Med. J. Cairo Univ., Vol. 89, No.

2, June: 627-634, 2021

www.medicaljournalofcairouniversity.net

Immediate Effect of Neurodynamic Tensioner Versus Proprioceptive

Neuromuscular Facilitation Stretch on Subjects with Short Hamstring
Syndrome
SAFAA M. SADEK, M.Sc.; RAGIA M. KAMEL, Ph.D. and MARWA Sh. SALEH, Ph.D.
The Department of Basic Sciences, Faculty of Physical Therapy, Cairo University

Abstract led trunk movement, walking, and jumping [2] . So,

hamstrings flexibility have been successfully pre-
Background: Decreased flexibility of Hamstrings has a
negative impact on the posture of lumbo-pelvic region and scribed for relief of low back pain which was found
may serve as a cause of low back pain. It is also a major to be increased in subjects' with hamstring tightness.
contributing factor for lumbar spine disorders, hamstring
strains and other sports related injuries. Any alterations in muscular flexibility could
Aim of Study: Tocompare the effects of (NT) Neurody-
directly influence the function of other joints in
namic Tensioner and (PNF) hold-relax stretching on hamstring the kinetic chain. So, optimal muscular flexibility
flexibility in order toidentify the most effective intervention and joint range of motion (ROM) are necessary
for short hamstring syndrome. for optimal physical (strength, endurance and
Material and Methods: Present study conducted as Pre- fitness) and psychosocial wellbeing [3] .
test - Post-test Experimental study.
The hamstrings act as a mechanical interface
Participants: Forty subjects with short hamstring syndrome
participated in this study. Subjects were subdivided into two
surrounding the sciatic nerve. Nerve adhesions in
matched groups; each group consisted of twenty subjects, the hamstring may alter neurodynamics and cause
group A who received neural tensioner in slump position; and abnormal mechanosensitivity of the sciatic nerve;
group B who received the PNF (hold-relax) stretching. which could influence hamstring flexibility. Neural
Outcome Measure: Knee extension angle (KEA) in degrees tissues involvement to hamstring flexibility has
was measured using the Active Knee Extension (AKE) test been studied in the literature [4,5] . Neural Mobili-
with using a digital goniometer. zation (NM) or Nerve Glide Stretches are active
Results: There was no significant difference in the KEA stretches in which the nervous system is made taut
between group A and B pretreatment ( p=0.75). There was no and then slack which explain the observed increase
significant difference in the KEA between group A and B post in flexibility [5] , through decreasing neural mech-
treatment (p=0.38).
anosensitivity by providing movement that lead to
Conclusions: Neurodynamic tensioner and PNF (hold- changes in the neurodynamics and modification
relax) stretching are equally effective in increasing hamstring of sensation.
flexibility immediately in subjects with short hamstring
syndrome.
The primary effect of neural mobilisation is to
Key Words: Hamstring flexibility – Neurodynamic tensioner restore the dynamic balance between movement
– PNF – Active knee extension test. of neural tissues and surrounding mechanical in-
terfaces, which allow reducing the intrinsic pres-
Introduction sures on the neural tissues and promoting optimal
FLEXIBILITY is an important factor in physical physiological function [6] .
fitness that enables smoothly and safety movement As reported in the study conducted by Sharma
[1] . Hamstring muscles have an important role in
et al. [14] , neural tensioner is effective as an adjunct
the performance of daily activities such as control- to static stretching on improving hamstring flexi-
bility as compared to static stretching alone. So,the
Correspondence to: Dr. Safaa M. Sadek, The Department of results of this study reinforce previous studies that
Basic Sciences, Faculty of Physical Therapy, Cairo University showed improvement in lower quarter flexibility

