Low Blood Flow Restriction Training on Low Back Pain (the)

Effect of Low Blood Flow Restriction Training on Nonspecific Low Back Pain Patients

The aim of this randomized controlled trial is to find the effectiveness of low load blood restriction training on improving hamstring muscle strength, alleviating pain and reducing functional disability in nonspecific low back pain patients

Study Overview

• Status: Not yet recruiting
• Conditions: Low Back Pain
• Intervention / Treatment: Other: Low Blood Flow Restriction Training; Other: Conventional PT

Detailed Description

Low back pain (LBP)-related disability and the related socioeconomic burden remain high despite the many treatment options and health care resources available for LBP. LBP can be caused by a specific pathology or trauma; however, in >90% of cases, an underlying disease is absent. The clinical course of this called as nonspecific LBP which is the most common type of low back pain and, some patients recover within weeks, and others experience persistent disabling symptoms leading to chronic LBP. Chronic low back pain (CLBP, pain lasting more than 12 weeks duration) is one of the most common chronic musculoskeletal disorders with high prevalence rates worldwide. Patients with CLBP have varying degrees of pain in the lumbar region of the spine, generally located between the lower ribs and the gluteal region.

Approximately 85% of patients have chronic non-specific low back pain (CNLBP) who do not have a specific patho-anatomical cause attributable to their pain in clinical examination. More than 50% of people in the United States are affected by CLBP. 90% adults will experience LBP in their lifetime, and the recurrence of LBP following chronic episode ranges from 24 to 87 %. The prevalence of LBP in children and adolescents has reaching around 39% of LBP lifetime prevalence in adults at 18 years of age. The prevalence of low back pain was 55.51% in Lahore, Pakistan.

Common nonspecific LBP symptoms include paravertebral muscle spasms, tight hamstrings, trigger points in the muscles, limited spinal range of motion, discomfort and pain. CNLBP is the most common musculoskeletal condition impacting performance leads to functional disability. Various factors associated with CLBP, including smoking, excessive BMI, poor muscle endurance, occupational ergonomic factors, poor posture, altered muscle firing rates, muscular imbalance, psychological factors as depression, inflexibility of the lower extremities, and leg length discrepancies.

Muscle tightness linked to postural disturbances and reduced extensibility resulting from increased hamstring stiffness could be a possible contributing factor to low back pain. Tight hamstring draws the pelvic into posterior rotation with greater flattening of lumbar lordosis which increase mechanical stress on the spinal soft tissues and altered hip biomechanics and lumbopelvic rhythm. If hamstrings are tight, then blood supply will be squeezed out of them leads to decreased muscle capacity, deconditioning and reduced strength which may cause abnormal changes in the bodily posture lead to lumbar hypo-lordosis causing LBP.

Chronic low back pain involves complex interaction of neuromuscular, inflammatory and neurophysiological processes that leads to constant pain. Long-term alterations in movement patterns due to muscular tightness result in structural changes within muscle fibers. The mechanism involved behind is arthrogenous muscle inhibition that inhibits alpha-motor neurons leading to decreased activation of stabilizing muscles. At molecular level, Peripheral and central sensitization contribute to LBP by releasing inflammatory mediators (substance P, bradykinin, cytokines and histamine) and by enhancing the excitability of spinal neurons respectively. Impaired neural drives alter proprioceptive feedback signals linked with increased adipose infiltration, reduced muscle quality, and diminished muscle efficiency.

In 1966, Yoshiaki Sato began developing the Kaatsu training method that has led to the current BFR training techniques that partially restrict arterial inflow. The physiologic effects of BFR at cellular level leads to activation of fast twitch muscle fibers increase in glycogen stores and protein synthesis that stimulates hypertrophy. On the molecular level, a state of localized metabolic stress due to hypoxic environment, causes an increase in growth hormone, stress-related upregulation of signaling factors and Insulin growth factor (IGF)-1 levels that improves vascular functions at low load training.

Conventional Physical Therapy leads to restoration or augmentation of the ability of neuromuscular system which is the most effective rehabilitation strategies for chronic LBP tackle the maladaptive changes in hamstring muscle morphology and function, and ranked third for improving LBP. It plays a major role in stabilizing the pelvis during trunk rotation, or when the center of gravity is grossly shifted as in CLBP. The main focus is on retraining the function of back and hip muscles by integration of exercise resulting in the fine-tuning of intersegmental motion of the spine.

