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The Effect of Neuromuscular Training on The Mechanical Response of The Lumbo-Pelvic-Hip Complex and Lower Extremities in Athletes with Hamstring Injuries And/or Low Back Pain During Functional Tasks

Protocol summary

Study aim
This study aims to address the lack of comparative evidence on neuromuscular training modalities by evaluating how dynamic neuromuscular stabilization (DNS), Nordic hamstring exercises (NHE), and askling training differentially modulate lumbopelvic-hip mechanics and lower limb coordination in athletes with hamstring injuries and/or low back pain during functional tasks.
Design
A controlled, parallel-group, randomized clinical trial with pre-post testing on 45 patients and 15 healthy individuals. Randomization uses Excel’s RAND function.
Settings and conduct
Following initial preparation, electromyographic activity, ground reaction forces, and plantar pressure are measured. Intervention groups receive an 8-week training program and are reassessed post-intervention.
Participants/Inclusion and exclusion criteria
Inclusion criteria: History of hamstring injury (past 6 months) and/or low back pain, no other lower extremity injuries, regular sports activity (≥3 sessions/week), and Aged 18–40 years. Exclusion criteria: New injuries during the study, incomplete participation in training sessions, use of neuromuscular-affecting medications, and chronic musculoskeletal/neurological disorders.
Intervention groups
Intervention Groups: Athletes with hamstring injuries and/or low back pain undergo an 8-week training program (3 groups: Dynamic Neuromuscular Stabilization (DNS), Nordic Hamstring Exercises (NHE), Askling Training) at a sports club. Control Group: Will not receive training intervention.
Main outcome variables
The amplitude, Free moment, and frequency spectrum of the ground reaction force; Amplitude and frequency spectrum of muscle electrical activity; and Onset and offset of the lower limb muscles

General information

Reason for update
Acronym
IRCT registration information
IRCT registration number: IRCT20240917063072N2
Registration date: 2025-05-29, 1404/03/08
Registration timing: prospective

Last update: 2025-05-29, 1404/03/08
Update count: 0
Registration date
2025-05-29, 1404/03/08
Registrant information
Name
farhad rezazadeh
Name of organization / entity
The university of mohaghegh ardabili
Country
Iran (Islamic Republic of)
Phone
+98 912 019 8026
Email address
rezazadeh.farhad@uma.ac.ir
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2025-05-31, 1404/03/10
Expected recruitment end date
2025-08-15, 1404/05/24
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The Effect of Neuromuscular Training on The Mechanical Response of The Lumbo-Pelvic-Hip Complex and Lower Extremities in Athletes with Hamstring Injuries And/or Low Back Pain During Functional Tasks
Public title
The Impact of Neuromuscular Training on Athletes with Hamstring Injuries and Low Back Pain
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
History of hamstring injury within the past 6 months Current low back pain Absence of concurrent lower extremity injuries Regular sports participation (minimum of 3 training sessions per week) Aged between 18 and 40 years
Exclusion criteria:
Occurrence of any new injuries during the study period Incomplete attendance in training sessions (missing >20% of sessions) Use of medications affecting neuromuscular function (e.g., muscle relaxants, antispasmodics) Diagnosed neurological disorders (e.g., cerebral palsy, Parkinson’s disease)
Age
From 18 years old to 40 years old
Gender
Both
Phase
N/A
Groups that have been masked
  • Participant
Sample size
Target sample size: 60
Randomization (investigator's opinion)
Randomized
Randomization description
Participants will be randomly assigned to one of four intervention groups—dynamic neuromuscular stabilization (DNS), Nordic hamstring exercises (NHE), Askling training, and control group—using a computer-generated randomization sequence via the RAND function in Microsoft Excel. Allocation concealment will be ensured by an independent researcher who is blinded to group assignments. The randomization ratio will be 1:1:1:1, and assignments will be securely stored in password-protected files until the completion of data collection.
Blinding (investigator's opinion)
Single blinded
Blinding description
This study includes three intervention groups and one control group. Participants, therapists, and assessors are blinded to group allocation. Participants are informed of trial participation but not group details. Randomization uses concealed computer-generated codes managed by an independent researcher.
Placebo
Not used
Assignment
Parallel
Other design features

Secondary Ids

empty

Ethics committees

1

Ethics committee
Name of ethics committee
Research Ethics Committees of University of Mohaghegh Ardabili
Street address
Ardabil, end of University street, University of Mohaghegh Ardabili
City
Ardabil
Province
Ardabil
Postal code
5619911367
Approval date
2025-04-30, 1404/02/10
Ethics committee reference number
IR.UMA.REC.1404.029

Health conditions studied

1

Description of health condition studied
Athletes with hamstring injuries and/or back pain
ICD-10 code
ICD-10 code description

