The effect of adding dry needling to muscle energy technique on flexibility and physical performance in athletes with hamstring tightness: a randomized controlled trial
To evaluate and compare the immediate and short-term effects of active dry needling combined with muscle energy technique (MET) versus sham dry needling combined with MET on hamstring flexibility, stretch tolerance, and functional performance in individuals with hamstring muscle tightness.
The study is conducted at the School of Rehabilitation Sciences, Iran University of Medical Sciences. Eligible participants are randomly assigned to two groups using block randomization. Outcome assessors and participants are blinded to group allocations.
Participants/Inclusion and exclusion criteria
Inclusion criteria: Recreational athletes aged 18 to 35 years; presence of hamstring tightness (Active Knee Extension [AKE] angle less than 160 degrees / AKE deficit of 20 degrees or greater); no history of lower extremity surgery or severe musculoskeletal injury.
Exclusion criteria: History of spine or lower limb surgery; lumbar radiculopathy or back pain within the past year; history of prior dry needling or acupuncture; needle phobia; coagulation disorders; active skin lesions at intervention site.
Intervention groups
Intervention group 1: Active dry needling applied to the hamstring muscle trigger points, followed by Muscle Energy Technique (MET).
Intervention group 2 (Control/Sham): Sham dry needling applied to the same points, followed by the same MET protocol.
Main outcome variables
Active Knee Extension (AKE) range of motion measured in degrees using a goniometer, and hamstring stretch tolerance measured using a Visual Analog Scale (VAS) before and immediately after intervention.
General information
Reason for update
Acronym
IRCT registration information
IRCT registration number:IRCT20180728040618N12
Registration date:2026-09-04, 1405/06/13
Registration timing:prospective
Last update:2026-09-04, 1405/06/13
Update count:0
Registration date
2026-09-04, 1405/06/13
Registrant information
Name
Holakoo Mohsenifar
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 21 2610 6933
Email address
mohsenifar.h@iums.ac.ir
Recruitment status
Not yet recruiting
Funding source
Expected recruitment start date
2026-09-23, 1405/07/01
Expected recruitment end date
2027-03-20, 1405/12/29
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The effect of adding dry needling to muscle energy technique on flexibility and physical performance in athletes with hamstring tightness: a randomized controlled trial
Public title
Effect of dry needling and muscle energy technique on hamstring tightness in athletes
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
Recreational athletes aged 18 to 35 years
Presence of hamstring tightness defined as an Active Knee Extension (AKE) deficit of 20 degrees or greater
Signing written informed consent to participate in the study
Exclusion criteria:
History of lower extremity surgery, orthopedic injuries, or neurological disorders
History of low back pain within the past year
History of prior dry needling or acupuncture
Needle phobia
Coagulation disorders or use of anticoagulant medications
Contraindications to dry needling (e.g., diabetes, vascular diseases, epilepsy, active skin lesions/infections at the treatment site, allergy, psychiatric disorders)
Concurrent hamstring stretching exercises or participation in other physical therapy or exercise programs during the study period
Age
From 18 years old to 35 years old
Gender
Both
Phase
N/A
Groups that have been masked
Participant
Outcome assessor
Sample size
Target sample size:
30
Randomization (investigator's opinion)
Randomized
Randomization description
Participants were randomly allocated into two groups (Intervention and Control) with a 1:1 ratio using a computer-generated randomization list (block randomization with variable block sizes). Allocation concealment was maintained using sealed envelopes.
Blinding (investigator's opinion)
Double blinded
Blinding description
This study is double-blinded (participants and outcome assessor). To blind the participants, sham dry needling is used in the control group. To blind the outcome assessor, group allocations are kept hidden from the assessor.
Placebo
Used
Assignment
Parallel
Other design features
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Ethics Committee of Iran University of Medical Sciences
Street address
Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran
City
Tehran
Province
Tehran
Postal code
1449614535
Approval date
2026-08-31, 1405/06/09
Ethics committee reference number
IR.IUMS.REC.1402.744
Health conditions studied
1
Description of health condition studied
Hamstring muscle tightness
ICD-10 code
M62.4
ICD-10 code description
Contracture of muscle
Primary outcomes
1
Description
Active knee extension range of motion (hamstring flexibility)
Timepoint
Before intervention and immediately after intervention
Method of measurement
Goniometer during Active Knee Extension (AKE) test
2
Description
Hamstring stretch tolerance
Timepoint
Before intervention and immediately after intervention
Method of measurement
Visual Analogue Scale (VAS) during Active Knee Extension test
Secondary outcomes
1
Description
Single leg hop distance
Timepoint
Before intervention and immediately after intervention
Method of measurement
Measuring tape in centimeters
2
Description
Triple hop distance
Timepoint
Before intervention and immediately after intervention
Method of measurement
Measuring tape in centimeters
Intervention groups
1
Description
Intervention group: Participants receive active dry needling applied to active trigger points of the hamstring muscle in 3 sessions (every other day), followed immediately by muscle energy technique (MET) for hamstring stretching.
