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Biomedicine: 2020; 40(4): 531-534 October – December 2020
DOI: https://doi.org/10.51248/.v40i4.335 Biomedicine- Vol. 40 No. 4: 2020
Research Article
Hamstring tightness causing low back pain among college going students - a cross-sectional
study
Kamalakannan, M.1, Hemamalini P.2, Divya T.2
1Assistant Professor, 2Physiotherapy Undergraduate, Saveetha College of Physiotherapy, SIMATS Chennai, Tamil Nadu, India
(Received: December 2019 Revised: September 2020 Accepted: November 2020)
Corresponding author: Kamalakannan M. Email: kamal1712@gmail.com
ABSTRACT
Introduction and aim: Posterior thigh muscles are also called the Hamstring group of muscles. Its major action is
knee flexion and minor action in hip extensor. It is one of the two joint muscles that involve the hip joint and knee
joint. When these muscles are shortened or become tight the movement in the hip and knee is affected or reduced. This
shortened muscle causes a posterior pelvic tilt that leads to a flat back. Prolonged tightness causes low back pain.
Tightness is mainly due to inadequate physical activity results in stiffness, osteoarthritis, and osteoporosis. The aim of
this study is to find whether tight hamstring causes low back pain in college-going students.
Materials and methods: The method used to measure the hamstring length in this study is the Active Knee Extension
Test. The knee angle is measure using universal goniometry. The knee angle should be between 80-90 degrees. If the
range is below 80 degrees, then that subject has a tight hamstring.
Results: Mean hamstring tightness in males is calculated and found that the left is more affected than the right. The
mean hamstring tightness in the female is calculated and found that the right side is more affected than the left side.
Both males and females having tightness at the range of 30-40 degrees are more.
Conclusion: This study shows that most of the colleges going students have knee range below 80 degrees. And
investigation reveals that 2/4th of the total experienced low back pain in their life. This pain experience is present in all
age group that comes under this study. Some students who involve in sports activities have tight hamstring. But some
do not have because of stretching muscles before and after the sports activity. By this, it is concluded that prevalence is
more among college-going, students.
Keywords: Hamstring tightness; low back pain; goniometry, SLR
INTRODUCTION
osterior thigh muscles are called hamstring group
muscles. They are semitendinosus,
semimembranosus, and biceps femoris long and
short head. All together flex the knee but the short head
of biceps femoris alone extends the hip (1). Hamstring
muscles originate from the ischial tuberosity of the
pelvis and posterior femur and inserts on the proximal
lateral tibia. It is one of the two joint muscles.
Hamstring muscles act as strong flexors of the knee
and weak extensors of the hip (2). The hamstring is a
variable length. Some person cannot touch their fingers
while standing as their hamstring muscles are rather
short or tight. The sciatic nerve supplies the hamstring
group of muscles. The length of the hamstring cannot
be directly measured, this measurement is done in the
angular measurement of unilateral hip flexion with the
knee extended (3). A universal goniometer was used to
measure the angle of the knee for hamstring length
measurements while the hip was maintained at 90
degrees of flexion (4). It was impossible to conclude
whether individuals with LBP have impaired hamstring
flexibility and stiffness. Hamstring tightness causes
chronic low back pain. It may get worse if left
untreated (5, 6). On this basis, this study is to
investigate the relationship between hamstring
flexibility and low back pain. Hamstring muscle
extensibility and low back pain are closely related and
have a correlation with age and gender. Hamstring
tightness increases with age and affects between 40-49
and mostly males are affected hamstring measurement
using straight leg raise test is less accurate because of
the rotation of pelvis that occurs during the test (7, 8).
The Active knee extension test is the best method to
rule out the extensibility range of the hamstring muscle
with the hip stabilized at 90 degrees and with accurate
instrument placement. This method gives reliable
measurements about hamstring extensibility and length
with a 90/90 position in supine. The amount of
extension was measured using both an electro-
goniometer and a standard goniometer. From this
finding, it can be stated whether mechanical low back
pain is caused by hamstring tightness (9, 10).
The tight hamstring can cause a posterior tilt of the
pelvis which causes back pain. Low back pain and gait
abnormality are commonly linked with movement
P
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Kamalakannan et al: Hamstring tightness causing……students - a cross-sectional study
DOI: https://doi.org/10.51248/.v40i4.335 Biomedicine- Vol. 40 No. 4: 2020
dysfunction at the lumbar spine, pelvis, and lower
limbs. If hamstrings are tight, then blood supply will be
squeezed out of them. Therefore, muscle is working
with less capacity to do work, which in turn causes low
back pain. Hamstring tightness leads to a high risk of
recurrent injury and reduces the performance and co-
ordination of athletes. So as to prevent such risk factors
for athletes and college-going students this study will
be an alarming sign. Because college students often
adopt a sitting posture for a long period of time. This
causes the hamstring to be in a contracted state for a
long time and goes for tightness. Tight hamstring
increases stress on low back and aggravates the pain
(11, 12). Previous history and early onset of low back
pain are associated with chronic low back pain in
adults, implying that prevention in adolescence may
have a positive impact in adulthood. Hence this study
was undertaken as there is a lack of literature on the
prevalence and severity of hamstring tightness hence
purpose of this study was to find hamstring tightness
among college-going students. This is just like the
screening process.
MATERIALS AND METHODOLOGY
A cross-sectional study was conducted at Saveetha
College of Physiotherapy, Thandalam. Ethical
clearance was obtained from the institution. 250
college students were assessed in this study. Informed
consent was obtained, Inclusion criteria: The age group
of 18-21 years. Exclusion criteria: Subject with any
past hamstring injury within the last 2years, any recent
hamstring surgery.
