Instrument-Assisted Soft Tissue Mobilization Versus Vibration Massage On Hamstring Flexibility And Strength, Knee Proprioception And Agility In Healthy Male Football Players: A Randomized Controlled Trial.

In football, muscle strain injuries are a cause of considerable disability among which hamstring injuries are amongst the most common sports injuries, accounting for 12-16% of all athletic injuries in football, especially when acceleration is required. 2 In high school football, muscle strains have been reported to comprise between 12% and 24% of all injuries. 3 They can be challenging to manage and usually have a high recurrence rate, of about one third within the first two weeks. Many risk factors leading to hamstring strains have been proposed, such as decreased flexibility, eccentric hamstring strength deficits or eccentric hamstring strength asymmetries, poor core stability involving the gluteal and trunk muscles and previous hamstring injury. 4 During strenuous activities like sprinting, study participants with less flexible hamstring tend to present with more relative elongation in all 3-hamstring muscle, translating to higher internal forces development.5 Physiotherapy interventions targeting flexibility may be important in controlling the amount of peak elongation reached during participation in high-intensity sports activities and normalization of hamstring eccentric strength deficits at hamstring lengthened states either due to the changes in eccentric strength in isolation or in conjunction with associated changes in fascicle length of the hamstring.

Hamstring flexibility and neuromuscular activation patterns may be important predictors not only for hamstring muscle strains but also for knee joint injury. Hamstring lack of flexibility is typically managed using static and dynamic stretching and also using Instrument-Assisted Soft Tissue Mobilization (IASTM) or therapeutic hand or Vibration Massage.6 Instrument-Assisted Soft TissueMobilization is intended to promote connective tissue remodeling by releasing adhesions using stainless steel tools and eliciting a local inflammatory response. Several case studies have been published documenting successful improvement in range of motion following Instrument Assisted Soft Tissue Mobilization. However, this intervention is under research and the evidence is inconclusive, largely due to variations in technique, tools, and duration of application. 7 Whereas, Massage is a physical therapy intervention with purported biomechanical (flexibility increase, tissue adhesion prevention), physiological (increased skin and muscle temperature, increased blood flow and parasympathetic activity), neurological (decrease muscle tension and pain perception) and psychological advantages. 8 Vibration massage, on the other hand, consists of vibration massage input to muscles, utilized to promote relaxation and flexibility gains, usually with the aid of an electromechanical device. 9 With Vibration Massage, Massage parameters such as the Vibration Massage frequency, duration, and amplitude can be better controlled in relation to difficulties in applying constant pressure, technique and duration with manual massage.

Currently, no consensus exists as the most appropriate Physiotherapy protocol for hamstring strength in football players. A wide array of Physiotherapy protocol has been recommended for increasing the hamstring strength in football players. These Physiotherapy protocols have different theoretical mechanisms of action, but all have the same aim, to improve flexibility, strength and function. There are various literature supporting Conventional Physiotherapy, Instrument-Assisted Soft Tissue Mobilization and Vibration Massage effects on hamstring flexibility and strength, knee proprioception and agility but there is no available evidence of comparing the effects of Conventional Physiotherapy, Instrument Assisted Soft Tissue Mobilization and Vibration Massage effects on hamstring flexibility and strength, knee proprioception and agility in Healthy Male Football Players. Thus, the need for the study is to compare the effects of Conventional Physiotherapy, Instrument Assisted Soft Tissue Mobilization and Vibration Massage effects on hamstring flexibility and strength, knee proprioception and agility in Healthy Male Football Players.