Download 5) Bandy WD, Irion JM. The effect of time on static stretch on

Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
Name of the Candidate
SHAH ANISH SUNILBHAI
and Address
SHREE DEVI COLLEGE OF
PHYSIOTHERAPY, MANGALORE
SHREE DEVI COLLEGE OF
2.
Name of the Institution
PHYSIOTHERAPY, BALLALBAGH,
MANGALORE, 5750003
MASTER OF PHYSIOTHERAPY(MPT)
3.
Course of study and
2 YEARS DEGREE COURSE.
subject
(MUSCULOSKELETAL DISORDER AND
SPORTS PHYSIOTHERAPY)
4.
Date of Admission to
20th MAY 2008
Course
5.
Title of the Topic “A COMPARATIVE STUDY BETWEEN THE
EFFECTIVENESS OF ‘STATIC STRETCHING
(ACTIVE)’ AND ‘AWARENESS THROUGH
MOVEMENT’ TECHNIQUE IN IMPROVING THE
FLEXIBILITY OF HAMSTRING MUSCLES IN
ASYMPTOMATIC INDIVIDUALS.”
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6.
Brief resume of the intended work :
6.1 Need for the study
The hamstring group of muscles is situated on the back of the thigh and consist
of three muscles namely the semitendinosus, the semimembranosus, and the long head of
biceps femoris. These muscles act as flexors of the knee and extensors of the hip and are twojoint muscles. The hamstring muscles are important contributors to the control of human
movement and are used in a wide variety of activities from running and jumping to forward
bending during sitting or standing and a range of postural controls.
The term Tightness, a very non-specific term, describes a mild restriction of
motion.1 Flexibility means “ability of a muscle to lengthen, and allowing one joint (or more
than one joint in a series) to move through a Range Of Motion (ROM)”, and loss of muscle
flexibility as “a decrease in the ability of the muscle to deform”, resulting in a decreased ROM
about a joint.2
Tightness in the hamstring muscles may be due to insufficient strength (forcegenerating capacity) impairment or imbalance, or dyssynergic contraction that can place
excessive strain on the hamstring muscles.3 Sitting for long periods, may also result in
tightness of hamstring muscles for, whilst the muscles are lengthened over the posterior hip in
sitting, they are shortened where they cross the posterior knee. Restricted flexibility can be
related to a number of variables, including joint capsule or other soft tissue restrictions. Lack
of hamstring flexibility is the most common cause for muscle strains in atheletes.4 Reduced
hamstring flexibility has been implicated in lumbar spine dysfunction a strong positive
correlation exists between decreased hamstring flexibility and low back pain. Good muscle
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flexibility allows the tissue to accommodate the stress imposed, thereby increasing the
efficiency and effectiveness of movement which in turn helps in preventing or minimizing the
injuries.
A variety of methods like static stretch,5 Propioceptive Neuro-muscular
Facilitation,6 dynamic range of motion,7 active motion in the neural slump position,8
‘Awareness through movement’ technique (ATM),9 etc. have been used to increase the
hamstring muscle flexibility.
Static stretching has been universally accepted as a safer form of stretching. In
this method, the soft tissues are lengthened just past the point of tissue resistance and then held
in the lengthened position for an extended period of time with a sustained stretch force.
“Awareness Through Movement” (ATM) technique is a process of verbally
guiding a person through an activity during which movements are done slowly and
continuously, within a comfortable range of movement, noticing when effort in other areas of
the body interfered with these specific movement intentions and trying to reduce those efforts
and breathe easily through the entire process.
Several studies have been done on Static stretching and “Awareness Through
Movement (ATM)” technique for improving flexibility of hamstring muscles. So the purpose
of the study is to compare the effectiveness of Static stretching and “Awareness Through
Movement (ATM)” technique on increasing the hamstring flexibility in asymptomatic
individuals as measured by knee extension range of motion with Universal Goniometer.
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Research Question
Whether there is a significant difference after administration of Static
stretching(active) and “Awareness Through Movement” (ATM) technique on flexibility of
hamstring muscles.
Null hypothesis
There will be no difference in flexibility of hamstring muscles after
administration of Static stretch(active) and “Awareness Through Movement” (ATM)
technique.
Alternate hypothesis
There will be a significant difference in flexibility of hamstring muscles after
administration of Static stretch(active) and “Awareness Through Movement”(ATM)
technique.
