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world journal of medical sciences 7 1 23 26 2012 issn 1817 3055 idosi publications 2012 doi 10 5829 idosi wjms 2012 7 1 61290 efficacy of pnf stretching techniques ...

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                     World Journal of Medical Sciences 7 (1): 23-26, 2012
                     ISSN 1817-3055
                     © IDOSI Publications, 2012
                     DOI: 10.5829/idosi.wjms.2012.7.1.61290
                                                         Efficacy of Pnf Stretching Techniques on 
                                               Hamstring Tightness in Young Male Adult Population
                                            Abdulrahim Zakaria, Ganeswara Rao. Melamand Syamala Buragadda
                                                               Department of Rehabilitation Sciences, 
                                 College of Applied Medical Sciences, King Saud University, Riyadh -11433, Saudi Arabia 
                          Abstract: To find out the efficacy of different PNF stretching techniques in improving Hamstring muscle
                          flexibility.Study Design included pre- post test control group design. Participants were 30 male students from
                          King Saud University between the age group of 18 to 24 years having Hamstring tightness and without any
                          musculoskeletal disorders formed the sample of this study. Subject’s age, height and weight were matched.
                          Informed consent was taken from all the subjects. Group I acts as a Control group consisting of 15 subjects who
                          receives Self stretch Group II acts as a Experimental group consisting of 15 subjects who receives Therapist
                          PNF stretch. Outcome Measures included straight leg raising test (SLRT) measured by Universal
                          goniometer..Results revealed that both the groups performed stretching 5 times a week for 6 weeks. Four
                          repetitions per session with relaxation period of 15 sec and stretch period of 15 sec. Pre test and Post test values
                          of the Control group and Experimental group were statistically analyzed by means of t-test.The Post test values
                          of Experimental and Control group were analyzed by Chi square test ( 2 test). The Significance level used for
                          this study is P<0.05. This study concluded that though statistically there is no significant difference between
                          self stretch and therapist applied PNF stretch, both are effective treatment methods but Therapist applied PNF
                          stretch is clinically more significant over self stretch.
                          Key words: Flexibility   Stretching   Proprioceptive Neuromuscular Facilitation (PNF)   Hamstring Tightness
                                         INTRODUCTION                                    of     joint   movement,   optimal   musculoskeletal
                          In the literature, the terms “flexibility” and “muscle         function and enhanced performance in day to day
                     length” are often used synonymously when referring to               activities.
                     the ability of muscles to be lengthened to their end range               Stretching techniques can be categorized as static,
                     [1]. Flexibility refers to the total range of motion of a joint     ballistic, slow active and Proprioceptive Neuromuscular
                     or group of joints. The structural characteristics of the           Facilitation. Scientific Stretching for Sport (3S) describes
                     joints and the mechanical properties of the connective              a modification of PNF. Numerous investigations establish
                                                                                         PNF techniques as more efficacious treatments than
                     tissues of the muscle tendon structures largely affect the          traditional static stretching exercise for range of motion or
                     extent of movement around a given joint. The specificity            flexibility enhancement. [3,12-14]
                     of movement that a person performs in regular physical                   The Straight leg raising (SLR) test is of great value in
                     activities  and stretching methods often define the                 assessing normality of the roots of the sciatic nerve and
                     development and improvement of the body’s range of                  tightness of the hamstring muscles [4]. The Value of the
                     motion.                                                             SLR test can be determined with the goniometer, a gravity
                          Stretching  techniques  are used  in clinical  practice        type goniometer or a tape measure [4-6].
                     to  increase  flexibility   with   some   support   for  their           The goal of all stretching programs is to optimize joint
                     use [2]. The flexibility of the hamstring muscles is                mobility while maintaining joint stability. Concern should
                     important in the prevention of injury, muscular and                 always be focused on the systematic, safe and effective
                     postural    imbalance    and   maintenance   of    full   range     application of the range of motion techniques utilized.
                     Corresponding Author: Abdulrahim Zakaria, Department of Rehabilitation Sciences, 
                                                College of Applied Medical Sciences, King Saud University, 
                                                Riyadh.11433, Saudi Arabia.  P.O. Box 10219,  Tel: +966 506767811.
                                                                                     23
                                                                      World J. Med. Sci., 7 (1): 23-26, 2012
                                   MATERIALS AND METHODS                                     relaxation period when the knee was allowed to bend.
