Effect of exercise using Elastic band, Manual therapy technique and Stretching in hamstring muscle flexibility in Low back pain

Not yet recruiting

• Conditions: Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder,

• Registration Number: CTRI/2023/01/049276
• Lead Sponsor: Mohammed Aejaz Siddiqui

Brief Summary

**EFFECT OF ECCENTRIC TRAINING USING THERA-BAND,MUSCLE ENERGY TECHNIQUE AND STATIC STRETCHING IN HAMSTRING MUSCLE FLEXIBILITYOF PATIENTS WITH MECHANICAL LOW BACK PAIN**

  Submitted by

Dr.M.Aejaz M Siddiqui

Parul institute of physiotherapy

 Year of Enrolment 2019-20

Registration no

190720301005

Research guide

Dr.Amalkumar Bhattacharya

MBBS, M.D (MEDICINE)

Faculty of Medicine

PARUL UNIVERSITY, LIMDA, WAGHODIA

VADODARA-391760, GUJARAT-INDIA

  Signature of the PHD Scholar                                                            Research Guide

 Forwarded by,

Head of Department (H.O.D)                                                   Dean (D.S & R)

TABLE OF CONTENTS

1.    Introduction

2.    Review ofliterature

3.    Scope andstatement of the problem

4.    Objectives ofthe studies

5. Hypothesis

6.  Methodology tools and technique

Inclusionand exclusion criteria

Sample

Design

Instrumentation

Procedure

7. Schedule of theproposed research work/Protocol

8. REFERENCES/Bibliography

APPENDICES

Appendix: A Consent Form

Appendix:B Data collection form

    **INTRODUCTION**

Stretching is used as part of physical fitness and rehabilitationprogramme because it is thought to positively influence performance and injuryprevention. Numerous studies1,3,5 have been conducted to investigatethe effectiveness of stretching. Shortness and contracture of hamstring musclemay cause limitation in range of motion(ROM), that restrict the normal range ofmuscle. This potentially harmful condition may be managed with a stretchingprogramme, which may be positively influence an individual’s functionalcapacity of daily living and decrease of injuries. Knee extension range ofmotion from tight hamstring muscle have been linked to injuries such ashamstring tendonitis and hamstring strains. These patient often receivespecific hamstring-stretching exercises as part of an overall rehabilitationprogramme. Several studies have reported an immediate increase in kneeextension ROM following the application of hamstring stretching exercises.2,4,5

Flexibility has been defined as the ability of a muscle to lengthen andallow one joint(or more than one joint in a series.) to move through a range ofmotion2. Increased flexibility is one of the basic concerns   addressed in the day to day practice ofphysical therapy. It is a goal for any patient recovery from a period ofimmobilization or injury involving the connective tissue. Optimal flexibilityis also desirable for participants in most athletic activity and normal day today function. A shortened muscle may create imbalance at joints and faultypostural alignment that may lead to injury and joint dysfunction.

Extensibility is defined as the ability tostretch a muscle   tendon unit to itsfullest length1. Muscle contracture result in decreasedextensibility joint motion. physical therapist have used many different methodto maintain and increased joint motion and   prevent deformity and dysfunction resultingfrom the muscle contracture .Research with clinical trials has long advocatedthe use of thermotherapy to increase flexibility in conjunction with astretching program design to lengthen tissue. Lengthening the musculotendinousunit and supporting connective tissue increase the range of motion(ROM) throughwhich a joint can move as well a the muscle ability to respond to stress placedupon it .

Twoterms critical to the physical properties of hamstring muscle requiredefinition. Elasticity is defined as the tendency of a tissue to return to itsresting length after passive stretch, somewhat like a rubber band. Plasticityis defined as the tendency of a tissue to assume a new and greater length afterpassive stretch, somewhat like stretching of chewing gum. Plasticity is thecritical property that enables a tissue to lengthen permanently.

Increased hamstring stiffness couldbe a possible contributing factor to low back injuries. Clinical observationshave suggested that hamstring tightness influences lumbar pelvic rhythm.Movement restrictions or postural asymmetry likely lead to compensatorymovement patterns of the lumbar spine, and subsequently to increased stress onthe spinal soft tissues and an increased risk of low back pain (LBP).

