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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 155-159

Is there any difference between Back Saver Sit-Reach Test and Modified Back Saver Sit-Reach Test in estimating hamstring flexibility among the primary school children?


1 Assistant Lecturer cum Fitness Instructor, Alva's College of Physiotherapy, Moodabidri, Karnataka, India
2 Associate Professor, Alva's College of Physiotherapy, Moodabidri, Karnataka, India
3 Associate Professor, Srinivas College of Physiotherapy, Mangalore, Karnataka, India
4 Assistant Professor, Maharishi Markandeswar Institute of Physiotherapy and Rehabilitation (MMIPR), Maharishi Markandeswar University, Mullana, Haryana, India

Date of Web Publication11-Nov-2014

Correspondence Address:
Asir John Samuel
MPT, Assistant Professor, Maharishi Markandeswar Institute of Physiotherapy and Rehabilitation (MMIPR), Maharishi Markandeswar University, Mullana-133207, Haryana
India
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Source of Support: The transportation to reach the identifi ed school was provided by Alva’s college of Physiotherapy, Moodabidri, South India, Conflict of Interest: None


DOI: 10.4103/2321-4848.144321

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  Abstract 

Background: Modified back saver sit-and-reach test (MBSSRT) has more advantages over Back saver sit-and-reach test (BSSRT) in measuring hamstring flexibility among middle school children and adolescents. However, whether MBSSRT can be used instead of the other among the primary school going children is not yet clear. Objective : To estimate the association between BSSRT and MBSSRT for measuring hamstring flexibility. Procedure : One hundred and forty-one healthy children (5-12 years) were selected from the primary school identified by the cluster sampling method for this cross-sectional study. The subjects were asked to perform three trials of BSSRT and MBSSRT (both leg) in randomized order. Average was used for data analysis. The association between the two tests was established by Spearman Rank Correlation test. Results: The correlation between BSSRT and MBSSRT for right lower limb ranged from 0.43 to 0.77 with mean correlation of ρ = 0.66 (P < 0.01) and for left lower limb ranged from 0.46 to 0.78 with mean correlation of ρ = 0.68 (P < 0.01). Conclusion: MBSSRT can be used alternatively instead of BSSRT to measure hamstring flexibility among the primary school children.

Keywords: Exercise test, field tests, low back pain, physical fitness, range of motion, sit-and-reach test, spine, sports


How to cite this article:
Gadhiya B, Arulsingh W, Arunachalam P, Samuel AJ. Is there any difference between Back Saver Sit-Reach Test and Modified Back Saver Sit-Reach Test in estimating hamstring flexibility among the primary school children? . Arch Med Health Sci 2014;2:155-9

How to cite this URL:
Gadhiya B, Arulsingh W, Arunachalam P, Samuel AJ. Is there any difference between Back Saver Sit-Reach Test and Modified Back Saver Sit-Reach Test in estimating hamstring flexibility among the primary school children? . Arch Med Health Sci [serial online] 2014 [cited 2019 Oct 17];2:155-9. Available from: http://www.amhsjournal.org/text.asp?2014/2/2/155/144321


  Introduction Top


Physical fitness plays an important role in maintaining a good health. [1],[2],[3] Epidemiologists say that lack of physical fitness is one of the reasons for the increase in childhood obesity in the last two decades. [2] Through standardized physical educational program, physical fitness of the children is regulated. Physical fitness testing is routine component of physical education classes in primary and secondary school. [4] The goals of the physical fitness-testing program are to provide continual monitoring of students fitness levels in targeted grades, to identify a student's weakness and strength so that areas in need of improvement can be seen, and to develop individualized programs. [5]

One area routinely focused in most fitness tests is flexibility. Adequate flexibility is an important characteristic of physical and health related fitness. Flexibility is described as the ability to move a joint through its complete range of motion. It is the extensibility of muscles as well as the non-contractile tissues such as joint capsule, ligaments, and tendons. [6] Importance of flexibility as a component of health-related fitness is related to prevention of orthopedic impairments later in life, especially lower back pain. [7] Inflexible muscle can make the musculotendinous unit susceptible to injury and can also lead to some pathological conditions at the joint on which it acts. [2],[7] Flexible muscles permit proper pelvic rotation, decrease disc compression, and avoid excessive stretch of musculatures. [8]