627
628 Neurodynamic Tensioner Vs PNF in Short Hamstring Syndrome

following different neural mobilization techniques Therapy, Cairo University with approval number
such as active slump tensioners [8] . (18-7-2019). Informed consent was received prior
to the intervention from each subject. Forty sub-
Proprioceptive Neuromuscular Facilitation jects, of both sexes with short hamstring syndrome
(PNF) is a more advanced form of flexibility train- were recruited from students of Faculty of Physical
ing that involves both the stretching and contraction Therapy, Cairo University and colleagues of phys-
of the target muscle group, While there are several iotherapists at Physical Therapy Department in
variations of PNF stretching, they all have one Menya-El Qamh Hospital.
thing in common; they facilitate muscular inhibition
[9] . Forty subjects with short hamstring syndrome
participated in this study. Subjects were subdivided
Proprioceptive Neuromuscular Facilitation into two matched groups, each group consisted of
(hold-relax) stretching, provides the greatest po- twenty subjects. The first group was the group A
tential for muscle lengthening, under the assump- who received neural tensioner in slump position;
tion that greater motor pool inhibition reduces the second group was the group B who received
muscle contractibility and therefore allows more the hold-relax for hamstring muscle.
muscle compliance [10] . Numerous investigations
established PNF techniques are more effective than Inclusion criteria: Subjects were included in
traditional stretching exercises for range of motion the study if they had Aged from 18-30 years [12] .
or flexibility enhancement [9] . with hamstring tightness of 20 (inability to achieve
'

greater than 160 of knee extension with hip at

'

O'tlora et al. [11] conducted a study on efficacy

90 of flexion) [13] . Also, subjects were selected
'

of static stretching and PNF stretch on hamstrings with right lower limb dominance [14] . With normal
length after a single session and concluded that body mass index (BMI).
PNF results into increase in hamstring flexibility.
these positive effects of neurodynamic tensioner Exclusion criteria: Subjects were excluded if
and PNF in improving the hamstring flexibility, they had any neurological or orthopedic diseases
up till now no studies have been conducted to affecting their lower extremity, Traumatic hamstring
determine which one of them is the most effective injury, Acute or chronic low back pain or Who
so, thisstudy was conducted to compare between already involved in any exercise programs for
neurodynamic tensioner in slump position and lower extremity in the last three months. All sub-
PNF (hold-relax) stretching in improving ham- jects were screened according to the inclusion and
string flexibility on subjects with short hamstring exclusion criteria, and randomly assigned into two
syndrome. equalgroups (20 each); the neurodynamic group
Considering the importance of hamstring flex- and PNF (hold relax) group.
ibility in general and athletic population, maintain- Measurements for both groups were taken as a
ing the flexibility of hamstring muscle is of utmost baseline pre intervention. Assessment was done
importance for health care professionals and to immediately at the same sessionpost intervention.
achieve this goal one needs to know the most
effective and efficient technique to gain hamstring Outcome measurement:
flexibility. Numerous studies have shown the indi- Measurements of hamstring flexibility were
vidual effectiveness of Neurodynamic tensioner obtained using the Active Knee Extension (AKE)
in slump position and PNF (hold-relax) in improv- test. The active knee extension Fig. (1) is a measure
ing the flexibility of hamstring muscle but there of hamstring flexibility; it had been performed
are no studies which shows the superiority of one while the participant lies supine on the examination
technique with respect to the other, hence the table wearing shorts [15] . With the dominant (tested)
purpose of the study is to compare the effectiveness hip and knee flexed to 90 degrees, held in position
'

of Neurodynamic tensioner in slump position versus by a wooden box, measuring 44.5cm wide, 42cm
PNF (Hold-Relax) technique in improving the high and 20cm deep was secured to the table with
hamstring flexibility in subjects with short ham- two Velcro straps; a third strap was used to secure
string syndrome. the participant's thigh and box, to maintain domi-
Material and Methods nant limb in 90 degree flexion and the non-tested
lower extremity secured to the table by Velcro
This study was a comparative experimental strap across the middle of the thigh to minimize
trial. Approval to conduct the study was obtained hip flexion during the procedure. While the partic-
from the ethics committee of the Faculty of Physical ipant maintaining a relaxed foot position, he was
Safaa M. Sadek, et al. 629