                                                                                             Thereafter, the leg was straightened and the procedure
                      Procedure:    Previous     history     of     hip     or      knee     was repeated four times.
                      or  spine  injuries,  any  contractures  or  deformities.                   Group II received the PNF technique applied by the
                      Neuromuscular,  cardiovascular  disorders,  any  subject               physiotherapist starting from the agonistic pattern of hip
                      missing  4  days  without  stretching,  subjects  involving            flexion,  adduction  and  external  rotation  (with  knee
                      in   any   other   physical   fitness   program   were                 extension) at the point of tightness in the hamstring
                      excluded.  Prior  to  assignment  to  group  each  subject             muscles. Thereafter, a ‘hold contraction’ was performed
                      who  met  the  inclusion  criteria in the study was                    when the subject attempted isotonic contraction of the
                      measured for  flexibility  of  the  right  hamstring  muscle.          antagonistic  pattern;  hip  extension,  abduction  and
                      Subjects   were  randomly  assigned  to  two  groups                   internal rotation which was maximally resisted by the
                      following the initial measurement of hamstring tightness               physiotherapist for 15 sec except the rotational
                      (measured  by  passive  straight  leg  raise  test  range              component of eversion and plantar flexion of foot and
                      between 40° and 70°).                                                  toes which was allowed to occur voluntary relaxation
                           Subjects assigned to Group I [N=15, age =20.3 ± 2.32              period of 15 sec was followed by a resisted contraction of
                      range 18 - 24 years] served as control group and performs              the agonistic  pattern  moving  the  leg  through  the
                      PNF self-stretching.                                                   lengthened range to the point where tightness in the
                           GroupII (N=15, age = 19.8 ± 2.94, range = 18-24years)             hamstring muscles was felt. This procedure was
                      served as experimental group and undergone therapist                   performed four times. Each intervention took 2 minutes
                      applied PNF stretch.                                                   consisting of four repetitions of 15 sec contraction and 15
                           Both the groups performed stretching 5 times a week               sec relaxation period. This procedure was done 5 days a
                      for 6 weeks. Four repetitions per session with relaxation              week for 6 weeks.
                      period of 15 sec and stretch period of 15 sec.
                           The subjects wearing unrestricted clothing were                   Subject Position for Passive SLRT: With subjects lying
                      asked to lie supine with the right side of the body parallel           on their  left  sides,  the  greater  trochanter  of  the  right
                      with the edge of the height adjustable plinth. The trunk               femur, lateral femoral condyle were identified and marked
                      and pelvis  were  placed  in  the  anatomical  position                with black marker to help ensure proper alignment for
                      determined by visual inspection.                                       goniometric measurements. The goniometer was placed
                           To avoid compensatory movements (4.5 cm) wide                     with stationary arm parallel to the edge of the table, the
                      straps were positioned across the anterior superior iliac              moving arm along the lateral midline of the thigh and the
                      spine and proximal third of the left thigh ensure that the             axis over the superior half of the greater trochanter. The
                      lumbar spine was in contact with the plinth, the subject               investigator slowly raised the extended right leg with the
                      was required to posterior tilt the pelvis in order to fix a            foot relaxed to the point where the subject felt tightness
                      towel placed between T              L against the plinth. A            in the hamstring muscles.
                                                    12 and  5
                      standardized   explanation   and  demonstration  was                        Before measuring  right  hip  flexion  range,  the
                      given to each subject.                                                 investigator  ensured  that the lumbar spine was in
                                                                                             contact  with  the  plinth by checking that the towel
                      Intervention: Group I was instructed to perform and active             placed under the subject’s lumbar spine could not be
                      straight leg rise applying all three components of motion              removed.
                      to the point of tightness in the hamstring muscles. This
                      included inversion and dorsiflexion of the right foot and              Pilot Study: Before going for the main study a pilot study
                      toes, raising the right leg by turning the heel towards the            was  conducted  with  10  subjects  the  purpose  was  to
                      opposite shoulder and clasping their hands around the                  overcome the practical difficulties in the treatment.
                      back of the thigh. Thereafter, the subject performed a hold
                      contraction by attempting to push the straight leg down                Data Analysis: Data analysis was performed manually Pre
                      towards the plinth against maximal self induced resistance             test and Post test values of the Control group and
                      through the hands for 15 sec while the right heel pointed              Experimental group were statistically analyzed by means
                      to the right lower edge of the plinth followed by a 15  sec            of t-test.
                                                                                         24
                                                                                      World J. Med. Sci., 7 (1): 23-26, 2012
                           Table 1: Comparison of range of motion with in groups                                  change [9]. There the results of this study may be
                           GROUPS Pre test           Post test  S.E       t      Level of Significance 0.05       considered to be clinically important as a range increase
                           I           60.06±4.98      82.2     1.31    16.90        highly significant           beyond 3 - 4° was found. However, although the PNF
                           II          60.90±6.55      87.8     1.75    15.37        highly significant           technique  applied  by  the physiotherapist  produced a
                           Table 2: Comparison of range of motion between two groups by using chi                 greater mean change in range than the self stretch
                                     square                                                                       incorporating the PNF components the difference was not
                           Groups            Pre test          Post test                      2                   significant
                           I              60.06±4.98              82.2             0.045 ( no significance)
                           II             60.90±6.55              87.8                                            Limitations of Study: The optimal stretch parameters for
                           Total          120.96                  170
                                                                                                                  stretching exercises are not known. The results of existing
                                  The Post test values of Experimental and Control                                research on the effect of duration, frequency and
                          group were analyzed by Chi square test ( 2 test). The                                   repetitions of stretching regimes vary considerably. The
                           Significance level used for this study is P<0.05                                       variation in the change in range of hip flexion amongst the
                                                                                                                  subjects indicates that the effectiveness of the stretching
                                                           RESULTS                                                regimes varied across individuals, which was also found
                                                                                                                  byother investigators. This may have been influenced by
                                  A total of 30 subjects between 18 - 24 years were                               the physical activity level or other characteristics of the
                          included  in  this  study  with their mean age group of                                 sample.
