Hamstring ShortnessNCT06855303
Muscle Energy Technique and Muscle Flexibility
A study testing Muscle Energy Teqnique using post isometric relaxation (PIR) principle, Muscle Energy Teqnique using receprocal inhibition (RI) principle and Conventional Treatment group in people with Hamstring Shortness, run by University of Hail at 1 site in Saudi Arabia.
Trial summary
The current study will compare the effect of using the muscle energy technique in 2 different methods on the hamstring muscle flexibility Read more about this study
- Who is it for?
- Ages 40 to 60 years
- Conditions the study is for
- Hamstring Shortness
- What is being tested?
- Muscle Energy Teqnique using post isometric relaxation (PIR) principle, Muscle Energy Teqnique using receprocal inhibition (RI) principle and Conventional Treatment group
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- 1 siteSaudi Arabia
- Study dates
- 30 Apr 2025to 15 Sep 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Radiologically and clinically diagnosed cases of Osteoarthritis knee by a certified Orthopaedic surgeon or Physiotherapist. Patients with Grade 2 or 3. Osteoarthritis knee according to Kellgren - Lawrence classification,
- Between the age group of 40-60 years, including both men and women.
- Hamstring tightness of more than 20 from the active knee extension test (AKET)
Who cannot join
- Other knee joint pathologies such as Chondromalacia patella, plica syndrome,
- Neurological disorders.
- Patients having lower extremity injury/surgeries in the past 6 months,
- Hip or knee fractures or deformity,
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparison Between the Effects of Two Different Muscle Energy Techniques on Hamstring Flexibility in Patients With Hamstring Tightness Secondary to Knee Osteoarthritis: Randomized Controlled Trial
The current study will compare the effect of using the muscle energy technique in 2 different methods on the hamstring muscle flexibility
Read the detailed description
Osteoarthritis (OA) is a painful musculoskeletal disease that primarily affects the knee, resulting in the gradual degeneration of articular cartilage. Knee OA commonly affects the elderly population and may cause impairment throughout the world. About 4% of the world's population suffers from osteoarthritis, especially in those who are 50 years of age or older.
Age, trauma, congenital and acquired deformity, metabolic conditions, obesity, muscle weakness or imbalance, an occupation that requires prolonged sitting and knee bending, and female gender are all risk factors linked to the development of Knee OA.
Knee pain, morning stiffness, knee locking, or giving way, crepitus, and functional impairments are the common clinical symptoms of Knee OA.
Initial treatment always begins with conservative modalities and progresses to surgical treatment when conservative treatment fails. There is a variety of conservative techniques available for the treatment of knee OA.
The two main muscles that move the knee joint are the quadriceps and hamstrings, which help the knee joint's ambulatory growth factors move smoothly and precisely.
The hamstring muscles are noted for their tendency to shorten, and knee OA has been linked to decreased hamstring flexibility that can put more strain on the knee joint, reduce range of motion, and walking abnormalities. Furthermore, reduced flexibility can result in patellofemoral syndrome, which can cause pain and restrictions in physical functioning and increase the compressive load on the patellofemoral joint. Patellofemoral syndrome frequently contributes to osteoarthritis.
In general, when muscle is flexible, the body may avoid unnecessary energy expenditure and improve movement accuracy, strength, and coordination to ensure that muscles and joints can move freely. Therefore, increasing hamstring flexibility can aid in relieving symptoms and reducing knee joint pressure in patients with knee OA.
The first-line treatment for all symptomatic knee OA patients includes education and physiotherapy. Among the physiotherapy techniques, muscle energy techniques (MET) like post-isometric relaxation (PIR) and reciprocal inhibition (RI) have become popular due to their efficacy in relaxing and lengthening muscles, reducing pain, and improving overall function in patients with knee OA. Furthermore, MET helps the body drain blood and bodily fluids through the lymphatic or venous pumps, strengthen muscles, and increase the range of motion in joints with limited range of motion.
Numerous studies have demonstrated the benefits of MET in improving function, flexibility, and pain in knee OA patients. For example, MET may be more beneficial than conventional treatments in enhancing knee OA patients' flexibility and functional outcomes, whether used with or without other techniques.
However, few studies have compared the relative effectiveness of various MET approaches in treating knee OA patients' flexibility, pain, and joint mobility problems.
Finally, the majority of research regarding the impact of the MET on hamstring flexibility has brief observation periods involving small samples and low quality, primarily focusing on healthy individuals under the age of 45. Consequently, additional high-quality research should evaluate the efficacy of MET on hamstring flexibility required with larger sample sizes that include older age groups.
Therefore, more research is required to evaluate the impact of different MET on hamstring flexibility in knee OA patients.