asked to extend his knee as far as he's comfortably the greater trochanter and the mark on the femoral
able, keeping the posterior aspect of the thigh in condyle, with other line drawn from the mark on
contact with box and stop at the point where he the fibular head to a mark just proximal to the
first felt the stretch sensation within the posterior lateral malleolus by using tape measurement. A
thigh areaand hold the position for about 5 seconds. total of 3 measurements were recorded and a mean
[16] . The angle of the knee extension was measured angle of the extension will be recorded for analysis.
using a digital goniometer by measuring the angle AKE was found to be valid and reliable for meas-
between a line drawn from the mark just distal to uring of hamstring muscle length [17] .

Fig. (1): Active knee extension test.

Intervention: relaxed anteriorly with flexion of both knees then

The neurodynamic tensioner: the subject is asked to maintain a thoracic slump,
The participants received NT technique on the and clasped both hands posteriorly at lumbosacral
sciatic nerve of the dominant leg as shown in Fig. level; the investigator passively flexed the cervical
(2A,B) (a. starting position) started with the subject spine with simultaneous extension of the knee with
in high sitting, cervical spine extended, both hands foot maintained in neutral position to dorsiflexion
630 Neurodynamic Tensioner Vs PNF in Short Hamstring Syndrome

(b. end position). The end position of neural ten- until a mild stretch sensation was reported. This
sioner was maintained for 60 seconds followed by stretch was hold for 7sec. This sequence repeated
10 seconds rest. The cervical spine then was ex- 5 times with each sequence separated from each
tended with flexion of the knee, and the spine was by a 20 second interval [9] .
straightened in the rest period to avoid any back
pain. Total 5 sets were done, each set consist of
one repetion [18] .

Fig. (3): PNF (hold-relax) technique.

Sample size:
(A)

Sample size calculation was performed prior

to the study using G*POWER statistical software
(version 3.1.9.2; Franz Faul, Universitat Kiel,
Germany) and revealed that the appropriate sample
size for this study was n=40. Calculations were
made using a=0.05, 0 =0.2 and large effect size
=0.91 and alloctation ratio N2/N1=1.
Statistical analysis:
Descriptive statistics and Unpaired t-test were
conducted for comparison of subjects characteristics
(B)
between both groups. Chi-squared test was used
for comparison of sex distribution between groups.
Fig. (2): Tensioner technique: (A) Starting position; (B) End
Normal distribution of data was checked using the
position.
Shapiro-Wilk test. Levene's test for homogeneity
of variances was conducted to ensure the homoge-
PNF (Hold-relax) stretch: neity between groups. Unpaired t-test was conduct-
The participants received hold-relax, as shown ed to compare the mean values of KEA between
in (Fig. 3). Subjects were in supine position with group A and B. Paired t-test was conducted for
their non-dominant lower extremity was strapped comparison between pre and post treatment in each
down the table. Predetermined time intervals for group. The level of significance for all statistical
stretching, contracting and relaxing will be used tests was set at p<0.05. All statistical analysis was
to standardize the method utilizing a stop watch. conducted through the statistical package for social
For each stretch, the therapist stretched the ham- studies (SPSS) version 22 for windows (IBM SPSS,
string muscle by passively flexing the hip with Chicago, IL, USA).
knee fully extended, allowing no hip rotation. The Results
hamstring muscle was stretched until the subject
reported the first mild stretch sensation; this posi- Subject characteristics:
tion was held for 7sec. Next, the subject then Table (1) showed the subject characteristics of
isometrically contracted the hamstring muscle for both groups. There was no significant difference
3sec by attempting to push his leg down towards between both groups in the mean age, weight,
the table against the resistance of the therapist. height and BMI (p>0.05). Also, there was no sig-
Following this, the subject asked to relax for 5sec. nificant difference in sex distribution between
The therapist then passively stretched the muscle groups (p=0.7).
Safaa M. Sadek, et al. 631

