International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 3(5), May, 2011

Pages: 31-35

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COMPARISON OF IMMEDIATE EFFECT OF MULLIGAN BENT LEG RAISE TECHNIQUE VS. PASSIVE STRETCHING ON HAMSTRING TIGHTNESS IN HEALTHY FEMALE VOLUNTEERS

Author: Cheraladhan E. Sambandam, Sejal N. Sailor, Tiruttani Ramesh

Category: Healthcare

Abstract:Background & Objective: Maintenance of flexibility is an essential component of any conditioning
program in developing joint mobility, improving athletic performance and preventing injuries. Good
flexibility also provides relaxation, ease muscle pain, helping quick recovery, reducing stress, keeping the
body feeling loose and agile. When soft tissue adaptively shortness overtimes muscle strength can also be
altered and length tension relationship of the muscle also altered. As the muscle shorter it no longer is
capable of introducing peak tension and develops tight weakness. Flexibility in hamstring muscle group is
necessary for the knee extension as well as many functional activities and in prevention of injury in which
the muscle group is elongated over hip and knee simultaneously. The study is aimed to compare the
effectiveness of Mulligan Bent Leg Raise technique and passive stretching on hamstring tightness.
Materials and Method: An experimental study was done to compare the Mulligan Bent Leg Raise
(MBLR) technique and passive stretching on hamstring muscle tightness. The study was conducted in a
physiotherapy college in Vadodara, India and ethical clearance was obtained from Institutional Review
Board. Sixty healthy female volunteers after signing informed consent form within the age of 20 - 30
years with tight hamstring muscles were randomly assigned into two groups. Group-1, Receiving
Mulligan Bent Leg Raise technique and Group-2, receiving passive stretching with knee extension.
Straight Leg Raise was measured with measure tape in centimeters from tip of the heel perpendicular to
the plinth before and immediately after intervention. Paired and independent t-test was used to analyze
data for significant improvement and homogeneity between groups.
Conclusion: This study concludes that there is significant improvement in Straight Leg Raise in both the
techniques but Mulligan Bent Leg Raise Technique is significantly more effective than passive stretching
in healthy females with Hamstring muscles tightness or limited Straight Leg Raise.

Full Text:

BACKGROUND AND OBJECTIVE Maintenance of flexibility is an essential component of any conditioning program in developing joint mobility, improving athletic performance and preventing injuries. Good flexibility also provides relaxation, ease muscle pain, helping quick recovery, reducing stress, keeping the body feeling loose and agile. When soft tissue adaptively shortness overtimes muscle strength can also be altered and length tension relationship of the muscle also altered. As the muscle COMPARISON OF IMMEDIATE EFFECT OF MULLIGAN BENT LEG RAISE TECHNIQUE VS. PASSIVE STRETCHING ON HAMSTRING TIGHTNESS IN HEALTHY FEMALE VOLUNTEERS Cheraladhan E. Sambandam1 , Sejal N. Sailor2 , Tiruttani Ramesh3 1Kashiba Jayashanker Pandya College of Physiotherapy, Sumandeep Vidyapeeth, Vadodara 2 Sri Swaminarayan Physiotherapy College, Surat E-mail of corresponding author: cheranmpt81@gmail.com 32 International Journal of Current Research and Review www.ijcrr.com Vol. 03 issue 05 May 2011 shorter it no longer is capable of introducing peak tension and develops tight weakness. Flexibility in hamstring muscle group is necessary for the knee extension as well as many functional activities and in prevention of injury in which the muscle group is elongated over hip and knee simultaneously.1 James and Karen et al have concluded that an increase in hamstring tightness may induce prolonged forefoot loading and through the windness mechanism be a factor that increases repetitive injury to the plantar fascia.2 Cooney KM., Sanders JO., Concha MC., Buczeh FL., have concluded that available knee extension, defined on the basis of clinical measures of first resistance to hamstring stretch, provides a biomechanical link between physical examination finding and dynamic limitation in terminal swing knee extension.3 Various researches4-9 have been made on different technique for improving hamstring tightness. Mulligan Bent Leg Raise technique being one of the developed technique to train stretch receptor of the muscle spindle to immediate accommodate a greater muscle length. The goal of this technique is to regain and to re-establish normal range of motion of hip and knee joint and mobility of soft tissues around nee joint. The study is aimed to assess the effectiveness of Mulligan Bent Leg Raise technique on hamstring tightness, to assess the effectiveness of passive stretching on hamstring tightness and to compare the effectiveness of Mulligan Bent Leg Raise technique and passive stretching on hamstring tightness.

