Effects of Dynamic Soft Tissue Mobilization in Reducing Hamstring Tightness in Knee Osteoarthritis

NCT04925895 | Completed

• 1 other identifier: 00003
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

The objective of this randomized control trial is to evaluate the effectiveness of dynamic soft tissue mobilization in comparison with the proprioceptive neuromuscular facilitation (hold-relax) technique in reducing hamstring muscle tightness, pain and improving physical functions in patients with knee osteoarthritis by using Visual Analog Scale-10 cm, Active Knee Extension Angle Test in degree and Knee Injury and Osteoarthritis Outcome Score. This study will be carried out at Sindh Institute of Physical Medicine and Rehabilitation and Dow Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi on the basis of non-probability purposive sample technique with screening for study criteria through a consultant physician (blinded) . After taking informed consent all participants will be randomly allocated into 2 groups i.e. 24 in interventional group 'A' and 24 in interventional group 'B' through second researcher who is not involved in screening, baseline assessment and providing intervention.The interventional group 'A' will received dynamic soft tissue mobilization on hamstring muscle along with cryotherapy on knee joint and isometric strengthening exercises for knee osteoarthritis while the interventional group 'B' will received proprioceptive neuromuscular facilitation (hold relax) technique on hamstring muscle along with cryotherapy on knee joint and isometric strengthening exercises for knee osteoarthritis. Twelve sessions will be given each of 30 minutes.Outcomes will be assessed at baseline and at last session.

Conditions

Knee Osteoarthritis; Muscle Tightness; Range of Motion; Dynamic Stretching

Outcome Measures

Primary Outcomes (2)

• Visual analogue scale in centimetre

  A bidirectional scale for subjective measurement for pain comprises of a 10 cm line labeling parallel on both sides, starts with least "no pain" (0 cm) and end on most "worst pain" (10 cm).

  upto 4 weeks

• Active Knee Extension Angle Test in degree

  It will used to assessing the hamstring muscle length by using goniometry with 90° of hip flexion. higher the degree higher will be the knee extension.

  upto 4 weeks

Secondary Outcomes (1)

• The Knee Injury and Osteoarthritis Outcome Score

  upto 4 weeks

Study Arms (2)

Dynamic soft tissue mobilization

EXPERIMENTAL

Dynamic soft tissue mobilization (DSTM) is a soft tissue mobilization technique use to treat tight spasm using progressive muscle activation.

Other: Dynamic soft tissue mobilization; Other: Cryotherapy; Other: Isometric knee strengthening excercises

Proprioceptive neuromuscular facilitation stretching

ACTIVE COMPARATOR

PNF stretching technique, a type of flexibility training that is effective in improving muscle flexibility and restore functional ranges using a wide array of techniques.

Other: Proprioceptive neuromuscular facilitation stretching; Other: Cryotherapy; Other: Isometric knee strengthening excercises

Interventions

Dynamic soft tissue mobilization OTHER

Dynamic soft tissue mobilization will be given in the following sequence, In supine position with 90˚ flexion of knee and hip joint deep longitudinal strokes will be applied from distal to proximal direction along with the tightened area of hamstring while passively stretching the hamstring. Total 5 longitudinal strokes will be applied followed by shaking for 20 seconds. Then progressed to the next dynamic technique in the above-mentioned sequence but the patient will be asked to do leg extension actively to achieve reciprocal inhibition of the hamstring muscle. In The next step, the subject will apply a force to the therapist's hand to engage the hamstring eccentrically as the muscle will be lengthened to its end range. In that position, the therapist will apply 5 deep longitudinal strokes from the distal towards the proximal direction on tight hamstring muscles.

Also known as: DSTM, dynamic soft tissue technique, soft tissue mobilization

Dynamic soft tissue mobilization

Proprioceptive neuromuscular facilitation stretching OTHER

The position of the patient will be supine lying with 90⁰ flexion of hip. Therapist will passively extend the knee joint where patient will feel a mild stretch. Then therapist will ask the patient to do knee flexion in counter resistance applied by the therapist by using about 50% of his maximum strength and isometric contraction of hamstring muscles will be achieved. Patient will maintain that isometric contraction for 8 seconds then relax on therapist command. Just after relaxation therapist will further stretch the hamstring muscle to the point of mild to moderate painless stretch and patient will hold it for 30 seconds. Three repetitions will be applied in each session.

Also known as: PNF stretchings, PNF exercises, PNF stretching exercise

Proprioceptive neuromuscular facilitation stretching

Cryotherapy OTHER

application of cold pack on knee joint for 10 minutes

Also known as: Cold pack, Icing

Dynamic soft tissue mobilization; Proprioceptive neuromuscular facilitation stretching

Isometric knee strengthening excercises OTHER

i. Isometric hip adductors exercises in crook lying: Two sets of 10 repetitions with a 10-seconds hold will be carried out. ii. Isometric quadriceps strengthening exercises in supine lying: A towel roll underneath the knee joint will be used to perform this exercise. Two sets of 10 repetitions with a 10-seconds hold will be performed.

Also known as: Isometrics, knee strengthening exercises, Isometric quads

Dynamic soft tissue mobilization; Proprioceptive neuromuscular facilitation stretching

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Both genders
• Subjects with 40 years of age and above
• Patients with hamstring tightness
• ACR clinical + radiological classification criteria for knee osteoarthritis

You may not qualify if:

• Patients with positive sciatic nerve test (SLR)
• Patients with neurological disorder impacting on lower extremity
• Musculoskeletal knee deformity e.g. varus
• Patients with lower limb internal fixation
• History of previous lower limb arthroplasty or another knee surgery
• Patients with history of infectious disease or malignancy effecting the lower extremity .
• Using assistive device(stick/cane)
• History of spinal surgery
• Patient having low backache or sciatica

Sponsors & Collaborators

• Dow University of Health Sciences: lead

Study Sites (1)

Dow University of Health Sciences

Karachi, Sindh, 75400, Pakistan

Location

Related Publications (1)

• Nafees K, Baig AAM, Ali SS, Ishaque F. Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial. BMC Musculoskelet Disord. 2023 Jun 2;24(1):447. doi: 10.1186/s12891-023-06571-y.

  PMID: 37268961 DERIVED

MeSH Terms

Conditions

Osteoarthritis, Knee

Interventions

Muscle Stretching Exercises; Cryotherapy; Exercise

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Khadija Nafees, MSAPT

  Dow University of Health Sciences

  PRINCIPAL INVESTIGATOR

• Shahzad Ali Syed, MSPT

  Dow University of Health Sciences

  STUDY CHAIR

• Aftab Ahmed Mirza Baig, MSAPT

  Dow University of Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Other than the principal investigator, another physiotherapist will work as outcomes assessor who will blind to the intervention type given to the patient who will be assessed.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: A single blinded randomized control trial in which total 48 patients will be enrolled and randomly allocated into 2 interventional groups equally. The randomization will be carried out through an open source software "research randomizer" by statistician.

Study Record Dates

• First Submitted: June 8, 2021
• First Posted: June 14, 2021
• Study Start: April 22, 2021
• Primary Completion: January 1, 2022
• Study Completion: January 10, 2022
• Last Updated: February 10, 2022

Record last verified: 2022-01

Locations

PA (1)