Journal of Musculoskeletal Research, Vol. 15, No.

3 (2012) 1250015 (9 pages)

World Scientic Publishing Company
DOI: 10.1142/S0218957712500157

NORMATIVE VALUES OF LOWER BACK AND HAMSTRING

FLEXIBILITY FOR NIGERIANS USING THE MODIFIED
SIT-AND-REACH TEST

Babatunde O. A. Adegoke
,, Godwin A. Akpan

and Chidozie E. Mbada

Physiotherapy Department, College of Medicine

University of Ibadan, Nigeria

Department of Medical Rehabilitation

College of Health Sciences
Obafemi Awolowo University, Ile | Ife, Nigeria

badegoke@comui.edu.ng

Accepted 9 May 2012

Published 31 July 2012
ABSTRACT
Purpose: Dearth of population-specic reference values is a limitation in the assessment of lower back
and hamstrings exibility. This study sought to establish a gender and age normative data for lower
back and hamstrings exibility in healthy Nigerians using the modied sit-and-reach test. Methods:
This study involved 4000 (1988 males and 2012 females) participants recruited using multistage
sampling technique. The participants whose ages ranged between 5 and 61 years were grouped into
12 age strata. The Acuex-1 tester (modied sit-and-reach box) was used to assess lower back and
hamstring exibility following standardized procedures. Data were analyzed using descriptive statistics of mean and standard deviation, percentiles. Results: The mean of the modied sit-and-reach
test scores (MSRTS) differed signicantly between the sexes ( p 0:001). MSRTS increased with age up
to age of 1519 years for male, and 3039 years for female. There were age and gender variations in
the percentile normative values of MSRTS for each of the 16 age categories. Conclusion: This study
established a population-specic normative data according to age and gender for lower back and
hamstrings exibility using the modied sit-and-reach test for healthy Nigerians. In general, females
had better lower back and hamstrings exibility than males.
Keywords: Flexibility; Lower back and hamstring; Modied sit-and-reach test; Nigerians.

1250015-1

B. O. A. Adegoke, G. A. Akpan & C. E. Mbada

INTRODUCTION
Tightness in the low back and hamstring muscles
is often related to muscle pain, decrease in the
range of motion at the joint on which the muscles
act and eventual stiffness.19,27,31 Adequate exibility of the hamstring and low back may prevent
low back problems, musculoskeletal injuries,
postural deviations, gait limitations, and risk of
falling.1,6 Though, muscular exibility is an important component of health and overall tness,
it is generally underestimated and overlooked by
health care professionals and practitioners.16
Furthermore, dearth of normative values and
dependence on criterion standard is a limitation
in the assessment of back functions performance.16 McIntosh et al.22 reported that when
evaluating muscle performance in the extremities, an examiner can compare the normal and
abnormal sides to quantify diminished function
but this type of intrinsic control is not available
for evaluation of the trunk. Therefore to identify
alterations of the trunk musculature from normal, a normative database is needed.22
Comparing test results of patients with normative values of healthy subjects may help
identify low back and hamstring tightness and in
turn aid in planning appropriate intervention.
The modied sit-and-reach test is probably the
most widely used measure of exibility and a
primary component of most physical tness
tests.9 The test was designed to measure the extensibility of the hamstring muscles and the
lower back articulations by evaluating the maximal reach an individual can make in a seated
position.9 Some investigators claim that this
method favors individuals with long arms in relation to their legs,11 while others have failed to
nd a limb-length bias in the test, perhaps due to
differences in methodology.10,20 However, studies using various sit-and-reach tests and its variants to assess hamstring muscles and low back

currently exist for some populations.2,9,16,17,27

Most of the exibility tests developed over the
years are specic to certain sports and are not
practical for use with the general population.16
Currently, there appears to be a dearth of normative values of lower back and hamstring exibility for Nigerians of different age groups using
the modied sit-and-reach test that could be used
in assessing this population in exibility rather
than American-based generated normative
values. This study aimed to establish gender and
age reference normative values of lower back and
hamstring exibility for Nigerians using the
modied sit-and-reach test.

