Comparison of Mulligan Bent Leg Raise vs Active Release Technique in Patients With Hamstring Tightness

Riphah International University

Status: Completed

Conditions: Hamstring Injury

Treatments: Other: Active Release Technique; Other: Mulligan Bent Leg Raise

Study type: Interventional

Funder types: Other

Identifiers

NCT05655585

REC -01393 Roheena Mustansar

Details and patient eligibility

About

The sedentary lifestyle of today's world, prolonged time period of sitting during office hours and educational setups do have an effect on the flexibility of bi-articular muscles. Hamstring flexibility is a significant variable as decreased extensibility has been suggested as a prejudicing feature for injuries, poor posture and non-specific low back pain.Active Release Technique (ART) is a soft tissue method that focuses on relieving tissue tension via the removal of fibrosis/adhesions which can develop in tissues as a result of overload due to repetitive use. These disorders may lead to muscular weakness, numbness, aching, tingling and burning sensations. ART has been reported to be both a diagnostic and a treatment technique.Mulligan's bent leg raise (BLR) is a stretching technique which is a modern progression in the treatment of hamstring tightness. It is indicated in hamstring tightness patients with backache having restricted or painful straight leg raise (SLR), leg pain above knee and it is very beneficial in the patients having gross bilateral limitations of straight leg raise. It stretches the lower extremity muscles in combination of hamstring, adductors and rotators

Full description

The hamstring muscle is two joint muscles and is certainly exposed to large length changes. The hamstring constitutes three large muscles that are semi-tendinosis, semi-membranous and biceps femoris. They are positioned in the posterior compartment of the thigh and act on the hip and knee joint as hip extensors and knee flexors. Flexibility dysfunction is a common problem encountered by general as well as athletic population specifically in hamstring.

The tightness of hamstring muscle not only causes decrease range of motion but it can also be a reason for many musculoskeletal dysfunctions. Tightness results in adaptive shortening of the contractile and non-contractile elements of the muscle. The two-joint muscles are more prone to shortening. The tightness of hamstring affects the lumbo-pelvic rhythm. Moreover the tight hamstring restricts the anterior tilting of pelvic in the position of spinal flexion which causes increase tension of muscles and ligaments in the lumbar area resulting in aggravated compressive load on lumbar spine. It also has an indirect effect on sacroiliac joint stability causing Sacro Iliac Joint pain.

The most common method of treatment is to initially feel for areas of soft tissue injury. Then, the tissue is taken from a shortened position to fully lengthened position with a specific hand contact on the soft tissue. This allows the contact to pass longitudinally along the soft tissue fibers and the lesion. The goal is to break up adhesions that may have formed from scarring within the soft tissue. In addition, ART also aims to restore soft tissue structures that feel strained or inflexible to their original healthy condition. The use of ART is becoming a commonality in the restoration of soft tissue injuries, especially in the world of competitive sports.

Active release technique therapy for the hamstrings is intended to relieve pain and lessen tightness and support the hamstring to reappear in its normal condition.

Mulligan's bent leg raise (BLR) is a stretching technique which is a modern progression in the treatment of hamstring tightness. It is indicated in hamstring tightness patients with backache having restricted or painful straight leg raise (SLR), leg pain above knee and it is very beneficial in the patients having gross bilateral limitations of straight leg raise. It stretches the lower extremity muscles in combination of hamstring, adductors and rotators. The BLR technique consists of three repetitions of pain-free isometric contraction of the hamstrings, performed in five progressively greater positions of hip flexion.

Enrollment: 44 patients

Sex: All

Ages: 30 to 50 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients having Low Back Pain due to hamstring tightness.
• Patients having Sacro Iliac Joint pain due to hamstring tightness.
• 20-40-degree active knee extension loss with hip in 90-degree flexion

Exclusion criteria

• Fractures of hip and knee.
• Patients with hamstring injury in past 2 years.
• Hypermobility of lower limb joint.
• Neurological abnormalities.
• Tumors
• Infection
• Medical history of injury to back
• Inflammatory conditions (rheumatoid arthritis, ankylosing spondylitis)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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44 participants in 2 patient groups

Active Release Technique

Experimental group

Description:

Participant will be in prone position on a couch with the therapist standing next to the patient. The patient is asked to flex the knee to 90 degree of the involved side. The therapist then applies gentle tension longitudinally to the hamstring muscle along the entire length while the patient actively moves his knee from flexion to extension

Treatment:

Other: Mulligan Bent Leg Raise

Other: Active Release Technique

Mulligan Bent Leg Raise

Experimental group

Description:

Participant was in supine lying on a high couch with the therapist in standing position lateral to the leg, which is to be stretched. Hip and Knee of the side to be stretched was bent at 90- 90 degree. Investigator places participant's flexed knee over his shoulder such that the popliteal fossa of the knee rest on his shoulder. A distraction (longitudinal traction force along the long axis of femur) was applied at the lower end of femur

Treatment:

Other: Mulligan Bent Leg Raise

Other: Active Release Technique