 **REVIEWOF LITERATURE**

Three types of stretching have been traditionally defined inliterature in an effort to increased flexibility: balastic stretching,proprioceptive neuromuscular facilitation and static stretching. Ballasticstretching is a technique involving a rhythmic bouncing position to lengthenthe muscle. Proprioceptive neuromuscular facilitation involves the use of briefisometric contractions of the muscle to be stretched before staticallystretching the muscle. Static stretching, considered  the “gold standard“ for measuringflexibility, is elongating the muscle to tolerance and sustaining the positionfor length of time.2,15

Throughstatic stretching stimulation of golgi tendon organs located in the myotendiousjunction is achieved resulting decreased muscle tone, additionally a slowlyapplied stretch helps reduce muscle tone by reducing the degree of myotaticreflex contraction, both neurophysiologic responses participate in theeffectiveness of the technique to elongate the muscle  through both elastic and plastic deformationof its non contractile component.

David et al8 state that acombination of static stretch and short wave diathermy treatment increased theextensibility of hamstring muscle more than static stretch treatment.

Knight et al4 evaluatedthe effect of superficial heat, deep heat and active exercises warm up prior tostretching compared with stretching alone on the extensibility   of calf muscle, They concluded that use ofultra sound for 7 minute prior to stretching might  be the most effective for increases ankledorsiflexion.

Theliterature reflects some interesting differences of opinion commonly heldbeliefs regarding flexibility training and consideration of static stretchingas the gold standard. Some author have questioned the importance of usingstatic stretching to help reduce injuries and improve performance.

Murphymade a compelling argument against the use of static stretching. Althoughstatic stretching is often used as part of pre-activity preparation, Murphyargued that the nature of static stretching is passive and does nothing towarm  muscle. Murphy suggested a betteropinion for maintaining or increasing flexibility of a muscle is through activecontraction using dynamic range of motion, there by adding fourth type ofstretching.

Dynamicrange of motion is technique that allows the muscle to elongate naturally andin it relaxed state. This elongation is achieved by having the subjectsconcentrically contract the antagonist muscle to move the joint through thefull available range in a slow controlled manner to stretch agonist musclegroup. Murphy theorized that range of motion is performed, metabolic processesincrease, These increase cause an increase in temperature that lead to allowfor smoother contraction. This wormed muscle is more pliable and moreaccommodating to the forces placed on muscle, leading to increase flexibilitygains.

AlthoughMurphy arguments were interesting, Bandy et al found that, when comparingdynamic range of motion with static stretching, the flexibility gains achievedwith static stretching programme were greater than those achieved in a dynamic range of motion. Therefore goldstandard for increasing flexibility is still considered static stretching.

Previousauthor1 suggested that most of injuries occurs in the eccentricphase of activity.   Although   early groups have examined dynamic range ofmotion, none have investigated the use of an eccentric agonist contraction toimprove flexibility, eccentric training a muscle through a full range of motiontheoretically could reduce injury rates and improve the performance of subjectand flexibility.

Russelet al2 proved that in males ages 15-17 years old, hip flexion rangeof motion gains with eccentrically training were equal to those made by staticstretching of hamstring muscle.

Muscle energy technique (MET) is amanual technique developed by osteopaths that is now used in many differentmanual therapy professions. It is claimed to be effective for a variety ofpurposes, including lengthening a shortened or contractured muscle, strengtheningmuscles, as a lymphatic or venous pump to aid the drainage of fluid or blood,and increasing the range of motion (ROM) of a restricted joint.1While muscle energy techniques are widely used by osteopaths and other manualtherapists, there is limited research supporting and validating its use, aswell as limited evidence to substantiate the theories used to explain theeffects of MET. Several researchers have examined the effect of contract-relaxtechniques (similar to MET) on hamstring flexibility, and found that thesetechniques produced increased muscle flexibility.10,11

Felipe Jose Jandre Reis et al,evaluated Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk Range ofMotion in Low Back Pain, and they found that : Participants with LBP showedrestriction in the pelvis and TF(trunk flexion) range of motion, but had highera mplitudes in the lumbar spine during forward bending.

Ju-hyun lee andcollegues check the effect ofhamstring stretching and nerve mobilization for patients with radicular lowerback pain and they found that Hamstring stretching and nerve mobilization canbe usefully applied for the therapy of patients with radicular lower back pain.18

Sousan Nikzad and collegues check the RelationshipBetween Hamstring Flexibility and Extensor Muscle Activity During a TrunkFlexion Task, and found that hamstring flexibility plays an important role inthe patterns of trunk and lower limb muscle activity onset, offset, andrecruitment.19

Yasuaki Mizoguchi and colleagues examine Physicalfunction characteristics in Japanese high school volleyball players with lowback pain and suggested that hamstring flexibility must be checked and improvefor these groups of athlete to increase their lumbar flexibility.2

 Many researchershave investigated various methods and techniques to determine the most effectiveway to increase joint ROM and muscle extensibility. Despite the numerous studiesconducted, controversy still remains within clinical practice and the literatureregarding the best methods and techniques for stretching.

