Effect of Active and Positional Release on Hamstring Flexibility in Athletes

NCT ID: NCT07167602

Last Updated: 2025-09-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 74 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-07-01
• Study Completion Date: 2025-08-29

Brief Summary

Hamstring shortening is common in athletes and often causes pain, limited flexibility, and reduced function, which negatively impact performance. Manual therapy techniques such as Active Release Therapy (ART) and Positional Release Therapy (PRT) are frequently used, but their comparative effectiveness remains unclear.

This randomized, single-blinded clinical trial enrolled 74 athletes aged 18-35 years with hamstring shortening at the University of Lahore. Participants were randomly assigned to receive either PRT with conventional physiotherapy (hot pack, TENS, stretching, ankle pumps) or ART with the same physiotherapy protocol. Each group received two supervised sessions per week for four weeks.

The primary outcomes were pain (Numeric Pain Rating Scale), range of motion (Popliteal Angle), and functional ability (Lower Extremity Functional Scale). The Active Knee Extension test was used as a secondary outcome.

This study seeks to determine which manual therapy approach provides greater improvements in pain, flexibility, and function, with the goal of guiding evidence-based rehabilitation for athletes.

Detailed Description

Hamstring shortening, also referred to as short hamstring syndrome, is a frequent condition in athletes and has been linked to pain, reduced range of motion, and functional limitations that affect both sports performance and quality of life. Studies suggest that up to two-thirds of athletes may experience hamstring tightness, often as a result of repetitive strain, muscle imbalance, or inadequate recovery. Addressing this condition is therefore a priority in sports rehabilitation to minimize risk of injury and optimize performance.

Manual therapy is widely used in clinical practice to manage hamstring-related impairments. Among the commonly applied methods, Active Release Therapy (ART) aims to release adhesions and improve soft tissue mobility through tension and guided movements, while Positional Release Therapy (PRT) works by placing the muscle in a position of comfort to promote relaxation and reduce neuromuscular tension. Although both techniques have shown promise individually, limited evidence exists directly comparing their effectiveness in athletes with hamstring shortening.

This single-site, single-blinded randomized controlled trial was conducted at the University of Lahore Teaching Hospital to address this gap. Seventy-four athletes between 18 and 35 years of age were recruited using convenience sampling and randomized to one of two groups. Group A received Positional Release Therapy in addition to conventional physiotherapy, while Group B received Active Release Therapy with the same physiotherapy protocol. Conventional care included hot pack application, transcutaneous electrical nerve stimulation, hamstring stretching, and ankle pumps. Both groups received two sessions per week for four weeks, with outcome measures collected at baseline and post-intervention. The primary outcome measures were pain intensity, hamstring flexibility, and lower limb function, assessed respectively using the Numeric Pain Rating Scale (NPRS), Popliteal Angle test, and Lower Extremity Functional Scale (LEFS). The Active Knee Extension (AKE) test was included as a secondary outcome. The study design incorporated allocation concealment with sealed envelopes, blinding of assessors, and standardized protocols to minimize bias.

By directly comparing PRT and ART, this trial aims to provide evidence to guide clinical decision-making for the management of hamstring shortening in athletes. The results may inform physiotherapists, sports medicine professionals, and rehabilitation specialists about the relative benefits of each technique and support the use of effective, evidence-based interventions to improve pain, flexibility, and function in athletic populations.

Conditions

Hamstring Shortening, Short Hamstring Syndrome

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Positional Release Therapy plus Conventional Physiotherapy

Participants in this group first received conventional physiotherapy consisting of hot pack application (10 minutes), transcutaneous electrical nerve stimulation (15 minutes), passive hamstring stretching, and ankle pumps. After conventional therapy, Positional Release Therapy (PRT) was administered for the medial and lateral hamstrings. PRT involved positioning the muscle in shortened positions of comfort and applying gentle pressure with specific limb movements to facilitate relaxation, reduce neuromuscular tension, and relieve discomfort. Each session lasted approximately 50 minutes (35 minutes conventional therapy + 15 minutes PRT) and was delivered twice weekly for 4 weeks.