- Conditions
- Hamstring Shortness
- Being tested
- Muscle Energy Teqnique using post isometric relaxation (PIR) principle, Muscle Energy Teqnique using receprocal inhibition (RI) principle, Conventional Treatment group
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Muscle Energy Teqnique using post isometric relaxation (PIR) principleOther
The contralateral leg may be either flexed or may lie straight on the plinth. The affected leg will be flexed at both the hip and knee joints, and then slowly straightened by the therapist until the restriction barrier is identified. The limb will be moved a little away from the restriction barrier and the isometric contraction against resistance is introduced. The patients will be asked to resist the movement with no more than 25% of strength. The contraction will be held for 7-10 seconds followed by complete relaxation of the limb. On exhalation, the knee joint will be straightened (extended) towards its new barrier, and through that barrier a stretch will be applied and maintained for 30 seconds. 3 repetitions
Muscle Energy Teqnique using receprocal inhibition (RI) principleOther
The supine patient will ask to fully flex the hip and knee on the affected side. The affected leg will then be slowly straightened by the therapist until the restriction barrier is identified. The calf of the affected leg will then be placed on the practitioner's shoulder that stands facing the head of the table on the side of the affected leg. Then the patient will be asked to attempt to straighten the lower leg utilizing the antagonists to hamstrings, employing approximately 20 percent of the strength of the quadriceps. This will be resisted by the practitioner for 5 to 7 seconds. Appropriate breathing instructions will be given. On exhalation, the knee joint will be straightened (extended) towards its new barrier and through that barrier a stretch will be applied and maintained for 30 seconds. 3 repetitions)four repetition
Conventional Treatment groupOther
This group will receive a 10 minutes application of high-frequency TENS. Hot moist pack: The patient will be made to lay in a supine position with the affected knee in slight flexion A hot moist pack will be applied around the knee for 15 minutes. Ankle pumps, Heel slides, Open chain knee flexion and extension exercises, Straight leg raise, Quad isometrics and Calf stretch. All these exercises were given 10 repetitions x1 set, three days/week
| Study group | Role | What they receive |
|---|---|---|
| group 1 | Experimental | this arm will receive muscle energy technique using the post isometric relaxation principle Receives: Other: Muscle Energy Teqnique using post isometric relaxation (PIR) principle; Other: Conventional Treatment group |
| group 2 | Experimental | this group will recieve muscle energy technique using the receprocal inhibition (RI) principle Receives: Other: Muscle Energy Teqnique using receprocal inhibition (RI) principle; Other: Conventional Treatment group |
| group 3 | Active comparator | This group will receive a 10-minute application of high-frequency TENS. Hot moist pack: The patient will be made to lie in a supine position with the affected knee in slight flexion. A hot moist pack will be applied around the knee for 15 minutes. Ankle pumps, Heel slides, Open chain knee flexion and extension exercises, Straight leg raise, Quad isometrics and Calf stretch. All these exercises were given 10 repetitions x1 set, three days/week. Receives: Other: Conventional Treatment group |
What is being measured
The primary outcome is the main question the study is designed to answer.
The Numeric Pain Rating
The numeric pain rating Scale (NPRS) is the simplest and most commonly used numeric scale to rate the pain from 0 (no pain) to 10 (worst pain). The NPRS will be used for subjective pain measurement that has good test-retest reliability.
Measured: From baseline to the end of the treatment at 6 weeks
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) will be used to measure symptoms and physical disability, originally developed for people with OA of the hip or knee. It evaluates three dimensions: pain, stiffness, and physical function
Measured: From baseline to the end of the treatment at 6 months
Sit and reach test
The Sit and reach test is one of the linear flexibility tests that helps to measure flexibility of the lower back and hamstring muscles.
equipment required: sit and reach box (or alternatively a ruler can be used, and a step or box).
procedure: This test involves sitting on the floor with legs stretched out straight ahead. Shoes should be removed. The soles of the feet are placed flat against the box. Both knees should be locked and pressed flat to the floor - the tester may assist by holding them down. With the palms facing downwards, and the hands on top of each other or side by side, the subject reaches forward along the measuring line as far as possible. After some practice reaches, the subject reaches out and holds that position for at least one to two seconds while the distance is recorded.
