Journal of Back and Musculoskeletal Rehabilitation 25 (2012) 161–169 161

DOI 10.3233/BMR-2012-0323
IOS Press

Effect of stretching program in an industrial

workplace on hamstring flexibility and
sagittal spinal posture of adult women
workers: A randomized controlled trial
José M. Muyora , Pedro A. López-Miñarrob,∗ and Antonio J. Casimiroc
a
Expresion Corporal Area, Faculty of Education, University of Almerı́a, Almerı́a, Spain
b
Department of Physical Education, Faculty of Education, University of Murcia, Murcia, Spain
c
Physical Education and Sport Area, Faculty of Education, University of Almerı́a, Almerı́a, Spain

Abstract. Objectives: To determine the effect of a stretching program performed in the workplace on the hamstring muscle
extensibility and sagittal spinal posture of adult women.
Material and methods: Fifty-eight adult women volunteers (mean age of 44.23 ± 8.87 years) from a private fruit and vegetable
company were randomly assigned to experimental (n = 27) or control (n = 31) groups. The experimental group performed
three exercises of hamstrings stretching of 20 seconds per exercise, three sessions a week for a period of 12 weeks. The control
group did not participate in any hamstring stretching program. Hamstring flexibility was evaluated through the passive straight
leg raise test and toe-touch test, performed both before and after the stretching program. Thoracic and lumbar curvatures and
pelvic inclination were measured in relaxed standing and toe-touch test with a Spinal Mouse.
Results: Significant increases (p < 0.01) in toe-touch score and straight leg raise angle (in both legs) were found in the
experimental group during post-test, while the control group showed a non-significant decrease for both toe-touch score and
straight leg raise test. A significant decrease in thoracic curve and significant increase in pelvic inclination were found in the
toe-touch test for the experimental group (p < 0.05). However, no significant changes were found in standing posture for any
group.
Conclusions: Hamstring stretching exercises performed in the working place are effective for increasing hamstring muscle
extensibility. This increase generates a more aligned thoracic curve and more anterior pelvic inclination when maximal trunk
flexion is performed.

Keywords: Work, stretching program, spine, pelvic

1. Introduction Systematic stretching over a period of time is needed to

Muscular flexibility is an important aspect of normal
human function. Maintaining normal muscle length
requires regular stretching to prevent muscle stiffness.
∗ Corresponding
author: Pedro A. López-Miñarro, Department of
Physical Education, University of Murcia, Campus Universitario de
Espinardo, CP, 30100 Murcia, Spain. Tel.: +34 868887051; Fax:
+34 868884146; E-mail: palopez@um.es.
increase the range of motion (ROM). Research suggests
that flexibility declines with age, with the maximum
ROM occurring in the mid-to-late twenties for men and
women, respectively [1]. Decreases in flexibility are
more evident in individuals that have passed their fourth
decade of life [20]. Performing regular stretching exer-
cises could reduce the decrease in flexibility occurring
over time.
Studies evaluating the effectiveness of different
stretching methods have typically focused on hamstring

