Mulligan Traction Straight Leg Raise Versus Post Isometric Relaxation on Hamstring Tightness in Asymptomatic Patients

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Asymptomatic
* 20-70 degrees active knee extension loss with hip in 90 degrees flexion in dominant limb.

Exclusion Criteria:

* Volunteers involved in recreational or flexibility sport activities.
* History of previous lower limb injury from past one year.
* History of fracture or surgery of back, pelvis, hip or knee.
* Spinal deformity.