Table (1): Comparison of subject characteristics between Effect of treatment on Knee extension angle:
group A and B.
- Within group comparison:
X ± SD t- p- There was a significant increase in KEA post
MD
Group A Group B value value treatment in both groups compared with that of
pretreatment (p>0.001). The percent of increase
Age (years) 23.6 ± 3.85 24.8 ± 3.31 –1.13 –0.77 0.44
in KEA in the group A and B groups were 8.72
Weight (kg) 63.95 ±9.52 61.85 ± 12.04 0.67 0.39 0.69
and 7.6% respectively.
Height (cm) 168.6 ±7.91 166 ± 10.86 1.07 0.95 0.34
BMI (kg/m ) 2
22.37 ± 1.8 22.21 ± 1.81 –0.11 –0.15 0.88 - Between groups comparison:
Males/females 9/11 8/12
2
(χ = 0.1) 0.74 There was no significant difference in KEA
between both groups pre-treatment (p>0.05). Also,
X : Mean. 2
χ : Chi squared value. Comparison between groups post treatment re-
SD : Standard deviation. p-value : Probability value.
MD : Mean difference. BMI : Body mass index.
vealed non-significant difference in KEA ( p>0.05).

Table (2): Mean of Knee extension angle pre and post treatment of both groups.
Group A Group B t- p-
KEA (degrees) MD (95% CI)
X ± SD X ± SD value value

Pre treatment 137.72±7.4 136.9±8.86 0.82 (–4.39: 6.05) 0.32 0.75

Post treatment 149.74±8.05 147.3 ± 9.41 2.44 (–3.17: 8.04) 0.87 0.38
MD (95% CI) –12.02 (–13.92: –10.11) –10.4 (–11.6: –9.22)
% of change 8.72% 7.6%
t-value –13.21 –18.26
p=0.001 p=0.001

X : Mean. CI : Confidence interval.

SD : Standard deviation. p-value : Level of significance.
MD : Mean difference. KEA : Knee extension angle.

180
The purpose of this study was to investigate
150 the immediate effect of neurodynamic tensioner
versus PNF (hold-relax) stretch on subjects with
KEA (degrees)

120 short hamstring syndrome.

90 Results of the current study showed that: Neu-
rodynamic tensioner and hold-relax were individ-
60
ually very effective, There was significant imme-
30 diate improvement in hamstring flexibility which
was depicted by increase range of motionmeasured
0 by active knee extension test using a digital goni-
Pre-treatment Post-treatment
ometer a significant increase in KEA post treatment
Group A Group B in the group A and B compared with that pretreat-
ment (p>0.001). While there was no significant
Fig. (4): Mean KEA pre and post-treatment of the group difference between both groups post treatment in
A and B. KEA (p>0.05).
In group A, which received neurodynamic ten-
Discussion sioner the mean AKE was improved significantly,
this result of the current study is supported by the
Muscular flexibility is an important aspect of study done by Herrington et al. [21] , who states
normal human function. Limited flexibility has that knee extension range of motion can be im-
been shown to predispose a person to several proved by adding tensioner technique in slump
musculoskeletal overuse injuries and significantly position.
affect a person's level of function. To prevent
muscle injuries, stretching exercises are usually As reported in a study conducted by Sharma et
recommended [19] . Reasons for stretching relate al. [7] , neural tensioner is effective as an adjunct
to beliefs that stretching exercises will increase to static stretching on improving hamstring flexi-
flexibility and decrease muscle stiffness [20] . bility as compared to static stretching alone. The
632 Neurodynamic Tensioner Vs PNF in Short Hamstring Syndrome