6.2 Review of literature
The results of one of the literature revealed that stretching exercises can
benefit athletes and social exercisers in numerous ways, including improving flexibility,
reducing the incidence of injury and enhancing the athletic performance.10 Stretching regimen
significantly increased flexibility and decreased the incidence of lower extremity injuries in a
group of military basic trainees as compared with a control group.11 Further the result of one
of the study shows that using a slow, static stretch of the hamstrings muscles for 15 seconds
and holding the stretch for 15 seconds caused increase in the Range Of Motion(ROM) of the
hamstring muscles, as measured by straight leg raising.12 A study was done on the effect of
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time and frequency of Static stretching on the flexibility of hamstring muscles states that 30
seconds duration of stretch is an effective amount of time to sustain a hamstring muscle stretch
in order to increase the range of motion.13 One of the study comparing the effectiveness of
static, ballistic, and PNF stretch states that static stretch has the least associated injury and is
the safest and most frequently used method of stretching.14 A comparative study of static,
dynamic, and PNF stretching techniques on the flexibility of hamstring muscles indicated that
all the three methods produced significant improvements in hamstrings flexibility.15
A study shows that “Awareness Through Movement”(ATM) technique
improves balance and coordination in people with multiple sclerosis.16 Further the result of one
of the study revealed that ATM technique improves balance and mobility in people with
chronic cardiovascular accident.17 Researchers in Australia found no effect of ATM technique
on hamstring muscle flexibility.12,13 Also, one of the study stated that ATM technique can be
used to lengthen the hamstring muscles.9 The findings of one of the study indicated that the
ATM intervention was not effective in increasing hamstring length when compared with
relaxation procedures or no treatment.18
The ‘Active Knee Extension Test’(AKET) is an objective and reliable tool for
measuring the hamstring muscle tightness.19
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6.3 Objectives of the study
1) To know the effectiveness of Static stretching(active), in improving hamstring
muscle flexibility.
2) To know the effectiveness of “Awareness Through Movement”(ATM) technique in
improving hamstring muscle flexibility.
3) To compare the effectiveness amongst the two groups of people which were given the
above mentioned therapies.
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MAT
7.
Materials and methods :
7.1 Source of data
1) Shree Devi Education Trust Colleges.
7.2 Method of collection of data
60 volunteers with asymptomatic hamstring muscle tightness between age group between
18-30 years will be randomly assigned into two groups.
Group A : Consists of 30 individuals to whom Static stretch(active) of the hamstring
muscles will be given for 5 days a week for 3 weeks.
Group B : Consists of 30 individuals to whom “Awareness through Movement(ATM)”
technique will be given to the hamstring muscles for 5 days a week for 3 weeks.
Inclusion Criteria:
1) Age group of individual should be 18-30 years.
2) Both sexes are included in the study.
3) Asymptomatic individuals with hamstring muscle tightness.
4) The subjects must not have an active knee extension angle greater than 150
degrees(full extension=180 degrees) as measured by Active Knee Extension Test.
Exclusion criteria:
1) Subjects having a history of orthopedic problems, surgery, or injury to the back, pelvis
or lower extremities, or history of hamstring injury.
2) Subjects having neurologic dysfunction. (eg. multiple sclerosis, cerebral palsy, or
peripheral neuropathy)
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3) Subjects having an active knee extension angle greater than 150 degrees(full
extension=180 degrees) as measured by Active Knee Extension Test.
Study Design:
Comparative cohort study.
Sampling:
Block random sampling.
Statistical Test:
1) Paired t-test
2) Unpaired t test.
3) One way ANOVA test.
4) Post hoc test.
Outcome Measure:
1) Active knee extension range of motion (AROM) with hips flexed at 90 degrees as
measured with a Universal Goniometer-360 degrees.
METHODOLOGY:
The techniques used will be explained to the subjects and all the subjects will have
to sign an institution approved informed consent prior to participation in the study. The
subjects will be screened and assessed on the day one. The above mentioned outcome measure
will be evaluated and reported before giving treatment. The subjects of Group A will be
administered Static stretching(active) for a period of 3 weeks. The subjects of Group B will
administered “Awareness Through Movement(ATM)” technique for a period of 3 weeks.
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Static stretching(active) for subjects belonging to group A:
The subject faces the table with their hips square, maintained erect torso, with
their arms on their hips, looks straight ahead, and flex forward at the waist until a hamstring
stretch is perceived. The stretching regimen will be performed 3 times, for 30 seconds each,
with a rest period for 15 seconds.
“ Awareness Through Movement” technique for persons belonging to Group B:
The movement segment will began with the subjects in the long sitting
position. The subjects will have to perform the extension of the knee, internal rotation of the
hip, and anterior tilt of the pelvis; all at the same time and vice versa, an organization of
movements designed to lengthen the hamstring muscles from both ends. These movements
will be done slowly and continuously, with the subjects resting when tired, and not to push
into the end-range of knee extension. The session lasts for 30 minutes where the ratio of
movement to rest will be 2:1.
