Effectiveness of Mulligan Bent Leg Raise Versus Proprioceptive Neuromuscular Facilitation Hold-Relax Exercise in Improving Hamstring Range of Motion and Muscle Performance: A Randomized Controlled Trial

Abstract

Objective: The primary goal is to compare the short-term effects of Mulligan Bent Leg Raise and Proprioceptive Neuromuscular Facilitation Hold-Relax techniques on hamstring flexibility and muscle performance. Methods: Sixty-four young adults with hamstring tightness were randomly assigned to either the Mulligan BLR group (n = 32) or the PNF Hold-Relax group (n = 32). Each participant underwent six intervention sessions. Hamstring flexibility was assessed using the Active Knee Extension (AKE) test, and muscle performance was evaluated through isometric strength testing. Data analysis involved paired and independent t-tests, with statistical significance set at p < 0.05. Results: Both groups showed significant improvement within their respective groups (p < 0.001). The Mulligan group increased range of motion by 5.37–6.82°, and strength by 19.69 N ± 5.20. The Proprioceptive Neuromuscular Facilitation group showed greater improvements, with range increasing by 9.84° ± 2.20 and strength by 30.69 N ± 5.67. Between-group comparisons confirmed superior range of motion gains for PNF (p < 0.001) and larger strength improvements (p < 0.001). Effect sizes were very large in both groups, but highest in the Proprioceptive Neuromuscular Facilitation group (Range of motion: -4.472; Strength: -5.417). Conclusion: Both Mulligan Bent Leg Raise and Proprioceptive Neuromuscular Facilitation Hold-Relax techniques significantly enhance hamstring flexibility and strength. Mulligan intervention produced a notable range of motion improvement, whereas Proprioceptive Neuromuscular Facilitation Hold-Relax intervention yielded greater gains in both ROM and muscle performance. These findings provide clinicians data-driven guidance to tailor interventions according to treatment goals