Comparison of Soft Tissue Techniques on Hamstring Flexibility Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The aim of this research is to compare the effects of Graston Technique, active release
      technique and PNF stretching on hamstring flexibility in Patients with Knee Osteoarthritis.
      Randomized controlled trials done at Riphah International University, Islamabad.. The sample
      size was 45. The subjects were divided in three groups, 15 subjects in Graston Technique
      group, 15 subjects in active release technique group and 15 in PNF stretching group. Study
      duration was of 6 months. Sampling technique applied was non probability purposive sampling
      technique. Male and female patients greater than 30 years of age, with unilateral or
      bilateral OA of grade 1 and 2 in Kellegren and Lawrence criteria for knee OA, having UL/BL
      hamstring tightness, Pain > 3 on NPRS, ROM > 200 from AKE test were included.

      Tools used in the study are NPRS, AKE test by goniometer, Lower extremity functional index
      (LEFI) and WOMAC.
    

Detailed description: 
      Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million
      people worldwide. It is expected that ten percent males and 18 percent females have knee or
      hip OA. It ranks as the fifth highest cause of years lost to disability in the whole
      population in high-income countries, and the ninth highest cause in low- and middle-income
      countries. In older people, OA is the utmost devastating musculoskeletal syndrome.

      It is a long-term chronic disease characterized by the destruction of articular cartilage and
      underlying bone. The degeneration occurs due to disarrangement in the usual process of repair
      of a joint. When the process breaks the synchronicity, there is slow deterioration of the
      articular cartilage. As a result, the biomechanical influences on the joints are also changed
      due to loss of normal joint line of gravity. This ultimately leads toward symptomatic changes
      which are a focal loss of the cartilage covering the articular ends; loss of normal joint
      space requires for smooth grating, osteophyte formation in joint, and remoulding of bone on
      peripheral areas and along the articular sides. Signs and symptoms are pain, a restricted
      range of joint movement, reduced muscle strength, restricted activities of daily living
      (ADLs) and instrumental activities of daily living (IADLS), and reduced quality of life.

      Exercise, weight loss in patients with knee and/or hip OA who are overweight or obese,
      self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first
      carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical
      nonsteroidal anti-inflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular
      glucocorticoid injections for knee OA are strongly recommended for treatment purposes. One
      major problem for patients with knee OA is poor hamstring flexibility. The stretching of the
      hamstring is a necessary intervention in the management of the OA knee. Although research and
      clinical experience has shown that treatment of hamstring flexibility is important, there is
      no widely acceptable form of treatment that is agreed upon to successfully improve
      flexibility of hamstrings.

      Instrument assisted soft tissue mobilization (IASTM) using Graston technique is a popular
      treatment for myofascial restriction. The IASTM treatment is thought to stimulate connective
      tissue remodeling through resorption of excessive fibrosis, along with inducing repair and
      regeneration of collagen secondary to fibroblast recruitment. In turn, this will result in
      the release and breakdown of scar tissue, adhesions, and fascial restrictions.

      Active release technique (ART) is also a technique that involves breaking down adhesions and
      scar tissue which cause pain and dysfunctions. It involves a clinician using their thumbs or
      fingers to apply deep tension to a trigger point while the involved tissue is moved from a
      shortened to lengthened position both actively by the patient and passively by the clinician.

      Proprioceptive Neuromuscular Facilitation (PNF) stretching technique is another technique
      utilized to improve muscle elasticity. This technique is specifically designed to stimulate
      mechanoreceptors and significant effect of static as well as PNF stretching on clinical
      symptoms of knee OA.
    

Intervention name(s): Graston technique group; Active release technique group; Proprioceptive Neuromuscular Facilitation stretching group
Intervention type(s): Other; Other; Other
Intervention description(s): Moist hot pack (10 minutes) Isometric quadriceps exercises (10 repetitions) Straight leg raise (10 repetitions) Graston technique steps 6 long strokes by the GT1 instrument on the hamstring muscle longitudinally. The Graston technique duration will be 5 minutes; Moist hot pack (10 minutes)
Isometric quadriceps exercises (10 repetitions)
Straight leg raise (10 repetitions)
ART steps:
Subject lies on the plinth in prone or in side lying position with the dominant side facing upwards.
Gentle tension is applied to the hamstring muscle along the entire length while stretching the leg in prone lying or side lying positions, depending on the level of pain and tightness of muscle (5 repetitions at 5 seconds interval).
Gentle tension is also applied at the origin and insertion of the hamstring muscle until the patient feels full release.; Moist hot pack (10 minutes)
Isometric quadriceps exercises (10 repetitions)
Straight leg raise (10 repetitions)
PNF technique steps:
The subject is in supine position with his non-dominant leg strapped down the table while the dominant leg rests on the therapist right shoulder.
The therapist stretches the hamstring muscle until the subject first reports a mild stretch sensation; held for 7 sec by passively flexing the hip with knee fully extended, allowing no hip rotation.
Next, the subject isometrically contracts the hamstring muscle for 3 sec and then relax for 5 sec.
This sequence is repeated 5 times at a 20 second interval.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Active release technique; Graston technique; Knee Osteoarthritis; PNF stretching; Hamstring tightness