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This randomized clinical trial aims to compare the effects of post-isometric relaxation (PIR) and post-facilitation stretch (PFS) on pain, range of motion, and disability in individuals with tight hamstring syndrome. Conducted at Riphah Rehabilitation Clinic, Lahore, participants aged 18-35 years with posterior thigh pain will be divided into two groups. Both groups will receive hot pack therapy and core strengthening exercises, with Group A receiving PIR and Group B receiving PFS. Outcomes will be assessed at baseline and after 4 weeks using NPRS, a disability questionnaire, and a goniometer, with data analyzed using SPSS version 25.
Both PIR and PFS are subtypes of Muscle Energy Techniques (MET) that have shown potential in improving muscle flexibility and reducing discomfort. This study aims to address the impacts of PIR and PFS on pain, ROM, and disability in patients with tight hamstrings syndrome, providing valuable insights for clinical practice and enhancing the understanding of effective interventions for this common musculoskeletal issue.
The current literature on stretching techniques for musculoskeletal conditions reveals several gaps specifically relevant to the effects of Post Isometric Relaxation (PIR) and Post Facilitation Stretch (PFS) on tight hamstrings syndrome. Despite the high incidence of hamstring tightness and its association with conditions such as nonspecific low back pain, there is limited research directly comparing the effects of Post Isometric Relaxation (PIR) and Post Facilitation Stretch (PFS) on this condition. While studies have explored various stretching methods such as Muscle Energy Technique (MET), static stretching, and myofascial release, there is a notable lack of direct comparative research between PIR and PFS in patients with tight hamstrings. Additionally, existing studies had often focused on immediate or short-term outcomes, with limited investigation into the long-term effects of these techniques on pain, range of motion (ROM), and disability.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Post Isometric Relaxation | Experimental | Patient applied the sub-maximal contraction almost 20%. Isometric contraction will be held for 10 seconds and then slight stretch for 30 seconds will be maintained. 4 contractions per treatment with 3 seconds rest between each contraction. This protocol continues 3 days/week for 4 weeks |
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| Post Facilitation Stretch | Active Comparator | Isometric contraction will be held for 10 seconds and then slight stretch for 30 seconds will be maintained. 4 contractions per treatment with 3 seconds rest between each contraction. This protocol continues 3 days/week 4 weeks. for hamstring flexibility |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Post Isometric relaxation | Other | Group A will receive Post Isometric Relaxation (PIR) Patient applied the sub-maximal contraction almost 20%. Isometric contraction was held for 10 seconds and then slight stretch for 30 seconds was maintained.4 contractions per treatment with 3 seconds rest between each contraction. This protocol continues 3 days/week for 4 weeks conventional treatment Hot pack for 10 minutes Pelvic bridging: The subjects will be asked to lie supine and with knee flexed and then raise the pelvis upward till the comfort then hold that position for 5 sec and repetitions were 10 times Cat and camel: The subjects will be requested to prone kneel and then take a deep breath from nose while making hump in the back (cat) and breathe out from mouth while curving the spine (camel) for 5 second 10 times repetitions |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric pain rating scale | The severity of pain will be measured by using the NPRS scale, which goes from '0' (meaning there is no pain) to 10'' (meaning there is most agony possible) ("pain is severe as you can imagine"). It was accepted that the scale was convenient for determining patients' pain thresholds. The NPRS scale has a score range of 0 to 10. It was a valid and reliable tool. Va;idity ranging from 0.79 to 0.95 and reliability from 0.67 to 0.96. | 4th week |
