International Journal of Physiotherapy and Research,

Int J Physiother Res 2018, Vol 6(1):2619-22. ISSN 2321-1822

DOI: https://dx.doi.org/10.16965/ijpr.2017.265
Original Research Article
EFFECTIVENESS OF POSITIONAL RELEASE TECHNIQUE VERSUS
ACTIVE RELEASE TECHNIQUE ON HAMSTRINGS TIGHTNESS
Shraddha Kothawale *, Keerthi Rao.
A.P.J Abdul Kalam college of Physiotherapy, Loni , Maharashatra , India.
ABSTRACT
Background: Hamstrings tightness a form of chronic dysfunction, is a sub-clinical problem often missed and
manifests in form of musculoskeletal pain or injuries. Positional Release Technique (PRT) and Active Release
Technique (ART) is a manual therapy technique of osteopathic origin. Its efficacy and effectiveness are under-
researched, with little evidence available to guide the practitioners about the most useful and efficacious
technique to increase the length of shortened muscles. Hence, this study aims at finding out an effective variant
Positional Release Technique and Active Release Technique which has an immediate effect on hamstrings flex-
ibility.
Objectives: The objectives of this study were to find out the effectiveness of Positional Release technique and
Active Release technique on Hamstring Tightness.
Methodology: Sixty participants with hamstrings tightness meeting the inclusion and exclusion criteria were
allocated into four groups: Group A:PRT , Group B:ART , with Twenty nine participants in PRT group and Twenty
Eight in ART Group . Pre intervention and post intervention Active knee extension test (AKE) and Sit to reach test
was measured using universal goniometer and measuring Scale to determine the effectiveness of the technique.
Results: Pre intervention the mean baseline scores of AKE and Sit to reach test for Group A, Group B, when
compared to their post intervention scores showed a highly significant (p<0.01) improvement.
Conclusion: Active Release Technique can be used as an effective physiotherapeutic intervention in reducing
hamstrings tightness instantly.
KEY WORDS: Hamstrings tightness, Positional Release Technique, Active Release Technique, Active Knee Exten-
sion test, Sit to reach test.

Address for correspondence: Dr. Shraddha Kothawale, A.P.J Abdul Kalam college of Physiotherapy,
Loni , Maharashatra , India. E-Mail: [email protected]
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DOI-Prefix: https://dx.doi.org/10.16965/ijpr
Article Information

Received: 20 Dec 2017 Accepted: 15 Jan 2018

Peer Review: 20 Dec 2017 Published (O): 11 Feb 2018
DOI: 10.16965/ijpr.2017.265 Revised: None Published (P): 11 Feb 2018

INTRODUCTION improved sense of well-being, better protection

Physical activity is defined as any bodily move- from injury because strong well developed
ment produced by skeletal muscles that result muscles safeguard bones, internal organs and
in energy expenditure. The energy expenditure joints. Improves cardio respiratory function,
can be measured in kilocalories [1]. Modern according to Buche and Prentice (1985) [1].
Physical Education commonly known as there is Physical activity benefits many parts of the body-
sports where pursuit of discipline freely formed the heart, skeletal muscles, bones, blood (for
such as biological, social and physical sciences. example, cholesterol levels), the immune
The benefits of physical fitness are numerous. system and the nervous system and can reduce
The person who is physically fit has greater many of the risk factors of non-communicable
amount of strength, energy and stamina an disease (NCDs).There is now overwhelming
Int J Physiother Res 2018;6(1):2619-22. ISSN 2321-1822 2619
 Shraddha Kothawale, Keerthi Rao. EFFECTIVENESS OF POSITIONAL RELEASE TECHNIQUE VERSUS ACTIVE RELEASE TECHNIQUE ON HAM-
STRINGS TIGHTNESS.

