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Year : 2022  |  Volume : 49  |  Issue : 2  |  Page : 148-151

Effects of muscle energy technique and proprioceptive neuromuscular facilitation stretch technique on hamstring muscle flexibility in recreational athletes

Department of Musculoskeletal and Sports Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India

Date of Submission09-Feb-2022
Date of Acceptance05-Jul-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
S Sudhakar
Krupanidhi College of Physiotherapy, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jss.jss_24_22

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Introduction: The most common muscle injury in sports is the hamstring muscle. It needs long rehabilitation and has a great possibility of recurrence as it has a great tendency to shorten. Stretching is the treatment used to improve muscular flexibility, thereby increasing range of motion, and the study prevents sports injuries and athletic performance. Aim of Study: The aim of this study is to compare the efficacy of muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) stretch technique on the flexibility of the hamstring among recreational athletes. Materials and Methods: Thirty healthy recreational athletes were divided into two groups MET and PNF for 4 weeks – 5 sessions/week. Outcome Measures: The Modified Back Saver's Sit and Reach Test was the outcome measure. Statistical Tool: The Student t-test was used for statistical analysis. Conclusion: There was a significant difference seen in the PNF stretch technique and hamstring flexibility with the use of the MET.

Keywords: Active knee extension test, flexibility, hamstring, Modified Back Saver's Sit and Reach Test, muscle energy technique, proprioceptive neuromuscular facilitation stretching

How to cite this article:
Dinesh D, Sudhakar S. Effects of muscle energy technique and proprioceptive neuromuscular facilitation stretch technique on hamstring muscle flexibility in recreational athletes. J Sci Soc 2022;49:148-51

How to cite this URL:
Dinesh D, Sudhakar S. Effects of muscle energy technique and proprioceptive neuromuscular facilitation stretch technique on hamstring muscle flexibility in recreational athletes. J Sci Soc [serial online] 2022 [cited 2022 Dec 1];49:148-51. Available from: https://www.jscisociety.com/text.asp?2022/49/2/148/354267

  Introduction Top

Extensibility is a mechanism of altered flexibility.[1] Muscle's potential to elongate and favor the series joint movement is termed flexibility.[2] A tight hamstring is identified when knee extension at 20°–0° with 90° hip flexion is not attained.[3] Reduced flexibility reduces the range of motion (ROM) of the knee, causes postural deviations, and also affects the gait pattern of the individual. It is one of the leading factors for muscle strain injury.[4] Hamstrings tend to undergo tightness even among young, healthy individuals and in recreational athletes. This makes them prone to muscle tears.[5],[6]

Muscle energy technique (MET) is the technique applied by a manual method and has been proved to be effective for lengthening a tightened muscle or contracture, enhancing joint range while accelerating the drainage of lymphatic fluid or blood by stretching the muscle.[4] The investigation supporting and approving utilization of MET is restricted, and proof to help the hypotheses used to clarify its effects is also limited.[1] Proprioceptive neuromuscular facilitation (PNF) is proved as an effective way to improve the elasticity of the muscle and improve the ROM.[7] It is based on Contract -Relax concept which enhances the facilitation and elongation of the muscle group.[8] PNF stretching comprises elongation and shortening of a focused muscle group. In the hold-relax technique which is a part of PNF, stretching and static compression are the safest way via autogenic inhibition which is delivered by utilizing isometric contraction.

Ahmed conducted a study that compares the effects of MET and dynamic extending on hamstrings adaptability in adults and concluded that better improvement was seen in MET as compared to dynamic stretching.[9] These techniques are simple and easy to apply on subjects with a lack of muscle flexibility. Vamsidhar et al. in their study showed that hold-relax technique paved better flexibility in the hamstring.[10]

Muscular tightness is the major cause of reduced joint ROM. Hence, the need arises to find out an effective technique that reduces hamstrings tightness, increases its flexibility, and combats the proportion of injury to the muscle. Compare the effects of MET and PNF extending on hamstring adaptability among recreational competitors remain the fundamental motivation behind the examination.

  Materials and Methods Top


The study was a pretest and posttest comparative experimental study conducted in Krupanidhi College of Physiotherapy, Bangalore. Thirty students were taken for the investigation. Male and female recreational athletes (nonprofessional, collegiate, and university-level competitive athletes) with an age group ranging from 17 to 25 years having bilateral hamstring tightness (lack of ability to reach knee extension of 20° to 0° with hip flexion of 90°) were taken for the study[3] and divided into two groups called Group A and Group B, each group having 15 students. After taking consent, Group A received MET and Group B received PNF. Subjects have a history of musculoskeletal injury, any injury to the hamstring muscle, and recent fracture pathology of the pelvis, hip, and knee, and surgeries of the lower limb in the last 6 months were set aside.