The active knee extension (AKE) test is used to check
the range of motion at the knee joint and assess the
hamstring tightness. This study was done mainly on
college-going students. The procedure is first explained
to the subjects and assessed their hamstring length by
active knee extension test. For this test, the subjects
were assessed on a couch in the supine position with
both the lower extremities extended and in a fully
relaxed position. Both anterior superior iliac spines are
aligned straight. The lower extremity which is not
being measured is kept fixed on the couch. The
subjects were asked to flex the measuring hip to 90
degrees and extend the knee as much as they can. With
this position, the knee angle is measured using the
Universal Goniometer in marked joint axis as lateral
epicondyle of the femur, and with the fixed arm along
the long axis of the femur and the movable arm along
the long axis of the tibia. The Active knee extension
measurements were defined as the degree of knee
extension from the knee at 90 degrees in relation to the
hip at 90degree. On each side, measurements are done
twice or thrice, and the mean angle is taken which was
used for the analysis. There is an association of
hamstring tightness and range of Motion in Anterior
pelvic tilt, lumbar motion, and trunk.
Statistical analysis
The collected data were tabulated below. Statistical
analysis was done on a blinded, intention to treat basis
using SPSS software (version 18.0). P<0.05 was set for
all analyses and the significance level was set to α=
0.05.
Table 1: Hamstring tightness measurement
Range in
degrees
Male
Female
Right
Left
Right
Left
20-30
23
18
29
24
30-40
57
66
52
32
40-50
26
33
21
37
50-60
29
23
12
18
Fig. 1: Hamstring tightness – male
Fig. 2: Hamstring tightness - female
RESULTS
In this study, there were 250 college-going students,
aged between 18-21years were included. With the
above-collected data and calculated degree of
hamstring tightness, we obtained the mean value. Mean
hamstring tightness in males is calculated and found
that the left is more affected than the right. The mean
hamstring tightness in the female is calculated and
found that the right side is more affected than the left
side. Both male and female having tightness at the
range of 30-40 degree is more.
DISCUSSION
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Kamalakannan et al: Hamstring tightness causing……students - a cross-sectional study
DOI: https://doi.org/10.51248/.v40i4.335 Biomedicine- Vol. 40 No. 4: 2020
This will be an alarming sign for the students to
prevent upcoming low back problems due to hamstring
tightness. This study includes all normal individuals
except those with low back pain and lumbar pain for
the past 2 years. Lack of mobility caused by tightness
or shortness of the ligaments and soft tissue causes
hamstring tightness (13, 14).
The tight hamstring is a frequent sign in Scheurmann
khyphosis after surgery and also gave preoperative
assessment for the lumbar pelvic range of motion.
There is a direct relationship between tight hamstring
and low back pain (15). A study measured the extent of
hamstring using electro goniometry and conventional
goniometry and resulted that the more the tightness the
higher the severity of low back pain. Tightness or
shortening of hamstring causes posterior tilt of the
pelvis which in turn increases the lumbar lordosis
results in severe lower back pain (16).
Hamstring tightness contributed by neural structures
causing severe pain in the posterior thigh, knee, leg,
and also in the cervical and thoracic region, which was
relieved by cervical extension and reduces the
discomfort. Passive knee angle was measured with a
standard force of 68.7N (7kg) applied proximal to the
lateral malleolus. Hamstring tightness in turn causes
patella femoral pain. Pain present in the front of the
knee and around the patella, this may be due to
vigorous use in athletics or training. Tight hamstring
Pull on the hip bone causing a slight rotation which
affects the curvature of the back leads to back pain and
lower back tightness and increases the incidence of a
hamstring strain. From the above discussion, it is clear
that hamstring tightness is caused because of the
overuse of muscle on college-going student’s age 18-
21 years (17). Tightness occurs in students who are not
involved in any physical activities. Their habit of
sitting with a flexed knee for the whole day cause the
hamstring muscles to shorten which causes the pelvic
bone to tilt posterior. The posterior tilt increases the
lumbar lordosis causing back muscle strain leads to
mechanical low back pain. Low back pain can be
regular hamstring stretch and physical activities and
often changing the Posture and walking. IA stokes
explain that hamstring muscle can restrict hip flexion
in standing. An individual with a short or tight
hamstring has an abnormal pelvic tilt in seating Posture
with greater flattening or reversal of the lumbar
lordosis. The range of hip flexion is measured using a
toe-touch test. This test is done in standing and sitting
hamstring tightness is a lack of ROM with the
continuous feeling of restriction in the posterior thigh
causing dysfunctional or restricted movement of the
Hip flexion (18, 19). Hamstring stiffness could be a
possible contributing factor to the low back pelvic
rhythm. Movement restrictions lead to compensatory
movement patterns of the lumbar spine and increase
stress on spinal soft tissues and increase the risk of low
back pain.
CONCLUSION
This study shows that most of the college-going
students have knee range below 80degree. And
investigation reveals that 2/4th of the total experienced
low back pain in their life. This pain experience is
present in all age group that comes under this study.
Some students who involve in sports activity and use
their hip and knee more like football players and
athletes etc. have tight hamstring. But some do not
have because of stretching muscles before and after the
sports activity. By this, we conclude that prevalence is
more among college-going, students. This is mainly
due to lifestyle adaptation.
CONFLICT OF INTEREST
There is no conflict of interest from other authors.
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