Comparison of Static Hamstring Stretching and Kinetic Chain Activation Technique on Individuals with Non-Specific Lower Back Pain: A Randomized Clinical Trial
Keywords:
Hamstring Tightness, Kinetic Chain Activation, Static Stretching, Non-Specific Low Back Pain, Flexibility, Functional Ability, Oswestry Disability Index, Visual Analogue ScaleAbstract
Background: Non-specific lower back pain (NSLBP) is a major contributor to global disability and impairs functional independence. Characterized by pain without any recognizable specific pathology, NSLBP accounts for up to 90% of lower back pain cases and is a leading cause of disability, absenteeism, and reduced quality of life. One biomechanical contributor is hamstring muscle tightness, which influences lumbopelvic posture and increases mechanical stress on the lower spine. Static hamstring stretching has long been implemented as a traditional physiotherapy intervention aimed at improving flexibility and reducing discomfort in the lower back, addressing local musculoskeletal issues but often neglecting broader kinetic and neuromuscular systems essential for recovery. Emerging evidence highlights the role of kinetic chain dysfunction in NSLBP, pointing to the need for dynamic interventions. The kinetic chain activation (KCA) technique offers a dynamic alternative by promoting coordinated muscle recruitment across multiple body segments —particularly the lower limb, pelvis, and trunk—to restore neuromuscular control, postural alignment, and functional movement.
Objective: This study compares the effectiveness of static hamstring stretching and kinetic chain activation techniques in reducing pain and improving functional ability in individuals diagnosed with NSLBP. The primary objective was to evaluate which of the two interventions provides superior therapeutic outcomes, with implications for neuromuscular retraining strategies in rehabilitative care.
Methods: A randomized clinical trial was conducted with 60 participants (aged 25–50 years) clinically diagnosed with NSLBP. Subjects were randomly assigned to either Group A (static hamstring stretching) or Group B (kinetic chain activation technique), with 30 participants in each group. Group A received a protocol of passive static stretching targeting the hamstring muscles, performed thrice a week for four weeks. Group B underwent a structured kinetic chain activation regimen emphasizing lower limb muscle activation. Both groups received three sessions per week over four weeks. Pain intensity, functional disability and hamstrings muscle flexibility were assessed pre- and post-intervention using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and Popliteal Angle respectively. Data were statistically analyzed using paired and unpaired t-tests, with a significance level set at p < 0.05.
Results: Both intervention groups demonstrated significant within-group improvements in pain and functional ability after the four-week protocol (p < 0.05). However, between-group comparisons revealed that Group B (kinetic chain activation) exhibited significantly greater reductions in VAS scores and ODI scores compared to Group A (static stretching). This
suggests kinetic chain exercises more effectively alleviate pain and support functional recovery by targeting underlying neuromuscular imbalances in NSLBP.
Conclusion: While static hamstring stretching remains beneficial in NSLBP management, kinetic chain activation techniques yield superior results in pain reduction and functional improvement. These results support the integration of dynamic, multi-joint activation strategies in physiotherapy for NSLBP. Beyond musculoskeletal care, the findings hold translational relevance for stroke rehabilitation, where restoring intersegmental coordination and neuromuscular control is critical. Applying kinetic chain principles to neurorehabilitation may enhance outcomes in stroke and related conditions. Future research with larger samples and longer follow-up is needed to validate these findings.
Trial Registration: This study was not registered in a clinical trial registry.
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