Can the active release technique help prevent or treat tendon injuries?

I have read some pilot studies with small samples sizes (see below), I wonder whether there are more extensive studies, ideally RCTs or SRs.

{1} George, James W., Andrew C. Tunstall, Rodger E. Tepe, and Clayton D. Skaggs. "The effects of active release technique on hamstring flexibility: a pilot study." Journal of manipulative and physiological therapeutics 29, no. 3 (2006): 224-227. https://www.ncbi.nlm.nih.gov/pubmed/16584948 ;https://scholar.google.com/scholar?cluster=1297471980492189395&hl=en&as_sdt=0,22 ; http://www.sciencedirect.com/science/article/pii/S0161475406000376

OBJECTIVE: The aim of this study is to determine if active release technique (ART) significantly increases hamstring flexibility in healthy male participants.

METHODS: Twenty physically active male participants with no current or previous history of lower extremity injury received ART on the origins and insertions of the hamstrings and dorsal sacral ligament. The sit-and-reach test was used before and after treatment to determine hamstring flexibility. Summary statistics were calculated, and pre and post hamstring flexibility scores were compared using a related samples t test.

RESULTS: There was a significant difference between the pre- and posttest groups (mean pre = 35.5 cm, df = 19, SD = 7.56; mean post = 48.3 cm, df = 19, SD = 7.07; P = .0015). All 20 participants increased their sit-and-reach scores following the application of ART.

CONCLUSIONS: This study demonstrated that a single ART treatment increased hamstring flexibility in a group of healthy, active male participants.

{2} Drover, Janice M., Dominique R. Forand, and Walter Herzog. "Influence of active release technique on quadriceps inhibition and strength: a pilot study." Journal of manipulative and physiological therapeutics 27, no. 6 (2004): 408-413. https://www.ncbi.nlm.nih.gov/pubmed/15319764 ; https://scholar.google.com/scholar?cluster=7686360738794548562&hl=en&as_sdt=0,22 ; http://www.sciencedirect.com/science/article/pii/S0161475404001010


To determine if Active Release Technique (ART) protocols could be used as an effective way to influence strength and muscle inhibition in the quadriceps muscles of athletes with anterior knee pain.


Pilot clinical outcome study.


The sample consisted of 9 athletes (4 male athletes, 5 female athletes) who were identified as suffering from unilateral anterior knee pain. A Biodex dynamometer and the interpolated twitch technique were used to determine isometric strength and inhibition in the quadriceps muscles, respectively. The treatment intervention consisted of the Active Release Technique treatment protocols for anterior knee pain. The experimental leg and contralateral leg were tested pretreatment and posttreatment, and the experimental leg was tested a third time approximately 20 minutes posttreatment.


Knee extensor moments were calculated by multiplying the moment arm by the forces measured by the Biodex dynamometer. Percentage of muscle inhibition was calculated by dividing the interpolated twitch torque (ITT) by the resting twitch torque (RTT), that is (ITT/RTT*100). A repeated measures analysis of variance (ANOVA) was used to compare pretreatment and posttreatment values for strength and muscle inhibition for the experimental and contralateral knees. The results showed no statistical significance.


ART protocols did not reduce inhibition or increase strength in the quadriceps muscles of athletes with anterior knee pain. Further study is required.

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