MATERIALS AND METHODS

A total of 4000 consenting apparently healthy
males and females whose ages ranged between
5 to 61 years participated in this study. The participants were volunteers who included students
from randomly selected government and private
primary and secondary schools, as well as junior
and senior civilian staff of the Ministry of Defence, in Lagos State, Nigeria. Exclusion criteria
were a positive history of hamstring injuries,
fractures, surgery or severe pain in the spine or
hamstring muscles in the recent past, inability to
assume the starting position, involvement in
competitive sports and pregnancy. Ethical
approval for the study was obtained from the
Research Ethics Committee of the University of
Ibadan/University Collage Hospital. Permissions
to conduct the study in the schools were obtained
from prescribed authorities of sites selected for
data collection.

Sampling Technique
The schools and junior/senior civilian staff from
the Ministry of Defence (MoD) were selected
using a multistage systematic sampling technique. There are six educational districts and 20

1250015-2

Normative Values of Lower Back and Hamstring Flexibility Using the Modied Sit-and-Reach Test

Universal Basic Education Boards in each of the

Local Government Areas (LGAs) in Lagos state,
Nigeria. The shbowl technique was used to select District IV, which comprised of Apapa,
Mainland and Surulere LGAs. Mainland LGA
was selected by the same sampling method.
Random selections of 16 schools (primary and
secondary) were made from a list of all the
schools in the same LGAs. Participatory classes
were selected by using shbowl technique. For
the civilian staff of MoD, shbowl technique was
also used to select ve units out of 40 units from
81 Division Nigerian Army area of responsibility
in Lagos state.

Measurements
The following anthropometric measurements
were taken: Height, weight, and Body Mass Index
(BMI). Participants height and body weight were
measured to the nearest 0.1 cm and 0.1 kg respectively using standardized instruments and
procedures. Participants BMI was then computed
using the standard formula viz: BMI weight
(kg)/height2 (m2).

Procedure
The test procedure was explained and demonstrated to the participants at inclusion. Participants properly warmed up for about 35
minutes prior to the rst trial by performing the
following stretching exercises:
Hamstring Stretch: The participant sat on the
oor with the leg extended out in front, forced
the knees at against the oor and grabbed the
knees. The participant was instructed to hold in
this stretched position for ve seconds and repeat
the procedure ve times.17 In erect standing,
participant placed one foot on a wooden stool
while keeping the other lower limb straight. The
ankle of the elevated leg was grasped and the

trunk bent toward this leg. The participant was

instructed to hold this stretched position for ve
seconds and repeat for ve repetitions.
Lower Back Stretch: The participant in supine
lying brought both knees to the chest, grabbed
each leg below the knee, and pulled both knees
slowly towards the shoulder. The participant was
instructed to hold this stretched position for ve
seconds and repeat for ve repetitions.
Side Stretch: From a standing position with
the feet spread apart, the participant slowly bent
sideward at the waist and was instructed to hold
this stretch position for ve seconds and repeat
the procedure for a total of ve repetitions.
Sit-and-Reach Test: The modied sit-andreach test was performed using the Acuex 1 tester
(modied sit-and-reach box | manufactured by
Novel Products, Inc. USA.). All participants removed their shoes for the test. The participant sat
on a oor mat with the back and head against a
wall, the knees fully extended, and the soles of the
feet against the Acuex 1. The L shaped moving
device (on the reach indicator) was perfectly even
with the end of the reach indicator. For the starting
position, the participant placed one hand on top of
the other and reached forward as far as possible
without allowing the head and back to come off
the wall. The shoulder was rounded as much as
possible, but neither head nor back came off the
wall at that time. The researcher then slided the
reach indicator on the Acuex 1 along the top of
the box until the sliding device touched the tip of
the participants ngers (Fig. 1). This was the
starting position for the test and the reach indicator
was held rmly in place throughout the rest of
the test. The participants head and back then
came off the wall, as the participant gradually
reached forward three times, pushing the sliding
device as far forward as possible along the reach
indicator during the third attempt and holding the
nal position for at least two seconds. During the
test, the knees were kept at against the oor

1250015-3

B. O. A. Adegoke, G. A. Akpan & C. E. Mbada

and age normative value tables for back and

hamstring exibility, the participants were classied into the following 12 age categories: 59,
1014, 1519, 2024, 2529, 3034, 3539,
4044, 4549, 5054, 5559 and 60 and over.
Physical characteristics and back and hamstring
exibility scores of all male and female participants were compared using independent t-test at
0.05 alpha level. The analyses were carried out
using SPSS 16 Version on software (SPSS Inc.,
Chicago, Ill., USA).
Fig. 1 Showing starting position for the modied sit-andreach test.

