310 IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Volume : 3 | Issue : 9 | September 2014 • ISSN No 2277 - 8179 Research Paper Physiotherapy *P. Ratan Khuman Department of Musculoskeletal Physiotherapy, C.U. Shah Physiotherapy College, Surendranagar, Gujarat. 363001. * Corresponding Author Lourembam Surbala Department of Neurological Physiotherapy, C.U. Shah Physiotherapy College, Surendranagar, Gujarat. 363001 Priyanka Patel Department of Musculoskeletal Physiotherapy, C.U. Shah Physiotherapy College, Surendranagar, Gujarat. 363001. Dhara Chavda Department of Musculoskeletal Physiotherapy, C.U. Shah Physiotherapy College, Surendranagar, Gujarat. 363001. Immediate Effects of Single Session Post Isometric Relaxation Muscle Energy Technique Versus Mulligan’s Bent Leg Raise Technique on Pain and Hamstring Flexibility in Knee Osteoarthritis Participants: A Randomised Controlled Study KEYWORDS : Osteoarthritis, Hamstring Flexibility, MET, BLR, AKE test ABSTRACT Osteoarthritis (OA) affects 33–46% of Indian adult with the consequence of pain, reduced function and restric- tion in daily activities. In this study, single session of post isometric relaxation muscle energy technique (PIR-MET), Mulligan’s bent leg raise technique (BLR) and MH alone were compared on pain and hamstring flexibility in knee OA. 90 participants were selected and randomly allocated into three groups (PIR-MET+MH; BLR+MH and MH alone, n=30 in each group). Visual analog scale and active knee extension test (AKE) were recorded at baseline and immediately after interventions. PRI-MET and BLR group were significantly effective (p<0.05) in reducing pain and improving hamstring flexibility whereas the MH group did not (p>0.05). BLR group was more effec- tive compare to PIR-MET and MH alone. In conclusion, a single session of PIR-MET and BLR technique were capable of reducing pain and improving hamstring flexibility in knee OA. INTRODUCTION: Osteoarthritis (OA) is one of the major public health problem which causes functional impairment that reduces quality of life (QOL) worldwide as reported by World Health Organization. 1 According to 2012 data, the prevalence rate of OA in both rural and urban India was ranging from 33% to 46 % of older adult population where female were more affected than men. 2 e OA is a chronic joint degenerative disease which mainly affect the weight bearing joints specially the lower limb joints. e pathophysiological changes in OA varies as the condition progress affecting joint articular cartilage as well as soft tissue around the joint. 3,4 Apart from known articular source of pain in OA knee, tightness of hamstring muscle is one of the non-artic- ular source of pain. Tightness of hamstring muscles if not cor- rected it is likely to develop flexion contracture of knee in later stage of the disease. 5 Previous studies reported that an increase in hamstring muscle activation with knee OA was seen while performing the activities of daily living. Normal knee joint load distribution may be altered due to over activation of hamstring muscle and contribution in disease progression in knee OA. Nor- malizing altered hamstring muscle over activation would be as important as strengthening the quadriceps muscle in preventing the disease progression. 6,7 e Mulligan’s bent leg raise (BLR) technique is a method of stretching which is painless in nature. It consist of gentle stretching of hamstring muscles performed in a specific direc- tion progressively towards hip flexion. It has been used as a method to achieve greater range of active knee extension (AKE) or straight leg raise (SLR) by increasing flexibility of hamstring muscles. is technique was designed to restore altered activa- tion of hamstring muscles. 8 On other hand, the muscle energy technique is a manual medicine soft tissue procedure that in- corporate precisely directed and controlled, patient initiated- voluntary contraction of muscles (isometric or isotonic contrac- tions) at varying levels of intensity against a distinctly executed counterforce applied by therapist. MET are classified as active techniques in which the patient contributes corrective force de- signed to improve musculoskeletal function and reduce pain. 9,10 ere are variety of interventions on literature supporting pain control in knee OA 11,12 but interventions emphasizing on im- proving hamstring flexibility in knee OA are limited and yet to be documented. e effectiveness of PIR-MET 13,14 and BLR technique 15,16 has been well documented in other conditions. However, comparison between two methods have not yet been documented in knee OA participants. So, effort of this study was to investigate and to compare the effectiveness of single session PIR-MET versus BLR technique along with MH and MH alone in reducing pain and improving hamstring flexibility in knee OA participants. We hypothesized that the single session interven- tion would be capable of reducing pain and improve hamstring flexibility in knee OA participants. METHODOLOGY: In this single intervention assessor blinded randomized con- trolled study, participants were recruited through advertisement with pamphlet in a local newspaper. ere were 162 respondents to advertisement who were interested to participate in the study. Participants were screened with thorough physical examination and 90 participants who fulfilled the selection criteria were re- cruited to volunteer in this study. Using a computer generated randomization method 90 eligible participants were randomly assigned into three groups (PIR-MET+MH: n=30; BLR+MH: n=30 and MH: n=30). e included participants were of age above 40 years, both gender, radiographic evidence of grade I or II in Kell- gren and Lawrence criteria for knee OA 17 , bilateral (but tested only severe side) or unilateral involvement, ambulate indepen- dently with or without assistive devices, ascend and descend at least a flight of stairs and those who were willing to volunteer in this study. e participants were excluded if they had low back pain, sciatica, history of recent lower limb or spinal surgeries, pathologies or deformities related to spine, knee or hip joints, any neurological disorders, other musculoskeletal problems as- sociated with the knee joint. e study obtained prior approval form the Institutional Ethical Committee. All participants pro- vided their demographic details (Table 1) after signing the in- formed consent form before collecting baseline data. e baseline pre-intervention outcome measures consisted of pain assessment using visual analog scale (VAS) and knee joint goniometry in active knee extension test (AKE) to assess the flexibility of hamstring muscles. VAS is a self-completed uni- dimensional single-item measure of pain intensity in the last 24 hours. e response options of the pain intensity were adhere to