OJHAS Vol. 9, Issue 3:
(Jul - Sep, 2010)
of passive stretching versus hold relax technique in flexibility of
Asst. Professor, Sumandeep Vidyapeeth, KJ Pandya College of Physiotherapy, Pipariya, Waghodia Road, Vadodara - 391760, Gujarat, India
Sumandeep Vidyapeeth, KJ Pandya College of Physiotherapy, Pipariya, Waghodia Road, Vadodara - 391760, Gujarat, India.
Address For Correspondence
Asst. Professor, Sumandeep Vidyapeeth,
KJ Pandya College of Physiotherapy,
Pipariya, Waghodia Road,
Vadodara - 391760,
Shankar G, Yogita. Effectiveness
of passive stretching versus hold relax technique in flexibility of
hamstring muscle. Online J Health Allied Scs.
Submitted: Jul 11, 2010;
Sep 9, 2010; Published: Oct 15, 2010
To compare the effectiveness of passive stretching and hold relax technique
in the flexibility of hamstring muscle. Methods:
A total of 80 normal healthy female subjects between age group 20-30
years referred to the department of physiotherapy, Sumandeep Vidyapeeth
University, sampling method being convenient sampling. The subjects
were randomly divided in two groups i.e. passive stretching group (n=40)
and PNF group (n=40) and given passive stretching and proprioceptive
neuromuscular facilitation technique respectively. Active knee extension
range was measured before and after the intervention by goniometer. Results:
t test showed a highly significant (p=0.000) increase in range of motion
in PNF group. Conclusion:
Proprioceptive neuromuscular facilitation technique is more effective
in increasing hamstring flexibility than the passive stretching.
Key Words: Stretching; Flexibility; PNF; Hold-relax; Hamstring
is a key component for prevention of injury and rehabilitation, stretching
decreases injury, improves performance in sports for overall fitness.1
is a therapeutic manoeuvre designed to increase mobility of soft tissue
and subsequently improves range of motion by elongating structures that
have adaptively shortened and have become hypomobile over time.2
neuromuscular facilitation (PNF) is used as inhibition technique to
assist with muscle elongation.
3 Passive stretching and isometric contraction encourage flexibility
or coordinate throughout limbs range of motion. Proprioceptive neuromuscular
facilitation is used to supplement daily stretching and employed to
quick gain in range of motion; decreases fatigue and prevent overuse
hold relax is a technique of facilitating normal muscle sensation and
muscle awareness, used in treating hyper tonicity or motor dysfunction.
It is often applied when there is muscle tightness in one side of joint
and when immobility is the result of pain.5 It is a relaxation
technique to obtain a lengthening reaction of muscle whose action is
antagonist to movement limited in range, it means increasing range of
movement in joints, it is effective, simple and pain free.3
recommendations are clouded by many misconceptions and conflicts, research
reports despite being limited has been promoted for years as an integral
part of fitness programme to decrease risk of injury, relieve pain associated
with sports.6 The specificity of movement that person performs
in regular physical activity and stretching method often define the
development and improves body’s range of motion. Goal of all stretching
programme is to provide joint mobility while maintaining joint stability.7
tightness is a limiting factor for optimal physical performance and
an important intrinsic factor for sports injury.8
is one of the commonest muscles often get tight as the biomechanics
of hamstrings are complex because they pull over two joints - hip and
knee so, their efficacy in producing force at knee is dictated by angle
of hip joint. Greater hamstring force is produced with hip in flexion
when hamstring are lengthened over joint, regardless of knee position.1
Tight hamstrings can have profound effect on seated postural alignment.
Posterior pelvic tilt is primary effect, with resultant kyphotic thoracic
spine and stress on cervical spine either hyper extended or flexed.
If hamstrings are unequally tight, the pelvis will rotate away from
tighter hamstrings. For example; if right hamstrings is tighter, the
pelvis will rotate towards left.9 Reduced hamstring muscles
flexibility has been implicated in lumbar spine dysfunction, with number
of studies showing positive correlation between decreased hamstrings
flexibility and low back pain.10
total of 80 asymptomatic subjects among students community of Sumandeep
Vidyapeeth University, Baroda within 20-30 years of age group were included
in this study who met the inclusion and exclusion criteria.
20 to 30 years
this study, 80 subjects were included within age group 20-30 years who
fulfilled inclusion criteria. Before starting intervention, active knee
extension range in high sitting position with hip in 90 degree flexion
measured through goniometer and again range was measured after completion
of study in same way. Subjects were equally divided in two groups as
Passive Stretching Group which was given passive stretching
Investigator kneel down on the mat and placed patient’s heel or distal
tibia against own shoulder and placed both of hands along the anterior
aspect of distant thigh to keep knee extended, opposite extremity is
stabilized in extension by belt and held in place by therapist’s knee
with in 0 degree extension, hip in neutral rotation and then investigator
flexes the hip as far as possible.