(Fig. 2). The nal number of centimeters reached to

the nearest half centimeter using the scale on the
left side of the reach indicator was recorded. Two
trials were conducted and the average of the two
scores were used as the nal test score.17

Data Analyses
Data were summarized using descriptive statistics of mean, standard deviation, percentiles and
graphs. For the purpose of constructing gender

Fig. 2 Showing male participant undergoing the modied

sit-and-reach test.

RESULTS
The presentation of participants distribution
according to their geo-political zone of origin
(Table 1) indicates that participants were from
the six geo-political zones of Nigeria though the
majority was from the south-west zone. The
participants age structure was compared with
that of the Nigerian population in Table 2. The
mean age, weight, height and body mass index of
all the participants were 16.70  11.50 years,
41.84  18.45 kg, 1.49  0.18 m and 17.9  5.03 kg/
m2, respectively. The independent t-test comparisons of the participants general characteristics and back and hamstring exibility scores of
male and female participants are presented in
Table 3. Male and female participants did not
differ signicantly in their age and weight but
female participants BMI and back and hamstring
exibility scores were signicantly higher
( p 0:001) than that of their male counterparts.
The normative mean and percentile data of back
and hamstring exibility by age and gender are
presented in Table 4. The mean and the median
values showed a progressive increase in exibility from age group 59 years through 1519
years before a slight decline. Similarly, the mean
and median exibility values increased from
2024 years to 4044 years but progressively
declined from 4549 years to 60 years old
category.

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Normative Values of Lower Back and Hamstring Flexibility Using the Modied Sit-and-Reach Test

Table 1 The Distribution of Participants According to their Geo-Political

Zone of Origin.
Zone of Origin

Number

Percentage

472
814
2102
477
57
78
4000

11.8
20.3
52.6
11.9
1.4
2.0
100.0

South East
South South
South West
North Central
North East
North West

Table 2 Comparison of Participants Age

Structure with that of the Nigerian Population.
Age Structure (%)
Age Group (Yrs)

Nigeria 24

Participants

13.1
28.2
24.6
17.1
10.4
2.4
4.1

|
59.5
28.4
7.0
4.4
0.9
|

04
514
1529
3044
4559
6064
65

DISCUSSION
In addition to calculating the sample size, we
recruited participants from public schools and
Ministry of Defence (MoD) to ensure adequate
number and national spread of participants in

this study. Specically, recruitment from MoD

ensured that participants in this study were from
all parts of Nigeria since employment of workers
by MoD must by law reect the federal nature of
Nigeria. Also, the city of Lagos is Nigerias economic and commercial hub and has the most
heterogeneous population in Nigeria. Our analysis indicated that participants were from all the
36 states and all the six geographical zones of
Nigeria. Also, our participants age structure
follows the age structure of the Nigerian population. Our sample is hence substantially representative of the Nigerian population.
Male and female participants were not signicantly different in their ages but male participants
were signicantly taller and had signicantly
smaller BMI and modied sit-and-reach test scores
than female participants. Girls have slightly larger
BMI values than boys from age 7 to 16 but BMI
values for men are slightly higher than for women
after 18. Although our study was not on BMI, we
suspect that females in the study had signicantly
higher BMI because over 50% of participants in this
study were from age 514 years; the age range
when females have higher BMI.
This study established gender and age normative values for lower back and hamstrings
exibility in apparently healthy Nigerians. Normative data on lower back and hamstring exibility in the general healthy population seems to

Table 3 Independent t-Test Comparison of the General Characteristics and Back and Hamstring Flexibility
Between Male and Female Participants.
Male =(n = 1988)
Mean  SD
Age (years)
Weight (kg)
Height (m)
BMI (kg/m 2 )
MSRTS (cm)