Hamstring tightness leads to posterior rotation of pelvis that alters the lumbopelvic rhythm or flattening of lumbar curve subsequently increased stress on the spinal soft tissues and it may be the reason for dysfunctions that may cause CLBP. Recent literature focused on different manual and therapeutic modalities with their short-term effects on non-specific low back pain. BFR induces muscle hypertrophy and improves strength and endurance, moreover serve as a stimulus to promote protein synthesis leading to the muscle activation and integration of hamstring. BFR has been identified as an alternative when high-load resistance training is not allowed and has been extensively documented in quadriceps and upper limb muscles in literature, however its effect on hamstring remains scarcely investigated as evidence linking hamstring tightness to altered lumbopelvic mechanics and an increased risk of low back pain. This study aims to find the effect of low load blood flow restriction training on improving hamstring strength, alleviating pain and decreasing functional disability in nonspecific low back pain patients

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk

Study Locations

• Pakistan
  • Islamabad, Pakistan, 46000
    • National Institute Of Rehabilitation Medicine G-8/2, Islamabad
    • Contact: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk
    • Contact: MUZAMMEL FATIMA, MS-OMPT*
    • Sub-Investigator: MUZAMMEL FATIMA, MS-OMPT*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Participants falling in this category would be recruited into the study.

1. Both gender
2. Age is between 18-45 years
3. Individuals with pain localized posteriorly below the costal margin and above the inferior gluteal folds for more than 12 weeks
4. A score greater than or equal to 4/10 on Numeric Pain Rating Scale (NPRS)
5. Hamstring muscle strength graded between (3- to 4) on MMT
6. Proximal thigh circumference between (27.0 cm to 56.0 cm), measured 10cm below the inguinal crease
7. Eligible for BFR training as per the Blood Flow Restriction Blood Flow Training Questionnaire

Exclusion Criteria:

Participants falling in this category would be excluded from the study.

1. Patients of spinal stenosis, disc herniation spondylolisthesis, spondylosis or osteoporosis will be excluded
2. Participants had a history of hip or lower extremity pathology requiring medical or surgical intervention.
3. History of venous thromboembolism (VTE), clotting or other hematologic disorder
4. Peripheral arterial disease, hypertension (blood pressure >140/90 mm Hg), coronary artery disease
5. Current Pregnancy
6. Patients who had difficulties in exercise performance due to mental problems.
7. Spinal cord infection like Cauda equina syndrome

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Conventional PT	Other: Conventional PT; All interventional participants will attend 3 weekly 45-50 minutes sessions for a duration of four week. Group B will receive electrical hot packs for 8-10 minutes followed by myofascial releases using a foam roller for 5-8 minutes primarily targeting the hamstring. Total 4 sets of each exercise (Glute bridge exercises, lumbar extension exercise, straight leg raise from prone and table top exercises) with 20 repetitions will be performed. Allow 30-60 sec rest interval
Other: Low blood flow restriction training	Other: Low Blood Flow Restriction Training; All interventional participants will attend 3 weekly 45-50 minutes sessions for a duration of four week. Group A will receive electrical hot packs for 8-10 minutes followed by myofascial releases using a foam roller for 5-8 minutes primarily targeting the hamstring. For low load BFR training therapist will place sphygmomanometer cuff 10cm below the inguinal crease on the upper 3rd of thigh. The inflation pressure range will be individualized intended to produce complete arterial occlusion measured manually by palpating posterior tibial artery until the pulse will be felt no longer. Deflate the pressure cuff up to 60-80% of the AOP to create partial arterial occlusion. Total 4 sets of each exercise (Hamstring curls, Single leg hamstring curls on stability ball, standing hamstring curl, hamstring curl with sliders) with 30 repetitions in 1st set and then 15 repetitions in remaining 3 sets. Allow 30-60 sec rest interval between sets

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Manual Muscle Testing (MMT)	MMT is the most commonly used method for documenting impairments in muscle strength. The examiner in the application of force to the subject's resistance evaluates the muscles being studied as subjectively "weak" or "strong" on a 5-point scale.	: 4 weeks
Numeric Pain Rating Scale (NPRS)	The NPRS is a segmented numeric version of the visual analog scale which is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score.	4 weeks
Oswestry Disability Index (ODI)	The Oswestry Disability Index (ODI) a patient-completed questionnaire which gives a subjective percentage score of pain-related disability in persons with low back pain (LBP). The Oswestry Disability Index (ODI) addresses a broader concept of disability than that directly related to pain intensity	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: KINZA ANWAR, MS-OMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): May 2, 2026
• Primary Completion (Estimated): May 2, 2027
• Study Completion (Estimated): May 12, 2027

Study Registration Dates

• First Submitted: May 4, 2026
• First Submitted That Met QC Criteria: May 4, 2026
• First Posted (Actual): May 8, 2026

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Low Back Pain; Blood Flow Restriction; hamstring muscle strength
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: Muzammel Fatima

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No