MC concluded that participants with the history
intended to study chronic low back pain
of low back pain may have significantly tight
subjects and the purpose of the study was to
hamstrings than participants with no history of
find out the correlation of age and hamstring
LBP.
10
flexibility in subjects having chronic LBP. As the
The hamstring flexibility is influenced by
amount of hamstrings tightness may be different
a number of factors like age, gender, Body
for males and females, the correlation was
mass index (BMI), occupation and physical
found out separately for both the gender. This
2
inactivity. Based upon general joint range of
information can be helpful for every physical
motion data11,
therapist for examination as well as treatment of
12
, a physical therapist could
expect Hamstrings muscle length (HML) to vary
the patients having chronic LBP.
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
stretch felt. Three repetitions were performed
MATERIAL AND METHODS
and an average of the three was taken as final
A co-relational study was conducted at
reading of popliteal angle. The same procedure
SBB College of physiotherapy, VS Hospital,
was repeated on the opposite side.
Ahmedabad. Convenience sampling was used.
Fig 1: Active knee extension test
The study consisted of 80 participants. The
study was carried out from November 2013 to
July 2014. Males and females having chronic
low back pain (more than 3months) in the age
group of 20 to 70 years who were not involved
in any flexibility programme and not taking any
physiotherapy
treatment
were
included.
Persons with previous history of knee injury,
knee deformity with limited range of movement
at knee and patients having radiating pain were
excluded. The Universal Goniometer was used
to measure the active knee extension test and
RESULTS
marker to mark the site of the fulcrum.
Statistical analysis was done using
Subjects were assessed for hamstring
SPSS version 16.0. Level of significance was
tightness using the active knee extension test
kept at 5% and the confidence interval (CI) at
(popliteal angle) as shown in figure 1.
20
The
95%. Pearson’s Co- relation coefficient was
subjects were in supine position with the hip
used for the co- relational analysis of hamstring
flexed to 90 degrees and knee flexed. The
flexibility for men and women of different age
testing was done on the right lower extremity
groups in chronic LBP subjects. The study
and subsequently on the left lower extremity.
population consisted of 40 males and 40
The marking was done over the lateral condyle
females. The mean age of the patients was
of femur. The fulcrum of the goniometer was
43.66years and the standard deviation (SD)
centered over the lateral condyle of the femur.
was 9.15years for both the genders. For
The proximal arm was aligned with the long axis
females mean and SD was 41.17 and 16.22
of
respectively and for males it was 46.15 and
femur
using
greater
trochanter
as
a
reference. The distal arm was aligned with the
13.89
lower leg using the lateral malleolus as a
correlation coefficient of age with degree of
reference. The subject was then asked to
hamstrings flexibility (DOHF) was r=-0.380,
extend the knee as far as possible until a mild
p<0.001
respectively.
as
Value
shown
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
in
of
Pearson’s
figure
2.
Fig 2: Scatter plot showing correlation of age and degree of hamstrings flexibility.
*DOHF-Degree of hamstrings flexibility
.
For the females the correlation of age and DOHF r=-0.219, p=0.174 and for males r=-0.526, p<0.001
respectively as shown in figure 3.
Fig 3: Correlation of age and hamstrings flexibility for men and women.
*DOHF- degree of hamstring flexibility
Discussion:
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
The aim of the present study was to examine
multifactorial
and
also
influenced
by
a
the influence of age and gender on hamstrings
generalized decline in activity level as persons
flexibility in patients having chronic low back
age.
pain. The findings of the present study show
The result of present study shows that
that the hamstrings flexibility reduces as the age
females tend to be more flexible than males of
advances. The reduction in the hamstrings
the
flexibility is more in the males than females.
difference is generally attributed to anatomical
Akinpelu AO did a study on influence of age on
variation in the joint structures.26This may also
hamstrings tightness in apparently healthy
be due to the fact that the men performed more
Nigerians and found similar results that the
rigorous physical work, resulting in greater joint
tightness increases as the age advances and
micro trauma, than their female counterparts.
males have more hamstrings tightness than
Nikoladis PT et al examined the relationship
their female counterparts.
21
same
age
throughout
the
life.
