Determinants of Harmstring Flexibility Among Manual Cigarette Workers

Authors

  • Fikri Ardiansyah Faculty of Public Health, Universitas Muhammadiyah Semarang
  • Ulfa Nurullita Faculty of Public Health, Universitas Muhammadiyah Semarang
  • Muhammad Muhibbi Faculty of Public Health, Universitas Muhammadiyah Semarang
  • Wulandari Meikawati Faculty of Public Health, Universitas Muhammadiyah Semarang

DOI:

https://doi.org/10.60074/visikes.v25i2.18046

Keywords:

Hamstring Flexibility, Cigarette Factory Workers, Exercise Habits, Age, Occupational Health

Abstract

The production of cigarettes involves manual labor, and some workers experience issues such as pain and cramping in the back of the thigh. These are symptoms of hamstring muscle shortening. Shortened hamstring muscles are often considered a primary risk factor for muscle injury, as well as a problem related to muscle health or the musculoskeletal system. The aim of this study is to determine the relationship between work posture, length of service, and individual characteristics and hamstring muscle flexibility. A cross-sectional study was conducted among 55 cigarette factory workers in Kudus, Indonesia, selected by proportional random sampling. Data on age, exercise habits, and years of experience were collected using questionnaires, while work position, BMI, and hamstring flexibility were assessed through observation, anthropometric measurements, and the V-Sit and Reach Test. Bivariate analysis used the Chi-square test at a 5% significance level. The mean age of the respondents was 46.51 years, with an average exercise frequency of 1.31 times per week. A total of 56.4% of respondents fell into the normal category, and 61.8% had a tenure of less than 4 years. Chi-square analysis showed the following results: age (p=0.020), BMI (p=0.205), exercise habits (p=0.000), work posture (p=0.273), and tenure (p=0.386). Conclusion: Age and exercise habits are risk factors associated with hamstring muscle flexibility among cigarette workers in Kota Kudus District, Kudus Regency. Age and exercise habits were significantly associated with hamstring flexibility. Workplace programs should promote regular physical activity, active breaks, mobility exercises, and stretching, particularly for older workers

References

Kellis E, Blazevich AJ. Hamstrings force-length relationships and their implications for angle-specific joint torques: A narrative review. BMC Sports Sci Med Rehabil. 2022;14(1):1–34. doi:10.1186/s13102-022-00555-6.

Liyanage E, Malwanage K, Senarath D, Wijayasinghe H, Liyanage I, Chellapillai D, et al. Effects of different physical therapy interventions in improving flexibility in university students with hamstring tightness-A systematic review and network meta-analysis. Int J Exerc Sci. 2024;17(3):359–81. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11042845/

Cai P, Liu L, Li H. Dynamic and static stretching on hamstring flexibility and stiffness: A systematic review and meta-analysis. Heliyon. 2023;9(8):e18795. doi:10.1016/j.heliyon.2023.e18795.

Afonso J, Rocha-Rodrigues S, Clemente FM, Aquino M, Nikolaidis PT, Sarmento H, et al. The hamstrings: Anatomic and physiologic variations and their potential relationships with injury risk. Front Physiol. 2021;12:1–22. doi:10.3389/fphys.2021.694600.

Akhtar H, Muskan P, Amjad R. Correlation of hamstring tightness with balance and mobility in young adults. Pak J Med Health Sci. 2023;17(3):295–7. Available from: https://www.researchgate.net/publication/370354772

Jenkins S, Tubbs RS. The sciatic nerve. In: Surgical Anatomy of the Sacral Plexus and Its Branches. Elsevier; 2020. p. 53–72. Available from: https://www.sciencedirect.com/science/article/pii/B9780323776028000118

Shamsi MB, Ahmadi A, Mirzaei M, Jaberzadeh S. Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: A randomized clinical trial. J Bodyw Mov Ther. 2022;30:196–202. doi:10.1016/j.jbmt.2022.02.023.