16.39
42.08
1.51
17.54
29.31







10.67
17.72
0.18
4.35
7.20

95% Condence Interval of the Difference

Female (n = 2012)
Mean  SD

p-Value

Upper

Lower







0.090
0.416
0.001*
0.001*
0.001*

1.330
0.669
0.030
1.016
1.318

0.096
1.619
0.053
0.394
0.436

17.01
41.61
1.47
18.25
30.18

12.27
19.15
0.18
5.59
7.03

Key: BMI Body Mass Index; modied sit-and-reach test scores (MSRTS).
*Signicant at p < 0:05.
1250015-5

B. O. A. Adegoke, G. A. Akpan & C. E. Mbada

Table 4 Normative Mean and Percentile Data of Back and Hamstring Flexibility by Age
and Gender (n = 4000).
Percentile
N

Sex

Mean SD

25th

50th

75th

95th

Range

59 yrs

443
595
1038

M
F
(M & F)

23.1  4.80
23.8  4.80
23.5  4.81

20.0
20.5
20.0

23.0
23.0
23.0

26.0
27.0
26.5

31.0
31.5
31.5

10.541.0
10.539.5
10.541.0

1014 yrs

714
628
1342

M
F
(M & F)

28.1  6.11
30.1  5.49
29.0  5.91

24.0
26.5
25.2

29.0
30.0
29.5

31.6
33.3
32.5

38.5
39.5
39.0

11.046.0
11.049.0
11.049.0

1519 yrs

390
246
636

M
F
(M & F)

34.5  6.89
35.3  5.51
34.8  6.40

30.0
31.0
30.5

34.0
34.5
34.5

39.3
39.5
39.5

46.8
43.8
46.3

13.053.3
18.053.0
13.053.3

2024 yrs

151
163
314

M
F
( M & F)

33.0  5.76
34.2  5.10
33.6  5.45

29.3
30.5
30.0

32.0
33.5
33.0

37.0
39.0
37.6

43.7
41.5
42.5

18.050.3
22.546.5
18.050.3

2529 yrs

88
98
186

M
F
(M & F)

32.8  5.35
34.5  4.98
33.7  5.23

29.1
30.5
30.0

32.5
34.5
33.0

36.2
39.5
37.6

40.8
42.5
41.5

17.549.5
24.546.5
17.549.5

3034 yrs

38
58
96

M
F
(M & F)

33.5  7.14
36.5  5.50
35.3  6.35

29.8
31.5
31.0

32.0
36.1
34.3

39.5
40.5
40.0

45.6
46.2
46.0

18.346.5
25.850.0
18.350.0

3539 yrs

52
60
112

M
F
(M & F)

33.4  4.80
37.0  5.71
35.3  5.59

30.0
31.8
31.0

33.5
38.5
35.8

36.7
40.5
40.0

40.7
46.5
43.0

20.842.5
21.049.5
20.849.5

4044 yrs

34
32
66

M
F
(M & F)

34.2  4.59
36.5  4.86
35.3  4.82

30.4
32.4
30.5

34.3
36.9
35.8

38.3
40.4
39.5

40.3
43.7
42.3

24.541.0
25.545.0
24.545.0

4549 yrs

25
62
87

M
F
(M & F)

32.5  4.66
35.1  5.69
34.3  5.51

30.3
30.5
30.5

31.5
34.4
33.0

35.8
39.0
38.5

41.1
44.4
43.8

20.041.5
23.548.0
20.048.0

5054 yrs

23
32
55

M
F
(M & F)

32.5  4.91
36.0  5.78
34.5  5.67

29.5
30.6
30.0

31.0
35.5
34.0

36.0
40.0
39.5

40.0
49.2
43.4

20.840.0
27.049.5
20.849.5

5559 yrs

13
20
33

M
F
(M & F)

30.6  6.22
31.6  5.28
31.2  5.59

26.4
27.4
27.3

29.5
31.3
30.3

35.0
34.4
34.5

43.5
41.5
42.1

22.343.5
23.041.5
22.343.5

60 yrs & older

17
18
35

M
F
(M & F)

30.7  4.49
31.2  5.69
30.9  4.62

28.8
28.5
28.5

29.5
30.5
30.0

34.4
32.1
32.3

39.5
43.0
42.6

23.539.5
25.043.0
23.543.0

1988
2012
4000

M
F
(M & F)

29.3  7.20
30.2  7.03
29.8  7.92

24.0
25.0
24.8

29.5
30.3
30.0

33.8
35.0
34.5

41.5
41.5
41.5

10.553.3
10.553.0
10.553.3

Age Group

All

M Male, F Female, M & F Male and female.

