Abstract / Summary
Introduction: Low Back Pain (LBP) is a prevalent condition affecting people of all ages and is difficult to manage because of its non specific nature. In addition to pain, it can alter muscle function, balance, body awareness, and joint movement. Need of the study: Calf muscle tightness may influence posture, balance, and LBP. Evidence linking Tendo-Achilles tightness with postural control, balance, and Non specific LBP (NSLBP)-especially in aquatic therapy is currently insufficient. Moreover, the objective evaluation of muscle adaptations following targeted stretching is limited. Hence, the present study is essential to scientifically examine the effects of Tendo-Achilles stretching using ultrasonographic assessment in individuals with NSLBP. Aim: To evaluate the effect of three weeks of Tendo-Achilles stretching on land versus water in subjects having NSLBP. Materials and Methods: The present randomised controlled trial will be conducted at KLE University’s Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, from January 2026 to June 2027. A total of 120 participants with NSLBP of three months to two years duration will be randomly assigned to three groups (n=40 each): Group A-conventional Transcutaneous Electrical Nerve Stimulation (TENS) and exercises, Group B-conventional TENS with land-based stretching, and Group C-conventional TENS with aquatic stretching, for three weeks (three sessions per week). Diagnostic ultrasonography will assess calf muscle length, echogenicity, and cross-sectional area. Calf flexibility, lumbar mobility, lower limb function, dynamic balance, and disability will be evaluated using the Weight Bearing Lunge Test (WBLT), Modified-Modified Schober Test (MMST), lower extremity functional scale, Y-Balance Test, and Modified Oswestry Disability Questionnaire, respectively. Analysis of Variance (ANOVA) and post-hoc Tukey’s test will be used for testing the significance of the hypothesis among groups. Paired t-test or Wilcoxon signed-rank test will be used for within-group comparisons, with p<0.05 considered statistically significant.