Miçooğulları M, Özgökalp İ, Angın S. Effects of instrument assisted and functional soft tissue mobilization on hamstring flexibility and skinfold thickness in sedentary adults. Sci Rep. 2026;16(1):1–9. doi:10.1038/s41598-026-41571-8.

Guzmán-Muñoz E, Zurita-Leiva C, Gómez-Araya F, Concha-Cisternas Y, Castillo-Paredes A, Montalva-Valenzuela F, et al. Impact of hamstring tightness on muscle activation in healthy young adults. J Funct Morphol Kinesiol. 2025;10(4):1–11. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12551086/

Shamsi MB, Shahsavari S, Safari A. A randomized clinical trial for the effect of static stretching and strengthening exercise on pelvic tilt angle in LBP patients. J Bodyw Mov Ther. 2020;24(3):15–20. doi:10.1016/j.jbmt.2020.01.002.

Sassonker K, Magnezi R, Moran D. Comparing right and left hamstring flexibility and its association to nonspecific lower back pain among women of different age groups. J Bodyw Mov Ther. 2023;36:404–9. doi:10.1016/j.jbmt.2023.07.014.

Allam NM, Ebrahim HA, Ibrahim Ateya M, Elneblawi NH, El-Sherbiny M, Fouda KZ. The association of hamstring tightness with lumbar lordosis and trunk flexibility in healthy individuals: Gender analysis. Front Bioeng Biotechnol. 2023;11:1–8. doi:10.3389/fbioe.2023.1251347.

Liyanage E, Jayasinghe HCB, Samarakoon SMCS. Immediate effects of static stretching and post isometric relaxation on hamstring flexibility among sedentary young adults: A pilot study. Int J Community Med Public Health. 2022;9(7):2854. Available from: https://www.ijcmph.com/index.php/ijcmph/article/view/9895

Danielsson A, Horvath A, Senorski C, Alentorn-Geli E, Garrett WE, Cugat R, et al. The mechanism of hamstring injuries - A systematic review. BMC Musculoskelet Disord. 2020;21(1):1–21. doi:10.1186/s12891-020-03658-8.

Handari HK. Hold relax dan static stretching meningkatkan fleksibilitas hamstring: Studi literatur. Physiother Health Sci. 2023;5(1):8–17. Available from: https://ejournal.umm.ac.id/index.php/physiohs/article/view/26241

De Castro-Maqueda G, Rosety-Rodríguez MÁ, Fernández-Santos JR. Body mass index and sedentary behaviour affect hamstring extensibility in primary education students. Sports. 2025;13(4):109. Available from: https://www.mdpi.com/2075-4663/13/4/109

Abate Daga F, Panzolini M, Allois R, Baseggio L, Agostino S. Age-related differences in hamstring flexibility in prepubertal soccer players: An exploratory cross-sectional study. Front Psychol. 2021;12:1–6. doi:10.3389/fpsyg.2021.758063.

Gite AA, Mukkamala N, Parmar L. Relationship between body mass index and flexibility in young adults. J Pharm Res Int. 2021;33:119–26. Available from: https://journaljpri.com/index.php/JPRI/article/view/2554

Priya S, Babu LG, Davis A. Correlation between BMI, hamstring flexibility and physical activity in desktop workers. Int J Multidiscip Res. 2026;8(4):1–6. Available from: https://www.ijfmr.com/papers/2026/4/83524.pdf

Kwan KYC, Ng KWK, Rao Y, Zhu C, Qi S, Tuan RS, et al. Effect of aging on tendon biology, biomechanics and implications for treatment approaches. Int J Mol Sci. 2023;24(20):15321. doi:10.3390/ijms242015321.