ISSN 1053-8127/12/$27.50  2012 – IOS Press and the authors. All rights reserved
162 J.M. Muyor et al. / Hamstring stretching in an industrial workplace
muscles, probably because these muscles are often tight
and are easy to stretch without interference from joint
structures. Hamstring flexibility is recognized as an
important component of physical fitness and plays a
substantial role in protecting the spine from possible
risk. Reduced hamstring muscle extensibility has been
proposed as a predisposing factor for low back disor-
ders [29] and changes in lumbopelvic rhythm [2].
Hamstring extensibility influences spinal posture
when trunk flexion postures are performed. Studies
have shown differences in thoracic and pelvic postures
in trunk bending positions between participants with
improved or reduced hamstring extensibility [2,7]. Im-
proved hamstring extensibility has been associated with
lower thoracic angle and greater hip flexion.
Different stretching methods such as static, ballistic,
and propioceptive neuromuscular facilitation have been
used to increase and maintain the ROM of joints. Many
studies have examined different stretching programs for
increasing hamstring flexibility [5,25] and found a sig-
nificant improvement. However, most studies involve
young people and athletes. Other intervention pro-
grams have been performed in school settings [26,28]
and found significant differences in straight leg raise
and sit-and-reach test after a stretching program, while
no improvements were shown for the control group.
Kuukkanen et al. [12] found a significant improvement
in hamstring flexibility after a home exercise program.
In the last decade, more focus has been on the work-
place as a convenient setting for health promoting ini-
tiatives [11]. Workplaces may implement physical pro-
grams in the hope of keeping workers healthy and re-
ducing healthcare costs. Since employed adults spend
about half of their workday waking hours at work-
places, offering physical activity programs at work may
be an efficient strategy to increase muscle flexibili-
ty [24]. However, only a few studies concerning ham-
string stretching intervention have been conducted in
the working setting. Holmström and Ahlborg [10] eval-
uated the effects on muscle extensibility in construc-
tion workers of a 3-month period of a 10-min morning
warming-up exercise performed at the building site ev-
ery working day. Moore [21] implemented a stretch-
ing program over a 2-month period for 60 employees
of a pharmaceutical manufacturing plant. Both studies
found a significant improvement in flexibility. How-
ever, neither study has analyzed the effect of a stretch-
ing program performed in the workplace on hamstring
extensibility and spinal posture of middle-aged women.
For these reasons, the aim of this study was to deter-
mine the effect of stretching program performed in the
workplace on the hamstring muscle extensibility and
spinal posture in adult women from a private fruit and
vegetable company.
2. Material and methods
2.1. Participants
Fifty-eight adult women between the ages of 38 and
50 years participated in the study. They were randomly
assigned to control (n = 31; mean age: 43.56 ± 8.56
years; mean height: 162.19 ± 5.82 cm; mean body
mass: 67.77 ± 14.20 kg) or experimental (n = 27;
mean age: 44.85 ± 9.63 years; mean height: 160.70 ±
7.93 cm; mean body mass: 67.87 ± 16.66 kg) groups.
The participants were volunteers from a private tomato
company. Inclusion criteria included: age between
35 and 50 years, working at least 8 hours per day in
a standing position, and no involved in organized or
non-organized physical exercise activities during the
previous year. Exclusion criteria included episodes of
hamstrings injuries, fractures, surgery or pain in the
spine or hamstring muscles over the past six months or
back pain induced by the test procedures.
2.2. Procedures
An Institutional Ethical Committee approved the
study. The purpose of the study was explained, and
volunteers signed an informed consent form.
The experimental group participated in a program
that included hamstring stretching exercises three times
a week for 12 weeks (Monday, Wednesday and Fri-
day, between 14:00 and 14:30 hours). The stretching
exercises were performed at the end of job session.
The stretching exercises took place during the working
hours. If a woman missed a session, she made up the
session on the next day. Any woman who missed more
than 2 days of stretching was removed from the data
analysis. All participants were instructed not to partic-
ipate in any other physical activity activities, and not to
alter their daily habits during the study.
The stretching program was conducted and super-
vised by a physical therapist. In all the stretching exer-
cises, the stretched positions were assumed gently and
slowly until the end-point of range. Once this position
was achieved, the participants held it for 20 seconds.
The therapist instructed them to feel a strain on the
hamstring muscles without feeling pain. Hamstrings
muscles were stretched with hip in flexion and knee in
 J.M. Muyor et al. / Hamstring stretching in an industrial workplace
Fig. 1. Stretching exercises.
extension, maintaining the spine in a neutral position,
with the women in the orthostatic, sitting and supine
positions (Fig. 1).
The control group was composed of women at the
same workplace who did not participate in the pro-
gram or in any other physical activity. This group re-
ceived no information or attention about spinal posture.
Hamstring muscle extensibility and spinal posture in
standing and during maximal trunk flexion with knees
extended were measured prior and after the stretching
program. The tests were performed one week prior to
beginning the intervention and again 1 to 2 days after
the end of the intervention period.
2.2.1. Hamstring muscle evaluation
The hamstring muscle extensibility was measured
using the passive straight leg raise and toe-touch tests.
For the straight leg raise while the participant was in
the supine position with legs extended, the axis of the
