Immediate and short‐term effects of manual, active, and combined therapies on lower limb range of motion in professional female footballers: A randomized controlled trial

Hamstring injuries are among the most frequent and recurrent musculoskeletal issues in professional women's football. Range of motion (ROM) limitations and neuromuscular fatigue are potentially modifiable risk factors targeted by preventive therapies OBJECTIVE: To compare the immediate and short-term effects of three intervention protocols-manual therapy, active neuromuscular exercises, and a combined approach-on hip and knee ROM in elite female football players during the competitive season METHODS: Sixty-six players were randomly allocated to one of three groups (n = 22 per group): passive therapy (Group A), active therapy (Group B), and combined intervention (passive and active therapy) (Group C). Hip and knee ROM were measured at baseline (Pre), immediately after a single intervention session (Post), and at 1-week follow-up (FU) and a 24-item questionnaire was completed for each player. Data were analyzed using repeated-measures analysis of variance (ANOVA) and post hoc tests with Bonferroni correction RESULTS: All groups showed significant within-group improvements over time in multiple ROM variables (p < .001). Between-group analyses at FU revealed significantly greater gains in passive left hip flexion for Groups B (p = .006) and C (p = .034) compared to Group A. Right hip external rotation also showed significant differences at FU (Group B > A, p < .001; Group B > C, p = .011). Mixed-model ANOVA indicated significant time × group interaction effects for passive left hip flexion (p = .014), right hip external rotation (p = .010), and left hip external rotation (p = .041), favoring the combined intervention CONCLUSION: Combined therapy produced superior short-term gains in specific ROM measures compared to isolated interventions. These findings suggest that integrated neuromuscular strategies may enhance flexibility outcomes relevant to hamstring injury prevention.