RESEARCH PROPOSAL

EFFECT OF WARM UP AND STRECHING ON HAMSTRING FLEXIBILITY

GUIDE: DR. PROSENJIT PATRA MPT (CARDIOPULMONARY) DOLPHIN INSTITUTE OF BIOMEDICAL & NATURAL SCIENCE MANDUWALA, DEHRADUN (U.K)

STUDENT RESEARCHER: ASHISH TOMAR MPT (SPORTS MEDICINE)

INTRODUCTION

Stretching is the general term used to describe any therapeutic maneuver designed to increase mobility of the soft tissue and subsequently improve range of motion (ROM) by elongating structure that have adaptively shortened and have become hypermobile. Flexibility is the ability to move a single joint or the series of joint smoothly and easily through an unrestricted, pain free ROM.1 In terminology of Moore and Hutton the four basic stretching technique described are ballistic stretching, static stretching,contrct relax stretching and contract relax-agonist contract. The latter two techniques are referred to as method of PNF2 . The ballistic stretch uses bouncing or jerking movements imposed on the muscle to be stretched. The quick, jerking motion that occur during the ballistic stretch can theoretically exceed the extensibility limit of the muscle in an uncontrolled manner and cause injury. The use of the technique therefore has not been widely supported in literature.3 The static stretch is a method in which the muscle is slowly elongated to tolerance (comfortable stretch, short of pains) and the position held with the muscle in this greatest tolerated length. Static stretching offers, advantages over the ballistic stretching method. Exceeding the extensibility limits of the tissue involved is unlikely. Also the technique requires less energy to perform and alleviates muscle soreness. Static stretching position ( standing , seated, supine) did not make a significant difference in the magnitude of range of motion improvement although there is evidence suggesting that pelvic position during standing stretches is important4

Low intensity and long duration stretching approaches may optimize increases in ROM among elderly people due to the amount of connective tissue , increased stiffness, and decreased elasticity that can occur with the ageing process5 The PNF technique of contract relax and hold relax involve the use of brief isometric contraction of the muscle to be stretched prior to a static stretch. PNF stretching was more effective then static or ballistic stretching technique.6,7,8 The PNF techniques presumbly not only require the most expertise of the three techniques described but an experienced therapist is required to administer the PNF technique.3 Gajdosik9 pointed out that along with hamstring, the deep fascia of the lower limb and the soft tissue of pelvic, including neurologic tissue10,11,12 could limit a straight leg raise test. In the same way, these non contractile tissues can come under tension during passive or active movement of hip flexion or knee extension. If the tensions of non-contractile tissue limit indirect measures of hamstring flexibility i.e. straight leg raise or active knee extension test then use of a stretching technique that emphasizes these tissues along with hamstring may be justified.14 Maitland15,16 described a neural tension test (i.e. slump test) in which active knee extension is performed by subjects in a sitting position while maintaining cervical and throcolumbar flexion. This position effectively tension, spinal cord and lumbosacral nerve root. Normal response of limited knee extension and ankle dorsiflexion range of motion occurred in the flexed or slumped posture, but full range was achieved after cervical flexion was released and the head returned to the upright position.17 Rather then shortened hamstring Maitland implicated the loss of movement of the dura mater and nerve root sleeves within the vertebral canal as the cause of limited knee extension and ankle dorsiflexion range of motion during slump maneurer.14 Maitland and Butler describe in detail the slump test sequence and its clinical application in assessment and treatment of spinal dysfunction. Use of active knee extension

movement in a neural slump test posture would appear to effectively tension neural and hamstring tissues.14

REVIEW OF LITERATURE :Kisner corolyn, Colby Lynn1- Theropatic exercise foundation and technique, jaypee,

brother. Defination and Type of stretching. William D Bandy, GeanM Irion3 They have studied the length of time the hamstring

muscles should be placed in sustained stretched position to maximally increase Range of Motion. William G. Webright, Billie Jane Randolph, David H. Perrin (1997)14 -They have

found effectiveness of non-ballistic, repetitive active knee extension movement performed in neural slump sitting position on hamstring flexibility in uninjured subject. Geoffrey D. Maitland16 They studied the normal pain response, predictable finding

on examination and use of the test in treatment.

NEED OF STUDY Comparison of non-ballistic active knee extension in neural slump position and static stretching on hamstring flexibility has not been performed on Indian student population.

PURPOSE OF THE STUDY It is to determine the effectiveness of non-ballistic stretching of hamstring flexibility on student population.

HYPOTHESIS Non-ballistic stretching will produce greater hamstring flexibility as compare to static stretch. NULL HYPOTHESIS No significant difference in increase in hamstring flexibility will be produced by non-ballistic static stretching when compared to static stretch alone.

METHOD:-

Sample size Source of subject

30 D.I.BN.S ; Sayal hostel; Santosh Medical college ; Harcharn Dass Medical college, I.M.A.R

DESIGN Experiment study INCLUSION CRITERIA

The entire subject should be free from disease that expected to effect hamstring length. Subject qualified for the study by having right hamstring inflexibility operationally defined by knee flexion angle greater than 15 as measured by a screening exam using active knee extension in supine with hip flexed 90. Graduate and under-graduate male & female student participated in the study having - Age - Height EXCLUSION CRITERIA - Weight

Individual suffering from any pathology of trunk. Individual having history of hamstring injury. Subject with any neuro muscular disorder. Leg length discrepancy. History of lower limb fracture. Any recent knee pathology.