universal goniometer was aligned with the axis of the
hip joint. The tester placed the stationary arm in line
with the trunk and positioned the moveable arm in line
with the femur. The participant’s leg was lifted passive-
ly by the tester into hip flexion. The tester placed one
hand under the calcaneus of the tested leg while main-
taining the knee joint in the extension with the other
hand. The opposite leg was fixed in straight position
during the leg raise by an auxiliary tester. The ankle of
the tested leg was restrained in plantar flexion to avoid
adverse neural tension. The endpoint for straight-leg
163
raise was determined by one or both of two criteria: (a)
the participants reported pain within their hamstring;
(b) palpable onset of pelvic rotation. A Unilevel in-
clinometer was used to control the posterior pelvic tilt.
The inclinometer was situated above the anterior supe-
rior iliac spine of the non-evaluated side. To maintain
the pelvis in a neutral position and avoid the posterior
pelvic tilt, the contralateral leg was held firmly down
against the plinth by means of a seat belt across the
upper and lower thigh. Moreover, the placement of
the Lumbosant or lumbar support was used to stabilize
the lumbar spine and pelvis, and rule out the effect of
posterior pelvic tilt on the measurement of hamstring
muscle extensibility [28]. The criterion score of ham-
string extensibility was the maximum angle (degree)
read from the goniometer at the point of maximum hip
flexion. Angles were recorded to the nearest degree for
each leg.
The toe-touch test was measured with a constructed
box (height: 32 cm). A reach distance of 50 cm corre-
sponded to the position of the feet against the box. The
final position that the participant reaches was the score
for each test. Scores were recorded in centimeters to
the nearest 0.5 cm using the scale on the box. Reaches
short of the toes were recorded as minus scores, and
reaches beyond the toes were recorded as plus scores.
The women were required to stand with knees
straight, legs together so that the soles of the feet were
flat against the end of the box. Verbal instructions
were provided at the start of the toe-touch test: “Slow-
164 J.M. Muyor et al. / Hamstring stretching in an industrial workplace
Fig. 2. Spinal measurement in the toe-touch test.
ly reach forward towards your toes as far as possible
while keeping your knees, arms, and fingers fully ex-
tended, with palms down and placing one hand on top
of the other and hold the position of maximum reach
for approximately 6 seconds” (Fig. 2).
2.2.2. Spinal posture measurement
The Spinal Mouse system (Idiag, Fehraltdorf,
Switzerland), a hand-held, computer-assisted electro-
mechanical-based device, was used to measure sagittal
spinal curvatures and pelvic inclination in the standing
and toe-touch test.
The Spinal Mouse is an electronic computer-aided
measuring device, which measures sagittal spinal range
of motion and intersegmental angles in a non-invasive
way, a so-called surface-based technique. The device is
connected radiographically via an analog-digital con-
verter to a standard PC. For global spinal angles, the
Spinal Mouse is a valid and reliable device [8,16,23].
In the standing position, the women assumed a re-
laxed position, with the head looking forward, the arms
hanging by the side, the knees normally extended, and
the feet shoulder-width apart. To classify the posture
in categories for thoracic kyphosis, the classification
proposed by Mejia et al. [18] was used: values be-
tween 20◦ and 45◦ were accepted as neutral thoracic
kyphosis; values below 20◦ were considered thoracic
hypokyphosis; and values above 45◦ were considered
thoracic hyperkyphosis. In the lumbar curve, values
between 20◦ and 40◦ were considered neutral; values
below 20◦ were considered hypolordotic; and values
above 40◦ were considered hyperlordotic [30].
Prior to measurements, the principal researcher de-
termined the spinous processus of C7 (starting point)
and the top of the anal crease (end point) by palpation
and marked these on the skin with a pencil. The Spinal
Mouse was guided along the midline of the spine (or
slightly paravertebrally in particularly thin individuals
with prominent processus spinous) starting at the pro-
cessus spinous of C7 and finishing at the top of the anal
crease (approximately S3). The thoracic (T1-2 to T11-
12) and lumbar (T12-L1 to the sacrum) spine and the
pelvic inclination (difference between the sacral angle
and the vertical) were recorded for each testing posi-
tion. In the lumbar curve, positive values corresponded
to lumbar kyphosis (anterior concavity). With respect
to the pelvic inclination, in the toe-touch test, a value
of 90◦ represented the vertical position. Thus, a greater
angle reflected a posterior pelvic tilt while a lower angle
reflected an anterior pelvic tilt.
2.3. Data analysis
The hypotheses of normality and homogeneity of the
variance were analyzed using Shapiro-Wilk and Lev-
ene tests, respectively. Descriptive statistics including
means and standard deviations were calculated. An in-
dependent t-test was conducted to examine differences
between both groups for all dependent variables in pre-
and post-test. A t test for dependent samples was used
to examine differences between pre- and post-test for
each group. The data were analyzed using the statistical
software SPSS (version 15.0). The level of significance
was set at p  0.05.
Intra-tester reliability of thoracic and lumbar curva-
tures and pelvic tilt was calculated in a previous study
(Muyor et al., 2011). Twenty subjects who did not par-
ticipated in this study were measured three times by the
same tester in standing position, sitting on a stool, and
prone lying in a single session. Intra-class correlation
coefficients (ICC) with 95% confidence intervals (CI)
were calculated. An ICCs upper or equal to 0.98 (95%
CI: 0.98–0.99) were obtained for thoracic kyphosis,
lumbar lordosis and pelvic tilt in all postures evaluated.
 J.M. Muyor et al. / Hamstring stretching in an industrial workplace 165