evidence that regular physical activity has normal texture,tension, and length by using
important and wide ranging health benefits [2]. various hand positions and soft tissue manipu-
Lack of flexibility has been suggested as a lation methods.
predisposing factor to hamstring strains. ART and Positional release technique has been
Decreased hamstring flexibility is suggested to proved separately to be effective in improving
be one of the predisposing factors for hamstring hamstring flexibility in previous studies. But
strains and hamstring stretches are routinely there is limited study done comparing these two
used as part of a pre-exercise routine, usually techniques i.e ART and PRT for the hamstring
after an aerobic warm-up. A wide array of muscle tightness. Hence, the aim of present
stretching techniques exists for reducing work is to study and compare the effectiveness
hamstrings tightness. Almost more than ten of Active release technique and PRT in normal
different stretching techniques are known, healthy subjects with hamstring tightness.
ranging from static stretching, dynamic stretch- MATERIALS AND METHODS
ing, proprioceptive neuromuscular facilitation,
muscle energy techniques, massage, Bowen Under convenience sampling,40 Subjects were
technique, active release technique, myofascial recruited from the A.P.J .Abdul Kalam college of
release and many more. All these techniques Physiotherapy,Loni.The subjects were randomly
differ in their mechanism of action but all aim divided into two groups, Group A (Positional
to reduce muscle tightness [3-5]. release technique) and Group B (Active release
technique) leg raise. All subjects read and signed
The Positional Release Therapy is a type of
an informed consent form approved by the
manual therapy that may be used effectively in
Institutional review board of the University.
treating chronic and sub-acute muscle spasm
and pain and disability that is often associated Inclusion criteria: Asymptomatic female partici-
with it. Positional release techniques are based pants with hamstrings tightness aged
strongly on the work of Dr. Lawrence H.Jones:his 18-30years, and hamstrings tightness measured
work in 1950‘s resulted in publication of Strain by Active knee extension test (AKE) with
and Counterstrain in 1964. Modern Positional popliteal angle less than 700 [8-10].
Release Therapy (PRT) makes use of updated Exclusion criteria: Any history of lower extrem-
positioning and accessory equipment while ity injury in past 3 months, Subjects involving in
preserving the original purpose and strategy of any sports and gymnasium activity, Unwilling to
strain counterstrain [6]. participate and sign in the informed consent,
Study has been done demonstrating that single Acute or chronic hamstrings strain, limb length
session of Active release technique treatment discrepancy and acute or chronic low back pain,
is effective in a group of healthy, active male Upper Motor Neuron lesion and Lower Motor
participants in improving hamstring flexibility. neuron lesion [8].8
Active release techniques (ART) is classified as Outcome measures
a multidisciplinary procedure that is practiced
Active Knee Extension Test (AKE): Sit to Reach
by numerous practitioners from a wide range of
flexibity test were measured pre and post inter-
medical professions and disciplines, including
vention.
Chiropractors, Physiotherapists, Massage
Therapists, Kinesiologists, Occupational Thera- Popliteal angle: With the subject supine on
pists, and Sports physicians [7]. The goals of ART plinth, with the help of goniometer angle is
are to restore optimal tissue texture, tension and measured between thigh and calf.
movement, restore the strength, flexibility, Sit and reach flexibility test: Sit and Reach test
function, and relative translation between soft is a wooden device with the following dimen-
tissue layers, release any soft tissue restrictions, sions: length of base 35cm, width 45cm, height
entrapped nerve, restricted circulatory struc- 32cm and length 55cm. To standardize the mea-
tures, or lymphatic restrictions. ART is used to surement scale of Sit and Reach, a measuring
find the specific tissues that are restricted, stick was placed on the sit and reach box for
physically work on the soft tissues back to their each test, with the reading of 23 cm in line with
Int J Physiother Res 2018;6(1):2619-22. ISSN 2321-1822 2620
 Shraddha Kothawale, Keerthi Rao. EFFECTIVENESS OF POSITIONAL RELEASE TECHNIQUE VERSUS ACTIVE RELEASE TECHNIQUE ON HAM-
STRINGS TIGHTNESS.

