Mulligan Traction Straight Leg Raise Versus Post Isometric Relaxation on Hamstring Tightness in Asymptomatic Patients
Condition: Hamstring Tightness
Study type: Interventional

Summary: 
      1. Comparison between Mulligan traction straight leg raise (TSLR) and Post Isometric
           Relaxation (PIR) on hamstring, on range of motion (ROM) of knee extension and
           flexibility of hamstring muscle.

        2. Secondary objective of the study is to compare the effectiveness of Mulligan Traction
           Straight Leg Raise (TSLR) and Post Isometric Relaxation (PIR) in lumber spine mobility
           in healthy individuals.

        3. This study will also help to reduce the financial burden of society by identifying the
           commonly neglected hamstring tightness as one of the causes of developing low back pain
           and eventually affecting their health.

        4. This study will provide evidence regarding prevention of low back pain as hamstring
           tightness is one of the risk factor for developing low back pain.
    

Detailed description: 
      Hamstring is the common muscle which undergoes adaptive shortening when compared with other
      group of muscles. Hamstrings refer to the three posterior thigh muscles and its action
      includes hip extension and knee flexion. Limited muscle extensibility is a common problem
      that affects various patient populations as well as healthy individuals. The ability of an
      individual to move smoothly depends on his flexibility, an attribute that enhances both
      safety and optimal physical activities. Flexibility is an important physiological component
      of physical fitness, and reduced flexibility can cause inefficiency in the workplace and is
      also a risk factor for low back pain. Muscle extensibility is an essential element of
      biomechanical function. Flexibility has been defined as the ability of a muscle to lengthen
      and allows one joint (or more than one joint in a series) to move through a range of motion
      and is an essential component of normal biomechanical functioning.

      The flexibility of hamstring muscle is important for general and athletic population and of
      almost importance for health care professionals, to achieve this goal one needs to know the
      most effective and efficient technique to gain hamstring flexibility. Lack of hamstring
      muscles extensibility conditions decrease the pelvic mobility. This invariably leads to
      biomechanical changes in the pressure distribution of the spine and consequent spinal
      disorders. Therefore, poor hamstring extensibility has been associated with thoracic hyper
      kyphosis , spondylolysis , disc herniation changes in lumbopelvic rhythm and low back pain.
      Hamstring tightness is also associated with low back and lower extremity musculoskeletal
      disorders leading to biomechanical changes of the pelvis and low back. The literature reports
      a number of associated benefits of flexibility including improved athletic performance,
      reduced injury risk, prevention or reduction of post-exercise soreness, and improved
      coordination.

      Stretching techniques are the treatments used to improve muscular extensibility to improve
      range of motion (ROM), and can help prevent damage in daily life or sports, reduce muscle
      pain, and improve muscle capability. There are various treatment for the hamstring stretching
      like active release technique, passive stretching, static stretching, Proprioceptive
      neuromuscular facilitation Stretching Techniques, eccentric stretching exercises for
      improving hamstring flexibility.

      Mulligan performs mobilization procedures while patients were moving, either actively or
      passively, or while they were performing a resisted muscle contraction .Indications for use
      of Mulligan's Traction Straight Leg Raise (TSLR) technique are limited range of motion of hip
      flexion together with low back pain with or without referred leg pain. The intention of this
      technique is to restore normal mobility. It stretches the lower extremity muscles in
      combination of hamstring, adductors and rotators. The Traction Straight Leg Raise technique
      is painless intervention that is said to have immediate benefits.

      Muscle energy technique (MET) is a procedure that involves voluntary contraction of a
      patient's muscle in a precisely controlled direction, at varying levels of intensity. It is
      unique in its application as the patient provides the initial effort while the practitioner
      facilitates the process. The benefits of muscle energy techniques (MET) include: Restoring
      normal tone in hypertonic muscles, strengthening weak muscles, preparing the muscle for
      subsequent stretching, improved joint mobility. It includes two techniques post isometric
      relaxation technique and reciprocal inhibition.

      According to a study muscle energy technique (post isometric relaxation technique - PIR) is
      more effective than ultrasound therapy with active static stretching and passive static
      stretching in improving the hamstring flexibility in individuals with hamstring tightness.A
      study compared two muscle energy techniques (MET with 30-s post isometric stretch phase vs
      MET with 3-s post-isometric stretch phase) for increasing flexibility of the hamstring muscle
      group and concluded that both techniques appeared to be equally effective in increasing
      hamstring extensibility. The findings suggest that altering the duration of the passive
      stretch component does not have a significant impact on the efficacy of MET for short-term
      increase in muscle extensibility.

      According to a study Mulligan traction straight leg raise technique is significantly
      effective in increasing straight leg raise (SLR) range of movement .A study demonstrated that
      both Mulligan traction straight leg raise (TSLR) and MET are effective in improving Knee
      range of motion (ROM) in subject with tight hamstring. The study showed that MET is
      significantly better then Mulligan traction straight leg raise (TSLR).The Effects of
      Hold-Relax Technique and Mulligan's Straight Leg Raise with Traction Technique on Flexibility
      of Shortened Hamstring was studied and concluded that both Mulligan's straight leg raise with
      traction technique and hold-relax technique show immediately. Although Mulligan's straight
      leg raise with traction technique was more increased average extension angle of knee joint at
      90-90 straight leg raise test than the hold-relax technique.A study compared immediate
      effects of traction straight leg and bent leg raise on hamstring muscle flexibility in normal
      individuals and concluded that Mulligan's traction straight leg raise technique was more
      effective in improving hamstring flexibility.
    

Intervention name(s): Mulligan Traction Straight Leg Raise (TSLR); Post Isometric Relaxation technique (PIR):
Intervention type(s): Other; Other
Intervention description(s): The patient was in a supine position on a low bed and the therapist faced the limb of the patient that was to be treated. The therapist grasped the lower leg of the patient just near the ankle and raises the leg off the bed to a position just above the painful range. The therapist flexes the knees. Traction was retained as far as possible with a straight leg lift if there was no pain. The pain-free traction straight leg raise range was administered for 10 second and the procedure was repeated three times.; The knee of the affected leg was extended, and the affected hip was flexed. Then the calf of the patient was placed on the shoulder of therapist. The therapist was standing on the side of the affected leg. The flexion of the hip was performed on the affected leg until resistance was felt. The patient was asked to gently push down on the therapist's shoulder with the leg. The therapist resisted hip extension to create an isometric contraction. The duration of the contraction was 10 seconds. Then the patient was instructed to relax and the therapist gently flexed the hip until the next barrier was felt. The technique was repeated three times.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: hamstring tightness; post isometric relaxation; SLR