Table 1
Mean (± standard deviation) values of straight leg raise angle and toe-touch test in experimental and control groups
Experimental group (n = 27) Control group (n = 31)
Pre-test Post-test Pre-test Post-test
Straight leg raise (degrees)
Right leg 84.16 ± 10.29 89.15 ± 10.78∗ 82.90 ± 9.47 80.48 ± 11.24†
difference post-/pre-test +4.99◦ −1.42◦
Left leg 83.70 ± 9.55 90.19 ± 10.48∗ 83.42 ± 11.68 82.68 ± 9.88 †
difference post-/pre-test + 6.49◦ −0.74◦
Toe-touch test (centimeters) 45.22 ± 7.21 49.81 ± 6.99∗ 45.63 ± 8.84 44.42 ± 9.52†
difference post-/pre-test +4.59 cm −1.21 cm
∗p < 0.05 with respect to pre-test; p < 0.01 with respect to experimental group.

Fig. 3. Percentage of participants in each category of thoracic curve while relaxed standing.

3. Results centage of neutral values for both thoracic and lumbar

The means and standard deviations of passive
straight leg raise angle (right and left limbs) and toe-
touch test scores are presented in Table 1. The pre-test
measurements demonstrated no differences between
groups before initiation of the stretching program. The
data showed significant increases in toe-touch score and
straight leg raise angle at post-test (in both legs) in the
experimental group, while the control group showed a
slight, non significant decrease for both toe-touch score
and straight leg raise angle (Table 1). No significant
differences were found between left and right straight
leg raise in both groups.
The percentage of women in each category of tho-
racic and lumbar angles in standing posture is presented
in Figs 3 and 4, respectively. The data show a high per-
curves.
The means and standard deviations of spinal posture
in standing and toe-touch test are shown in Table 2.
In standing, no significant differences were found be-
tween pre- and post-test for any variable. A significant
decrease in thoracic curve was found in the toe-touch
test for the experimental group. A significant increase
in pelvic flexion was also detected in the experimental
group. No significant differences were found between
pre- and post-test in the control groups.
4. Discussion
The purpose of this study was to examine the ef-
fects of a hamstring stretching program performed at
the working place on hamstring extensibility and spinal
166 J.M. Muyor et al. / Hamstring stretching in an industrial workplace