MATERIALS AND METHOD

An experimental study was done to compare the Mulligan Bent Leg Raise (MBLR) technique and passive stretching on hamstring muscle tightness. The study was conducted in a physiotherapy college in Vadodara, India and ethical clearance was obtained from Institutional Review Board. Sixty healthy female volunteers after signing informed consent form within the age of 20 - 30 years with tight hamstring muscles i.e. subjects with decreased Straight Leg Raise (SLR) test (less than 70 cm) were randomly divided in to two groups thirty each, Group- 1: Receiving Mulligan Bent Leg Raise technique with 3 repetition of pain free five second isometric contraction of the hamstring muscles and Group-2: Receiving passive stretching with knee extension with 3 repetition of 30 second hold for hamstring muscles for both sides, first right side was completed and then the left side. SLR was measured with measure tape in centimeters from tip of the heel perpendicular to the plinth before and immediately after intervention.

Procedure

Mulligan Bent Leg Raise Technique Physical Therapist stands at the side of the subject while the subject is in supine. Firstly stretch the right side and then on the left side. Place subject‘s flexed knee over Physical Therapist‘s shoulder and now ask her to push away with her leg and then relax. At this point push her bent knee up as for as you can in the direction of her shoulder on the same side provided there is no pain. It is painful after the direction by taking her leg more medially or laterally. Sustain for thirty seconds and lower the leg to the bed with the bent knee over your shoulder. After being repeated 3 times you expect a marked improvement when you again to SLR. Place your one hand under her knee and clasp under her heel with other. You flex her hip as for as possible keeping her knee flexed. The heel would now be off the bed. The patient is now asked to push her leg down to the bed against your resistance and then relax. At the point you raise the leg gently as for as you can from the bed maintaining or increasing the knee flexion and introducing some hip-abduction at the same time. There must be no pain if painful after the directions of raised leg medially or laterally or even add some hip rotation. If still painful abandon the technique. As with the knee over your shoulder repeat 3 times and then reassess.10

Technique Used For Passive Stretching With the subject‘s knee fully extended support the patient‘s lower leg with your arm or shoulder. Stabilize the opposite extremity along the anterior aspect of thing with your other hand or a belt or with the assistance of other person. With the knee in maximum extension, flex the hip as for as possible. Alter the position. Kneel on the mat and place the subject‘s heel against your shoulder place both of your hands along the anterior aspects of the distal femur to keep the knee extended. The opposite extremity is stabilized in extension by a belt or lower and held in place by therapist‘s knee.1

 

RESULTS

Table-1 shows the Comparison of SLR value of Mulligan Bent Leg Raise Technique and passive stretching before and after intervention with paired t-test for both sides separately with its p value. In MBLR group for right side SLR value the mean ± SD before intervention is 63.70 ± 4.18 and after intervention is 79.65 ± 3.57, for left side before is 63.90 ± 3.75 and after is 78.70 ± 2.62 with p < 0.001 showing significant reduction in hamstring muscles tightness. In passive stretching group for right side SLR value the mean ± SD before intervention is 63.40±3.48 and after intervention is 72.75 ± 3.71, for left side before is 62.95 ± 3.57 and after is 72.05 ± 3.72 with p < 0.001 showing significant reduction in hamstring muscles tightness. Homogeneity of both groups before intervention was tested by using independent t-test, the p value for right side is equal to 0.807 and left side is 0.418 proves the same between groups. Inter group comparison of after intervention values are also done by using independent t-test which was showing p<0.001 for both sides conforms significant difference between the effect of two group with more changes in MBLR group than passive stretching group (with respect to mean values shown in table- 1) which is shown in Table-2.