This
Similarly another
between age and hamstring flexibility of male
study done by Bell RD et al on relationship of
soccer players and they found that flexibility
age and sex with the range of motion of
was significantly lower among those soccer
seventeen joints also found a general decline in
players who are younger than among their older
flexibility as the age advances, with women
counterparts.13So
having greater range of motion than males
hamstrings flexibility increases as the age
throughout their life.
22
according
to
them
the
advances as the younger soccer players were
Krabak BJ et al in their study on neuro
giving less attention to flexibility training.
physiological influence on hamstrings flexibility
According to James WY et al there is no
found that females have greater mean popliteal
difference in the HML as the age advances and
angle for HML than men.
23
Data of the current
there is significant influence of gender on HML,
study demonstrated a statistically significant
with women having more HML than their male
loss of hamstrings muscle length as the age
counterpart.18This was due to the fact that they
advances. Decrease in flexibility with aging is
have taken subjects from their institution’s
largely attributed to a loss in elasticity in the
fitness center. Their physical activity level may
connective tissue surrounding the muscles
be more and that may not become the
which
go
through
shortening
representative sample. So depending on the
24, 25
Decrease in joint range of motion
study population results may be different if the
and muscle flexibility with aging may be due to
study is done on healthy inactive subjects or
the age associated molecular cross-linking in
those with a history of LBP. Walker et al
collagen molecules that can potentially alter the
examined the active mobility of the extremities
mechanical characteristics of collagen at the
and found that there is no significant gender
cellular level. Moreover, the loss of joint range
relationship.26
process.
of
motion
or
a
muscle
normal
flexibility
is
likely
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
Lack of hamstring muscles extensibility also
decreases pelvic mobility.
leads
to
27
biomechanical
pressure distribution
of
This invariably
changes
the
in
spine
hamstrings flexibility in men than women as the
age advances.
the
and
Conflict of interest: None.
consequent spinal disorders.28 Therefore, poor
hamstring extensibility has been associated with
REFERENCES
thoracic
disc
1. Sarah Bellew, Hayley Ford, and Emma
herniation, changes in lumbopelvic rhythm and
Shere The Relationship between Hamstring
low back pain.29Additionally, individuals with
Flexibility and Pelvic Rotation around the
shortened hamstring muscles present gait
Hip during Forward Bending The Plymouth
limitations,
Student Journal of Health & Social Work
kyphosis,
increased
spondylolysis,
risk
of
falls,
susceptibility to musculoskeletal injuries.
and
30
Due to this loss of joint mobility, older
2010, Issue 2, 19-29.
2. Papageorgiou
AC
et
al.
Influence
of
persons are more susceptible to injury from
previous pain experience on the episode
vigorous physical activity. Regular exercise
incidence of low back pain: results from the
including hamstrings stretching exercises can
South Manchester Back Pain Study. Pain
minimize the effect of this age related decrease
1996; 66:181–5.
in ROM for the patients suffering from any
3. Spitzer WO et al. Scientific approach to the
musculoskeletal disorders especially patients
assessment and management of activity-
having LBP. This may reduce the possible
related spinal disorders. Spine 1987; 12:54–
contribution of hamstring tightness to these
59.
disorders, especially LBP problems.
4. Koley S, Sandhu NK. An association of
Some limitations were there in the
body composition components with the
present study. The study included the subjects
menopausal status of patients with low back
having osteoarthritis of knee joint as the age
pain in Tarn Taran, Punjab, India. Journal of
advances person may more or less develop
Life Sciences,2009;1(2): 129-132
some amount of degenerative changes in the
5. Koley S, Sharma D. An association of
joint. The goniometer was not masked while
percent body fat with some anthropometric
taking repeated measurements. This may cause
variables in patients with low back pain.
experimenter bias during the testing. BMI not
South Asian Anthropologist.2009; 10(1): 29-
considered as a criterion during data analysis
33.
which may have some effect.
CONCLUSION
6. Koley S, Sharma L, Kaur S. Effects of
occupational
exposure
to
whole
body
Result of the present study shows that
vibration in tractor drivers with low back pain
as the age advances the hamstrings flexibility
in Punjab. Anthropologist.2010a;12(3): 183-
reduces. There is more reduction in the
187.