the heel position of each test. The participants Table 4: Intra-group comparison of sit to reach test
sat on the bed and fully extended two legs so among the groups.
that the sole of the foot was flat against the Groups N Mean
Standard
T value P value
Deviation
end of the box. They extended their arms for-
Post A 29 15.42 3.531
ward, placing one hand on top of the other. With Intervention B 28 24.53 4.662
-0.82 0.007
palms down, they reached forward sling hands
Test applied: Unpaired t test
along the measuring scale as far as possible
The group treated with Active release technique
without bending the knee of the extended leg.
showed significant improvement in Popliteal
Throughout testing, the physiotherapist checked
angle (p<0.01) and sit and reach flexibility test.
to ensure that the heel remained at the 23 cm
(p<0.01) as compared to Positional Release
mark. Three trials were performed on one side.
Technique Result also showed a significant
The forward reach scores were recorded in cen-
difference within the groups post-intervention.
timeters to the nearest 0.5 cm using the scale
on the box [10]. DISCUSSION
Statistical Analysis: The statistical analysis was The result of the present study demonstrated
done using t-test to compare between the that PRT and ART increases immediate post-
groups and within the group and level of signifi- intervention hamstring flexibility and range of
cance was set up at p < 0.01. motion. Both the groups showed improvement
in Popliteal angle and sit and reach flexibility
RESULTS AND TABLES
measurements. The reduction in spasm is due
Out of these, sixty participants agreed to to PRT which acts on the muscle spindle mecha-
participate in the study. The participants were nism and its associated reflex mechanism
divided into two groups Group A- Positional ( which controls spasm) to promote a more
Release Technique for Twenty nine participants normal firing of the spindle and a more normal
and Group B-Active release technique Twenty level of tension in the muscle, which results in
eight participants. The groups were named as: a more normal relationship within the various
Group A-PRT group, Group B- ART group. soft tissue surrounding the area. PRT technique
Table 1: Baseline demographic and clinical data among works to reduce the hyperactivity of the
groups. myotatic reflex arc and to reduce the overwhelm-
Demographic ing afferent nerve impulses within the arc that
Group A Group B P value
Characteristics may lead to an overflow of neurotransmitter into
Age (years) 20.48 ± 1.29 20.60 ±1.66 0.54 the associated dermatome, resulting in referred
Weight (kg) 56.31±11.49 55.00±9.24 0.63 pain. This phenomenon is known as “facilitated
Height (cm) 159.44±5.62 162.500±7.92 0.09 segment”. PRT sets the stage for normal
2
BMI (kg/m ) 21.959±4.09 20.921±3.88 0.33 processes to occur more efficiently. Reduction
Table 2: Comparison of AKE among the groups. in localized spasm increases range of motion,
Pre Post increases circulation and improves lymph drain-
Group Intervention Intervention t value p value Interference age and increases the potential for more
(degrees) (degrees)
normal biomechanics [6].
Highly
Group A 55.000±8.098 61.207±8.938 11.332 p < 0.0001
significant Heggannavar et al. (2014) suggested that the
Group B 59.179±7.024 66.571±6.636 17.211 p < 0.0001
Highly role of PRT is to relieve the somatic dysfunc-
Significant
tion, which may be expressed as decreased joint
Test applied: Paired t test
play, loss of ROM and postural asymmetry. The
Table 3: Comparison of Sit to reach test among the groups.
muscle has to be held in the position of ease for
Pre Post 90 seconds. During this period, PRT affects prop-
Groups Intervention Intervention T value p value Interference
(degrees) (degrees) rioceptive activity and helps to normalize tone
Group A 15.517±4.469 21.448±3.531 14.609 p < 0.0001
Highly and set the normal length-tension relationship
Significant in the muscle. Thus there is elongation of the
Highly
Group B 15.429±4.717 23.607±4.932 19.947 p < 0.0001
Significant involved muscle fibre to its normal state [11].
Test applied: Paired t test The Active Release Technique group showed
Int J Physiother Res 2018;6(1):2619-22. ISSN 2321-1822 2621
 Shraddha Kothawale, Keerthi Rao. EFFECTIVENESS OF POSITIONAL RELEASE TECHNIQUE VERSUS ACTIVE RELEASE TECHNIQUE ON HAM-
STRINGS TIGHTNESS.

marked improvement in Active Knee extension Vice-Principal, College of Physiotherapy, Loni for
and sit to reach test after five days of interven- her guidance, consistent encouragement,

How to cite this article: Shraddha Kothawale, Keerthi Rao. EFFECTIVENESS OF POSITIONAL RELEASE TECHNIQUE VERSUS ACTIVE RELEASE TECHNIQUE ON HAMSTRINGS
tion. wisdom and patience. My sincere thanks go to
ART unique to other manual therapy. Patient’s Dr. Subhash Khatri, Principal, along with all the
active movement puts the A in ART. Therapists teaching staff for their unconditional support and
use their hands to evaluate the underlying soft motivation throughout the completion of this
tissue. Benefits include breaking up of scar tis- dissertation. I thank all the participants for their
sue. Muscle is able to lengthen which can in- tolerance and co-operation.
crease ROM and strength. Muscle, tendon, liga- Conflicts of interest: None
ments are able to move more freely, which takes REFERENCES
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