Effectiveness and Comparison of Mulligan Techniques in Improving Straight Leg Raise in Subjects with Hamstring Tightness and Comparison of Mulligan in Improving Raise in Subjects with Hamstring

To evaluate the effectiveness of Mulligan bent leg raise technique, 2 legs rotation technique and straight leg raise with traction technique in subjects with hamstring tightness. 64 normal healthy subjects (25 females and 39 males) were recruited in the study under simple randomization method. Purposive nonprobability convenient sampling technique was used to collect the data. Group A received single session of Mulligan bent leg raise technique, Group B received single session of Mulligan two legs rotation technique and group C received single session of Mulligan straight leg raise with traction technique for hamstring tightness. Numeric pain rating scale and straight leg raise range were measured pre intervention and post intervention. Data was analyzed by IBM SPSS 21 using paired t-test and one-way anova. Numeric Pain Rating Scale was significantly reduced in all 3 groups with a p value p< 0.01 and Straight leg raise was significantly improved post single session of intervention with p value p < 0.01. All Mulligan techniques were effective in improving pain score and straight leg raise range of motion but bent leg raise technique was most effective among all. Straight Leg


Introduction
Flexibility is an attribute that enhance optimal physical functioning and is defined as the ability of an individual to move smoothly. Our body has multiple muscle groups, some of them have tendency to get weak and some muscle groups are prone to tightness. Muscle tightness is caused by decrease in flexibility of muscle and is assumed as an intrinsic risk factor for causing muscle injury resulting in reduced range of motion of the respected joint Hamstring is one of the muscle groups that is prone to tightness Hamstring muscles cover the posterior aspect of thigh and consists of semimembranosus, semitendinosus and biceps femoris. Inability to achieve more than 160 degrees range of knee extension with 90 degrees of hip flexion is deliberated as hamstring tightness. Hamstring injuries and strains are common in athletes and are caused by lack of hamstring flexibility. These injuries are slowly recovered and decrease the overall performance or normal individuals as well as athletes [1]. One of the causes of low back pain is hamstring tightness. Recent studies suggest that subjects who perceive their hamstrings to be tight are unlikely to have altered hamstring muscle extensibility or length. Altered neural tissue mobility also referred to as altered neurodynamic could be a significant contributor to "perceived hamstrings tightness".
Conventionally, hamstrings stretching exercises are employed to treat perceived hamstrings tightness. There is a paucity of literature assessing the effectiveness of exercises targeting neural tissue

ARTICLE INFO ABSTRACT
To evaluate the effectiveness of Mulligan bent leg raise technique, 2 legs rotation technique and straight leg raise with traction technique in subjects with hamstring tightness. 64 normal healthy subjects (25 females and 39 males) were recruited in the study under simple randomization method. Purposive nonprobability convenient sampling technique was used to collect the data. Group A received single session of Mulligan bent leg raise technique, Group B received single session of Mulligan two legs rotation technique and group C received single session of Mulligan straight leg raise with traction technique for hamstring tightness. Numeric pain rating scale and straight leg raise range were measured pre intervention and post intervention. Data was analyzed by IBM SPSS 21 using paired t-test and one-way anova. Numeric Pain Rating Scale was significantly reduced in all 3 groups with a p value p< 0.01 and Straight leg raise was significantly improved post single session of intervention with p value p < 0.01. All Mulligan techniques were effective in improving pain score and straight leg raise range of motion but bent leg raise technique was most effective among all. mobility or neurodynamic as opposed to conventional hamstrings stretching exercises [2]. college students with hamstring tightness were recruited in study.
It was observed that hamstring flexibility was increased more with the use of shortwave diathermy in conjunction with prolonged hamstring stretching [4]. PNF technique in 90/90 active stretch showed more improvement in knee range of motion than 90/90 passive techniques. No correlation was observed between hamstring flexibility and initial tightness, exercises frequency per week and age [5]. Emilio J Puentedura et al. conducted a study on immediate effects of quantified hamstring stretching: Hold-relax proprioceptive neuromuscular facilitation versus static stretching. 33 subjects with hamstring shortness were recruited in study. Comparing the effectiveness of HR-PNF and SS techniques showed no significant difference. Both stretching techniques resulted in significant immediate increase in hamstring flexibility [6].

Objective of the Study
To compare and evaluate the effectiveness of Mulligan's bent leg raise technique, two legs rotation and leg raise with traction to improve Straight leg raise in subjects with hamstring tightness.

Materials and Methodology
The study was conducted at Pakistan railway hospital, Informed consent was taken from subjects before data collection and ethical considerations were followed. Data was managed and analyzed statistically by using IBM SPSS software version 21.
Paired t-test was applied within the groups to test whether there was reduction in pain and improvement in ROM, post-intervention.
One-way Anova test was applied to make comparison between groups. Results were displayed in the form of tables. pre-and post-intervention difference. NPRS and SLR were significantly improved within all 3 groups with a p value < 0.05 (Table   2). An analysis of variance showed that NPRS score before technique between groups and within groups was non-significant with a p-value i.e., p>0.05, F (2, 61) = 0.572, p=0.567. NPRS score after technique between groups and within groups was non-significant with a p-value i.e., p> 0.05, F (2, 61) =2.337, p=0.105. (Table 3)  An analysis of variance showed that SLR before technique before technique between groups and within groups was non-significant with a p-value i.e., p> 0.05, F (2, 61) = 0.121, p = 0.886. SLR after technique between groups and within groups was non-significant with a p-value i.e., p> 0.05, F (2, 61) = 0.007, p = 0.993 (Table 3). A turkey posts hoc test revealed that NPRS pre-and post-intervention between groups A, B and C was non-significant with a p value (p > 0.05). A turkey posts hoc test revealed that SLR pre-and postintervention between group A, B and C was non-significant with a p value (p > 0.05) ( Table 4). Range of SLR and hip flexion as compared to pelvic rotation were significantly increased post intervention with a p-value p<0.001.

Results
it was concluded that Mulligan TSLR technique was preliminary evident in reduction of low back pain [10]. It was supported by the observations made in the current study representing SLR was significantly improved in subjects by using Mulligan techniques, post intervention with p-value p<0.01.

Conclusion
It was concluded that all Mulligan techniques were effective in improving pain score and straight leg raise range of motion but bent leg raise technique was most effective among all.