INSTRUMENTATION Double arm plastic goniometer with full circle protector. A video camera. Weight measure machine. Height measure machine

PROTOCOL:

Based on inclusion and exclusion criteria the subjects are randomly selected and classified into 2 groups. Group-A : Subject will perform Non-ballistic stretch for 1 sec, this was repeated 30 times followed by static stretch for 30 sec after a rest interval of 5 min. Group B : Subject will only perform static stretch for 30 second. PROCEDURE

Active Knee Extension Test13 Subject will wear shorts to allow easy access to the bony landmark. Adhesive tape will be applied to the right lower extremity of each subject in the left side lying at the following landmarks: 5.0 cm distal to the greater trochanter, 5 cm proximal to the lateral femoral condyle, 5.0 cm distal to fibular head and 5.0 cm proximal to the inferior tip of the lateral malleous. Wooden ruler will be used to maintain hip flexion at 90 during active knee extension movement. Prior to each trial movement the Goniometre will be used to repositioned the hip at 90 of flexion. The left lower extremity will rest at 0 of hip flexion. A rolled towel will be placed under the head and neck to support the cervical spine. Subjects will stabilize the right him at 90 of flexion by inter locking the finger of both hand at the distal thigh. Subject will be instructed to actively extend their right knee to limit, keeping the foot relaxed in plantar flexion. The goniometer will be used to measure the degree from full extension. Subject demonstrating a knee flexion angle greater then 15 will be optionally defined as having hamstring in flexibility and allowed to participate in the study.

Each subject performed 4 practice trial and 3 test trials for active knee extension with ankle in relaxed planter flexion with end range knee extension position attained during the last second. A 60 sec rest period will be given after each trial. For Group A : Subject will perform non-ballistic stretch followed by static stretch after rest interval of 5 min everyday for 2 week. For Group B : Subject perform static stretch once daily for 2 week. Static Hamstring Stretch : Static hamstring stretch will be performed on plinth in modified hurdlers position. Subject will flexed forward from the hips, attempting to maintain the spine in neutral position. It will be emphasized to each subject to try and maintain the neutral spine by avoiding cervical flexion and moving only from the hip. Subject will be flexed from the hip until a stretch sensation will be felt in the posterior thigh knee or calf once this position will be achieved the stretch should be sustained for 30 sec. Non-ballistic active stretch : The non-ballistic active stretch will be performed during sitting on a plinth at a height which did not allow foot contact with the floor. With the thigh supported leg flexed and popletial fossa touching the table edge, the subject will sit slump as far as possible, producing full thorco-lumbar flexion. The cervical spine will be then fully flexed. With finger interlocked, the subjects hand will be placed on the posterior aspect of their hand. Overpressure will be provided to the cervical and thoroco lumbar spines by the weight of the relaxed arms. The right foot will be maximally dorsiflexed. The knee was then extended to end range white dorsiflexion should be maintained. End range of knee extension will be operationally defined as the point where firm resistance or stretch will be felt at the posterior thigh, knee or calf. Subject then lower the leg relaxed the foot in planter flexion. This stretch movement sequence will be repeated rhythmically for total of 30 repetitions.

GONIOMETER MEASUREMENT OF KNEE RANGE OF MOTION. Knee Extension Flexion Normal Range of Motion 0 to 135 Position of Goniometer Axis on centered on lateral aspect of knee joint at tibial condyle. Stationary bar on lateral aspect of thigh to parallel longitudinal axis of femur. Moveable bar parallel to longitudinal axis of tibia on lateral aspect of leg. Goniometer reading will taken at the time of screening and at the end of the two weeks for all subject

ASSESSMENT FORM Name Observation Age Gender Address Occupation Medical History observation Past History Examination Active Range of Knee Extension ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................

DATA COLLECTION FORM

Name Age Sex Height / Weight Group

................................................................................ ................................................................................ ................................................................................ ................................................................................ ................................................................................

Variable 1 AROM Using AKE

Pre Intervention 2 3 Average

Post Intervention 2 3 Average

REFERENCES:

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11. Richard B.,Richard G.,Barney F.,Effect of ankle dorsiflexion on active and passive unilateral straight leg raising. Physcial Therapy 65(10)1478-1482, oct 1985 12. J. D. G. Troup,Straight leg raising (SLR) and the qualifying test for increased root tension . Spine 6(5) 527, oct 1981 13. Richard Jagdosik,Gary Lusin,Hamstring muscle tightness ( Reiability of active knee extension test) .Physcial Therapy 63(7)1085-1088 july1983. 14. William G.W.,Billi Jane Randolph,David H. P.,Comparison of non- ballistic active knee extension in neural slump postion and static stretch techniques on hamstring flexibility. Jouranal of Orthopadiec Sports Physical Therapy 26(1)7-12 july 1997 15. G. D. Maitland,Negative disc exploration ; positive cannal signs .Australian Jouranal of Physiotherapy 325(3) 129-134 1979 16. Geoffrey D. Maitland,The slump test ; Examination and treatment Australian Journal of Physiotherapy 31(6) 215-219 1985