Effects of Neurodynamic Sliding Versus Eccentric Training on Lower Extremity Function, Strength and Proprioception in Athletes with Short Hamstring Syndrome.

NCT06748560 | Completed

• 1 other identifier: MOHAMMADYEDITEPESPORTTHESIS
• Study Type: interventional
• Target: 54
• Locations: 1 country
• Sites: 1

Brief Summary

Hamstring strains are among the most common injuries in field sports, accounting for 10% of all team sports injuries and often leading to long-term absence from activities. Risk factors include older age, previous injuries, reduced flexibility, and strength deficits. The hamstrings play a critical role in dynamic stability and joint preservation, particularly for the hip and knee. While stretching is crucial for injury prevention, there is debate over optimal techniques. The neurodynamic sliding technique (NST) and eccentric training (ET) are two methods that can improve flexibility and reduce injury risk. This study uniquely combines ET with NST to address hamstring tightness in athletes, aiming to evaluate their effects individually and in combination on knee muscle strength, range of motion, proprioception, and lower limb function compared to a control group. The hypotheses examine whether these interventions differ in their impact on eccentric and concentric knee strength, the knee flexor/extensor strength ratio, range of motion, proprioception, and dynamic balance (measured via the Y Balance Test). The null hypothesis (H0) proposes no differences, while the alternative hypothesis (H1) suggests significant differences among the intervention methods.

Conditions

Hamstring Tightness; Hamstring Injury Prevention

Keywords

Hamstring; Tightness; Neurodynamics; Eccentric exercise

Outcome Measures

Primary Outcomes (1)

• Passive Straight Leg Raise (SLR) test

  To measure passive hamstring flexibility, participants will lie supine on a bed with their pelvis and opposite thigh secured using straps to prevent compensatory movements. A goniometer will be positioned with its axis at the greater trochanter of the femur, the fixed arm aligned with the midaxillary line, and the moving arm along the lateral malleolus. With the knee extended and the ankle in a neutral position to avoid calf muscle stiffness, the thigh is gently flexed until hamstring tightness is felt. The straight leg's elevation angle will be measured three times, and the average will determine hamstring flexibility. Individuals with an angle less than 75° are classified as having short hamstring muscles.

  1-2 minutes

Secondary Outcomes (3)

• Knee muscle strength

  10 minutes

• Knee joint proprioception

  10 minutes

• Y balance test

  15 minutes

Study Arms (4)

Eccentric training

ACTIVE COMPARATOR

The group is consist of 13 participants who did the following treatment protocol: The Nordic exercise served as the foundation for the intervention, focusing on eccentric loading as participants resisted falling forward. To minimize DOMS and ensure adherence, a two-week preparatory phase of mixed concentric/eccentric leg curls using a stability ball was implemented. Following this, the gradual progression outlined by Mjolsnes et al. led to a four-week Nordic hamstring curl regimen. Weekly supervision ensured proper technique and compliance throughout the program.

Other: Eccentric training

Neurodynamic sliding technique

ACTIVE COMPARATOR

The group is consist of 14 participants who did the following treatment protocol: The neurodynamic sliding technique (NST) was applied to the dominant leg's sciatic nerve in the NST and ETNST groups. The technique involves alternating stress proximally and distally to promote nerve sliding. Participants performed two sets of movements-cervical flexion with knee and ankle flexion, and cervical extension with knee and ankle extension-repeated actively for 60 seconds, five times per session. Over six weeks, both groups underwent three supervised sessions per week led by an experienced researcher.

Other: Neurodynamics

Eccentric training and neurodynamic sliding technique

EXPERIMENTAL

The group consist of 13 participants who did the following treatment protocol: They underwent a combined treatment incorporating both eccentric training (ET) and the neurodynamic sliding technique (NST). Participants followed the graduated Nordic hamstring exercise protocol for eccentric strengthening, alongside the nerve-sliding movements targeting the sciatic nerve. This combined approach aimed to optimize muscle flexibility, strength, and neural mobility. The interventions were performed over six weeks, with three supervised sessions per week to ensure proper execution and adherence.

Other: Neurodynamics; Other: Eccentric training

Control

NO INTERVENTION

Interventions

Neurodynamics OTHER

Following Castellote-Caballero et al., the neurodynamic sliding technique (NST) was applied to the dominant leg's sciatic nerve in the NST and ETNST groups. The technique involves alternating stress proximally and distally to promote nerve sliding. Participants performed two sets of movements-cervical flexion with knee and ankle flexion, and cervical extension with knee and ankle extension-repeated actively for 60 seconds, five times per session. Over six weeks, both groups underwent three supervised sessions per week led by an experienced researcher.

Eccentric training and neurodynamic sliding technique; Neurodynamic sliding technique

Eccentric training OTHER

The Nordic exercise served as the foundation for the intervention, focusing on eccentric loading as participants resisted falling forward. To minimize DOMS and ensure adherence, a two-week preparatory phase of mixed concentric/eccentric leg curls using a stability ball was implemented. Following this, the gradual progression outlined by Mjolsnes et al. led to a four-week Nordic hamstring curl regimen. Weekly supervision ensured proper technique and compliance throughout the program.

Eccentric training; Eccentric training and neurodynamic sliding technique

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: male
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age between 18-30 years old
• Have a normal body mass index (BMI)
• Have hamstring tightness as indicated by the results of an SLR examination of less than 75o (39).
• Have hamstring tightness as indicated Active Knee Extension Test (AKET) was used to evaluate hamstring shortness. Individuals with AKET angles less than 150 degrees were considered as samples (146).
• Ability to perform exercises.
• Don't having plates (implants) in the lower limbs.
• Not having a history of fracture in the lower limb (with or without realignment process).
• Not having history of surgery to repair joint capsules, ligaments, muscles, and nerves,
• A history of or experiencing Hernia Nucleus Pulposus (HNP).

You may not qualify if:

• Receiving physical therapy or other conventional therapy in the past 6 months.
• Absence in one of the pre- or post-test sessions.
• Absence of more than two sessions in practice sessions.

Sponsors & Collaborators

• Yeditepe University: lead

Study Sites (1)

Yeditepe university

Istanbul, Ataşehir, Turkey (Türkiye)

Location

Study Officials

• Elif Tuğçe ÇİL, Assistant Prof. Dr.

  Physiotherapy and Rehabilitation department, Yeditepe University, istanbul, Turkey

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Prof. Dr.

Study Record Dates

• First Submitted: December 3, 2024
• First Posted: December 27, 2024
• Study Start: August 4, 2023
• Primary Completion: December 1, 2023
• Study Completion: October 1, 2024
• Last Updated: December 27, 2024

Record last verified: 2024-12

Locations

TU (1)