Rajivgandhi University of Health Sciences, Karnataka s2

DISSERTATION SYNOPSIS

SUBMITTED TO

RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

TOWARD PARTIAL FULFILMENT OF

MASTER OF PHYSIOTHERAPY DEGREE COURSE

MASTER HIRAL SHAILESH

UNDER THE GUIDANCE OF

B. A. Boomadevi

VIKAS COLLEGE OF PHYSIOTHERAPY MARYHILL, KONCHADY, MANGALORE-575006

2011-13 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE

REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the Candidate MASTER HIRAL SHAILESH and Address VIKAS COLLEGE OF PHYSIOTHERAPY AIRPORT ROAD MARYHILL, KONCHADY MANGALORE – 575008

2. Name of the Institution VIKAS COLLEGE OF PHYSIOTHERAPY Mangalore.

3. Course of study and subject Master of Physiotherapy in musculoskeletal disorders and sports.

4. Date of admission to Course 24-06-2011

5. Title of the Topic A COMPARATIVE STUDY BETWEEN THE EFFICACY OF ACTIVE SELF STRETCHING AND SELF PNF TECHNIQUE ON FLEXIBILITY OF HAMSTRINGS MUSCLES IN NORMAL INDIVIUALS.

6) Brief resume for the need of the study 6.1) NEED FOR THE STUDY.

Hamstring muscle is the muscles of the back of the thigh and consists of the semitendinosus, the semimembranosus, the long head of the biceps femoris, and the ischial head of the adductor magnus1. They share common characters, origin from ischial head and inserted into one of the bones of the leg 1. They are chief knee flexors1. Hamstring muscle strain represents a significant injury to the athlete participating in sporting activities. Lack of hamstring flexibility has been correlated to hamstring muscle injury 13. Hamstring stretching is therefore one of useful clinical exercises for increasing range of motion, muscle flexibility, improving muscle balance, and preventing of muscle from injury 9. Flexibility is a key component for injury prevention and rehabilitation. Stretching is important for reducing injury and improving the performance in sports and for overall physical fitness. Athletes are often given stretching protocols to improve their stretching7. Several stretching techniques are used to increase joint range of motion10.12,13. For example, techniques were used to improve muscle flexibility; conventional regiments (static stretch, ballistic stretch, passive stretch), modified Proprioceptive Neuromuscular Facilitation (PNF) - slow reversal hold relax (SRHR) 5, PNF – hold-relax (HR)6or PNF- contract-relax (CR)7 . A number of previous studies have shown that proprioceptive neuromuscular facilitation(PNF) stretching techniques produces greater range of motion than passive or ballistic stretching methods12,14,15,20,21,22. However other studies have reported that the results achieved with static and ballistic techniques are comparable with those achieved with PNF techniques16,17,18. But the literature is inconclusive regarding which stretching is the best for increasing the muscle length. Therefore the purpose of the study is to measure the effect of active self-stretching and self PNF technique on hamstring flexibility.

HYPOTHESIS 1. Null hypothesis (Ho)

There is no significant difference between the effects of active self-stretching and self PNF stretching of the hamstrings muscle.

2. Alternative hypothesis (H1)

There is significant difference between the effects of active self-stretching and self PNF stretching of the hamstrings muscle.

6.2) REVIEW OF LITERATURE. 1. Bonnar BP et al6 carried out the study to determine the isometric contraction hold time that best produces gains in hip range of motion after a 3-s (3-HR), 6-second (6-HR), and 10-s (10-HR) hold-relax PNF stretch. There were no significant differences for the between groups (3-HR, 6-HR, 10-HR) main effect or for the interaction term. All 3 hold- time conditions produced significant gains in hip range of motion compared to baseline measurements.

2. Marek et al9 examine the short-term effects of static and proprioceptive neuromuscular facilitation stretching on peak torque (PT), mean power output (MP), active range of motion (AROM), passive range of motion (PROM), electromyographic (EMG) amplitude, and mechanomyographic (MMG) amplitude of the vastus lateralis and rectus femoris muscles during voluntary maximal concentric isokinetic leg extensions at 60 and 300 degrees. Both static and proprioceptive neuromuscular facilitation stretching caused similar deficits in strength, power output, and muscle activation at both slow (60 degrees) and fast (300 degrees) velocities.

3. Yuktasira B et al7 investigated the long-term effects of two different stretching techniques on the range of motion (ROM) and on drop jump (DJ). Static and proprioceptive neuromuscular facilitation (PNF) stretching techniques improved the ROM, but neither of the stretching exercises had any statistically significant effect on the DJ scores. 4. Tanigawa MC et al10 investigated the acute effect of two stretching intensities in the range of motion (ROM) of knee extension, after a single training session. Fourteen males participated in this study. Both lower limbs of each volunteer were assessed, being one leg submitted to a submaximal stretching program (SSP) and the other to a maximal stretching program (MSP). The findings demonstrated that the maximal stretching program causes an acute increase at ROM.

5. Sharman, Melanie J et al8 suggests than an active PNF stretching achieves greatest gain in ROM, e.g utilizing a shortening contraction of the opposing muscle to place the target muscle on the stretch, followed by a static contraction of target muscle.

6. Sullivan et al 17 compare static stretch (SS) and proprioceptive neuromuscular facilitation (PNF) hamstring stretching techniques while maintaining the pelvis in two testing positions: anterior pelvic tilt (APT) or posterior pelvic tilt (PPT). There was not a significant difference between SS or PNF stretching technique in the APT position. There was not a significant increase in hamstring flexibility in the PPT group with either stretching technique (P > 0.05). The results suggest that APT position was more important than stretching method for increasing hamstring muscle flexibility.

