Comparison of Mulligan Bent Leg Raise vs Active Release Technique in Patients With Hamstring Tightness
Condition: Hamstring Injury
Study type: Interventional

Summary: 
      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
    

Detailed 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.
    

Intervention name(s): Active Release Technique; Mulligan Bent Leg Raise
Intervention type(s): Other; Other
Intervention description(s): 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; 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
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pain; active release technique; mulligan bent leg raise; hamstring tightness