Also we can find that will increase inhamstring flexibility will reflect the mechanical low back pain.

 **SCOPE AND STATEMENT OF THE PROBLEM**

·      A shortened muscle may create imbalance at joints and faultypostural alignment that may lead to injury and joint dysfunction, thereforestretching is important to prevent such injuries.

 Â·      MET (5sec) when compared to long duration static stretching takesless time and therefore can be incorporated quick stretching of muscle.

·      MET (5sec) is a simple technique than apparatus equipped longduration stretching technique.

 Â·       Instatic stretching chance of injury is also high. Thus a new term dynamicstretch comes, but again injury occurs in eccentric phase of activity.

 Â·       Eccentricstretching comes into play. Because theoretically and practically could reducethe rate of injury and improve performance.

 Â·Many stretching techniques areemployed by athletes and patients in clinical and sporting settings, toincrease flexibility.

    STATEMENTOF PROBLEM

Whether any of these two intervention eccentric training withthera-band, and Muscle Energy Technique(MET) will be more effective than thestatic stretching in improving hamstring muscle flexibility in patient withmechanical low back pain?

Whether changes in hamstring flexibilitywill effect mechanical low back pain?

**OBJECTIVEOF THE STUDY**

The purpose of study is to determine the effect of eccentrictraining, MET and static stretching on hamstring flexibility in increasing kneeextension ROM in patients with mechanical low back pain.

Also improvement in mechanical low backpain after that.

                                                 Hypothesis

Experimental hypothesis:

Eccentric training with thera band or MET improves hamstring muscle flexibility more than staticstretching.

Null hypothesis:

There is no difference between the effect of eccentric training, MET and static stretching to improveflexibility of hamstring muscle.

Operationaldefinitions:

Static stretching: it is defined as elongating the muscle totolerance and sustaining the position for a length of time.3

Eccentric training: Is defined as, to lengthen the muscle byeccentric agonist contraction to improve flexibility.2

Flexibility: It is has been defined as the ability of muscle tolengthen and allow one joint (or more than one joint in a series) to movethrough a range of motion.2

Tight hamstring: It will be determine by the 90-90 test.

Muscle energy technique (MET): Itis a manual medicine procedure that has been described as a gentle form ofmanipulative therapy effective for treating movement restriction of both thespine and extremities.

  **METHODOLOGYTOOLS AND TECHNIQUES**

Samples: a total sample of 90 subjects having mechanical low backpain with hamstring tightness with age group of 20-60 years.

Source of subjects: All the subjects will be recruited fromphysiotherapy Clinics and health Centres.

 Inclusioncriteria:

·       Agegroup 20-30 years.

·       Subjectswith tight hamstring muscle.

(Inability to achieve 20 degree of active knee extension.)90-90test.

·       Patientswith mechanical back pain.

 Exclusioncriteria:

·      Hyper mobility of knee joint.

·      Subjects under medication(muscle relaxants, corticosteroid).

·      Skin disease like skin ulcers and warts.

·      Open wounds and ulcers.

·      Neurological problems

·      Circulatory problems like arterial and venous disease.

·      Metal implants in the legs

   Method ofselection and assigning:

Method will be the random sampling. On the basis of inclusion andexclusion criteria all the subject will be informed the purpose of the study,and an informed consent will be taken from them prior to participation.  The subjects will be then randomly assignedto Group-A, Group-B & Group-C. Each group consist of 30 subjects.

 Design of the study:

It will be a comparative study. The study has pre-test, post-testexperimental design. Measurement was taken prior to and at the end of 3rd,6th and 8th week post treatment session. It will be adouble blinded study, the subjects being unaware of the groups they belong to.

Variables:

Dependantvariables:

·      Active knee extension range of motion by 90-90 test

·      Hamstring flexibility.

·      Intensity of pain

Independentvariables

- Static stretching.

- Eccentric training.

- MET

Equipment/Instrumentation/Tools:

1. A black coloured thera band will be used.

2. A standard transparent full circle goniometer will be used, the transparency of the goniometer is helpful in noting the marks (lines and dotes) drawn over the skin.