| Measure | Description | Time Frame |
|---|---|---|
| Active Knee Extension Test | AKE is an active test considered as a gold standard for hamstring flexibility assessment. The AKE test interrater reliability was excellent, with ICC2, values of 0.87 (0.58-0.97; 95%CI) for the dominant knee and 0.81 (0.41-0.94; 95%CI) for the nondominant knee and standard error of measurement (SEM) values of 3.5° (18.0°- 31.7°; 95%CI) and 3.8° (16.9°-31.7°; 95%CI) respectively. Minimal detectable change was between 9.7° and 10.5°. No significant difference in mean AKE measurements was noted between the first and second testing sessions for both raters (Table 4). The ICC3,1 values ranged from 0.78 to 0.92. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Hira Shaukat, TDPT | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zafar Hospital lahore | Lahore | Punjab Province | 54810 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26464889 | Background | Castellote-Caballero Y, Valenza MC, Puentedura EJ, Fernandez-de-Las-Penas C, Alburquerque-Sendin F. Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome. J Sports Med (Hindawi Publ Corp). 2014;2014:127471. doi: 10.1155/2014/127471. Epub 2014 Apr 15. | |
| 27288515 |
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| Post Facilitation stretch | Other | Group B will receive Post Facilitation Stretch (PFS) Isometric contraction was held for 10 seconds and then slight stretch for 30 seconds was maintained. 4 contractions per treatment with 3 seconds rest between each contraction. This protocol continues 3 days/week 4 weeks. for hamstring flexibility conventional treatment Hot pack for 10 minutes Pelvic bridging: The subjects will be asked to lie supine and with knee flexed and then raise the pelvis upward till the comfort then hold that position for 5 sec and repetitions were 10 times Cat and camel: The subjects will be requested to prone kneel and then take a deep breath from nose while making hump in the back (cat) and breathe out from mouth while curving the spine (camel) for 5 second 10 times repetitions |
|
| 4th week |
| Modified Oswestry Disability Index | The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. The ODI remains a valid and vigorous measure of condition-specific disability. The authors recommend the use of version 2.0. The data presented are a guide to the power of the instrument to detect meaningful changes in disability status. | 4th week |
| Duhig S, Shield AJ, Opar D, Gabbett TJ, Ferguson C, Williams M. Effect of high-speed running on hamstring strain injury risk. Br J Sports Med. 2016 Dec;50(24):1536-1540. doi: 10.1136/bjsports-2015-095679. Epub 2016 Jun 10. |
| 14751943 | Background | Woods C, Hawkins RD, Maltby S, Hulse M, Thomas A, Hodson A; Football Association Medical Research Programme. The Football Association Medical Research Programme: an audit of injuries in professional football--analysis of hamstring injuries. Br J Sports Med. 2004 Feb;38(1):36-41. doi: 10.1136/bjsm.2002.002352. |
| 21448404 | Background | Rahnama N. Prevention of football injuries. Int J Prev Med. 2011 Jan;2(1):38-40. No abstract available. |
| 18007232 | Background | Skoffer B. Low back pain in 15- to 16-year-old children in relation to school furniture and carrying of the school bag. Spine (Phila Pa 1976). 2007 Nov 15;32(24):E713-7. doi: 10.1097/BRS.0b013e31815a5a44. |
| 23948840 | Background | Arab AM, Nourbakhsh MR. Hamstring muscle length and lumbar lordosis in subjects with different lifestyle and work setting: comparison between individuals with and without chronic low back pain. J Back Musculoskelet Rehabil. 2014;27(1):63-70. doi: 10.3233/BMR-130420. |
| 28121207 | Background | Hollman JH, Berling TA, Crum EO, Miller KM, Simmons BT, Youdas JW. Do Verbal and Tactile Cueing Selectively Alter Gluteus Maximus and Hamstring Recruitment During a Supine Bridging Exercise in Active Females? A Randomized Controlled Trial. J Sport Rehabil. 2018 Mar 1;27(2):138-143. doi: 10.1123/jsr.2016-0130. Epub 2018 Mar 1. |
| 22895873 | Background | Kumazaki T, Ehara Y, Sakai T. Anatomy and physiology of hamstring injury. Int J Sports Med. 2012 Dec;33(12):950-4. doi: 10.1055/s-0032-1311593. Epub 2012 Aug 15. |