Comparative Efficacy of Remote TMJ-Region Myofascial Release vs. Local Static Stretching for Hamstring Flexibility in Athletes: A Randomized Controlled Trial Simulation

Abstract

Executive Summary
Hamstring flexibility is a critical component of athletic performance and rehabilitation, traditionally addressed
through local interventions such as static stretching, However, emerging theories of myofascial continuity suggest
that manual therapy applied at remote locations, specifically the temporomandibular joint (TMJ) and upper cervical
region, may influence lower limb range of motion (ROM). This research paper evaluates the comparative efficacy
of a remote TMJ-region myofascial release (MFR) protocol versus traditional static hamstring stretching in a
simulated randomized controlled trial involving 60 athletes.
The study employed a parallel-group design where participants were allocated to either a four-week TMJ-region
MFR program or a supervised static stretching program. Outcomes were assessed using the active knee extension
(AKE) test, passive straight leg raise (PSLR), and the sit-and-reach (SK) test. The results, derived from a synthetic
demonstration dataset, indicate that while both interventions produced significant within-group improvements in
hamstring flexibility, direct static stretching was superior to the remote MFR protocol. Specifically, the stretching
group showed a mean AKE improvement of 12.2°, compared to 9.3° in the MFR group, representing a statistically
significant between-group difference of 2.9.
Discussion of these findings highlights the hierarchy of intervention specificity, where direct mechanical loading of
the target tissue remains the most effective strategy. Nonetheless, the consistent improvement observed in the remote
MFR group supports the hypothesis of neurophysiological modulation likely through altered stretch tolerance and
suboccipital muscle inhibition-and potentially modest mechanical transmission via myofascial chains. The study
concludes that while TMI-region MFR may serve as a valuable adjunct in sports physiotherapy, particularly when
local loading is contraindicated, traditional stretching remains the primary clinical recommendation for Improving
hamstring extensibility.