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
7. Koley S, Kaur J, Sandhu JS. Biological risk
extremity overuse injuries in military basic
indicators for non-specific low back pain in
trainees. J Sports Med. 1999; 27:173-176.
young adults of Amritsar, Punjab, India.
17. Link CS, Nicholson GG. Lumbar curvature
Journal of Life Sciences.2010b;2(1): 43-48
in standing and sitting in two types of chairs:
8. Mistry GS, Vyas NJ, Sheth MS. Comparison
relationship of hamstring and hip flexor
of hamstrings flexibility in subjects with
muscle length. Phys Ther. 1990; 70:611-
chronic low back
618.
individuals.
pain versus normal
Journal
of
clinical
and
experimental research. 2014;2(1):44-46.
gender on HML in healthy adults. J Ortho
9. Lance TT, James RT. Physical therapy of
the low back 2001; 3rd edition: 60-63.
and hip motion. Spine 1997; 22(5):552-8.
11. Reese NB, Bandy WD. Joint Range of
and
extension test. Journal of
Bodywork and
Movement Therapies: 2005; (9) 256–259
20. Akinpelu AO, Bakare U. Influence of age on
Philadelphia, PA: WB Saunders Co; 2002;
hamstrings tightness in apparently healthy
58-60.
Nigerians. Journal of Nigerian society of
DJ.
assessment,
Length
reliability of a self-monitored active knee
Testing.
12. Maggee
Muscle
sports physiotherapy 2005; 35:246-252.
19. Norrisa CM, Matthewsb M. Inter-tester
10. Clare MC et al. Kinematic analysis of lumber
Motion
18. Youdas JW. The influence of age and
Orthopedic
th
4
ed,
physical
Philadelphia,
PA:
Saunders; 2002:784-786.
physiotherapy.2005; 15(2):27-29.
21. Bell RD, Hoshizaki TB. Relationships of age
and sex with range of motion of seventeen
13. Nikolaidis P et al. Age-Related Differences
of Hamstring Flexibility in Male Soccer
Players. Baltic journal of health and physical
joint actions in humans. Can J Appl Sport
Sci. 1981; 6:202-206.
22. Heyward VH et al. Advanced Fitness and
Exercise 2nd Prescription. Edition. London:
activity, 2012; 4(2):110-115.
14. Chan SP, Hong Y, Robinson PD. Flexibility
W.B. Saunders Co. 1991; 23-27.
and passive resistance of the hamstrings of
23. Krabak BJ. Neurophysiologic influences on
young adults using two different static
hamstrings flexibility. Clin J Sport Med;
stretching protocols. Scand J Med Sci
2001; 11(4):242-6.
Sports. 2001;11:81-86.
24. De Veries HA et al. Physiology of Exercise
15. Gajdosik RL, Rieck MA, Sullivan DK,
for Physical Education and Athletics. 4
th
Wightman SE. Comparison of four clinical
Edition. Dubuque: A. William and C. Brown
tests for assessing hamstring muscle length.
Co. 1986; 47-52.
J Orthop Sports Phys Ther. 1993; 18:614618.
16. Hartig
25. Worrel TW et al. Effect of hamstring muscle
performance. J of ortho sport phys1994;
DE,
hamstring
Henderson
flexibility
JM.
Increasing
decreases
20(3):154-159.
lower
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38
26. Walker JM et al. Active mobility of the
29. López
Miñarro
PA,
Rodríguez
García
extremities in older subjects, phys ther,
PL. Validity of the lumbo-sacral position in
1984; 64:919-9123.
bending as measure of hamstring muscle
27. Kendall FP, McCreary EK. Muscles:Testing
and function with posture and pain. 5th
edition
Lippincott,
Williams,
& Wilkins,
Baltimore.2005; p. 213-20.
28. Da Silva R, Gómez-Conesa A. Shortened
extensibility on young athletes. Archivos de
Medicina del Deporte 2008b; 25:103-110.
30. Erkula G, Demirkan F. Hamstring shortening
in healthy adults. J Back Musculoskelet
Rehabil 2002; 16:77-81.
hamstring syndrome. Fisioterapia 2005; 30.
p. 186-193.
Gopi et al., International Journal of Therapies and Rehabilitation Research 2014; 3 (4): 31-38