An interventional study of Single-Session Neuroathletic Training and Active Control in Hamstring Tightness, sponsored by Ankara Yildirim Beyazıt University. Completed at 1 site in Turkey (Türkiye). Open to participants aged 18 Years to 35 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-10-22.
Sponsored by Ankara Yildirim Beyazıt University · Not applicable, Interventional, and Treatment
Hamstring tightness may be accompanied by limitations in flexibility and movement along the back of the body. Neuroathletic training combines exercises involving vision, eye movements, balance-related sensory input, and movement coordination. Its immediate effects on muscle activity and mobility require investigation.
This randomized study compared a single 20-minute neuroathletic training session with a 20-minute active control session in 40 adults aged 18 to 35 years with hamstring tightness. Participants were assigned to two groups of 20, with equal numbers of male and female participants in each group.
The neuroathletic training session included visual preparation exercises, eye movement drills, vestibular stimulation, trunk extension preparation, and visually guided movement tasks. The active control session consisted of light walking followed by non-ballistic dynamic stretching of the lower limbs, upper limbs, and trunk. Both sessions were supervised.
Before and after the assigned session, muscle activity was assessed in four muscle groups along the posterior chain using surface electromyography during the Superman exercise. Hamstring flexibility was assessed using an active knee extension test, and ankle dorsiflexion was assessed using a weight-bearing lunge test.
The study evaluated whether the immediate changes in these measures differed between neuroathletic training and the active control session.
This randomized, parallel-group study investigated the acute effects of neuroathletic training on posterior-chain muscle activation, hamstring flexibility, and ankle dorsiflexion range of motion in adults with hamstring tightness.
Forty participants aged 18 to 35 years, comprising 20 male and 20 female participants, were randomly allocated to a neuroathletic training group or an active control group. Each group included 20 participants, with equal numbers of male and female participants. The study compared the pre-session and post-session responses to two supervised interventions of equal duration.
The neuroathletic training intervention consisted of one individualized, supervised 20-minute session delivered by certified trainers. The session included five components: visual resets for 2 minutes, oculomotor drills for 4 minutes, vestibular stimulation for 4 minutes, cerebellar priming for 4 minutes, and visuomotor reactivity tasks for 6 minutes. Exercises included periorbital massage, palming, chart-based reaction tasks, pinhole-glasses reaction tasks, ocular tracking, hip and spinal extension preparation, convergence-divergence exercises, Brock string exercises, lunge oscillations, and alternating gaze tasks using letter cards. Trainers followed a standardized checklist covering exercise order, dose, instructions, and participant positioning.
The active control intervention consisted of a supervised 20-minute session of light overground walking followed by non-ballistic dynamic stretching of the major muscle groups of the lower limbs, upper limbs, and trunk. The same trainers supervised both interventions. Session duration, trainer attention, and verbal encouragement were matched. The active control session did not include the targeted visual, vestibular, oculomotor, or cognitively demanding components of the neuroathletic training session.
Surface electromyographic activity was recorded bilaterally from the biceps femoris long head, gluteus maximus, lumbar erector spinae, and gastrocnemius lateral head using an eight-channel wireless system. Signals were sampled at 2000 Hz. Skin preparation and electrode placement followed standardized procedures, and the electrodes remained in place between the pre-session and post-session assessments.
Before baseline task assessment, maximum voluntary isometric contraction tests were performed for each muscle to provide normalization reference values. Three 5-second maximal contractions were completed for each muscle on each side, with 60 seconds of rest between trials and 2 minutes between muscles. A submaximal familiarization trial preceded the maximal trials, and muscle testing order was randomized.
Task-related muscle activity was recorded during the Superman exercise. Participants lay prone with their arms extended overhead and simultaneously raised their arms, upper trunk, and lower limbs from the floor. Movement was paced with a metronome. Three repetitions were completed, with 60 seconds of rest between repetitions. The same testing procedure was used before and after the assigned intervention.
Electromyographic signals were band-pass filtered at 20-450 Hz, rectified, and processed using a root-mean-square algorithm with a 100-millisecond moving window. For each muscle, task amplitude was normalized to the highest reference amplitude obtained during the maximum voluntary isometric contraction trials. Right and left values were averaged, and the mean across task repetitions was used for analysis.
Hamstring flexibility was assessed using an active knee extension test with maximum hip flexion. Angular measurements were obtained with a digital inclinometer positioned on the tibial crest. Ankle dorsiflexion range of motion was assessed using a weight-bearing lunge test and reported in degrees.
The study evaluated acute pre-session to post-session changes in muscle activation, hamstring flexibility, and ankle dorsiflexion. It did not include a reported long-term follow-up assessment.
Ankara Yildirim Beyazıt University is the lead sponsor of 238 studies on the registry; 55 are open to participants now.
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Participants completed one supervised 20-minute neuroathletic training session comprising visual resets (2 minutes), oculomotor drills (4 minutes), vestibular stimulation (4 minutes), cerebellar priming (4 minutes), and visuomotor reactivity tasks (6 minutes). Sessions were delivered one-to-one by certified trainers using a standardized checklist for exercise order, dose, instructions, and participant positioning.
Behavioral: Single-Session Neuroathletic Training
Participants completed one supervised 20-minute active control session consisting of light overground walking followed by non-ballistic dynamic stretching of the major muscle groups of the lower limbs, upper limbs, and trunk. The same trainers supervised both groups. Session duration, trainer attention, and verbal encouragement were matched to the neuroathletic training session. Targeted visual, vestibular, oculomotor, and cognitively demanding exercises were omitted.
