Bowen Technique With Retro-walking on Hamstring Flexibility in Knee Osteoarthritis (A)

Effects of Bowen Technique With Retro-walking on Hamstring Flexibility in Knee Osteoarthritis Patients

The aim of this randomized controlled trial is to find the effects of Bowen technique with retro-walking on hamstring flexibility, pain, dynamic mobility and knee related disability in knee Osteoarthritis patients

Study Overview

• Status: Recruiting
• Conditions: Knee Osteoarthritis
• Intervention / Treatment: Other: Bowen technique with Retro-walking; Other: Conventional Treatment

Detailed Description

The term osteoarthritis is also known as degenerative joint disease because of wear and tear process occur in articular cartilage. OA affect the joints, the tissue surrounding the joint and other connective tissue. The symptoms of knee OA is most common seen in obese and aged individuals. There are three compartment that affected in knee OA include medial, lateral and patellofemoral joint. The OA takes 10 to 15 years to develop. The pathophysiology of the OA is still under investigation. Traditionally it was considered that it was due to aging factor because wear and tear process occur in articular surfaces.

But now it's considered there are multiple factors that involve in the origin of OA include biomechanical and inflammatory factors. Knee OA is influenced by family history, age, obesity, joint shape, genu valgus and varum and inflammation by metabolic syndrome. In radiological findings wo notice that bony osteophytes, damaging of articular cartilage, sclerosis of the subchondral bone seen, and it's become severe later. Knee OA may be modified or may be unmodified. In unmodifiable include genetically or congenital. But in modifiable is excessive weight. In Modern treatment we focus on improve the function limitation and quality of life which we can improve by physiotherapy Several muscles are involved in the support of knee. The 2 major muscle groups quadriceps and hamstrings are involved in the movement and stability of the knee joint. The quadriceps and hamstrings provide the knee stability in frontal plane. In knee OA pathogenesis important muscle imbalance arise from quadriceps group of muscles or hamstring group of muscles weakness, which is usually assessed by quadriceps hamstrings ratio(Q:H). In knee OA medial compartment of tibiofemoral joint is mostly involved.

Bowen technique helps in restore the fascia disturbances and muscle imbalances. During the application of the Bowen technique, it stimulates the brain ascending neural impulses to allow the fascia changes this mechanism is called fascia plasticity.) Bowen therapy works on our body nervous system by stimulating the parasympathetic nervous system and encourage the state of relaxation and healing. Bowen moves are applied on the muscle's origin, insertion, or belly of muscles where Golgi receptors are located. Bowen therapy improves body ability to function at a cellular level.

Backward walking increases the coordination because during backward walking isometric and concentric activity both are occurred. The backward walking mechanism is different from the forward walking, in backward walking toes contact the ground first and the heel is lifted off the ground in early stance. Retro walking can minimize the burden on the joint and increase the muscle length in normal healthy individuals.

This study aims to find the effects of Bowen technique with retro-walking on hamstring flexibility, pain, dynamic mobility and knee related disability in knee Osteoarthritis patients.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Islamabad, Punjab Province, Pakistan, 46600
      • Recruiting
      • Shaafi international hospital,ISLAMABAD
      • Contact: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk
      • Contact: AQSA BUTT, MS-OMPT*
      • Sub-Investigator: AQSA BUTT, MS-OMPT*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 40-60 years
• Both gender: male and female
• Less than 80-degree hip flexion angle on passive SLR, Active knee extension greater than 20 indicates hamstring muscle tightness
• Kellgren and Lawrence classification (stage I and stage II)
• Bilateral hamstring tightness
• Visual analogue scale value greater than 3
• Pain duration more than 3 months

Exclusion Criteria:

• Meniscal injury or ligamentous injury
• Muscle/tendon injuries of hamstring
• Spinal Injuries and any other co- morbidity
• Any surgery, infection, trauma, pregnancy, fracture and fall
• Involvement in regular flexibility yoga program
• Patient with intra articular steroidal therapy with in last 6 months
• Patient involvement in another intervention study
• Malignancy
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Bowen technique with Retro-walking	Other: Bowen technique with Retro-walking; In initially step the patient in prone position and therapist approach on the same side of the treatment limb. Use the thumb by applying the pressure on the lateral side of the target muscle. The treatment sequence will begin with thumb gradually involve the finger. a single treatment consists of a series of specific sequences of these moves with frequent pauses 2 to 5 minutes to allow time for the body to respond. Treatment session duration 15-20 minutes occur 3 days per week, for 4 weeks. Week 1(retro-walking on flat surface for 5 minutes) week 2(retro walking on flat surface for 7 minutes) week 3(retro-walking on flat surface for 10 minutes) week 4 (retro-walking on flat surface for 15 minutes) .Conventional PT including 1- hot pack 2-isometric quadriceps exercise(1 set of 10 reps twice a day)2-SLR stretch (1set of 10 reps twice a day)4-isometric hip adduction exercise( 1 set of 10 reps twice a day)5-Terminal knee extension( 1 set of 10 reps twice a day) total duration is 3 sessions
Other: Conventional PT	Other: Conventional Treatment; Conventional PT including 1-. Hot pack 2- isometric quadriceps exercise (1 set of 10 reps twice a day) 3-SLR Stretch (1set of 10 reps twice a day) 4 -isometric hip adduction exercise (1 set of 10 reps twice a day) 5-Terminal knee extension (1 set of 10 reps twice a day) Total duration is 3 sessions per week for 4 consecutive weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analogue scale VAS	The VAS is psychomotor response scales to investigate a unidimensional measure of pain intensity. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score.	4 weeks
Active knee extension test	Active knee extension will use to access the flexibility of the hamstring muscle. Ask the patient to lay down in spine position while flexing the hip 90-degree, other leg down with couch and leg to be test with both hands. The goniometer will place on knee and ask the patient to extend the knee holding hip flex 90 degree	4 weeks
SLR	A goniometer will be used to measure the range of hip flexion on passive SLR and range less than 80 degree indicate that the hamstring muscle tightness	4 weeks
Timed Up and Go (TUG) Test	The TUG test measures the time taken by a participant to stand up from a standard chair, walk a distance of 3 meters, turn around, walk back to the chair, and sit down. It assesses dynamic balance and functional performance.	4 weeks
Knee injury and osteoarthritis score	In KOOS include 42 items in five subscales to check different categories i.e. pain (9 items), symptoms (7 items), functions in the activity of daily living (ADLs) (17) items), sports and recreational activities (5 items), and quality of life (4 items).	4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: KINZA ANWAR, MS-OMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): October 25, 2025
• Primary Completion (Estimated): September 20, 2026
• Study Completion (Estimated): September 25, 2026

Study Registration Dates

• First Submitted: September 25, 2025
• First Submitted That Met QC Criteria: November 18, 2025
• First Posted (Actual): November 20, 2025

Study Record Updates

• Last Update Posted (Actual): November 20, 2025
• Last Update Submitted That Met QC Criteria: November 18, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Knee Osteoarthritis; Bowen technique; Hamstring tightness; Retro-walking
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: Aqsa Butt

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No