                          [20.3 ± 2.32]  in  Control group and mean age group of                                         It was not possible to quantify the force applied by
                          [19.8 ± 2.94] in Experimental group.                                                    the physiotherapist although the point of cessation of
                                  The study consists of two groups (I and II). Group I                            stretch was governed by the subjects, which was shown
                          consisted of 15 subjects (N=15) who performed PNF self                                  to have an acceptable level of error. The generalisability
                          stretch. Group II consisted of 15 subjects (N=15) who                                   of the study results is limited and the small sample size
                          were given therapist applied PNF stretch                                                means that the results should be interpreted with care.
                                                                                                                         The subjects taken were only males so the
                                                        DISCUSSION                                                generalisability will be limited to only males. The small
                                                                                                                  sample size reduced the statistical power increasing the
                                  This study is an attempt to find out any significant                            risk of a type II error. Although an attempt was made to
                          difference between therapist applied PNF stretch and self                               stabilize the pelvis by placing straps across the left thigh
                          stretch groups. The results in this study suggest that                                  and asking the subject to fixate a towel by posterior tilting
                          there is significant difference in the Pre test and Post test                           the pelvis, pelvic movements could not completely be
                          scores of therapist applied PNF stretch and self stretch                                eliminated.
                          groups. The post test scores of both stretches did not                                         The increase in flexibility of the hamstring muscles
                          show a significant difference.                                                          should not be extrapolated to other muscle groups as
                                  Wallin et al found an increase of 6.2° of hip flexion                           fusiform muscles produce large range than pinnate
                           range after 14 sessions of a contract - relax method. Sady                             muscles.
                           et al found an increase of 9.4° in hip flexion range after 18                                 The Universal goniometer used in this study has
                           sessions of a contract - relax - antagonistic - contract                               scope for error; an electronic goniometer would have
                           method. In both studies modified PNF-techniques were                                   prevented this aspect of error.
                           used. The stretching regimes in this study were only
                           performed once for 2 minutes yet appeared to result in                                                              CONCLUSION
                           greater changes than the published studies described
                           previously. [1]                                                                               Both stretching regimes, which incorporated the
                                  Bandy et al who applied static stretching to                                    facilitator components of PNF-techniques, achieved a
                           hamstring  muscles  found  that  one   stretch  session                                significant increase in hip flexion range. As both
                           with  duration  of  30  sec  and  with  a  follow  up of 5                             stretching regimes achieved clinically significant
                           days a week for 6 weeks is the best intervention method                                improvement in range so individual or organizational
                           [7-10]. Boone et al suggested an increase of 3 - 4°                                    factors can be considered when deciding which stretching
                           measured  by  the  same  evaluator to determine real                                   regime to use.
                                                                                                             25
                                                               World J. Med. Sci., 7 (1): 23-26, 2012
                         The findings of the present study are important to        5.    Donna C. Boone et al. Reliability of goniometric
                   physiotherapists who commonly use stretching regimes                  measurements. Physical Therapy, 58(11): 1355-1360.
                   and   teach    them  to  patients  as  part  of  the  self      6.    Chang-Yu Hsieh, Joan M. Walker and Katie Gillis.
                   management programme.                                                 Straight-Leg-Raising Test Comparison of Three
                                                                                         Instruments Physical Therapy, 63(9):  1429-1433.
                         This study concluded that though statistically there      7.    Bandy, W.D. and J.M. Irion, 1994. The effect of time
                   is  no  significant  difference  between  self  stretch  and          on static stretch on the flexibility of the hamstring
                   therapist applied PNF stretch both are effective treatment            muscles- Orthop sports Phys. Ther.,  20(3): 154- 9.
                   methods but therapist applied PNF stretch is clinically         8.    Bandy, W.D., J.M. Irion and M. Briggler, 1998. The
                   more significant over self stretch                                    effect of static stretch and dynamic range of motion
                                                                                         training on the  flexibility of the Hamstring muscles. -
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                                                                                26
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...World journal of medical sciences issn idosi publications doi wjms efficacy pnf stretching techniques on hamstring tightness in young male adult population abdulrahim zakaria ganeswara rao melamand syamala buragadda department rehabilitation college applied king saud university riyadh saudi arabia abstract to find out the different improving muscle flexibility study design included pre post test control group participants were students from between age years having and without any musculoskeletal disorders formed sample this subject s height weight matched informed consent was taken all subjects i acts as a consisting who receives self stretch ii experimental therapist outcome measures straight leg raising slrt measured by universal goniometer results revealed that both groups performed times week for weeks four repetitions per session with relaxation period sec values statistically analyzed means t chi square significance level used is p...

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