Effect Of Bowen Technique On Hamstring Flexibility In Subjects With Non-Specific Chronic Low Back Pain
Abstract
Background: Non-Specific Chronic Low Back Pain (NSCLBP) is characterized by pain localized below the costal margin and above the inferior gluteal folds, lasting for over 12 weeks without identifiable pathology. Hamstring tightness is a significant contributing factor, as reduced flexibility alters pelvic and lumbar mechanics, increasing stress on the spine. The Bowen Technique, a soft tissue remedial therapy, is hypothesized to promote muscle relaxation and improve flexibility.
Study Design: A Randomized Control Trial
Aim: This study aims to assess the effect of the Bowen technique on hamstring flexibility among subjects with Non-specific Chronic low back pain.
Objective: The objective of this study is to find the effect of the Bowen Technique on hamstring flexibility in subjects with Non-specific Chronic Low Back Pain.
Participants: A total of 72 participants aged 18–60 years were recruited as per inclusion criteria and randomized into two groups: the experimental group and the control group.
Method: This experimental study included 72 participants with NSCLBP and reduced hamstring flexibility. Participants were divided into two groups, Experimental Group Received Bowen Technique treatment once a week for 4 weeks and Control Group Performed static hamstring stretches 5 days a week for 4 weeks. The outcomes were assessed using the Active Knee Extension (AKE) test for hamstring flexibility, the Visual Analog Scale (VAS) for pain, and the Oswestry Disability Index (ODI) for functional disability. Post-intervention measurements were recorded at 4 weeks and after a period of 3 weeks as follow-up.
Result: The results of a paired two-sample t-test were analysed to compare post-intervention outcomes with those measured during a 3-week follow-up for three clinical parameters: Active Knee Extension (AKE) in degrees, Visual Analog Scale (VAS) for pain, and Oswestry Disability Index (ODI) in percentages. For AKE, the mean values post-intervention (154.36°) and at follow-up (154.22°) were nearly identical, with variances slightly decreasing from 10.87 to 9.72. In terms of pain intensity measured by VAS, the mean decreased from 4.64 post-intervention to 4.44 at follow-up, indicating a small reduction in pain. For the ODI, mean values post-intervention (31.33%) and follow-up (31.39%) remained very close. The mean AKE increased from 149.47 pre-intervention to 154.36 post-intervention, showing improved hamstring flexibility in Non-specific Chronic Low Back Pain. The mean pain score decreased from 6.583 pre-intervention to 4.639 post-intervention, demonstrating significant pain reduction. The mean ODI score dropped from 35.778% pre-intervention to 31.333% post-intervention, indicating improved functional ability.
Conclusion: The Bowen Technique significantly improves hamstring flexibility, reduces pain, and enhances functional ability in individuals with NSCLBP. The findings suggest that the Bowen Technique is an effective, non-invasive therapeutic intervention for managing NSCLBP and should be considered as an alternative or adjunct to conventional treatment strategies.
References
2. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192-300.
3. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482-91.
4. Gajdosik R, Bohannon R. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Phys Ther. 1987;67(12):1867-72.
5. Wilks J, Cashmore A. The Bowen Technique: An overview of its principles and practice. J Bodyw Mov Ther. 2006;10(2):147-54.
6. Rodgers W. Mechanisms of action of the Bowen Technique in musculoskeletal pain management. Complement Ther Clin Pract. 2015;21(3):165-70.
7. Clinton S, Newell D, Downey P. Systematic review of the Bowen Technique in musculoskeletal pain. Int J Ther Massage Bodywork. 2013;6(3):16-23.
8. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: A discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69(5):683-94.
9. Akshata Chaphekar and Others: Prevalence of Hamstrings Tightness Using Active Knee Extension Test among Diamond Assorters. Indian Journal of Public Health Research & Development, April-June 2021, Vol. 12, No. 2
10. Mohamad Shariff A Hamid & others: Interrater and Intrarater Reliability of the Active Knee Extension (AKE) test among healthy Adults. J. Phys. Ther. Sci. 25: 957-961,2023
11. Bonstra AM & Others: Reliability and validity of the visual analogue scale for disability in patients with chronic Musculoskeletal Pain. International Journal of Rehabilitation Research. 2008, Jun; 31(2): 165-9
12. Matthew Yates. The Oswestry Disability Index. Occupational Medicine 2017;67:241-242 doi: 10.1093/0ccmed/kqw051
13. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47.
14. Arab AM, Ghamkhar L, Emami M, Nourbakhsh MR. Altered muscular control during prone hip extension in women with and without low back pain. Physiother Theory Pract. 2011;27(6):491–8.
15. Youdas JW, Krause DA, Hollman JH, Harmsen WS, Laskowski ER. The influence of gender and age on hamstring muscle length in healthy adults. J Orthop Sports Phys Ther. 2005;35(4):246–52.