3. A standard stop watch will be used to note duration of static stretching.

 Procedure/Technique:

The informedconsent will be obtained from all the subjects, after the study procedureexplained. Subjects will be randomly assigning in to Group-A, Group-B andGroup-C

Group –A**:** eccentric training with thera band.

The eccentric group (n =30) willperform range-of-motion eccentric training for the hamstring muscles. Thesubject lay supine with the left leg fully extended. A 3-ft (0.91-m) piece ofblack theraband will be wrapped around the heel and the subject held the endsof the theraband in each hand. The subject will be instructed to keep the rightknee locked in full extension and the hip in neutral internal and externalrotation throughout the entire activity. The subject will then instruct tobring the right hip into full hip flexion by pulling on the theraband attachedto the foot with both arms, making sure the knee remained locked in fullextension at all times. Full hip flexion defined as the position of hip flexionat which a gentle stretch was felt by the subject. As the subject pulls the hipinto full flexion with the arms, he will instruct to simultaneously resist thehip flexion by eccentrically contracting the hamstring muscles during theentire range of hip flexion. The subject will instruct to provide sufficientresistance with the arms to overcome the eccentric activity of the hamstringmuscles, so that the entire range of hip flexion took approximately 5 secondsto complete.

Onceachieved, this flexed hip position held for 5 seconds, and then the extremityis gently lowered to the ground (hip extension) by the subject’s arms. Thisprocedure will be repeated 6 times, with no rest between repetitions, therebyproviding

a total of 30seconds of stretching at the end range2.

Group—B:  static stretching technique.

The staticgroup (n =30) will statically stretch for 30 seconds 3 days per week for 6weeks using methods described by Bandy et al3 and Russel et al2 Subjects will perform the hamstring stretch by standing erect with theleft foot planted on the floor and the toes pointing forward. The heel of thefoot to be stretched placed on a plinth/chair with the toes directed toward theceiling. The subject then flexed forward at the hip, maintaining the spine in aneutral position while reaching the arms forward. The knee remained fullyextended. The subject continued to flex at the hip until a gentle stretch wasfelt in the posterior thigh. Once this position was achieved, the subjectmaintained this position for 30 seconds.

 Group—C: MET

This group willreceive MET, here PIR technique of MET will be used, which will be repeated 4times (5 second contraction, 3second relaxation) in each session for a periodof 3 days a week for 6 weeks.

Apart from thispatient will also receive conventional treatment for the low back pain in theform hot pack and isometric abdominal and pelvic bridging exercises for thegiven period of time.

Methods of measurement

Terminalextension is determined as the point at which the researcher felt a firmresistance to the movement. Once terminal extension reached, the researcherholding the goniometer ensure proper alignment and the blinded goniometer isrevealed to the assisting examiner for the measurement to be read and recorded.Zero degrees of knee extension was considered full hamstring muscleflexibility. No warm-up was allowed before data collection.

                                      Protocol/Schedule:

Assessment: pre-test measurement of hamstring flexibility will beperformed with 90-90 test. Subjects, who will be found suitable for the study,will be requested to sign consent forms. A detailed subjective examination willbe done.

We include subjects with mechanical low back pain having hamstringtightness. And we will also take oswestry disability scale and NPRS to evaluatethe pain and disability in such patients.

Subject allotted in different groups will be given treatment forthe 3 days a week for 6 weeks. Measurement will be taken prior and after theend of 3rd and 6th week. Last measurement is taken afterthe 2 week of rest period.2

Total duration of the study will be for 6 weeks and there will berest period of 2 weeks after the last treatment session to check for theeffectiveness of each intervention. So total protocol for the study will be of 8weeks.

Total duration for the study will be of 1 year.

**DATA COLLECTION**

All the required data will becollected by me. Consent form will be given to the subjects in vernacularlanguage also.

**DATA ANALYSIS**

Data will be collected from controland experimental group; will be analysed with suitable statistical testprobably one way ANOVA test will be used for post-test analysis.

            **REFERENCES/BIBILOGRAPHY:**

1.    Kenneth C. Wessling, Dawn A Devane: Effect of static stretching vs.SS and US combined on hamstring muscle extensibility in healthy woman. Physicaltherapy, May 1987;67(5);674-69.

2.    Russel T. Nelson; William D. Bandyt: Eccentric training and staticstretching improves hamstring flexibility of high school males. Journal ofathletic training,2004 :39(3):254-258

3.    Bandy WD, Irion JM, Brigller M,: The effect of static and dynamicrange of motion training on the flexibility of hamstring muscle. -JOSPT1998:27(4)295-300.

