One of the most prevalent, significant, and leading causes of disability in industries is
chronic low back pain (CLBP) which also leads to poor quality of life. 50.4% of patients
with low back pain reported a history of prolonged unsupported sitting. A study which
evaluates muscle tightness in women desk job workers shows 89.83% have Hamstring
tightness, whereas 35.59% have Iliopsoas tightness. In today's world majority of jobs
require long hours sitting or standing with limited body movements like those involving
computers and visual displays, bankers, teachers, industrial workers, architects, and so
forth. This sedentary lifestyle has a negative effect on muscles, leads to the shortening
which was one of the main contributors to the development of LBP. The iliopsoas, along
with other back muscles, is said to play an essential role in stabilizing the pelvis. the
shortening of the iliopsoas muscle produced inappropriate loading on the lumbar spine,
mostly resulting in greater lumbar lordosis and anterior pelvic tilting thereby acting as
a risk factor for low back pain. Patients with LBP also reported shorting of hamstring
muscles due to Long-duration sitting.
When treating low back pain, physiotherapy is just as helpful as medication. For acute,
chronic, or subacute low back pain, take into consideration the addition of
non-pharmacological therapy that has been shown to be beneficial. PNF technique is one of
the specific advanced physical exercises.
Joint movement limitation, traction, stretching, and resisted movement are all part of
proprioceptive neuromuscular facilitation (PNF). It is effective for restoring ROM,
strength, and flexibility to injured or stiff muscles. The PNF Method depends on movement
patterns that enhance sensory-motor function. It has been proposed that PNF corrects the
distorted impulses generated from muscle proprioceptive receptors. As a result, it
lessens discomfort and aims to increase muscle strength.
Proprioceptive neuromuscular facilitation (PNF) is a form of flexibility exercises used
to resolve muscle shortening and straining. Studies show that PNF stretching can help
individuals with chronic back pain by improving hip range of motion, functional
impairment, and pain management. According to a literature review published from 1970 to
February 2020, PNF was more effective in helping people suffering with chronic low back
pain to relieve their pain and enhance their waist function. A study of India, in 2015
concluded that PNF (modified hold relax) was more effective than ART at increasing
hamstring flexibility and reducing pain and impairment. A study conducted in 2017 shows,
PNF(CRAC) stretching technique on iliopsoas combined with hamstring stretching is
effective to reduce back pain. In just one session, the PNF group had experienced
significantly more benefits than the MET group in terms of pain relief, lumbar lordosis
reduction, and loosening of the tight iliopsoas. A thesis comparing between PNF exercise
and McKenzie method, in which PNF exercise shows better improvement in the low back pain
than McKenzie method. another study supports the literature that when treating patients
with chronic low back pain, the rhythmic stabilization training technique of
proprioceptive neuromuscular facilitation combined with a series of isotonic exercises
proved to be beneficial than either technique used alone. Researchers also observed that
application of PNF stretching significantly reduces low back pain and dysfunction in
patients with chronic low back pain.
In a study they have analyzed the relationship between the iliopsoas and hamstring
tightness on LBP. The most powerful and deep hip flexor is the iliopsoas muscle, which is
not normally stretched during daily activities. People whose occupations require them to
sit for extended periods of time may notice a shortening of these muscles due to
adaptation changes. Tightness in that area causes anterior pelvic tilting and
hyper-lordosis of the spine, which strain the back muscles and eventually results in low
back pain. Muscle flexibility increases and the pelvis retrovert and neutralize when we
stretch the iliopsoas. A study found an association between passive hip extension and
prolonged sitting/physical inactivity. Results showed there was 6.1° more passive hip
extension in the high activity & minimal sitting group when compared to the low activity
& prolonged sitting group. muscle imbalances due to muscle tension and weakness affects
neutral lumbopelvic alignment, among them hamstring extensibility is considered the most
important. The tightness in the hamstring causes the adaptive shortening of the muscles
leading to posterior pelvic tilt along with the flattening of the lumbar spine which
causes pain in the low back. A study concluded that Participants with low back pain had
significantly shorter hamstring muscle length than participants without low back pain.
Moreover, the hamstring is one of the stabilizers of the pelvic motion in the sagittal
plane by controlling the anterior pelvic tilt.
When iliopsoas muscle shortens, the hip joint's biomechanics get disrupted to cause
anterior pelvic tilting, according to literature in order to compensate iliopsoas
tightness, hamstring contracts to hold the pelvis in its position, which can lead to its
tightness because of constant remaining in contracted phase and vice versa. this
pathophysiology affects the lumber spine's curvature and causes low back discomfort and
exaggeration of subjective symptoms. PNF stretching improves mobility and helps in the
healing of injuries by using reflexes to produce deeper stretches that loosen up tight
muscles.
The aim of the study to evaluate the effects of PNF in terms of decreasing low back pain,
increasing range of motion and improving flexibility of the hamstrings and iliopsoas.
Their association in LBP can be found through studies and my study based on this point
will show whether targeting these two muscles would have any effect on lumbar back pain.
And as there is no published literature available in national evidence on the effects of
the PNF technique on either hamstring or iliopsoas tightness, my study bridges the gap
and will be a beneficial addition to the literature and also will recommend a
cost-effective, easy and harmless treatment that can be implemented as an effective
treatment for low-back pain patients.