results support our hypothesis that addressing in length. While the MTU is under stretch, the
neural structures along with muscle tissue (ham- amount of force generated by the viscous compo-
string) can improve KEA, an indicator of posterior nent to resist the elongation decreases over time
thigh flexibility. Lastly, the results of this study (stress relaxation) [7,14] . When the force attempting
reinforce previous studies that showed improvement to lengthen the MTU is sustained, the MTU grad-
in lower quarter flexibility following different ually elongates (creep) [7] .
neural mobilization techniques such as active slump
tensioners [8] . During PNF stretching (hold-relax) autogenic
inhibition of the target muscle takes place. Moore
The probable reason of improved KEA post and colleagues [26] approved the theoretical basis
neural stretch can be attributed to the improved of PNF stretching and proposed that the relax
physiological functions of nervous system, includ- portion of hold-relax maneuver should be applied
ing improved axoplasmic flow and reduced neural quickly after the hold position. Therefore the results
mechano sensitivity [5] . This explanation can be of this study can be correlated with the popular
supported by previous studyconducted by Ellis et belief that PNF stretching techniques lead to re-
al. [22] using high resolution ultrasound which laxation/inhibition of the stretched muscle via the
concluded that the neural mobilization exercises two physiological mechanisms proposed by Sher-
(sliders and tensioners) produce significant excur- rington namely reciprocal inhibition and autogenic
sion of the sciatic nerve at the posterior mid-thigh. inhibition.

McHugh et al. [23] established that when neural Also, positive effects of PNF stretching tech-
tension (thoracic and cervical flexion) is added to niques of the current study is supported by study
a hamstring stretch, the increased stretch sensation conducted by Surburg and Schrader, [27] , who
is not caused by contractile tissue response or concluded that PNF techniques are more effective
increased EMG activity. The main changes in than traditional stretching exercises for range of
contractile response occur during the last 10 degrees motion or flexibility enhancement.
of movement. Therefore neural tension is respon-
As reported in the study Hindle et al., [28] ,
sible for the increased stretch sensation during
PNF has been shown to have a positive effect on
range.
active and passive range of motions which reinforce
In group B, which received PNF (hold-relax) the results of the current study.
the mean AKE was improved significantly. Possible
This explanation is supported by previous study
explanation for the improved hamstring flexibility
conducted by Milad, [29] . Who states thatwhen a
for the subject in group B could be caused by the
muscle is tight, a stimulation of the GTO will send
effect of PNF which has been attributed to neuro- a message to the same muscle to relax for instance,
physiological and mechanical factors [24] . The if biceps brachii muscle is contracted, a stimulation
neurophysiological foundation of stretching is of biceps brachii tendon will send a message to
based on the neural inhibition of the muscle under- the biceps to relax.
going stretching. The Golgi tendon organ (GTO)
is a nerve receptor that fires when tension increases This inhibitory effect is thought to diminish
in the tendon. This tension can be due to stretch muscle activity and, therefore, allow for relaxation
or muscle contraction when the GTO fires a signal so that the muscle can be stretched. Motor pool
that is sent to the spinal cord, causing the agonist excitability has been measured by the Hoffman
muscle to relax. This can increase the ROM by reflex during soleus muscle static stretching, con-
autogenic inhibition of the target muscle [9] . As a tract-relax stretching, and contract-relax-agonist-
mechanical factor, the muscle-tendon unit (MTU) contract stretching techniques. Motor pool excita-
is believed to respond viscoelastically during the bility significantly diminished after the contract-
stretching maneuver [24] . Viscous and elastic me- relax and contract-relax-antagonist-contract meth-
chanical properties refer to the response of the ods of PNF stretching over static stretching of the
tissue load, which is a property of the viscous and soleus. This inhibitory effect has been suggested
elastic components. The elastic component is the to increase muscle compliance, allowing for in-
ability of the tissue to return to the previous form creased length during a stretch without stimulation
after deformation. The viscous component is related of the stretch reflex [14] . Hence neurodynamic
to the fluid part of the muscle, which deviates in tensioner and PNF have an immediate effect on
response to mechanical force [25] . The viscous hamstring flexibility Thus, both the stretching can
property within an MTU elongates in response to be used in clinical practicefor improving the
a slow sustained force and will resist rapid changes flexibility of hamstring muscle.
Safaa M. Sadek, et al. 633