Other: Active Control
A single supervised 20-minute session incorporating visual preparation, eye movement exercises, vestibular stimulation, trunk extension preparation, and visually guided movement tasks. Exercises included periorbital massage, palming, slap-tap chart tasks, pinhole-glasses reaction tasks, star-chart exercises, hip and spinal extension priming, convergence-divergence exercises, Brock string fixation, lunge oscillations, and alternating gaze tasks using letter cards. Delivery followed a standardized exercise checklist.
A single supervised 20-minute session consisting of light overground walking followed by non-ballistic dynamic stretching of the major muscle groups of the lower limbs, upper limbs, and trunk. The intervention provided general physical activity without the targeted visual, vestibular, oculomotor, or cognitively demanding exercises included in neuroathletic training. Session duration, trainer attention, and verbal encouragement were matched between groups.
Biceps Femoris Long Head Muscle Activation
Biceps femoris long head muscle activity was recorded bilaterally using surface electromyography during three standardized Superman repetitions. Signals were sampled at 2000 Hz, band-pass filtered at 20-450 Hz, and processed using root-mean-square amplitude with a 100-ms moving window. Task amplitude was normalized to the highest reference amplitude obtained from three maximum voluntary isometric contraction trials and expressed as a percentage of that reference (%MVC). Values were averaged across three repetitions and between the right and left sides. Change was calculated as post-session minus baseline %MVC and expressed in percentage points. Higher values indicate greater normalized muscle activation during the task.
Time frame: Baseline and immediately after the single 20-minute intervention session, on the same day.
Gluteus Maximus Muscle Activation
Gluteus maximus muscle activity was recorded bilaterally using surface electromyography during three standardized Superman repetitions. Signals were sampled at 2000 Hz, band-pass filtered at 20-450 Hz, and processed using root-mean-square amplitude with a 100-ms moving window. Task amplitude was normalized to the highest reference amplitude obtained from three maximum voluntary isometric contraction trials performed during resisted prone hip extension with the knee flexed to 90 degrees. Values were expressed as %MVC and averaged across three repetitions and between sides. Change was calculated as post-session minus baseline %MVC and expressed in percentage points. Higher values indicate greater normalized muscle activation during the task.
Time frame: Baseline and immediately after the single 20-minute intervention session, on the same day.
Lumbar Erector Spinae Muscle Activation
Lumbar erector spinae muscle activity was recorded bilaterally using surface electromyography during three standardized Superman repetitions. Signals were sampled at 2000 Hz, band-pass filtered at 20-450 Hz, and processed using root-mean-square amplitude with a 100-ms moving window. Task amplitude was normalized to the highest reference amplitude obtained from three maximum voluntary isometric contraction trials involving resisted prone trunk extension with the pelvis and lower limbs stabilized. Values were expressed as %MVC and averaged across three repetitions and between sides. Change was calculated as post-session minus baseline %MVC and expressed in percentage points. Higher values indicate greater normalized muscle activation during the task.
Time frame: Baseline and immediately after the single 20-minute intervention session, on the same day.
Gastrocnemius Lateral Head Muscle Activation
Gastrocnemius lateral head muscle activity was recorded bilaterally using surface electromyography during three standardized Superman repetitions. Signals were sampled at 2000 Hz, band-pass filtered at 20-450 Hz, and processed using root-mean-square amplitude with a 100-ms moving window. Task amplitude was normalized to the highest reference amplitude obtained from three maximum voluntary isometric contraction trials involving a single-leg heel raise held isometrically with the knee extended and manual resistance applied over the shoulders. Values were expressed as %MVC and averaged across three repetitions and between sides. Change was calculated as post-session minus baseline %MVC and expressed in percentage points. Higher values indicate greater normalized muscle activation during the task.
Time frame: Baseline and immediately after the single 20-minute intervention session, on the same day.
Hamstring Flexibility
Hamstring flexibility was assessed using the active knee extension test with maximum hip flexion. The knee angle was measured in degrees using a Dualer IQ digital inclinometer (J-Tech Medical, USA) positioned on the tibial crest. Participants actively extended the knee while maintaining the required hip position. The outcome was the change in knee extension angle from baseline to the post-session assessment, calculated as post-session minus baseline degrees. Using the angular convention reported in the manuscript, larger angles indicate greater knee extension and greater hamstring flexibility.
Time frame: Baseline and during the post-session assessment following the single 20-minute intervention, on the same day.
Ankle Dorsiflexion Range of Motion
Ankle dorsiflexion range of motion was assessed using the weight-bearing lunge test. Ankle mobility was evaluated in a weight-bearing position, and the result was recorded as an angular measurement in degrees. The outcome was the change in ankle dorsiflexion range of motion from baseline to the post-session assessment, calculated as post-session minus baseline degrees. A positive change indicates increased ankle dorsiflexion range of motion.
Time frame: Baseline and during the post-session assessment following the single 20-minute intervention, on the same day.
Plan to share: Yes — De-identified individual participant data underlying the published results, including participant characteristics, group allocation, and pre- and post-intervention outcome measurements, will be available upon reasonable request to the corresponding author. Sharing will be subject to participant consent provisions, applicable institutional requirements, and a data use agreement. Direct identifiers and information that could reasonably identify individual participants will not be shared.
Supporting information: Study protocol
Time frame: Beginning 6 months after publication of the main study results and continuing for 5 years.
Access criteria: Qualified researchers may submit a written request to the corresponding author describing the research question, requested variables, and proposed analysis. Requests will be reviewed by the study team for scientific merit, feasibility, and compliance with consent and institutional requirements. Approved requests will require a data use agreement.
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