Ayala et al. showed acceptable reproducibility measures for the sit and reach test with 8.74% coefficient of variation (CV) and 0.92 intraclass correlation coe
Measured: From baseline to the end of the treatment at 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Mar 2025
- Study start30 Apr 2025
- Primary completion15 Sep 2025
- Study completion15 Sep 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Hamstring ShortnessStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- The study model will include 2 parallel groups of equal number. Each group will receive a different variation of muscle energy technique (MET)
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 50 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Hail
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Hisham Mohamed Hussein, University of Hail
- Investigators
- Hisham M Hussein, PhD, Principal investigator, University of Hail
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06855303
- Sponsor's protocol ID
- H-2025-585
- Status last verified
- Mar 2025
- First submitted
- 25 Feb 2025
- Last updated
- 2 Dec 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: because they will be used in other future studies
Study at a glance
From the registry record, last updated by the sponsor on 2 Dec 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison Between the Effects of Two Different Muscle Energy Techniques on Hamstring Flexibility in Patients With Hamstring Tightness Secondary to Knee Osteoarthritis: Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06855303
- Acronym / sponsor ID
- H-2025-585
- Conditions
- Hamstring Shortness
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 50 participants (actual)
- Lead sponsor
- University of HailUniversity, hospital or other
- Study start
- 30 Apr 2025 (actual)
- Primary completion
- 15 Sep 2025 (actual)
- Study completion
- 15 Sep 2025 (actual)
- First posted
- 3 Mar 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The current study will compare the effect of using the muscle energy technique in 2 different methods on the hamstring muscle flexibility
Detailed description
Osteoarthritis (OA) is a painful musculoskeletal disease that primarily affects the knee, resulting in the gradual degeneration of articular cartilage. Knee OA commonly affects the elderly population and may cause impairment throughout the world. About 4% of the world's population suffers from osteoarthritis, especially in those who are 50 years of age or older.
Age, trauma, congenital and acquired deformity, metabolic conditions, obesity, muscle weakness or imbalance, an occupation that requires prolonged sitting and knee bending, and female gender are all risk factors linked to the development of Knee OA.
Knee pain, morning stiffness, knee locking, or giving way, crepitus, and functional impairments are the common clinical symptoms of Knee OA.
Initial treatment always begins with conservative modalities and progresses to surgical treatment when conservative treatment fails. There is a variety of conservative techniques available for the treatment of knee OA.
The two main muscles that move the knee joint are the quadriceps and hamstrings, which help the knee joint's ambulatory growth factors move smoothly and precisely.
The hamstring muscles are noted for their tendency to shorten, and knee OA has been linked to decreased hamstring flexibility that can put more strain on the knee joint, reduce range of motion, and walking abnormalities. Furthermore, reduced flexibility can result in patellofemoral syndrome, which can cause pain and restrictions in physical functioning and increase the compressive load on the patellofemoral joint. Patellofemoral syndrome frequently contributes to osteoarthritis.
In general, when muscle is flexible, the body may avoid unnecessary energy expenditure and improve movement accuracy, strength, and coordination to ensure that muscles and joints can move freely. Therefore, increasing hamstring flexibility can aid in relieving symptoms and reducing knee joint pressure in patients with knee OA.
The first-line treatment for all symptomatic knee OA patients includes education and physiotherapy. Among the physiotherapy techniques, muscle energy techniques (MET) like post-isometric relaxation (PIR) and reciprocal inhibition (RI) have become popular due to their efficacy in relaxing and lengthening muscles, reducing pain, and improving overall function in patients with knee OA. Furthermore, MET helps the body drain blood and bodily fluids through the lymphatic or venous pumps, strengthen muscles, and increase the range of motion in joints with limited range of motion.
Numerous studies have demonstrated the benefits of MET in improving function, flexibility, and pain in knee OA patients. For example, MET may be more beneficial than conventional treatments in enhancing knee OA patients' flexibility and functional outcomes, whether used with or without other techniques.
However, few studies have compared the relative effectiveness of various MET approaches in treating knee OA patients' flexibility, pain, and joint mobility problems.
Finally, the majority of research regarding the impact of the MET on hamstring flexibility has brief observation periods involving small samples and low quality, primarily focusing on healthy individuals under the age of 45. Consequently, additional high-quality research should evaluate the efficacy of MET on hamstring flexibility required with larger sample sizes that include older age groups.
Therefore, more research is required to evaluate the impact of different MET on hamstring flexibility in knee OA patients.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 3
- Model description
- The study model will include 2 parallel groups of equal number. Each group will receive a different variation of muscle energy technique (MET)
| Arm | Type | Receives |
|---|---|---|
| group 1 | Experimental | Other: Muscle Energy Teqnique using post isometric relaxation (PIR) principle, Other: Conventional Treatment groupthis arm will receive muscle energy technique using the post isometric relaxation principle |
| group 2 | Experimental | Other: Muscle Energy Teqnique using receprocal inhibition (RI) principle, Other: Conventional Treatment groupthis group will recieve muscle energy technique using the receprocal inhibition (RI) principle |
| group 3 | Active comparator | Other: Conventional Treatment groupThis group will receive a 10-minute application of high-frequency TENS. Hot moist pack: The patient will be made to lie in a supine position with the affected knee in slight flexion. A hot moist pack will be applied around the knee for 15 minutes. Ankle pumps, Heel slides, Open chain knee flexion and extension exercises, Straight leg raise, Quad isometrics and Calf stretch. All these exercises were given 10 repetitions x1 set, three days/week. |
Who may qualify
- Ages
- 40 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Radiologically and clinically diagnosed cases of Osteoarthritis knee by a certified Orthopaedic surgeon or Physiotherapist. Patients with Grade 2 or 3. Osteoarthritis knee according to Kellgren - Lawrence classification,
- Between the age group of 40-60 years, including both men and women.