Limitations of the study: slump position and static stretch techniques on hamstring
flexibility. J. Orthop. Sports Phys. Ther., 26: 7-13, 1997.
It appears to be difficult to generalize the results
of this study due to the small number of subjects. 9- SINGH A.K., NAGARAJ S. and PALIKHE R.M.: Neu-
Also, this studydetermines only the immediate rodynamic sliding versus PNF stretching on hamstring
flexibility in collegiate students: A comparative study.
effects of neurodynamic tensioner and hold-relax International Journal of Physical Education, Sports and
techniques. In the future, studies on the long- Health, 4 (1): 29e33, 2017.
termeffects of both techniques including more
10- ETYNRE B.R. and ABRAHAM L.D.: H-reflex changes
subjects should be performed. Also it would be during static stretching and two variations of propriocep-
very interestingto compare the effect of the two tive neuromuscular facilitation techniques. Clin. Neuro-
techniques in subjects with a history of hamstring physiology, 63 (2): 174- 9, 1986.
injuryand low back pain.
11- O'TLORA, CARTWRIGHT A., WADE C.D., HOUGH
A.D. and SHUM G.L.: Static stretching and PNF stretch
Conclusion: on hamstrings length: Journal of strength and conditioning
It can be concluded that neurodynamic tension- research, 25 (6): 1586-91, 2011.
er and PNF (hold-relax) are equally effective in 12- GADPAL P. and ASGAONKAR B.: Comparison of im-
immediately increasing hamstring flexibility in mediate effect on hamstring flexibility using non ballistic
subjects with short hamstring syndrome. active knee extension in neural slump position and static
stretch technique. International Journal of Physiotherapy
Acknowledgements: and Research, 5 (6): 2425-31, 2017.
The authors would like to acknowledge and 13- DRAPER D.O., CASTRO J.L., FELAND B., SCHULTH-
express their thanks to all subjects who participated IES S. and EGGETT D.: Shortwave diathermy and pro-
in this study. longed stretching increase hamstring flexibility more than
prolonged stretching alone. J. Orthop. Sports Phys. Ther.,
References 34 (1): 13-20, 2004.
14- SPERNOGA S.G., UHL T.L., ARNOLD B.L. and GAN-
1- ODUNAIYA N.A., HAMZAT T.K. and AJAYI O.F.: The SNEDER B.M.: Duration of Maintained Hamstring Flex-
effects of static stretch duration on the flexibility of
ibility After a One-Time, Modified Hold-Relax Stretching
hamstring muscles. Journal of Biomedical Research, 8: Protocol. Journal of Athletic Training, 36 (1): 44-48,
79-82, 2005. 2001.
2- LUMBROSO D., ZIV E., VERED E. and KALICHMAN
15- FELAND J.B., MYRER J.W., et al.: Acute changes in
L.: The effect of kinesio tape application on hamstring
hamstring flexibility: PNF versus static stretch in senior
and gastrocnemius muscles in healthy young adults. J.
athletes. Physical Therapy in Sport, 2: 186-193, 2001.
Bodyw Mov. Ther., 18:130-8, 2014.
3- LAW R.Y., HARVEY L.A., et al.: Stretch exercises 16- ADEL R.A. and AHMED F.S.: Short Term Effects of
increase tolerance to stretch in patients with chronic Neurodynamic Stretching and Static Stretching Techniques
musculoskeletal pain: A randomized controlled trial. on Hamstring Muscle Flexibility in Healthy Male Sub-
Physical Therapy, 89 (10): 1016-1026, 2009. jectsInternational Journal of Medical Research & Health
Sciences, 36-41 ISSN No: 2319-5886, 2016.
4- MENDEZ-SANCHEZ R., ALBURQUERQUE-SENDIN
F., FERNANDEZ-DE-LAS-PENAS C., BARBERO- IG- 17- NORRIS C.M. and MATHEWS M.: Inter-tester reliability
LESIAS F.J., SANCHEZ-SANCHEZ C., CALVO- of a self-monitored active knee extension test. Journal of
ARENILLAS J.I., et al.: Immediate effects of adding a bodywork and movement therapies, 9: 256-259, 2005.
sciatic nerve slider technique on lumbar and lower quadrant 18- SHARMA S., BALTHILLAYA G., RAO R. and MANI
mobility in soccer players: A pilot study. Journal of R.: Short term effectiveness of neural sliders and neural
Alternative Complementary Medicine Jun, 16 (6): 669- tensioners as an adjunct to static stretching of hamstrings
675, 2010. on knee extension angle in healthy individuals: A rand-
5- CASTELLOTE-CABALLERO Y., VALENZA M.C., et omized controlled trial. Physical Therapy in Sport, 17:
al.: Immediate effects of neurodynamic versus muscle pp. 30-37, 2016.
stretching on hamstring flexibility in subjects with short
19- NAGARWAL A.K., ZUTSHI K., RAM C.S. and ZAFAR
hamstring syndrome. A pilot study. Physical Therapy in R.: Improvement of Hamstring Flexibility: A Comparison
Sport, 14 (3): 156-162, 2013. between Two PNF Stretching Techniques: International
6- ELLIS R.F. and HING W.A.: Neural mobilization: A Journal of Sports Science and Engineering, 4 (1): 25-33,
systematic review of randomized controlled trials with 2010.
an analysis of therapeutic efficacy, 16 (1): 8-22, 2008.
20- ANAP DEEPAK and BHOIR TEJASHREE: Immediate
7- SHARMAN M., CRES SWELL A. and RIEK S.: Proprio- effect of mulligan bent leg raise technique versus self
ceptive Neuromuscular Facilitation Stretching: Mecha- myofacial release on hamstring tightness in young adults
nisms and Clinical Implications. Sport Med., 36 (11): Arandomized control trial. Indian Journal of Physical
929-939, 2006. Therapy, 2016.
8- WEBRIGHT W., RANDOLPH B. and PERRIN D.: Com- 21- HERRINGTON LEE: Effect of Different Neurodynamic
parison of non-ballisticactive knee extension in neural Mobilization Techniques on Knee Extension Range of
634 Neurodynamic Tensioner Vs PNF in Short Hamstring Syndrome