Table 2
Sagittal spinal curvatures in the toe-touch test and standing for both groups in the pre- and post-tests
Experimental group (n = 27) Control group (n = 31)
Pre-test Post-test Pre-test Post-test
Toe-touch test
Thoracic spine 45.82 ± 8,53◦ 37.32 ± 7.95◦∗ 43.69 ± 8.56◦ 42.85 ± 10.88◦ †
Lumbar spine 13.61 ± 7,98◦ 14.18 ± 8.01◦ 15.38 ± 14.17◦ 13.78 ± 15.01◦
Pelvic inclination 85.29 ± 9,30◦ 79.03 ± 10.37◦∗ 84.72 ± 12.70◦ 85.66 ± 12.11◦ †
Standing
Thoracic spine 31.93 ± 10.28◦ 32.59 ± 10.13◦ 32.73 ± 9.23◦ 34.01 ± 10.12◦
Lumbar spine −25.87 ± 17.74◦ −26.67 ± 14.03◦ −23.56 ± 16.96◦ −25.32 ± 16.03◦
Pelvic inclination 18.56 ± 13.97◦ 17.67 ± 11.12◦ 17.03 ± 13.11◦ 15.93 ± 11.97◦
∗p < 0.05 with respect to pre-test; †p < 0.05 with respect to experimental group.

Fig. 4. Percentage of participants in each category of lumbar curve while relaxed standing.

