Active Isolated Stretch and Post Facilitation Stretch on Hamstring Flexibility in Trans-tibial Amputees.
Condition: Amputation
Study type: Interventional

Summary: 
      The aim of this study is to examine the effect of two techniques on hamstrings flexibility in
      trans-tibial amputees. Reduced flexibility can cause insufficiency at the workplace.
      Increasing flexibility is to decrease risk of injury, enhances performance and incorporate
      rehabilitation programs . Further studies are still needed in order to enhance patient
      rehabilitation protocol and anticipate the prosthetic process. Evidence based Physical
      therapy could be considered a valid support improving knee contractures in patients with
      trans-tibial amputation.This research provide an important addition to the evidence-based
      treatment intervention of physical therapy in amputees rehabilitation as no comparative study
      between Active Isolated Stretch and Post Facilitation Stretch on hamstring flexibility is
      done in trans-tibial Amputees.
    

Detailed description: 
      Trans-tibial amputation (Below-knee amputation) that involves removing the foot, ankle joint
      and distal tibia and fibula with related soft tissue structures . Amputations occurs due to
      variety of reasons including trauma, diseases, tumors, infections and congenital
      malformations .Traumatic amputations tend to occur in younger and active age and in Pakistani
      amputee population the majority 65-70% the cause of amputation is traumatic and 50-60% are
      Trans-tibial amputations. Several complications related to the amputation-prosthesis
      interface needs attention while managing amputees including joint full range of motion
      especially in the joint immediately proximal to the amputation site. The trans-tibial
      amputees are prone to develop flexion deformity of the knee . Normal active range of motion
      of the knee is 0° extension and 140° flexion. In many people after Tran's tibial amputation
      with a flexion deformity, active range of motion of the ipsilateral knee is reduced . The
      main cause of occurrence of flexion deformity of the knee is the muscle shortening and
      tightness especially the hamstrings muscles due to the long periods in a bending position or
      inactivity due to the illness or lack of exercise .

      Muscle Energy Techniques are used for lengthening of the muscles and improve range of motion
      (ROM) in joints . Active Isolated Stretching (AIS) is a uniquely effective exercise system
      with the advantages of specificity, active initiation, Incremental assists, Gentle motion,
      Brief duration, Multiple repetitions and Deep breathing. To stretch the hamstring muscles by
      lifting the leg straight up, stay on the mid-sagittal plane (keep the legs parallel). If the
      leg rotates out to the side, you lose much of the hamstring stretch and start affecting other
      muscles instead . While In Post Facilitation Stretch technique the hypertonic and shortened
      muscle is placed between a fully stretched and a fully relaxed state. Contracture of
      hamstrings using a maximum degree of effort for 5-10 seconds while the therapist resists the
      force. After this relaxation is done and effort is released and the therapist applies a rapid
      stretch to a new barrier and is held for 15 seconds. The relaxation is for 20 seconds and the
      procedure is repeated between three to five times and five times more .

      Study concluded that the AIS helps to restore the deteriorated flexibility of the muscles .
      In 2013 study concluded compare the Muscle Energy Techniques with static stretches' for
      increasing hamstring flexibility in post burn patients. Their results shows that Both
      treatment groups had highly significant gains in knee extension ROM after 5 and 8 days post
      stretching exercises. But MET had highly significant gains in knee extension ROM than static
      stretching after 8 days of treatments .

      In 2014 studied the three groups of 60 male students of Semnan University of Medical Sciences
      having shortened hamstring muscles. The 1st group underwent the hold relax technique, 2nd
      group underwent static stretches' and the 3rd group with no interventions for 4 weeks and
      three times a week. Results were recorded with goniometer before and after the sessions.
      Their results showed that both methods have a significant effect on increasing the motion
      range of knee. But no significant difference was observed between the static stretch and
      hold-relax techniques .

      In 2019 study reviewed 4 studies related to active isolated stretches' for knee extension who
      evaluated 53 subjects who performed knee extension stretches 4 times a week for 4 weeks. The
      increase in ROM was statistically significant after the 1st week of AIS and in static
      stretches after 2 to 4 weeks. The AIS increase in ROM was significantly greater than for the
      static stretch exercise. Another study studied 30 subjects and their results showed that both
      modes of stretching significantly increased ROM, but AIS increased ROM significantly more
      than the static stretch exercise. Another study evaluated 30 subjects and reported that only
      the AIS significantly increased ROM. study reported on 30 subjects concluded that AIS
      increased ROM more than 11% versus the 8% by static stretch but the difference was not
      statistically significant .
    

Intervention name(s): active isolated stretch; Post Facilitation Stretch
Intervention type(s): Other; Other
Intervention description(s): Active Isolated Stretch (AIS);
The shortened hamstring muscle will be isolated.
The hamstring will be stretched.
This Stretches will be Repeated eight to 10 times.
Stretch will be hold for no more than two seconds.
Exhale on the stretch; inhale on the release. Other amputees training exercises;
weight-shifting
Dynamic balancing activities
Stool stepping
Braiding
Gait exercises
Climbing/descending the stairs; Participants of this group will receive Post Facilitation Stretch (PFS);
The shortened hamstring muscle will be placed between a fully stretched and a fully relaxed state.
The patient will be asked to contract the hamstring using a maximum degree of effort for 5-10 seconds while the therapist will resists thepatients force.
The patient will be then asked to relax and release the effort, whereas the therapist will apply a rapid stretch to a new barrier and is held for 10 seconds.
The patient relaxes for approximately 20 seconds and the procedure will be repeated to five times (8) (18).
2. Other amputees training exercises;
weight-shifting
Dynamic balancing activities
Stool stepping
Braiding
Gait exercises
Climbing/descending the stairs
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Trans-tibial Amputees; Isolated Stretch; Post Facilitation Stretch