Effect of Active and Positional Release on Hamstring Flexibility in Athletes

NCT07167602 | Completed DMC

• 1 other identifier: UOL/I/REB/25/09/0060
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 1

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.

Conditions

Hamstring Shortening, Short Hamstring Syndrome

Keywords

hamstring shortening, short hamstring syndrome, athlete, physiotherapy, manual therapy, active release therapy, positional release therapy

Outcome Measures

Primary Outcomes (3)

• Hamstring flexibility (Popliteal Angle test)

  Hamstring flexibility was assessed with a universal goniometer during the Popliteal Angle test. Participants lay supine with the hip flexed to 90°, and the knee was extended until a stretch was felt. The angle between the thigh and lower leg was recorded; larger angles reflect greater hamstring tightness. This test is widely used to quantify hamstring shortening.

  Baseline and 4 weeks after intervention

• Pain intensity (Numeric Pain Rating Scale, NPRS)

  Pain severity in the posterior thigh was measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 ("no pain") to 10 ("worst imaginable pain"). Participants reported their average pain over the preceding 24 hours. This outcome captures the degree of symptom relief experienced after either Positional Release Therapy or Active Release Therapy.

  Baseline and 4 weeks (end of intervention)

• Lower extremity function (Lower Extremity Functional Scale, LEFS)

  Functional ability was measured using the LEFS, a 20-item patient-reported questionnaire assessing difficulty with daily and sports-related lower limb activities. Each item is scored from 0 ("extreme difficulty or unable to perform") to 4 ("no difficulty"), for a total score range of 0-80. Higher scores indicate better function. The LEFS has high reliability (0.85-0.99) and validity for musculoskeletal conditions.

  Baseline and 4 weeks after intervention

Secondary Outcomes (1)

• Hamstring tightness (Active Knee Extension test, AKE)

  Baseline and 4 weeks after intervention

Study Arms (2)

Positional Release Therapy plus Conventional Physiotherapy

EXPERIMENTAL

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.

Behavioral: Positional Release Therapy; Other: Conventional Physiotherapy

Active Release Therapy plus Conventional Physiotherapy

ACTIVE COMPARATOR

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.

Behavioral: Active Release Therapy; Other: Conventional Physiotherapy

Interventions

Positional Release Therapy 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.

Also known as: PRT, positional release technique

Positional Release Therapy plus Conventional Physiotherapy

Active Release Therapy 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.

Also known as: ART, active release technique

Active Release Therapy plus Conventional Physiotherapy

Conventional Physiotherapy OTHER

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

Active Release Therapy plus Conventional Physiotherapy; Positional Release Therapy plus Conventional Physiotherapy

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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°

You may not qualify if:

• 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

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

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

Lahore, Punjab Province, Pakistan

Location

Study Officials

• Muhammad Asim Arif

  University Institute of Physical Therapy, University of Lahore

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: This was a single-blinded trial. The outcomes assessor was blinded to group allocation and not involved in treatment delivery. Randomization was performed using sealed opaque envelopes, and group assignments were concealed from the assessor throughout data collection to minimize bias.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study used a parallel assignment design in which 74 athletes with hamstring shortening were randomized into two equal groups. Group A received Positional Release Therapy combined with conventional physiotherapy, while Group B received Active Release Therapy combined with the same physiotherapy protocol.

Study Record Dates

• First Submitted: September 4, 2025
• First Posted: September 11, 2025
• Study Start: July 1, 2025
• Primary Completion: August 29, 2025
• Study Completion: August 29, 2025
• Last Updated: September 11, 2025

Record last verified: 2025-09

Locations

PA (1)