Primary outcomes

1

Description
Walking – Running – Planned Directional Change Running – Reactive Directional Change Running – Counter movement Jump (CMJ) – Squat Jump (SJ) – Y-Balance Test
Timepoint
Primary outcomes will be assessed at the following two time points: Baseline: Before the initiation of the 8-week training intervention (pre-test). Post-intervention: Immediately following the completion of the 8-week training program (post-test).
Method of measurement
Bertec forceplate, Biometric Electromyography (EMG) System, RSScan Footscan® System, Visual Analogue Scale

Secondary outcomes

empty

Intervention groups

1

Description
Intervention group: Dynamic Neuromuscular Stabilization (DNS) Group, DNS exercises aim to improve postural control and core stability and include movements such as Baby Position, Rolling, Side-Lying, Tripod, Squat, and Czech Get-Up. The exercises emphasize diaphragmatic breathing and intra-abdominal pressure (IAP) regulation. The intervention will be conducted three times per week for eight weeks, with each session lasting between 45 and 60 minutes.
Category
Treatment - Other

2

Description
Intervention group: Nordic Hamstring Exercise (NHE) Group, Nordic exercises aim to eccentrically strengthen the hamstring muscles to prevent injury. They involve a controlled forward descent from a kneeling position with assistance from a partner or a support strap, following the protocol developed by Petersen et al. (2011). The intervention will be conducted three times per week for eight weeks, with each session lasting between 45 and 60 minutes.
Category
Treatment - Other

3

Description
Intervention group: Askling Training Group, This group performs eccentric hamstring exercises based on the L-protocol developed by Askling et al., which includes lunge exercises, dynamic stretching, and controlled running drills. The intervention will be conducted three times per week for eight weeks, with each session lasting between 45 and 60 minutes.
Category
Treatment - Other

4

Description
Control group: Participants in this group will receive no structured exercise intervention during the eight-week period and will continue their normal daily activities without any change.
Category
Other

Recruitment centers

1

Recruitment center
Name of recruitment center
Mohaghegh Ardabili University Health and Wellness Center
Full name of responsible person
Farhad Rezazadeh
Street address
Mohaghegh Ardabili University, University Street
City
Ardabil
Province
Ardabil
Postal code
5619911367
Phone
+98 45 3150 5627
Email
rezazadeh.farhad@uma.ac.ir

Sponsors / Funding sources

1

Sponsor
Name of organization / entity
University of mohaghegh ardabili
Full name of responsible person
farhad rezazadeh
Street address
Mohaghegh Ardabili University, University Street
City
Ardabil
Province
Ardabil
Postal code
5551914555
Phone
+98 912 019 8026
Email
rezazadeh.farhad@uma.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
No
Title of funding source
The University of Mohaghegh Ardabili
Proportion provided by this source
100
Public or private sector
Private
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic

Person responsible for general inquiries

Contact
Name of organization / entity
Mohaghegh Ardabili University
Full name of responsible person
Farhad Rezazadeh
Position
Assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Sport Medicine
Street address
Mohaghegh Ardabili University, University Street
City
Ardabil
Province
Ardabil
Postal code
5619911367
Phone
+98 45 3150 5627
Email
rezazadeh.farhad@uma.ac.ir

Person responsible for scientific inquiries

Contact
Name of organization / entity
Mohaghegh Ardabili University
Full name of responsible person
Farhad Rezazadeh
Position
Assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Sport Medicine
Street address
Mohaghegh Ardabili University, University Street
City
Ardabil
Province
Ardabil
Postal code
5619911367
Phone
+98 45 3150 5627
Email
rezazadeh.farhad@uma.ac.ir

Person responsible for updating data

Contact
Name of organization / entity
Mohaghegh Ardabili University
Full name of responsible person
Farhad Rezazadeh
Position
Assistant professor
Latest degree
Ph.D.
Other areas of specialty/work
Sport Medicine
Street address
Mohaghegh Ardabili University, University Street
City
Ardabil
Province
Ardabil
Postal code
5619911367
Phone
+98 45 3150 5627
Email
rezazadeh.farhad@uma.ac.ir

Sharing plan

Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available
Study Protocol
Yes - There is a plan to make this available
Statistical Analysis Plan
Yes - There is a plan to make this available
Informed Consent Form
No - There is not a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available
Analytic Code
Yes - There is a plan to make this available
Data Dictionary
Yes - There is a plan to make this available
Title and more details about the data/document
Collected data will be made available to the public as articles and the thesis after analysis.
When the data will become available and for how long
Access period is 2 months after printing the results
To whom data/document is available
The instructor and the examiner
Under which criteria data/document could be used
Article and thesis
From where data/document is obtainable
Supervisor
What processes are involved for a request to access data/document
Raw data cannot be published.
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