4.    Clauda A Knight, Carrie R Rutledge Susan J Hall. Effect ofsuperficial heat, deep heat and active exercises warm up on the extensibilityof hamstring. Physical Therapy 2001;81;(6)1206-1214.

5.    James W. Youndas, David A. Krause. The effect of static stretchingof the hamstring muscle-tendon unit on active knee extension range of motion,JOSPT july 2003,33(7).

 6.    Rather Aijaz Y, puja Chaudhary, Nishat Quddus, Ultra sound and prolonged long duration stretchingincrease hamstring muscle extensibility more than identical stretching alone.indian Journal of  O.T &P.T.vol.1,no.3(2007-2009).

 7.    Ian W. muir et al, Effect of hamstring stretching exercises on theresistive torque during passive knee extension in healthy subjects.

 8.    David O.Draper et al, shortwave diathermy and prolonged stretchingincrease hamstring flexibility more than prolonged stretching alone .JOSPTvol.34, no.1, jan2004.

 9.    Cynthia C.norkin, Measurement of joint motion, a guide ofgoniometry.

 10.   Kris Jensen, Richard P Di Fabilo, Evaluationof eccentric exercises in treatment of patellar tendonitis. physical therapyvol.69, no.3, march1989

 11.  BallentyneF, Fryer G, Mc Laughlin et al. The effect of muscle energy technique onhamstring extensibility : The mechanism of altered flexibility.*Journal of osteopathic medicine.2003;6(2):59-63.*

 12.  MagnussonSP, Simonsen EB, Aagaard P, Dyhre-Poulsen P, McHugh M, Djaer M. Mechanical andPhysiological Responses to Stretching With and Without Pre-isometricContractionin Human Skeletal Muscle. *Archives of Physical Medicine and Rehabilitation*.1996; April 77: 373-8

 13.  Dong HoKwak, PT1, 2), Young Uk Ryu, PT, PhD2)\*

Applyingproprioceptive neuromuscular facilitation stretching: optimal contraction    intensity to attain the maximum increase inrange of motion in young males

(J. Phys. Ther.Sci.,27: 2129–2132, 2015)

 14.  LandonLempke, Rebecca Wilkinson, Caitlin Murray, and Justin Stanek The Effectivenessof PNF Versus Static Stretching on Increasing Hip-Flexion Range

Of motion.(Journal of Sport Rehabilitation, 2018, 27, 289-294).

 15.  PhilPage, PT, PhD, ATC, CSCS, FACSM

Clinicalcommentary.current concepts in muscle stretching for exercise andrehabilitation

TheInternational Journal of Sports Physical Therapy | Volume 7, Number 1 |February 2012 | Page 109.

 16.   Hashim Ahmed, MPT), Amir Iqbal, MPT),Shahnawaz Anwer, MPT, ),Ahmad Alghadir, MS, PhD, PT) Effect of modifiedhold-relax stretching and static  stretching on hamstring muscle flexibility. J.Phys. Ther. Sci. 27: 535–538, 2015.

17.  BuasellRB, Li YF. *Power Analysis for Experimental Research: A Practical Guide ForThe Biological, Medical and Social Sciences. Cambridge,* UK: CambridgeUniversity; 2002.

18.  Felipe Jose JandreReis, Adriana Ribeiro Maced et al,Influence ofHamstring Tightness in Pelvic, Lumbar and Trunk Range of Motion in Low BackPain and Asymptomatic Volunteers during Forward Bending. Asian spine general,2015,9:4

19.  Abdulsattar et al, Effect of Strethching programme of hamstring muscles on low backpain among surgeons. Vol 2,issue 4, 2019.

20.  Ju-hyun Lee, PT, MS1),Tae-ho Kim, PT, PhD1)\*The treatment effect of hamstring stretching and nervemobilization for patients with radicular lower back pain. J. Phys. Ther. Sci.29: 1578–1582, 2017

21.  Erica N. Johnson, DPT,James S. Thomas, PhD, PT. Effect of Hamstring Flexibility on Hip and LumbarSpine Joint Excursions During Forward-Reaching Tasks in Participants With andWithout Low Back Pain. Arch Phys Med Rehabil Vol 91, July 2010.

22. Sousan Nikzad,MSc, Soraya Pirouzi, Shohreh Taghizadeh, PhD, and Ladan Hemmati, PhD.Relationship Between Hamstring Flexibility and Extensor Muscle Activity Duringa Trunk Flexion Task. Journal of Chiropractic Medicine. March 2020.