Category
Rehabilitation
2
Description
Control group: Participants receive sham dry needling (using non-penetrating sham needles over the hamstring muscle area) in 3 sessions (every other day), followed immediately by the identical muscle energy technique (MET) protocol as the intervention group.
Category
Placebo
Recruitment centers
1
Recruitment center
Name of recruitment center
School of Rehabilitation Sciences, Iran University of Medical Sciences
Full name of responsible person
Holakoo Mohsenifar
Street address
No. 23, Shah Nazari St, Madar Sq, Mirdamad Blvd, Tehran
City
Tehran
Province
Tehran
Postal code
1540913711
Phone
+98 21 2222 8051
Email
mohsenifar.h@iums.ac.ir
Web page address
https://rehab.iums.ac.ir
Sponsors / Funding sources
1
Sponsor
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
empty
Title of funding source
Proportion provided by this source
Public or private sector
empty
Domestic or foreign origin
empty
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
empty
2
Sponsor
Name of organization / entity
Iran University of Medical Sciences
Full name of responsible person
Holakoo Mohsenifar
Street address
Hemmat Expressway, Iran University of Medical Sciences
City
Tehran
Province
Tehran
Postal code
1449614535
Phone
+98 21 86701
Email
mohsenifar.h@iums.ac.ir
Web page address
https://iums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Iran University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic
Person responsible for general inquiries
Contact
Name of organization / entity
Iran University of Medical Sciences
Full name of responsible person
Holakoo Mohsenifar
Position
Associate Professor
Latest degree
Ph.D.
Other areas of specialty/work
Physiotherapy
Street address
No. 23, Shah Nazari St, Madar Sq, Mirdamad Blvd, Tehran
City
Tehran
Province
Tehran
Postal code
1540913711
Phone
+98 21 2222 8051
Email
mohsenifar.h@iums.ac.ir
Web page address
https://rehab.iums.ac.ir
Person responsible for scientific inquiries
Contact
Name of organization / entity
Iran University of Medical Sciences
Full name of responsible person
Holakoo Mohsenifar
Position
Associate Professor
Latest degree
Ph.D.
Other areas of specialty/work
Physiotherapy
Street address
No. 23, Shah Nazari St, Madar Sq, Mirdamad Blvd, Tehran
City
Tehran
Province
Tehran
Postal code
1540913711
Phone
+98 21 2222 8051
Email
mohsenifar.h@iums.ac.ir
Web page address
https://rehab.iums.ac.ir
Person responsible for updating data
Contact
Name of organization / entity
Iran University of Medical Sciences
Full name of responsible person
Holakoo Mohsenifar
Position
Associate Professor
Latest degree
Ph.D.
Other areas of specialty/work
Physiotherapy
Street address
No. 23, Shah Nazari St, Madar Sq, Mirdamad Blvd, Tehran
City
Tehran
Province
Tehran
Postal code
1540913711
Phone
+98 21 2222 8051
Email
mohsenifar.h@iums.ac.ir
Web page address
https://rehab.iums.ac.ir
Sharing plan
Deidentified Individual Participant Data Set (IPD)
Yes - There is a plan to make this available
Study Protocol
Yes - There is a plan to make this available
Statistical Analysis Plan
Yes - There is a plan to make this available
Informed Consent Form
Yes - There is a plan to make this available
Clinical Study Report
Yes - There is a plan to make this available
Analytic Code
Yes - There is a plan to make this available
Data Dictionary
Yes - There is a plan to make this available
Title and more details about the data/document
De-identified individual participant data, study protocol, and outcome measurements including AKE ROM, stretch tolerance, and leg hop test results.
When the data will become available and for how long
Starting 6 months after publication of the main results in a peer-reviewed journal
To whom data/document is available
Academic and clinical researchers in the field of physiotherapy and sports rehabilitation.
Under which criteria data/document could be used
For systematic reviews, meta-analyses, and secondary analytical studies upon approval of a formal proposal.
From where data/document is obtainable
Dr. Holakoo Mohsenifar (Email: mohsenifar.h@iums.ac.ir)
What processes are involved for a request to access data/document
Applicants must send a formal request email to the principal investigator along with a brief research proposal. The request will be evaluated by the study investigators within a maximum of 14 business days.
Comments
Data will be made available solely for non-commercial academic research after signing a data sharing agreement.