- Hamstring tightness of more than 20 from the active knee extension test (AKET)
Key exclusion criteria (4 listed)
- Other knee joint pathologies such as Chondromalacia patella, plica syndrome,
- Neurological disorders.
- Patients having lower extremity injury/surgeries in the past 6 months,
- Hip or knee fractures or deformity,
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Muscle Energy Teqnique using post isometric relaxation (PIR) principleThe contralateral leg may be either flexed or may lie straight on the plinth. The affected leg will be flexed at both the hip and knee joints, and then slowly straightened by the therapist until the restriction barrier is identified. The limb will be moved a little away from the restriction barrier and the isometric contraction against resistance is introduced. The patients will be asked to resist the movement with no more than 25% of strength. The contraction will be held for 7-10 seconds followed by complete relaxation of the limb. On exhalation, the knee joint will be straightened (extended) towards its new barrier, and through that barrier a stretch will be applied and maintained for 30 seconds. 3 repetitions | Other | group 1 |
| Muscle Energy Teqnique using receprocal inhibition (RI) principleThe supine patient will ask to fully flex the hip and knee on the affected side. The affected leg will then be slowly straightened by the therapist until the restriction barrier is identified. The calf of the affected leg will then be placed on the practitioner's shoulder that stands facing the head of the table on the side of the affected leg. Then the patient will be asked to attempt to straighten the lower leg utilizing the antagonists to hamstrings, employing approximately 20 percent of the strength of the quadriceps. This will be resisted by the practitioner for 5 to 7 seconds. Appropriate breathing instructions will be given. On exhalation, the knee joint will be straightened (extended) towards its new barrier and through that barrier a stretch will be applied and maintained for 30 seconds. 3 repetitions)four repetition | Other | group 2 |
| Conventional Treatment groupThis group will receive a 10 minutes application of high-frequency TENS. Hot moist pack: The patient will be made to lay in a supine position with the affected knee in slight flexion A hot moist pack will be applied around the knee for 15 minutes. Ankle pumps, Heel slides, Open chain knee flexion and extension exercises, Straight leg raise, Quad isometrics and Calf stretch. All these exercises were given 10 repetitions x1 set, three days/week | Other | group 1, group 2, group 3 |
Primary outcome
The Numeric Pain Rating
Time frame: From baseline to the end of the treatment at 6 weeks
The numeric pain rating Scale (NPRS) is the simplest and most commonly used numeric scale to rate the pain from 0 (no pain) to 10 (worst pain). The NPRS will be used for subjective pain measurement that has good test-retest reliability.
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
Time frame: From baseline to the end of the treatment at 6 months
The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) will be used to measure symptoms and physical disability, originally developed for people with OA of the hip or knee. It evaluates three dimensions: pain, stiffness, and physical function
Sit and reach test
Time frame: From baseline to the end of the treatment at 6 weeks
The Sit and reach test is one of the linear flexibility tests that helps to measure flexibility of the lower back and hamstring muscles. equipment required: sit and reach box (or alternatively a ruler can be used, and a step or box). procedure: This test involves sitting on the floor with legs stretched out straight ahead. Shoes should be removed. The soles of the feet are placed flat against the box. Both knees should be locked and pressed flat to the floor - the tester may assist by holding them down. With the palms facing downwards, and the hands on top of each other or side by side, the subject reaches forward along the measuring line as far as possible. After some practice reaches, the subject reaches out and holds that position for at least one to two seconds while the distance is recorded. Ayala et al. showed acceptable reproducibility measures for the sit and reach test with 8.74% coefficient of variation (CV) and 0.92 intraclass correlation coe
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Dec 2025.
- Individual participant dataSharing planned: No. because they will be used in other future studies
Related trials for Hamstring Shortness
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Effect of Specific Versus General Hamstring Stretch on Clinical Outcomes in Patellofemoral Pain Syndrome (PFPS)
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Hisham M Hussein, PhD principal investigator
University of Hail
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Muscle Energy Teqnique using post isometric relaxation (PIR) principle, Muscle Energy Teqnique using receprocal inhibition (RI) principle and Conventional Treatment group in people with Hamstring Shortness, run by University of Hail at 1 site in Saudi Arabia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Saudi Arabia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The Numeric Pain Rating (time frame: From baseline to the end of the treatment at 6 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Dec 2025.