1250015-6

Normative Values of Lower Back and Hamstring Flexibility Using the Modied Sit-and-Reach Test

be scarce except for those reported in studies

from Canada17 and the United States of America.8 Normative data on low back and hamstring
exibility are used by physiotherapists and
physical educators in the assessment of physical
tness and back function impairment and as a
reference tool in rehabilitation.18,20,21 Good exibility is generally assumed to be associated with
improvements in body alignment and position,
performance in sports and other activities and
also lowers the risk of development of musculoskeletal injuries and functional disability.8,12
However, there is a caution that ones placement
in the normative ranking does not necessarily
relate directly to disease risk or health status but
knowledge of ones position relative to the population distribution may be useful for motivating
behavioral change or evaluating individual improvement relative to that of the population.
The results of this study indicated that Nigerian females had signicantly higher lower back
and hamstring exibility than their male counterparts. This nding is in agreement with previous reports that females had higher lower back
and hamstring exibility than their male counterparts.17,26 The study of Beighton et al.7 on an
African population indicated that females between 0 and 80 years of age were more exible
than their male counterparts while Youdas et al.30
also reported that hamstring muscles of females
were signicantly more exible than those of
their male counterparts. Similarly, Corkery et al.13
reported signicant differences between the
exibility of the hamstring muscles of male and
female Americans. In contrast, Van Herp et al.29
reported consistently greater exibility in male
than female in age 2060 years. Reese and
Bandy23 opined that range of motion equality
between sexes ended between ages 18 and 35 and
thereafter, males developed more lumbar extension and females more lateral exion. Anthropometric and morphological differences that exist

between male and female may account for signicant differences in health related physical
performance tests results. Some investigators
opined that differences in anatomical body type
may inuence physical performance.14,15 Mens
pelvic bones are generally heavier and rougher;
the brim is not as rounded; the cavity is less
spacious; the sacrosciatic notch, pubic arch, and
sacrum are narrower; and the acetabula are closer
together than womens while generally, most
women have broader and shallower hips than
men and therefore a greater range of motion in
the pelvic region.25 These anatomical gender
differences, between the pelvic regions of men
and women allow the female human body a
greater range of exibility. This difference has
been attributed by Allender et al.4 to the more
strenuous works and recurring trauma experienced by males, which limit the extensibility of
the soft tissues that traverse the joints.24
From the results of this study, percentile
ranking showed that lower back and hamstrings
exibility increased with age up to 40 years, but
declined thereafter. The trend observed in this
study, agreed with previous studies.5,17 Balogun
and Songonuga5 in a study among Nigerians
found that spinal exibility increased with age up
to 40 years after which it declined. This is probably due to the progressively greater difference in
relation to the regular physical activity pattern of
individuals when they reach adulthood and
subsequent years. Akinpelu et al.3 suggested that
the progressive decline in exibility with age can
be attributed to changes in muscular elasticity and
decreased level of physical activity that comes
with advancing age. The 95th percentile lower
back and hamstrings exibility of male participants across all ages in this study is lower than the
one reported by Hoeger and Hoeger17 among
Americans. However, female participants in the
study by Hoeger and Hoeger17 exhibited progressively higher scores than female Nigerians in

1250015-7

B. O. A. Adegoke, G. A. Akpan & C. E. Mbada

this study up to age 3039 years, while female

participants older than age 40 years in this study,
exhibited higher exibility scores than female
participants in the study by Hoeger and Hoeger.17
Furthermore, the 95th percentile lower back and
hamstring exibility scores of both male and female participants progressively increased across
all age groups. Racial differences could account for
the variation in exibility test results across various populations.24,28
In conclusion, this study established population-specic normative data according to age and
gender for lower back and hamstring exibility
using the modied sit-and-reach test for healthy
Nigerians. In general, females had higher lower
back and hamstring exibility than males.

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