7. Bandy WD ET AL 23 examine the length of time the hamstring muscles should be placed in a sustained stretched position to maximally increase ROM. The results of this study suggest that a duration of 30 seconds is an effective time of stretching for enhancing the flexibility of the hamstring muscles.

6.3) AIMS AND OBJECTIVES. The objective of the study is to investigate, in a randomized, prospective study the effect of self-active stretching hamstring exercise versus the effect of and self PNF stretching exercise, in normal healthy subjects 18 – 25 years, having mild hamstring tightness. Specifically, to determine 1. The study the effect of self-active stretching hamstring exercise on hamstring muscle. 2. The effect of self PNF stretching exercise on on hamstring muscle. 3. To compare the effect between active self-stretching with self PNF technique on hamstring flexibility.

7) MATERIALS AND METHODS 7.1) SOURCE OF DATA

Data will be collected from the female undergraduate and post graduate physiotherapy students of Vikas college of Physiotherapy, Mangalore, having mild hamstring tightness, after obtaining informed consent.

7.2) METHOD OF COLLECTION OF DATA

Research Design Pre and post test experimental study will be used.

Sampling method Random sampling method

Inclusion Criteria  18 years to 25 years

 Female students.

 Subjects having mild hamstrings muscle tightness i.e. angle more than 20 degree of full extension while performing 90-90 Straight leg raising test 4.

 Subjects with normal BMI – 18.5 – 24.9 27.

Exclusion Criteria  Age above 25 years

 Male students.

 Subjects with hamstring strain  Subjects having moderate to severe hamstring tightness, i.e. angle more than 55 degree of full extension while performing 90-90 Straight leg raising test 4.

 Subjects having any knee or ankle joint pathology.

 Subjects having prolapsed intervertebral disc or any back pathology.

 Subjects with BMI greater than 25 27.

Methodology 60 students who are having mild hamstring tightness will be recruited for the study after obtaining informed consent. Subjects who fulfill the following inclusion and exclusion criteria will be randomly assigned to one of two groups. Each group will consist of 30 female subjects, within the age group of 18 to 25 years. Group I will be trained for active self-stretching hamstring exercises and Group II will be trained for self PNF technique for hamstrings.

Interventions Both groups will be trained for 1 session a day for 6 weeks, each session will be of 10- 15 minutes. To prevent the injury due to stretching warm up for both groups would be taught and also will be told as a necessary pre requisite before starting the stretch. The warm up will include active knee extensions in standing and lying position which has to be repeated 10 times.

Group 1: This will consist of 20 normal healthy female subjects and they will be trained in active self-stretching hamstring exercises which consist of the following, subject will lie supine on the floor, with one leg through a doorway and the other leg ( the one to be stretched ) propped up against the door frame. For the effective stretch the pelvis and the opposite leg must remain on the floor with the knee extended. To increase the stretch, the subject will be told to move the buttock closer to the frame, keeping the knee extended3.the subject will be told to hold it for 30 seconds then relax. Repeat for 5 times

Group 2: This will consist of 20 normal healthy female individuals and they will be trained in self PNF technique for hamstrings exercises which consist of the following, subject will lie supine on the floor, with one leg through a doorway and the other leg (the one to be stretched) propped up against the door frame. For the effective stretch the pelvis and the opposite leg must remain on the floor with the knee extended. The subject will be taught to perform the hold relax technique by pressing the heel of the leg being stretched against the door frame causing isometric contraction of the hamstrings for 5 counts, relaxing it then lifting the leg away from the frame3.

7.1 Outcome measures:

Before the beginning of the rehabilitation protocol and after 6 weeks of training, all the subjects will be evaluated in the following outcome measures. All measurements will be taken both before and after the stretching phase, with no warm-up or stretching before measurement.

1. Back saver sit and reach test 4, 33: Shoes should be removed first. Subject will sit on the floor with one leg out straight and the other leg with the knee bent and its foot flat on the floor (see image). The outstretched foot is placed with foot against the box. With hands placed on top of each other and palms facing down, the subject reaches slowly forward along the measuring line as far as possible. After three practice reaches, the fourth reach is held for at least one second while the distance is recorded. The subject will repeat the test three times and the best score taken. 2. 90-90 Straight leg raising test 4: Subject will be instructed to lie supine position with hip and knee flexed at 90 degree, landmarks will be made over lateral malloeloi, lateral femoral condyle, greater trochanter. The hip will be maintained at 90 degree verified with goniometer rand subject will be told to actively extend the knee as far possible. Once they will no longer extend the knee, or the hip will begin to lose the 90° angle as determined, the angle of knee flexion was then obtained measured by goniometer. 30. 3. Bend knee stretch test 4.

7.2 Statistical tests: The following statistical tests will be used to analyze the collected data 1. Paired and unpaired t-tests

7.3 The study requires non-invasive investigations and interventions to be conducted on patients. The investigations to be conducted include physical examination of hip, knee and ankle joint like inspection, palpation, joint range of motion with the help of goniometer. Interventions in the treatment that are used for this study are active self-stretching and self PNF stretching of the hamstrings muscle

7.4 A. Has the study required any investigation or No other investigation. intervention to be conducted on animals or human beings?

B. Has Ethical clearance obtained I. Yes, Ethical clearance is obtained from the institutional ethical committee of Vikas College of Physiotherapy.

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