posture in middle-age women workers. The main find-
ings indicate that incorporating hamstring stretching in
the working place produces an improvement in the toe-
touch score and straight leg raise angle. The improve-
ment observed in the toe-touch test for the experimental
group is related to improved hip flexion. The pelvic in-
clination in the toe-touch test between pre- and post-test
measurements was improved around 6 degrees. How-
ever, the control group showed a non significant reduc-
tion in the both measures between post- and pre-test
values.
Several studies have reported improved hamstring
extensibility after stretching programs [5,25] and our
results are in concordance with these findings. Supervi-
sion of a stretching program provides additional bene-
fits for improving hamstring flexibility [19]. Stretching
three times a week with a reduced volume is sufficient
to improve flexibility in middle-age women. Stretch-
ing protocols similar to our study including some sets
of exercises performed 3 days per week and holding
the stretching between 10 to 30 seconds for several
weeks have revealed significant improvement on ham-
string extensibility. However, the sample of most stud-
ies included young adults, athletes or school-children.
Few studies have been advocated in middle-age adults.
Analyzing the effect of stretching programs in middle-
age participants is necessary because decreases in flex-
ibility are evident in individuals that have passed their
fourth decade of life [20].
Increased hamstring extensibility could result from
increased stretch tolerance [6] and/or structural/mech-
anical changes in the viscoelastic characteristics of the
hamstring muscles [25]. In the current study, static
stretching was used because it has been shown to be
effective in increasing hamstring length. This type of
stretching takes the muscle to its end range and main-
 J.M. Muyor et al. / Hamstring stretching in an industrial workplace
tains this position for a specified duration. In all the
stretching exercises, the spinal curvatures were main-
tained in a neutral position and the pelvis was situated
in neutral or slightly anterior pelvic tilt.
Previous studies have also analyzed the effect of dif-
ferent programs in a working context on hamstring ex-
tensibility. Holmström and Ahlborg [10] evaluated the
effects on muscle extensibility of a 3-month period con-
sisting of a 10-minute morning warming-up exercise,
performed at the building site every working day. Thir-
ty construction workers participated in the program.
Significant increases of hamstring extensibility were
seen in comparison with a control group of construc-
tion workers at other building sites. Moore [21] im-
plemented a stretching program including 36 sessions
over a 2-month period to 60 employees of a pharma-
ceutical manufacturing plant. The stretching sessions
were held 5 times a day and lasted 5–8 min. The
stretching exercises involved the neck, shoulder, arm,
trunk, hip, back and legs. After the completion of the
stretching program, they found a significant improve-
ment in flexibility. However, the study did not include
a control group. Hilyer et al. [9] reported that flexibil-
ity training had a beneficial effect on the sit-and-reach
test (13.4%) for the experimental group after a 6-month
stretching program. Furthermore, they found a sig-
nificant decrease (p < 0.001) in the sit-and-reach test
(−10%) for the control group. Kuukkanen et al. [12]
analyzed the effects of progressive therapeutic exercise
on muscle flexibility in chronic low back pain patients
who performed a home exercise group or an intensive
training group. The intervention period lasted three
months and hamstring flexibility increased among the
intensive training and home exercise groups between
pre- and post-intervention. However, neither study an-
alyzed the influence of these programs in sagittal spinal
curvatures.
Li et al. [13] stated that hamstring stretching pro-
gram may affect lumbar and hip motion during forward
bending. Because the hamstring muscles originate at
the ischial tuberosity of the pelvis, it is logical that ten-
sion in the hamstring muscles will have an influence on
movement and posture of the pelvis [3]. Carregaro and
Coury [2] found that participants with reduced ham-
string extensibility presented higher trunk movement
amplitudes and a restriction on pelvis movements dur-
ing handling tasks, which can overload the spine during
handling of materials. The influence of hamstring ex-
tensibility on pelvic and thoracic posture in trunk flex-
ion postures with knees extended has been described in
previous studies [15] although hamstring extensibility
167
does not affect pelvic inclination or spinal curvatures in
relaxed standing [7,14]. The tension in the hamstring
when participants adopt a relaxed standing posture is
reduced. For this reason, no significant differences
were found between pre- and post- measurements in
standing.
Gajdosik et al. [7] in young adult population and
López-Miñarro and Alacid [14] in young paddlers
found a different pattern in spinal and pelvic postures
between males according to their differences in ham-
string extensibility. The participants with higher ham-
string extensibility showed lower thoracic angles and
greater anterior pelvic inclination when the sit-and-
reach or toe-touch tests were performed. However, both
studies were cross-sectional. Our results are consistent
with these research, showing that women of the ex-
perimental group reached an increased anterior pelvic
range of motion and decreased flexion of the thoracic
angle. This decrease could be related to their improved
capacity to reach their toes due to greater pelvic flexion.
When the pelvis reaches a greater flexion posture the
trunk is more vertical and indeed it is not necessary to
use the full available thoracic flexion. The reduced tho-
racic kyphosis in trunk flexion movements is important
because more neutral postures have been associated to
lower compressive and shear forces in the intervertebral
tissues [17].
There are several methodological considerations
with regard to research design. The passive straight
leg raise was used to determine the hamstring muscle
extensibility. However, Davis et al. [4] recommend
using the passive knee extension angle as a measure
of hamstring extensibility because this test minimizes
pelvis motion. The placement of the Lumbosant or
lumbar support was used to stabilize the lumbar spine
and pelvis, and rules out the effect of posterior pelvic
tilt on the measurement of hamstring muscle extensi-
bility [28]. The toe-touch test was chosen because the
procedure is simple, easy to administer, requires min-
imal skills training, and has shown a moderate-high
criterion-related validity with respect to the straight leg
raise angle [27].
This study has several limitations. As regards meth-
odological criterion with respect to sample selection,
only women without current or chronic history of low
back pain were recruited. Moreover, spinal posture is
influenced by the resistance of the paravertebral mus-
cles and pelvic awareness. However, in this study there
was no intervention neither measurement of these vari-
ables. Future studies should investigate the relation
between low back pain, spinal curvatures and pelvic
168 J.M. Muyor et al. / Hamstring stretching in an industrial workplace
posture in several positions. Other studies should com-
pare the effects of stretching across different occupa-
tional groups with distinct demands and working pos-
tures. Furthermore, the long-term effects of hamstring
stretching exercises require further investigation. Lon-
gitudinal studies are needed to determine the long-term
effects of stretching exercises in spinal posture.
5. Conclusions
Hamstring stretching exercises performed in the
working place are effective for increasing hamstring ex-
tensibility in middle-aged women. This improvement
is related to a better sagittal alignment of thoracic curve
and greater anterior pelvic inclination when maximal
trunk flexion posture with knees extended is performed.
Acknowledgments
This study was supported by grant No. 34/UPB20/10
(Salud integral en la empresa: Programa de actividad
fı́sica y de prevención de riesgos psicosociales en el
ámbito laboral) from the Spanish Superior Council of
Sports.
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