Fede C, Fan C, Pirri C, Petrelli L, Biz C, Porzionato A, et al. The effects of aging on the intramuscular connective tissue. Int J Mol Sci. 2022;23(19):1–16. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9569538/

Colman M. The impact of aging on human musculoskeletal anatomy: A comprehensive review. J Morphol Anat. 2024;8(4). Available from: https://www.hilarispublisher.com/open-access/the-impact-of-aging-on-human-musculoskeletal-anatomy-a-comprehensive-review.pdf

Amir TL, Sari N, Wibowo E. Hubungan indeks masa tubuh dengan tingkat fleksibiltas otot harmstring pada pemain sepak bola. Jurnal Fisioterapi. 2021;18(2). Available from: https://ejurnal.esaunggul.ac.id/index.php/Formil/article/view/4321

Primasoni N. Hubungan antara indeks massa tubuh (IMT) dengan fleksibilitas otot hamstring atlet sepak bola junior Daerah Istimewa Yogyakarta. Jorpres (Jurnal Olahraga Prestasi). 2022;18(2). Available from: https://garuda.kemdiktisaintek.go.id/documents/detail/3348301

Putri M, Dewi AANTN, Sundari WSU. Hubungan antara durasi duduk dan posisi duduk dengan fleksibilitas otot hamstring pada pegawai kantor Instansi Pemerintah Sewaka Dharma Kota Denpasar. Majalah Ilmiah Fisioterapi Indonesia. 2020;8(3). Available from: https://www.researchgate.net/publication/346208930

Shamsi MB, Mirzaei M, Shahsavari S, Safari A, Saeb M. Modeling the effect of static stretching and strengthening exercise in lengthened position on balance in low back pain subject with shortened hamstring: A randomized controlled clinical trial. BMC Musculoskelet Disord. 2020;21(1):1–9. doi:10.1186/s12891-020-03803-3.

Greggi C, Visconti VV, Albanese M, Gasperini B, Chiavoghilefu A, Prezioso C, et al. Work-related musculoskeletal disorders: A systematic review and meta-analysis. J Clin Med. 2024;13(13):3899. doi:10.3390/jcm13133899.

Iqbal MA, Azeem A, Jaffar N, Arooj M, Iqbal MS, Nasir A, et al. Association of hamstrings tightness with prolonged sitting in young adults. Healer J Physiother Rehabil Sci. 2026;6(3):30–7. Available from: https://thehealerjournal.com/index.php/templates/article/view/669

Zhang X, Ren W, Duan Y, Yao J, Pu F. The biomechanics effect of hamstring flexibility on the risk of Osgood-Schlatter disease. J Healthc Eng. 2022;2022:3733218. doi:10.1155/2022/3733218.

Lee I, Sim S, Jin S. Hamstring stretching significantly changes the sitting biomechanics. Int J Ind Ergon. 2021;84:103163. doi:10.1016/j.ergon.2021.103163.

Lestari HD, Sahri M. Studi keluhan Musculoskeletal Disorder (MSDs) di UD. Berkah Alam Tahun 2021. VISIKES Jurnal Kesehatan Masyarakat. 2021;20(2). Available from: http://publikasi.dinus.ac.id/index.php/visikes/article/view/4927

Granic A, Suetterlin K, Shavlakadze T, Grounds MD, Sayer AA. Hallmarks of ageing in human skeletal muscle and implications for understanding the pathophysiology of sarcopenia in women and men. Clin Sci. 2023;137(22):1721–51. doi:10.1042/CS20230232.

Araújo LP, Figueiredo Godoy AC, Fortes Frota F, Barbalho Lamas C, Quesada K, Rucco Penteado Detregiachi C, et al. Sarcopenia in the aging process: Pathophysiological mechanisms, clinical implications, and emerging therapeutic approaches. Int J Mol Sci. 2025;26(24):1–31. doi:10.3390/ijms26241234.

Niazi S, Gandomi F, Soufivand P, Ghazaleh L. The effect of tissue stretching and release strategies on neck muscles fatigue and pain intensity in office workers affected by chronic neck pain: A rater-blind, semi-experimental study. Health Sci Rep. 2025;8(4):e2541. doi:10.1002/hsr2.2541.