In flexibility screening field tests, the most commonly used measure is the sit-and-reach test (SRT). [9],[10] Several forms of SRT are commonly used to evaluate the hamstring and lower back flexibility. [11] Patterson et al. [12] indicated that the Back saver sit-and-reach test (BSSR) test was moderately related to hamstring flexibility test in middle school girls and boys, but Taher et al.[13] recommended the use of Modified back saver sit-and-reach test (MBSSR) to measure hamstring flexibility. Recently Pooja et al.[14] conducted a study regarding the comparison of BSSR test to MBSSR test for measurement of hamstring flexibility in female university students. She concluded that BSSR test was highly related to hamstring flexibility. As there is a lack of knowledge in primary school children regarding hamstring flexibility and as flexibility varies with the age, this study aimed to reveal whether both BSSRT and MBSSRT can be used alternatively in estimating hamstring flexibility among primary school children.

Procedure

The sample was recruited from the recognized primary school. The school was identified randomly by the cluster sampling technique. The study was conducted according to the ethical guidelines of the Helsinki Declaration (Revised 2008). University research committee and institutional ethics committee approved the study protocol (ACP/OP/2013/OL07). Pilot study was conducted to foresee procedural difficulty and for the sample size estimation and thus sample size was estimated to be 141 with power of the study 80 percent and type I error not more than 5% (P < 0.05). Children who had any recent musculoskeletal injuries such as fractures, dislocations, joint instability or any soft tissue injuries, recent surgeries in low back and lower limbs in past 6 months, congenital deformity of lower limb, and limb length discrepancy were excluded from the cross-sectional study. Children aged 5-12 years were selected by simple random sampling. A prior informed consent was obtained from the school authorities as well as from all parents and participants. They were ensured that confidentiality of the data would be maintained. We took 6 days to collect the data of 141 students during timings of 2-4 p.m. each day.

Participants were asked to remove their shoes, prior to all testing. Anthropometric measurement such as weight and height of the students were measured. Participants were informed to perform warm-up exercises for five minutes. [15] Following the warm-up exercise, the principal investigator demonstrated procedure of each test, then the participants were asked to perform three trials of BSSR (left and right leg) and MBSSR (left and right leg) in randomized order and average of each trials were used for data analysis. The participants were allowed to rest for 5 minutes between each test. All measurements were conducted on the same session. Participants were instructed to exhale as they are bending forward, to avoid rapid forceful movement, and strictly never to stretch to the point of pain. [16]

BSSRT

The test was administered using a standard sit-and-reach box on which the standard measuring tape was placed. The heel was made to align with the reading of 23 cm in the measuring tape. [17] The participants were asked to assume long sitting position with one leg fully extended so that the sole of the foot was flat against the end of the box. The participants were asked to bend other leg so that the sole of the foot was flat on the floor and 2-3 cm to the side of the straight knee as in [Figure 1]a. With the extended leg as straight as possible, hands on top of each other (tips of the middle fingers even), and palms down, the participant slowly reached forward sliding the hands along the box scale as far as possible. The score was recorded as the most distant point on the measuring tape contacted by the fingertip from [Figure 1]b. Participants were asked to hold this position shortly for two seconds. A qualified physiotherapist recorded the average of the three trials on each leg.
Figure 1: (a) Starting position of BSSRT. (b) End position of BSSRT. Abbreviations: Back saver sit-and-reach test – BSSRT

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MBSSRT

In this test, the participants performed a single-leg sit-and-reach on a wooden bench on which the measuring tape was placed. The untested leg was placed on the floor with knee at approximately 90°. The participant aligned the sole of the foot of the tested leg with the 50-cm mark on the measuring tape. [11] Thereafter, participants were asked to reach forward as far as possible while maintaining the knees, arms, and fingers fully extended, and keeping the two hands on top of each other (tips of the middle fingers even) and palms down as shown in [Figure 2]. They were asked to hold this position shortly two seconds. The score was recorded as the most distant point on the bench contacted by the middle fingertip. [13] A qualified physiotherapist recorded the average of the three trials on each leg.
Figure 2: Child in MBSSRT position with knee flexed at approximately 90° and resting on the stable support. Abbreviations: Modifi ed Back saver sit-and-reach test – MBSSRT

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After recording the score of all tests, a comparative analysis was done between BSSRT and MBSSRT to find out if both the tools are same in measuring hamstring flexibility among primary school children.