The experimental procedure is given as a flowchart in [Figure 1].
Figure 1: Flowchart of the experimental procedure

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Active knee extension test

The subject was made to lie down in supine position and had to extend his/her knee actively till a firm resistance was felt by themselves. Goniometer focused on the femur at the point of the lateral epicondyle. The measurements of both legs were recorded. [Figure 2] shows the representative picture for 65 measurements of active knee extension ROM.
Figure 2: Measurement of active knee extension ROM. ROM = Range of motion

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Muscle energy technique

MET was involved using postisometric relaxation. The subject was made to lie down in supine lying and his hips were flexed passively and his legs reached out. This was done till pressure was felt by the therapist and a stretch was reported by the subject. An isometric contraction of knee flexor muscles was performed by the subject by squeezing the lower extremity against the highest point of the therapist's shoulder. The intensity of this contraction should be approximately 50% of the maximal contraction. This contraction is maintained for 7–10 s. Following this, 2–3 s of relaxation was given and then the lower limb was stretched by the therapist passively to a limit of palpable hindrance or a resistance to further extension establishing for 30 s, followed by bringing the lower limb down and relaxed for approximately 10 s. Two more times this procedure was repeated.[9] MET was applied three sessions per week for 2 weeks.

Proprioceptive neuromuscular facilitation stretch technique

PNF stretching technique was applied using the hold-relax technique. The subject was flat on the back with 90° hip flexion. The expert should expand the participant's knee joint until a sensitive widening sense by a participant in hamstring muscles. Knee flexion against the obstruction applied by the hand of the therapist was involved. Power from a participant over half the ultimate quality and isometric type of constriction was picked up in the hamstring muscles. A player is instructed to release the hamstring after holding it in Isometric Contraction for eight seconds. After the muscular relaxation, that the specialist slightly stretched the hamstring muscle where the Player feels smooth to delicate expansion as they go through their range of motion. In every session, this same procedure is repeated three times. PNF stretching was followed for three sessions per week and a total of 2 weeks. In between two sessions, 1-day rest is must.[11]

Modified Back Saver's Sit and Reach Test

FITNESSGRAM analysis guide was involved. The trial was controlled utilizing the Lafayette elasticity analyzer (SR box). The member sat at the Sit and Reach Box and completely expanded a single leg to complete the goal. The patient then bowed another leg to ensure that the pad's base was level. It is approximately 7 to 10 cm away from the straight leg. With the all-encompassing leg as a baseline as expected under the circumstances, hands-on one another, and palms falling, the members gradually came to advance, gliding the first along with the case range very long. The therapist recorded the average of the trails of three on two legs.[12] [Figure 3] shows the representational image of the Modified Back Saver's Sit and Reach Test (BSSRT).
Figure 3: Modified Back Saver's Sit and Reach Test

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  Results Top

On comparing the mean values of both the groups on BSSRT, huge increments reflected in posttest. As a result, Group A (MET) has the most extreme mean value (32.13) and is more efficient than Group B (PNF stretching) (26.60). Subsequently, the null hypothesis was dismissed. The mean values of pretest and posttest within Group A and Group B on BSSRT indicated profoundly noteworthy distinction at P ≤ 0.001. The correlation of BSSRT within Group A and Group B in pretest and posttest is given in [Table 1].
Table 1: Correlation of BSSRT within Group A and Group B in pretest and posttest

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Analysis reveals that there is no statistically significant difference in the values of BSSRT between Group A and Group B, with a difference in posttest when compared with the pretest values (P ≤ 0.05) [Figure 4]. The mean value of Group A was found to be significantly higher than Group B.
Figure 4: Graph showing the correlation of BSSRT values within a group in pretest and posttest. BSSRT = Back Saver's Sit and Reach Test

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Based on the BSSRT, the pretest and posttest values of Group A and Group B shows high significance (***P ≤ 0.001) [Figure 5]. The correlation of BSSRT within the groups between pretest and posttest is given in [Table 2].
Figure 5: The correlation between pretest and posttest values of BSSRT among the groups. BSSRT = Back Saver's Sit and Reach Test

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Table 2: Correlation of BSSRT within the groups between pretest and posttest values

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  Discussion Top

According to [Table 1], posttest mean values are a significant increase in both the groups, but the mean value of Group A was higher and more effective than Group B. In [Table 2] based on the BSSRT, the values between pretest and posttest of Group A and Group B showed that there is a major difference (*** P ≤ 0.001). According to the mean worth of analyzed statistics, the flexibility of hamstring muscle was much improved by MET (P ≤ 0.001).

MET has been emphasized as a technique effective in improving the flexibility of muscles, especially in hamstrings. PNF stretch is one such technique that is used in practice but has been least studied on its effectiveness to decrease the hamstring muscle tightness. The present study compared the MET and PNF hold-relax technique to improve the elasticity of hamstring muscles and led to the result that MET has more efficiency in improving the hamstring muscle flexibility.