23. Takaaki Nishimura, RPT, MS1, 2), Ryo Miyachi, RPT,PhD3) Relationship between low back pain and lumbar and hip joint movement indesk workers. J. Phys. Ther. Sci. 32: 680–685, 2020

24. YasuakiMizoguchi, MSa , Kiyokazu Akasaka, PhDb,c,∗ , Takahiro Otsudo, PhDb,c , Toby Hall, PhDd,e Physical functioncharacteristics in Japanese high school volleyball players with low back pain Acase-controlled study. Mizoguchi et al. Medicine (2020) 99:46.

          APPENDIX: A

CONCENT FORM

Title- Effect of eccentric training using thera-band, MET and staticstretching in improving hamstring muscle flexibility of patient with mechanicallow back pain

 You are invited to participate in the study which is beingdone as part of fulfilment of PHD programme .

Introduction – This research is being undertaken to find theeffect of eccentric training using thera-band, MET and  static stretching in improving hamstring  muscle flexibility

About the Procedure- Subjects fitting the inclusion criteriawould undergo an evaluation procedure and treatment.

Benefits of participation­­­­­­­­­­­­—the study benefits youin a way that it will increase your awareness regarding exercise and use offlexibility of muscle.

Risk of participation- there is no any as such risk regardingintervention.

Right to withdrawal— you have the right to withdraw from theresearch at any point of time as desirabable

     Confidentiality

All the information about you would be kept confidential andlimited to me and research guide

Dr. Amalkumar sir and will not be shared any person who isnot a part of this study. We also request you to use the data, and photographfor presentation and publication purpose.

   Declaration

I, ----------------------- voluntarily agree to participatein this study. I have been informed to my satisfaction level about theprocedure, risk, and benefits of the study. I reserve my right to withdraw atany point of time and I understand participation is voluntarily and refused toparticipate will have no penalty or loss of benefits to whichever I amentitled. I understood that no compensation is being offered or is available ormy participation and I have contact address of  Mr. siddiqui M. Aejaz, if I require anyfurther clarification.

\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature

 Contactaddress

Mr.siddiqui m. aejaz

Email:aijaz00786@yahoo.com

Cell:9173006095

              APPENDIX: B

DATA COLLECTION FORM

 Name:                                                                                        Date:

Age:                                                                                             Sex:

Address:

Contact no:

Occupation:

Symptom:

 Test performa:

 

| | | | | | | | | |

| --- | --- | --- | --- | --- | --- | --- | --- | --- |

| Day 1

 Pre-Test

1st week

 Post-Test

2nd week

 Post-Test

3rd week

 Post-Test

4th week

 Post-Test

5th week

 Post-Test

6th week

 Post-Test

After 2 week follow up

|90-90 test

NPRS

        

|Group-A

        

|Group-B

        

|Group-C

Detailed Description

Not available

Study Timeline

• Study Start: 2023-01-02
• Last Update Posted: 2023-01-25

Recruitment & Eligibility

• Status: Not Yet Recruiting
• Sex: All
• Target Recruitment: 90

Inclusion Criteria

• Subjects with mechanical low back pain Tightness in hamstring muscle diagnosed with 90-90 test.
• (Inability to achieve 20 degree of active knee extension in supine position.).

Exclusion Criteria

• Hyper mobility of knee joint.
• Subjects under medication(muscle relaxants, corticosteroids).
• Skin disease like skin ulcers and warts.
• Open wounds and ulcers.
• Neurological problems Circulatory problems like arterial and venous disease.

Study & Design

• Study Type: Interventional
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Hamstring flexibility	on intial assessment (Pre-intervention), after 3 weeks, after 6 weeks, after 8 weeks (follow-up)

Secondary Outcome Measures

Name	Time	Method
Disability	on intial assessment (Pre-intervention), after 3 weeks, after 6 weeks, after 8 weeks (follow-up)
Pain	on intial assessment (Pre-intervention), after 3 weeks, after 6 weeks, after 8 weeks (follow-up)

Trial Locations

Locations (1)

M.S. Physiotherapy and Pain Relief Center; 🇮🇳 Ahmadabad, GUJARAT, India

M.S. Physiotherapy and Pain Relief Center

🇮🇳Ahmadabad, GUJARAT, India

Dr M Aejaz M Siddiqui

Principal investigator

09173006095

dr.aijaz00786@gmail.com