TOOLS:
Universal Goniometer (360 degrees).
7.3 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly.
Yes.
Subjects receive Static stretching and ATM technique.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes.
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8.
List of References:
1) Carolyn Kisner and Lynn Allen Colby. Therapeutic Exercise: Foundations and
Techniques, Stretching (pg. no. 171-215), Fourth Edition, Jaypee Publishers, New
Delhi, 2002.
2) Zachezewski JE. Improving flexibility, In: Scully RM, Barnes MR, eds. Phys Ther.
Philadelphia, Pa: JB Lippincott Co; 1989; 698-699
3) Agre JC. Hamstring injuries: proposed etiological factors, prevention, and treatment.
Sports Med. 1985; 2: 21-33.
4) Kujala UM, Orava S, Jarvinen M: Hamstring injuries: Current trends in treatment and
prevention. Sports Med. 1997; 23: 397-404.
5) Bandy WD, Irion JM. The effect of time on static stretch on the flexibility of the
hamstring muscle. Phys Ther. 1994; 74: 845-850.
6) Sullivan MK, Dejulia JJ, Worrel TW. Effect of pelvic position and stretching method
on hamstring muscle flexibility. Med Sci Sports Exer. 1992; 24: 1383-1389.
7) Bandy WD, Irion JM, Briggler M. The effect of static stretch and dynamic range of
motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther.
1998; 27:295-300.
8) Webright W, Randolph B, Perrin D. Comparison of non-ballistic active knee extension
in neural slump position and static stretch techniques on hamstring flexibility. J Orthop
Phys Ther. 1997; 26: 7-12.
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9) James Stephens, Joshua Davidson, Joseph De Rosa et al. Lengthening the hamstring
muscles without tretching using “Awareness Through Movement”. Phys Ther, 2006;
vol 86.
10) Smith CA. The warm-up procedure, to stretch or not to stretch: a brief review. J
Orthop Sports Phys Ther. 1994; 19: 12-17.
11) Hartig, DE, Henderson JM. Increasing hamstring flexibility decreases lower extremity
overuse injuries in military basic trainees. Am J Sports Med. 1999; 27: 173-176.
12) Gajdosik RL. Effects of static stretching on the maximal length and resistance to
passive stretch of short hamstring muscles. J Orthop Phys Ther. 1991; 14: 250-255.
13) Bandy WD. and Irion JM: The effect of time and frequency of static stretch on
flexibility of the hamstring muscles . Phys Ther. 1997; 77: 1090-1096.
14) Smith L.L., Brunetz M.H, Chenair T.C. et al, The effects of static and ballistic
stretching on delayed onset muscle soreness. Research Quarterly, 1993; 64(1): 103107.
15) Lucas KE, Nuzik S, Personius W et al. Low load prolonged stretch vs high load brief
stretch in treating knee contractures. Phys Ther. 1984; 64: 330.
16) Stephens J, DuShuttle D, Hatcher C, et al. use of Awareness Through Movement
improves balance and balance confidence n people with multiple sclerosis: a
randomized controlled study. Neurology Report. 2001; 25: 39-49.
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17) Baton G. Deutsch JE. Effects of Feldenkrais Awareness Through Movement On
balance in adults with chronic neurological deficits following stroke: a preliminary
study. Complementary Health Practice Review. 2005: 10: 203-210.
18) Michelle James, Gregory Kolt, Janet McConville et al. The effect of a Feldenkrais
program and relaxation procedures on hamstring length. Austr Phys. 1998:vol 44: no 1.
19) Gajdosik , Ri Lusin, G. Hamstring muscle tightness: reliability of an active kneeextension test. Phys Ther. 1983; 63: 1085-1090.
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9.
Signature of the Candidate
10.
Remark of the Guide
11.
Name and Designation of
Prof. S. PADMAKUMAR
(In Block Letters)
PRINCIPAL,
11.1 Guide
SHREE DEVI COLLEGE OF
PHYSIOTHERAPY, MANGALORE-03.
11.2 Signature
11.3 Co-guide
11.4 Signature
11.5 Head of Department
Prof. S. PADMAKUMAR
11.6 Signature
PRINCIPAL,
SHREE DEVI COLLEGE OF
PHYSIOTHERAPY, MANGALORE-03.
12.
12.1 Remark of the
Chairman And Principal
12.2 Signature
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