Motion in the Slump Position. Journal of Manual & extensibility: The mechanism of altered flexibility. J.
Manipulative Therapy, 14 (2): 101-107, 2006. Osteopath. Med., 6: 59e63, 2003.

22- ELLIS R.F. and HING W.A.: Comparison of Longitudinal 26- MOORE A. and CARL KUKULKA G.: Depression of
Sciatic Nerve Movement With Different Mobilization Hoffmann reflexes following voluntary contraction and
Exercises: An In Vivo Study Utilizing Ultrasound Imaging, implications for proprioceptive neuromuscular facilitation
42 (8): 667-675, 2012. 27- SURBURG P.R. and SCHRADER J.W.: Proprioceptive
neuromuscular facili-tation techniques in sports medicine:
23- McHUGH M.P., JOHNSON C.D. and MORRISON R.H.:
A reassessment. J. Athl Train, 32 (1): 34-9, 1997.
The role of neural tension in hamstring flexibility Scand
J. Med. Sci. Sports Sports, 22: 164-169, 2012. 28- HINDLE K.B., WHITCOMB T.J., BRIGGS W.O. and
HONG J.: Proprioceptive Neuromuscular Facilitation
24- Magnusson S.P., Simonsen E.B., et al.: Biomechanical (PNF): Its Mechanisms and Effects on Range of Motion
responses to repeated stretches in human hamstring muscle and Muscular Function. Journal of Human Kinetics, 31:
in vivo.American Journal of Sports Medicine, 24 (5): 105-113, 2012.
622e628, 1996.
29- MILAD H. CHANNEL: Reciprocal and Autogenic Inhi-
25- BALLANTYNE F., FRYER G. and McLAUGHLIN P.: bition, Video, viewed march 2015, https://www.youtube.
The effect of muscle energy techniquenon hamstring com/watch?v=PztKO_KWvnE, 2012.