 

DISCUSSION

As a pre-treatment procedure thirty subjects satisfying inclusion criteria were selected for the study. Whole treatment procedure was explained to the all subjects. The subjects were divided in to two groups with fifteen in Mulligan Bent Leg Raise technique group and fifteen in Passive Stretching group. Before the treatment SLR was measured with measure tap from tip of the heel to perpendicular to the plinth. The first group was given Mulling Bent Leg Raise technique with 3 repetition of pain free five second isometric contractions of the hamstring muscles. The second group was given Passive Stretching with knee extension with the 3 repetition of 30 second hold of the hamstring muscles. After the treatment again SLR was measured. The 34 International Journal of Current Research and Review www.ijcrr.com Vol. 03 issue 05 May 2011 difference was seen between pre and post measurement. Hall T., Hardt S., Schater A. and Wallin L., (2005) have concluded that this study provides preliminary evidence for efficacy of the Mulligan Bent Leg Raise technique in improving SLR 24 hrs after treatment. Pain also improved but not more so than following the placebo.11 Halbertsma JP, Mulder I, Goeken LN, Eisma WH have said that the acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.12 Teys P., Bisset L. and Vicenzino B, have concluded that the result of Mulligan‘s mobilization with movement technique has an immediate positive effect on both Range of Motion and pain in subjects with painful limitation of shoulder movement.9 Vicenzino B., Paungmali A., Teys P, have said that there are an increasing no. of reports espousing the clinically beneficial effect of Mulligan‘s mobilization with movement techniques. The most frequent report effect is that of an immediate and substantial pain reduction accompanied by improved function. Prompted by these dramatic effects are questions regarding the mechanism of action that undergoes mobilization with movement.13

CONCLUSION

This study concludes that there is significant improvement in Straight Leg Raise in both the techniques but Mulligan Bent Leg Raise Technique is significantly more effective than passive stretching in healthy females with Hamstring muscles tightness or limited Straight Leg Raise.

 

 

 

References:

1. Carolyn Kisner , Lynn Allen Colby : Therapeutic exercise : Foundation and Techniques : 1996; 144, 174 – 175.

2. Harty James, Soffe Karen, O‘toole Gary; Stephens Michael M:The Role Of hamstring tightness in plantar fasciitis. Foot and ankle international. ISSN 1071-1007, 2005, Vol. 26, No. 12. PP 1089-1092.

3. Cooney KM, Sanders JO, Concha MC, Buczek EL: Novel biomechanics demonstrate gait dysfunction due to hamstring tightness. Clin. Biomech. (Bristol, Avon) 2006 Jan: 21 (1) 59 – 66.

4. D. Hopper, S Deacon, S Das, A Jain, D Riddell. Dynamic soft tissue mobilization in increases hamstring flexibility in healthy male Subjects : Curtin University of Technology, shenton park, WA 6008, Australia 2005.

5. Feland JB Marin HN : Effect of Submaximal Contraction intensity in Contract-relax proprioceptive neuromuscular fascilitation stretching; Br. J Sports Med. 2004.

6. Halbertsma JP, Goeken LN, Stretching exercises: effect on passive extensibility and stiffness in short hamstrings of healthy subjects; Arch Phys Med Rehabil. 1994 Sep;75(9):976-81

7. Hall T., Anuar K, Darlow B, Ryder M, Smith T: The effect of Mulligan traction straight Leg Raise in Participants with short hamstrings; Annn, Acad, Med, Singapore 2003 Sep (32).

8. Spernoga SG, ULITL, Arnold BL, Gonsheder BM Duration of maintained hamstring Flexibility after a one time, modified hold-Relax Stretching 35 International Journal of Current Research and Review www.ijcrr.com Vol. 03 issue 05 May 2011 protocol. J Athl Train 2001 Mar. 36(1) 44-48.

9. Teys P. Bisset L, Vicenzino B, The initial effect of a Mulligan‘s mobilization with movement technique on range of movement and pressure pain threshould in pain-limited shoulder; Man. Ther, 2006 Oct; 25.

10. Brain R. Mulligan Manual Therapy: 2005: 70 – 71.

11. Hall T, Hardt S, Schafer A, Wallin L: Mulligan bent leg raise technique –a preliminary randomized trial of immediate effects after a single intervention; Man; Ther. 2006, May: 11(2) 130 – 5.

12. Halbertsma JP, Mulder I, Goeken LN, Eisma WH: Repeated Passive stretching : Acute effect on the passive muscle movement and extensibility of short hamstring Arch. Phys Med, Rehabil 1999 Apr. 80(4) 407 – 14.

13. Vicenzion B, Paungmali A, Teys PMulligan‘s mobilization with movement, positional faults and pain relief current concepts from a critical review of literature Man, Ther. 2006 Sep 5.

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

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A study by Muhas C. et al. entitled \"Study on Knowledge & Awareness About Pharmacovigilance Among Pharmacists in South India\" is awarded Best article for Vol 14 issue 22
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A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
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A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
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A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
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A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
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A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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