There is evidence which proposes that MET shows better results in enhancing muscle flexibility when compared with passive stretching. Waseem et al. suggested that improvement in muscle elasticity following MET results in the connective tissue by the way of a mix of creep and plastic changes.[2] Due to the biomechanical and neurophysiological changes in the muscle, the tolerance to stretching increases.

Moore and Kukulka validated and suggested that the hold-relax technique in the PNF stretch technique causes relaxation/inhibition of stretched muscle by reciprocal inhibition and autogenic inhibition.[13] The reason for this effect is conjectured via neural hindrance in the stretched muscle. The reflex activity reduced by the neural inhibition leads to more noteworthy unwinding and diminished protection from the stretch and hence greater ROM.[14]

  Conclusion Top

This analysis focused on the fact that nonballistic active knee extension and PNF (hold-relax) stretch technique yields a significant reduction of hamstring tightness and improves the flexibility of the subjects with bilateral hamstring tightness. The outcome proposed that PNF (hold-relax) stretch technique demonstrated more prominent improvement than nonballistic active knee extension. The investigation uncovers that there is a significant difference in nonballistic active knee extension and PNF (hold-relax) stretch technique in the management of subjects with bilateral hamstring tightness.


The sample size was quite small, and the duration of the study was short. The study was performed uniquely for the age of 17–26 years.


The current study can lead to further studies in professional competitors as well as competitors from various games with huge sample size.


The authors would like to thank the Management of Krupanidhi College of Physiotherapy and the Krupanidhi Research Incubation Center (K-RIC) for providing the support and resources for conducting the research work.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ballantyne F, Fryer G, McLaughlin P. The effect of muscle energy technique on hamstring extensibility: The mechanism of altered flexibility. J Osteopath Med 2003;6:59-63.  Back to cited text no. 1
Waseem M, Nuhmani S, Ram CS. Efficacy of muscle energy technique on hamstring muscles flexibility in normal Indian collegiate males. Calicut Med J 2009;7:1-5.e4.  Back to cited text no. 2
Ishanka W, Iresha K, Nilushika W, Charith W, Chamika W, Yancy M, et al. The prevalence of hamstring tightness among the male athletes of the university of Peradeniya in 2010 Srilanka. Int J Phys Med Rehabil 2013;1:1-2.  Back to cited text no. 3
Patterson P, Wiksten DL, Ray L, Flanders C, Sanphy D. The validity and reliability of the back saver sit-and-reach test in middle school girls and boys. Res Q Exerc Sport 1996;67:448-51.  Back to cited text no. 4
Pratiksha G. Asgaonkar bharati 2017; comparison of immediate effects on hamstring flexibility using non-ballistic active knee extension in neural slump position and static stretch technique. Int J Physiother Res 2017;5:2425-31.  Back to cited text no. 5
Thakur D, Rose S. A study to find out the correlation between the right and left hamstring length in both genders to determine the prevalence of hamstring tightness among college students. J Health Allied Sci NU 2016;6:46-52.  Back to cited text no. 6
Hindle KB, Whitcomb TJ, Briggs WO, Hong J. Proprioceptive neuromuscular facilitation (PNF): Its mechanisms and effects on range of motion and muscular function. J Hum Kinet 2012;31:105-13.  Back to cited text no. 7
Ahmed H, Iqbal A, Anwer S, Alghadir A. Effect of modified hold-relax stretching and static stretching on hamstring muscle flexibility. J Phys Ther Sci 2015;27:535-8.  Back to cited text no. 8
Ahmed AR. A comparative study of muscle energy technique and dynamic stretching on hamstring flexibility in healthy adults. Bull Fac Ph Th Cairo Univ 2011;16:1-6.  Back to cited text no. 9
Vamsidhar N, Thiruppathi A, Reddy RS, Sivaprasad Y, Suneelkumar K. A comparative study on the effectiveness of static stretch and hold-relax techniques over hamstring flexibility. Int J Physiother 2014;1:248-51.  Back to cited text no. 10
Meena V, Shanthi C, Madhavi K. Effectiveness of PNF stretching versus static stretching on pain and hamstring flexibility following moist heat in individuals. Int J Physiother 2016;3:529-34.  Back to cited text no. 11
Baltaci G, Un N, Tunay V, Besler A, Gerçeker S. Comparison of three different sit and reach tests for measurement of hamstring flexibility in female university students. Br J Sports Med 2003;37:59-61.  Back to cited text no. 12
Moore MA, Kukulka CG. Depression of Hoffmann reflexes following voluntary contraction and implications for proprioceptive neuromuscular facilitation therapy. Phys Ther 1991;71:321-9.  Back to cited text no. 13
Feland JB, Myrer JW, Merrill RM. Acute changes in hamstring flexibility: PNF versus static Stretch in senior athletes. Phys Ther Sport 2001;2:186-93.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1], [Table 2]


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