Comparative Effects of Bowen Technique and Mulligan Knee Extension Technique on Flexibility and Performance in Athletes with Quadriceps Tightness

Abstract

Background: Quadriceps tightness is a common musculoskeletal condition in athletes, often caused by repetitive loading, inadequate stretching, or muscular imbalance. It leads to restricted flexibility, impaired performance, and increased risk of injury. Effective therapeutic interventions targeting muscle extensibility are therefore essential to optimize performance and prevent injuries. Manual therapy techniques such as the Bowen Technique and the Mulligan Knee Extension Technique have been widely used for managing lower limb muscle tightness, but direct comparative evidence on their relative efficacy in addressing quadriceps tightness remains limited. Objective: This study aimed to compare the effects of the Bowen Technique and the Mulligan Knee Extension Technique on flexibility, pain, and performance outcomes in athletes with quadriceps tightness. Methods: Thirty athletes (15 males, 15 females; aged 18–30 years) with clinically diagnosed quadriceps tightness were randomly assigned to either a Bowen Technique group or a Mulligan Knee Extension Technique group. Both groups received three 30-minute sessions per week for four weeks. Outcomes included flexibility (Active Knee Extension [AKE] test, Sit-and-Reach test), performance (vertical jump height, 30-m sprint time), and pain (Visual Analog Scale [VAS]). Data were analyzed using paired and independent t-tests with a significance level of p < 0.05. Results: Both interventions significantly improved flexibility, performance, and pain scores (p < 0.05). The Bowen group demonstrated significantly greater improvements in AKE (15.2 ± 2.1° vs. 12.8 ± 1.9°, p = 0.003), Sit-and-Reach (25.4 ± 3.5 cm vs. 22.1 ± 3.2 cm, p = 0.012), sprint time (4.52 ± 0.12 s vs. 4.67 ± 0.14 s, p = 0.004), and VAS (1.2 ± 0.3 vs. 1.5 ± 0.4, p = 0.028). Vertical jump height improved in both groups, with a non-significant trend favoring Bowen (45.3 ± 5.6 cm vs. 42.7 ± 4.9 cm, p = 0.187). Conclusion: Both Bowen and Mulligan techniques effectively enhance flexibility, reduce pain, and improve performance in athletes with quadriceps tightness. Bowen therapy showed marginally superior results, particularly in flexibility, sprint performance, and pain reduction, suggesting it may be preferred when comprehensive outcomes are desired.