Effects of suboccipital or thoracolumbar self-myofascial release added to hamstring stretching on flexibility, spinal mobility, and balance in recreational athletes with hamstring tightness: a three-arm randomized controlled trial

Abstract

Hamstring stretching and self-myofascial release are commonly used in sports physiotherapy, exercise preparation, and rehabilitation to acutely improve range of motion. However, whether self-myofascial release applied to anatomically remote regions provides additional benefits remains uncertain. This trial investigated whether adding suboccipital or thoracolumbar self-myofascial release to hamstring stretching improves immediate hamstring flexibility, spinal mobility, and balance compared with stretching alone in recreational athletes with hamstring tightness. In this assessor-blinded, three-arm randomized controlled trial, 103 university students who were recreational athletes and had hamstring tightness were randomly allocated to suboccipital self-myofascial release plus hamstring stretching (SO-SMFR; n = 35), thoracolumbar self-myofascial release plus hamstring stretching (TL-SMFR; n = 34), or hamstring stretching alone ( n = 34). The primary outcome was the bilateral mean Active Knee Extension Test (AKET) angle measured immediately after the intervention. Secondary outcomes included the sit-and-reach test, finger-to-floor distance, cervical and lumbar range of motion, and static and dynamic balance. Outcomes were analyzed using analysis of covariance (ANCOVA) adjusted for baseline values, followed by Holm-adjusted pairwise comparisons. Baseline-adjusted bilateral mean AKET differed among groups (F(2,99) = 4.04, p = 0.021, partial η²=0.075). TL-SMFR produced a lower adjusted AKET angle than stretching (mean difference − 3.87°, 95% CI − 6.60 to − 1.14°; Holm-adjusted p = 0.018), whereas SO-SMFR did not differ significantly from stretching (− 2.39°, 95% CI − 5.09 to 0.32°; p = 0.166). Both differences were below the prespecified 8° minimal detectable difference. No significant group effects were found for sit-and-reach, finger-to-floor, cervical mobility, or balance. A nominal lumbar-flexion effect favouring TL-SMFR did not remain significant after false-discovery-rate adjustment. TL-SMFR added to hamstring stretching produced a small immediate improvement in active knee extension compared with stretching alone; however, the magnitude of this effect was below the measurement-based MDD and did not generalize to other flexibility, spinal-mobility, or balance outcomes. The additional effect of SO-SMFR was inconclusive. Thus, the practical and clinical relevance of the observed AKET improvement remains uncertain. Repeated-session studies in sport-specific populations are needed to determine whether this effect is sustained and clinically relevant. The trial protocol was prospectively registered at ClinicalTrials.gov (NCT07096076 on March 25, 2025).

The authors' abstract, as published at the source. BMC Sports Science Medicine and Rehabilitation, 2026 · DOI ↗