Gustafsson T, Ulfhake B. Aging skeletal muscles: What are the mechanisms of age-related loss of strength and muscle mass, and can we impede its development and progression? Int J Mol Sci. 2024;25(20):11210. doi:10.3390/ijms252011210.

Silva JMN, Teixeira RS, Bispo LGM, Rodeghiero Neto I, Lisboa AHS, Martins VWB. Occupational risks, musculoskeletal disorders, and quality of work life: An age-based analysis. Musculoskelet Sci Pract. 2026;82:103513. doi:10.1016/j.msksp.2026.103513.

Kurniawan B, Rahfiludin MZ, Setyaningsih Y, Nurjazuli N, Lestantyo D, Widjasena B, et al. Effects of stretching exercises on muscle tension, fatigue, strength, and lactic acid accumulation: A pre-experimental study among fish transport workers. Narra J. 2024;4(1):5–12. doi:10.52225/narra.v4i1.350.

Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, et al. Effects of different long-term exercise modalities on tissue stiffness. Sports Med Open. 2022;8(1):112. doi:10.1186/s40798-022-00462-7.

Warneke K, Thomas E, Blazevich AJ, Afonso J, Behm DG, Marchetti PH, et al. Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts. J Sport Health Sci. 2025;14:100985. doi:10.1016/j.jshs.2025.100985.

Wiguna NIAP, Karsi D. Hubungan antara indeks masa tubuh dan tingkat aktivitas fisik terhadap fleksibilitas otot punggung bawah dan hamstring pada siswa SMK Kesehatan Bali Kresna. Jurnal Yoga dan Kesehatan. 2023;6(2):189–200. Available from: https://www.researchgate.net/publication/375528266

Bittencourt AS, Silva Vieira PA, Catarino Ferreira MC, Primo LL, Nara Deiro T, Roberto Avelino P, et al. The impact of overweight on flexibility and functional capacity. J Nov Physiother. 2017;07(06):371. Available from: https://www.researchgate.net/publication/322596671

Živoder I, Hodić V, Zaplatić Degač N, Potočnjak J, Arapović M, Kuzmić A, et al. Motor capabilities and body composition in health vs. non-health university students: A pilot study. Life. 2025;15(10):1504. doi:10.3390/life15101504.

Dong Y, Jiang P, Jin X, Jiang N, Huang W, Peng Y, et al. Association between long-term static postures exposure and musculoskeletal disorders among university employees: A viewpoint of inflammatory pathways. Front Public Health. 2022;10:1021430. doi:10.3389/fpubh.2022.1021430.

Teixeira D, Cervaens M. Work-related postural risk and musculoskeletal symptoms in seamstresses: Implications for ergonomic and movement-based interventions. J Bodyw Mov Ther. 2026;48:554–61. doi:10.1016/j.jbmt.2026.03.015.

Salma HNN. Analysis of work posture on Musculoskeletal Disorders (MSDs): Literature review. Int J Health Eng Technol. 2026;4(6):2249–53. Available from: https://afdifaljournal.com/journal/index.php/ijhet/article/view/642

Henriques JIR, Nugraha MHBS, Adiputra LMISHA. Hubungan fleksibilitas otot hamstring dengan kecepatan berjalan lanjut usia di Denpasar. Majalah Ilmiah Fisioterapi Indonesia. 2021;9(1). Available from: https://garuda.kemdiktisaintek.go.id/documents/detail/1997634

Yudhaningrum HR, Pradita A, Endaryanto AH, Hargiani FX. Hubungan fleksibilitas otot hamstring dengan nyeri punggung bawah pada pasien poli fisioterapi di Rumah Sakit Petrokimia Gresik. Jurnal Keperawatan Muhammadiyah. 2023;8(1). Available from: https://journal.um-surabaya.ac.id/JKM/article/view/16116

Downloads

Published

2026-09-30

Issue

Section

Articles