Index to Chiropractic Literature
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ID 18720
  Title Comparison of active release technique and proprioceptive neuromuscular facilitation for improving hamstring flexibility: a randomized controlled trial [platform presentation; the Association of Chiropractic Colleges' Thirteenth Annual Conference, 2006]
Journal J Chiropr Educ. 2006 Spring;20(1):15-16
Peer Review Yes
Publication Type Meeting Abstract
Abstract/Notes INTRODUCTION: The hamstrings are commonly injured muscles in athletic activities. Over half (51%) of the therapy provided at the 1996 Olympic Games involved a hamstring injury. Most studies have concluded that inflexibility contributes to lower extremity injury. Techniques previously investigated for improving hamstring flexibility include static stretching, exercise, heat, massage and proprioceptive neuromuscular facilitation (PNF). PNF is a common stretching technique and involves an alteration between maximal contractions, relaxation and stretching; including the techniques of hold-relax and contract-relax. Active Release Technique (ART) is a manual therapy for treating soft tissue problems. Its procedures involve taking tissue from a shortened to lengthened position while using a manual contact to maintain tension along the tissue's fibers. The current evidence suggests that PNF significantly increases hamstring flexibility when compared with other interventions like static and ballistic stretching. There are anecdotal reports and a pilot trial suggesting that ART can significantly improve hamstring flexibility. There are no comparative studies on hamstring flexibility using ART and PNF. The purpose of this randomized controlled trial was to compare the ability of ART and PNF to increase hamstring flexibility in an asymptomatic population as well as determine if the effects were maintained at a 10-day follow-up.

METHODS: This study was reviewed and approved by the Institutional Review Board of the Logan College of Chiropractic. 34 participants (25 males, 9 females), mean age 26.5 SD ± 5.3 were recruited. The participants were randomly assigned to ART (13), PNF (11) or Control (10) groups. Participants were seen 2 times a week for 2 weeks and at a 10-day follow-up. The ART group received treatment to the dorsal sacral ligament, hamstring origins, insertions and muscle bellies. The PNF group received 5 cycles of contract-relax stretching. The control group sat in a room with an investigator for 5 minutes. The Active Knee Extension test was used to measure hamstring flexibility by a masked investigator. Measurements were taken before and after each encounter and at follow-up. A one-way analysis of variance (ANOVA) was used to compare the group means at treatment 1 (T1), following treatment 4 (T4) and at the 10 day follow-up (T10). A one-tailed paired samples t-test was used to compare the scores within the groups at T1, T4 and T10. A one-tailed independent samples t-test was used to compare the scores between the groups at T1, T4 and T10. The a priori alpha level was set at .05.

RESULTS: The one-way ANOVA showed no significant differences between the group means at T1, T4 and T10. The ART group show statistically significant improvement at T4, while the PNF group showed statistically significant improvement at T4 and T10. There was no significant difference between the ART and PNF group means at T4; however there was a significant difference between the groups at T10.

DISCUSSION: ART and PNF failed to significantly increase hamstring flexibility compared to control at the end of the two-week treatment period and 10-day follow-up. The lack of significant difference between the control and experimental groups might have been attributed to our asymptomatic population that lacked measured deficits in flexibility. At the 10-day follow-up the PNF group had significantly greater flexibility compared with ART. This may indicate that ART's effectiveness is dependent on mechanical deformations or tension within the musculoskeletal system not typically found in normal asymptomatic populations. It may also represent PNF's ability to impact contractile functions of the muscle that may not contain mechanical pathologies such as connective tissue changes. The results of this study suggest the need for future comparative trials using symptomatic populations.

This abstract is reproduced with the permission of the publisher.

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