Data analysis

The participants included for the study were 141. All data was analyzed by using Statistical Package for Social Sciences, version-20 (IBM® SPSS® v20). The normality of the collected data was established using Kolmogorov Smirnov Z test, and it was found to be that the data does not follow normal distribution; hence, we used non-parametric test. Descriptive statistics were reported as mean (95% confidence interval, 95% CI) and range. To find out the correlation between the two field tests, the Spearman rank correlation test was used. Significance level, α was set at P < 0.05.


  Results Top


[Table 1] shows the descriptive statistics in mean (95% CI) and range of the primary school children recruited. Among them, 79 were male and 63 female were recruited. Both males and females were approximately matched in their age, height, and weight. Their significance was displayed in [Table 2]. This matching improves the strength of the study.
Table 1: Descriptive statistics of the primary school children recruited

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Table 2: Demographic characteristic differences between male and female recruited

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The correlation scatter block between BBSSRT and MBSSRT were portrayed in [Figure 3] and [Figure 4]. According to Porteney and Watkins criteria in determining the strength of association between the two independent variables, there exists good degree of direct association between BSSRT and MBSSRT.
Figure 3: Scatter plot displaying the association between right-sided Modifi ed back saver sit-and-reach test (MBSSRT) and Back saver sit-and-reach test (BSSRT)

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Figure 4: Scatter plot displaying the association between left-sided Modified back saver sit-and-reach test (MBSSRT) and Back saver sit-and-reach test (BSSRT)

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  Discussion Top


This study included the primary school children, as the measure of hamstring flexibility was not established in this population. Prior to testing, participants were asked to remove their shoes and belt to avoid any discomfort while measuring their flexibility. As students were having physical education class in afternoon from 2 p.m. to 4 p.m., the test was conducted during the same time to maintain uniformity. Six day were taken for data collection at the above mentioned time, with different grade students, but for each student all tests were conducted on the same day. Before testing, the students were informed to perform warm-up exercise for 5 minutes. No participants were eliminated because of their inability to perform the test. No one was in an incorrect position during the test, and no injuries occurred during testing.

Associations between BSSRT and MBSSRT test have been established in adolescent age group, but not in children. Therefore, this study served the purpose among primary school children. Although the BSSRT and MBSSRT are the most commonly used field measures of hamstring flexibility in current fitness test batteries, Baltaci et al. [16] reported that BSSRT has a disadvantage, i.e., it causes excessive posterior disk compression. Therefore, MBSSRT was proposed as an alternative for assessing hamstring flexibility. Even according to Staylen et al., [11] MBSSRT is more preferable test to measure hamstring flexibility. MBSSRT adopts the position of single leg stretch, which eliminates excessive posterior disk compression of the vertebrae, and requires only a measuring ruler and a 12-inch high bench, which is easily available in most school settings. Moreover, the specific posture when performing the test eliminates the abnormal position and discomforting feeling of the unstretched leg, as in the original BSSRT. The original BSSRT often elicits a discomforting feeling at the hip joint of the bent leg. The other contributing factors are the abnormal joint angle of the hip when the participant reaches forward, and the involvement of the adductor muscle group and the gluteus muscle group of the bent leg, which may limit the forward stretch motion. Therefore, the MBSSR test has been rated as the most comfortable test compared with other tests. This is probably due to the elimination of the adductors and gluteus muscles involvement when the bent leg is hanging down from the bench. The above may contribute to difference in flexibility between the two tests.

According to Portney and Watkins criteria, the results of this study state that there exists a good degree of association (ρ = 0.66, P < 0.01) between right-sided BSSRT and MBSSRT. Similarly, there exists good degree of association (ρ = 0.68, P < 0.01) between left-sided BSSRT and MBSSRT. This supports the findings of Patterson et al. and Taher et al. in estimating hamstring flexibility. Thus, both BSSRT and MBSSRT can be used alternatively. As MBSSRT has more advantages over BSSRT, we suggest the use of MBSSRT in determining hamstring flexibility.

The use of random sampling method, cluster sampling, and matching of age, height, and weight between males and females are the strengths of the study. One limitation of this study is the unavoidable minimal human error during the measurements. This can be overcome by using digital scales. Further, the study can be expanded over other pediatric populations, such as children with cerebral palsy, muscular dystrophy, etc.

The clinical implications of the study are that as one measurement seems to be sufficient to measure hamstring flexibility, MBSSRT is safer, practically feasible, and more comfortable of the two sit-and-reach protocols. Moreover, MBSSRT reduces the strain on the participant's back due to the use of bench for measurement.