PNF Group which was given Hold Relax technique
Subjects were randomly assigned and modified holds relax stretch performed
with hip in neutral position. For each stretching, investigator gave
passive stretching until the subject reports mild stretching sensation
and hold that position for 7 seconds, next sub maximal isometric
contraction of hamstring muscle for 7 seconds by asking to push her
leg back towards table against resistance of investigator after contraction
relaxation for 5 seconds, investigator then passively stretched the
muscle until the mild stretch sensation was reported the stretch was
hold for 7 seconds, this sequence was repeated 5 times on each subject.
Shows Comparison of Range of Motion (ROM) between Passive Stretching
& Hold Relax Group. (Note: BS = Before Stretching & AS = After
shows intragroup comparison between Group 1 (i.e. Passive Stretching) & Group 2
(i.e. Hold Relax) which clearly depicts that increase in Range of Motion (ROM)
in Group 2.
comparison there is increase in ROM (73.650) after passive
stretching in Group 1 and ROM increased after hold relax (79.320)
than before hold relax (73.050) in Group 2.
current study is a comparative study done with an attempt on increasing
the hamstring length by using 2 different techniques, i.e. passive stretching
and hold relax.
this study, 80 normal female subjects have been taken and randomly divided
into 2 groups. Active knee extension is measured using goniometer before
any physical intervention and at the end of intervention it is measured
study shows highly significant increase in ROM in both groups but this
finding cannot be generalised or converted to clinically significant
data since sample of male population in current study is not included,
while comparing both groups, hold relax is found more effective than
passive stretching (t-value -4.763).
relax has been found to be more effective because the isometric muscle
action completed immediately before the passive stretch which help to
achieve autogenic inhibition - a reflex relaxation that occurs
in muscle where the golgi tendon organ stimulated.
present finding is in accordance with Scott Spernoga et al, who found
that sequence of 5 modified hold relax stretching produced significant
increase in hamstring flexibility.11 On the basis of this
study, modified hold relax protocol has been used and the present study
shows that hold relax increases more range of motion11, this
is consistent with Sharman Malanie who found that proprioceptive
neuromuscular facilitation produces superior ROM.12
current study is not in accordance with Worrell TW et al (1994),
who found that 60 seconds stretching had no improvement in ROM as for
ROM to be maintained, stretching must be continued13 and
Sullivan MK et al., (1992) who concluded that there is no significant
increase in hamstring flexibility with either of stretching technique.14
is another study which shows there is no significant difference in ROM
in standing and supine hamstring stretching as they are equally effective
conducted by “Decoster LC (2004).15
variables are uncontrolled in the study and their influence on the results
is assumed to be null, the result affected by assumption which is different
level of physical activity of subjects. The difference in the force
applied for stretching to the subjects may be confounding
factor in result obtained.
Conclusions and Recommendations
It has been
proved that study of effectiveness of hamstring lengthening there is highly
significant increases in ROM with hold relax as compared to passive stretching,
but further studies with different set of variables and situation are required
to substantiate the current findings.
limitations of the current study were the sample size and female population.
Though the result obtained was very highly significant to generalize
the findings into a clinically useful data the study has to be replicated
in a bigger sample size.
the uncontrolled variables of the current study could be controlled,
the sensitivity and specificity of the findings can be increased. Further
studies should also aim at studying both the genders separately to obtain
a more accurate and generalized results.
- Noble CCB. Flexibility – a major component of physical fitness. Journal
of Physical Education 1980;51-57.
- Kisner C, Colbey LA. Therapeutic Exercise Foundations And
Techniques, Fourth Edition, FA Davis Company 2003. pp 173
- Dena Gardiner M. Principles of Exercise Therapy, Fourth Edition, CBS Publication
- Robert M. Facilitating Stretching. Third Edition 2007. Human Kinetics.
medical dictionary, Ellsevier, Eighth Edition
- Schuback B, Hooper J. A Comparison of self stretching incorporating proprioceptive neuromuscular facilitation components and therapist applied
proprioceptive neuromuscular facilitation technique on hamstring flexibility.
Journal of Physiotherapy. 2004;90:51-57.
- Karvitz L, Heyward VH. Flexibility Training. Journal of Fitness
- Levangie PK, Norkin CC. Joint Structure and Function. Fourth
Edition, FA Davis Company 2005. pp 376
- Portoghese C. Rehabilitation Management. The interdisciplinary Journal
of Rehabilitation. June 2005
- James S, Joshua D. Lengthening the hamstrings muscles without stretching using
‘Awareness through movement’ Journal of physical therapy
- Spernoga SG, Uhl TL. Duration maintained hamstrings flexibility after one time, modified hold relax stretching
protocol. Journal of Athletic Training. 2001;6:44-48.
- Malanie S. Proprioceptive neuromuscular facilitation stretching Mechanism
and clinical implication. Journal of Sports Medicine 2006;36(11):929-939.
TW, Smith TL et al. Effect of hamstring stretching on hamstring muscle
performance. Journal of Orthopaedic Sports 1994;20(3):154-159.
MK, Dejullian JJ et al. Effect of pelvic position and stretching method
on hamstring muscle flexibility. Journal of Medical Science, Sports
LC. Standing and Supine hamstring stretching are equally effective. Journal of Athletic training 2004;39(4);330-334.