Group Type: EXPERIMENTAL

Positional Release Therapy

Intervention Type: BEHAVIORAL

A manual therapy technique applied to the medial and lateral hamstrings after conventional physiotherapy. In PRT, the affected muscle is placed in a position of maximal comfort and relative shortening, while gentle pressure and controlled joint movements are applied. This position is held for approximately 30 seconds and repeated three times per session. The method aims to decrease neuromuscular tension, reduce pain, and promote muscle relaxation through a reflexive response. Distinct from Active Release Therapy, PRT does not involve active contractions or longitudinal tension but instead relies on positioning and relaxation to achieve therapeutic effects.

Conventional Physiotherapy

Intervention Type: OTHER

Hot pack, TENS, hamstring stretching, ankle pumps (common to both groups).

Active Release Therapy plus Conventional Physiotherapy

Participants in this group also received conventional physiotherapy consisting of hot pack application (10 minutes), transcutaneous electrical nerve stimulation (15 minutes), passive hamstring stretching, and ankle pumps. Following conventional care, Active Release Therapy (ART) was administered. ART involved applying longitudinal tension to the hamstring muscles while guiding the limb through specific ranges of motion, combined with brief isometric contractions of the hamstrings and quadriceps. This technique aimed to release adhesions, restore soft tissue mobility, and improve flexibility. Each session lasted approximately 50 minutes (35 minutes conventional therapy + 15 minutes ART) and was delivered twice weekly for 4 weeks.

Group Type: ACTIVE_COMPARATOR

Active Release Therapy

Intervention Type: BEHAVIORAL

A manual therapy technique applied to the hamstrings after conventional physiotherapy. ART combines therapist-applied longitudinal tension with patient movement and brief isometric contractions of both hamstrings and quadriceps. The limb is guided through specific ranges of motion to break down adhesions, restore tissue mobility, and improve flexibility. Unlike Positional Release Therapy, ART is an active technique requiring patient engagement through contractions and controlled movement against resistance, targeting scar tissue and myofascial restrictions.

Conventional Physiotherapy

Intervention Type: OTHER

Hot pack, TENS, hamstring stretching, ankle pumps (common to both groups).

Interventions

Positional Release Therapy

A manual therapy technique applied to the medial and lateral hamstrings after conventional physiotherapy. In PRT, the affected muscle is placed in a position of maximal comfort and relative shortening, while gentle pressure and controlled joint movements are applied. This position is held for approximately 30 seconds and repeated three times per session. The method aims to decrease neuromuscular tension, reduce pain, and promote muscle relaxation through a reflexive response. Distinct from Active Release Therapy, PRT does not involve active contractions or longitudinal tension but instead relies on positioning and relaxation to achieve therapeutic effects.

Intervention Type: BEHAVIORAL

Active Release Therapy

A manual therapy technique applied to the hamstrings after conventional physiotherapy. ART combines therapist-applied longitudinal tension with patient movement and brief isometric contractions of both hamstrings and quadriceps. The limb is guided through specific ranges of motion to break down adhesions, restore tissue mobility, and improve flexibility. Unlike Positional Release Therapy, ART is an active technique requiring patient engagement through contractions and controlled movement against resistance, targeting scar tissue and myofascial restrictions.

Intervention Type: BEHAVIORAL

Conventional Physiotherapy

Hot pack, TENS, hamstring stretching, ankle pumps (common to both groups).

Intervention Type: OTHER

Other Intervention Names

PRT; positional release technique; ART; active release technique

Eligibility Criteria

Inclusion Criteria

• Participants with age between 18 to 35
• Both genders
• Athletes with BMI between 18.5 kg/m² and 29.9 kg/m².
• Basketball, Football And Badminton Players.
• Athletes who practices atleast 3 days per week.
• Participants with Numeric pain rating scale values > 4.
• Participants with unilateral tightness of hamstring muscle with SLR < 80° and AKE < 125°

Exclusion Criteria

• Participants with any acute chronic hamstring strain or lower back pain.
• Participants with leg length discrepancy.
• Participants with a sedentary lifestyle.
• Participants with upper motor neuron or lower motor neuron lesion.
• Participants with any previous history of lower extremity injury in the past three months
• Participants who are not willing to sign the consent

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Lahore

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Muhammad Asim Arif

Role: PRINCIPAL_INVESTIGATOR

University Institute of Physical Therapy, University of Lahore

Locations

University of Lahore - Teaching Hospital, University Institute of Physical Therapy

Lahore, Punjab Province, Pakistan

Countries

Pakistan

Other Identifiers

UOL/I/REB/25/09/0060

Identifier Type: -

Identifier Source: org_study_id