  Conclusion Top


There exists a good degree of direct association between BSSRT and MBSSRT. Thus, both can be used alternatively in estimating hamstring flexibility among primary school children. As MBSSRT has more advantages over BSSRT, we suggest the use of MBSSRT for estimating hamstring flexibility.


  Acknowledgement Top


The authors are thankful to the children, their parents and the head of DJ English Medium School, Moodabidri, South India who gave their time and cooperation. This study would not be possible without them. Special thanks to the management who provided space in their school auditorium for data collection. We also appreciate the assistance provided by the physiotherapist, Dr. Bipin Rai in data editing.

 
  References Top

1.Watter RT, Neil F, Linda SP. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 9 th ed. Philadelphia: Lippincott Williams &Wilkins; 2013.  Back to cited text no. 1
    
2.Fabunmi A, Akaraiwe, Chiamaka A, Akosile. Hamstring flexibility: Relationship between straight leg raise and back saver sit-and-reach tests. ICHPER-SD 2008:14-7.  Back to cited text no. 2
    
3.Corbin C, Pangrazi B. The health benefits of physical activity. J Phys Act Fit Res Dig 1993;1:1-7.  Back to cited text no. 3
    
4.Cornbleet SL, Woolsey NB. Assessment of hamstring muscle length in school-aged children using the sit-and-reach test and the inclinometer measure of the hip joint angle. Phys Ther 1996;76:850-5.  Back to cited text no. 4
    
5.Suzann K, Robert J, Margo N. Physical therapy for children. 4 th ed. Linda Duncan. USA; 2012. p. 205-38.  Back to cited text no. 5
    
6.Ruiz JR, Castro-Piñero J, Artero EG, Ortega FB, Sjöström M, Suni J, et al. Predictive validity of health-related fitness in youth: A systematic review. Br J Sports Med 2009;43:909-23.  Back to cited text no. 6
    
7.Kawano MM, Ambar G, Oliveira BI, Boer MC, Cardoso AP, Cardoso JR. Influence of the gastrocnemius muscle on the sit-and-reach test assessed by angular kinematic analysis. Rev Bras Fisioter 2010;14:10-5.  Back to cited text no. 7
    
8.Haskell WL, Montoye HJ, Orenstein D. Physical activity and exercise to achieve health-related fitness components. Public Health Rep 1985;100:202-12.  Back to cited text no. 8
    
9.Chung JW, Chung LM, Chen B. The impact of lifestyle on the physical fitness of primary school children. J Clin Nurs 2009;18:1002-9.  Back to cited text no. 9
    
10.Milliken LA, Faigenbaum AD, Loud RL, Westcott WL. Correlates of upper and lower body muscular strength in children. J Strength Cond Res 2008;22:1339-46.  Back to cited text no. 10
    
11.Hui SS, Yuen PY. Validity of the modified back-saver sit-and-reach test: A comparison with other protocols. Med Sci Sports Exerc 2000;32:1655-9.  Back to cited text no. 11
    
12.Patterson P, Wiksten DL, Ray L, Flanders C, Sanphy D. The validity and reliability of the back saver sit-and-reach test in middle school girls and boys. Res Q Exerc Sport 1996;67:448-51.   Back to cited text no. 12
    
13.Taher A, Navid N, Morteza RS. Normalizing score of the modified back-saver sit-and-reach test in middle school boys. Int J Sports Sci Eng 2010;4:99-5.  Back to cited text no. 13
    
14.Pooja S, Poonam R. Comparison of back saver sit and reach test and modified back saver sit and reach test as a measurement of hamstring flexibility in female college student. J Rom Sports Med Soc 2008;28:1-7.  Back to cited text no. 14
    
15.López-Miñarro PA, Andújar PS, Rodrñguez-Garcña PL. A comparison of the sit-and-reach test and back saver sit-and-reach test in university students. J Sports Sci Med 2009;8:116-22.  Back to cited text no. 15
    
16.Baltaci G, Un N, Tunay V, Besler A, Gerçeker S. Comparison of three different sit and reach tests for measurement of hamstring flexibility in female university students. Br J Sports Med 200;37:59-61.  Back to cited text no. 16
    
17.JG Hartman, M Looney. Norm referenced and criterion-referenced reliability and validity of the Back saver sit-and-reach. Meas Phys Educ Exerc Sci 2009;7:71-7.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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