1 Effects of Aerobic Exercise and Resistance Exercise on Patients with Diabetes Mellitus II - Shilpa Kasar, Dr.Nisha Shinde(PT), Sambhaji Gunja

2 Effect Of Non Ballistic Active Knee Extension In Neural Slump Position On Hamstring Tightness - Dr Seema Saini (PT)

3 Prevalence of Adhesive capsulitis in Diabetic Patients - An Observational Study.-Pooja D.Patil, Dr.Pooja Deshpande (PT), Dr.Parag Ranade (PT).

4 Inter-rater reliability of trial error and spring balance method for Quadriceps Femoris Strength Assessment in Normal Young Adults - Manashi Thakkar,Dr Prajakta Patil(PT)

5 Proportion of work-related musculoskeletal complaints in I.T. Students - Ankita P. Joshi, Dr. Kiran Satpute (PT)

6 The Efficacy of Anterior Versus Posterior Joint Mobilization on Functional Activity in Patients with Adhesive Capsulitis- Dr.Ankita Chitre(PT), Dr.Pooja Deshpande(PT), Dr.Chandan Kumar(PT)

7 Comparison between Quadriceps and Hamstrings muscle strength in dominant and non- dominant side in females of age 20-40 years- Cross Sectional Study. -Ms. Shruti. D, Dr. Sonali N (PT),Dr. Sharmishtha G(PT)

8 Comparison of Shoulder Rotation Range of Motion in Scaption and In Frontal Plane. -Ms. Ankita R. Deodhar, Dr.Kiran Satpute

9 Changes of Rate-Pressure Product in 6 Minute Walk Test and Step Test in normal Individuals-Prospective Pilot Study- Vaibhavi Mehendrakar, Dr.Senthil Kumar E.

10 Lumbar Flexion Relaxation Phenomenon in Patients with Acute and Subacute Mechanical Low Back Pain and Normal Subjects:- Ms. Hetal S. Desai, Dr. Rahul Singh Bisen (PT)

Smt. Kashibai Navale e – Journal of Physiotherapy

Publication of

Sinhgad Technical Education Society's

Smt. Kashibai Navale College of PhysiotherapyNarhe, Pune – 41.Sinhgad Institutes

Sr. No. Index

Pg.No.

1

5

8

11

14

18

22

25

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It is with a great pleasure and honor; I welcome you to the

inaugural issue of the Sinhgad e-journal of Physiotherapy. Physiotherapy

profession though is very old; there is a great change in the academic

attitude due to its research vision in the last 15 years. Due to the Health

Sciences Universities in many states of India, and specially Maharashtra

University of Health Sciences, Nashik, there is more awareness and

opportunities in the field of Teaching Technology and Research

Methodology for Physiotherapy teachers and students. Improved healthier academic environment and

inter faculty communication has helped the teachers and students to get involved in many more research

studies, independently as well as inter faculty projects.

Though the research studies are done much more in not only the numbers but of much better quality,

there is dearth of opportunities to present their work exclusively in Physiotherapy research conferences

or to publish their work in Physiotherapy journals.

Goals to start this e-journal are, firstly to establish and promote a collegial research culture and secondly,

to provide opportunities for facilitation for the physiotherapy professional communication.

We wish to encourage more contributions from the Physiotherapy Community to ensure a continued

success of the journal. Authors, reviewers and guest editors are always welcome. We also welcome

comments and suggestions that could improve the quality of the journal.

Dr. A. V. Patil, (P.T)Managing Editor

PrincipalSKNCOPT, Pune.

WELCOME MESSAGE

01

Abstract

Background: Diabetes mellitus is a chronic disease that causes serious health complications including renal (kidney) failure, heart disease, stroke, and blindness. Approximately 17 million Americans have diabetes. Unfortunately, as many as one-half are unaware they have it. Purpose: To find out & compare the effectiveness of aerobic exercise and resistance exercise in type 2 diabetes Mellitus patients. Methods: The prospective comparative study consists of thirty participants with clinical diagnosis of Type 2 diabetes. Sampling Method: Simple Random sampling by tossing the coin and allocation of the participants to the two groups: Group A & Group B. Selection Criteria Inclusion Criteria: Both male and female, Patients diagnosed as Type 2 Diabetes, Age between 40 to 60 years, Exclusion Criteria: Patients with severe illness group A received aerobic exercises and group B received resistance exercises. Results: The results of the study showed that there was a significant reduction of blood suger level and total cholesterol (p<0.05) in both the groups. Conclusion: Study concludes Aerobic exercise and Resistance exercise both have similar effect on blood suger level and total cholesterol in patient with type 2 diabetes mellitus.

Keywords: Diabetes mellitus, Aerobic exercises, Resistance exercises, Blood sugar level, Cholesterol.

INTRODUCTION

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger.Diabetes mellitus is a chronic disease that causes serious health complications including renal (kidney) failure, heart disease, stroke, and blindness. Approximately 17 million Americans have diabetes. Unfortunately, as many as one-half are unaware they have it.1Type I diabetes, sometimes called juvenile diabetes and begins most commonly in childhood or adolescence. In this form of diabetes, the body produces little or no insulin. This form also is called insulin-dependent diabetes because people who develop this type need to have daily injections of insulin. Type II Sometimes called age-onset or adult-onset diabetes, this form of diabetes occurs most often in people who are overweight and who do not exercise1,2.Several Methods help in lowering down the risk of diabetes. This study will emphasize on two methods of training the type 2 diabetes mellitus patients i.e. Aerobic exercises and resisted exercises which will help the patients to continue the same treatment to avoid being prone. Aerobic exercise is physical exercise of relatively low intensity that depends primarily on the aerobic energy generating process. Aerobic literally means "Living in Air" and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism3. Generally, light to moderate intensity activities that are sufficiently supported by aerobic metabolism can be performed for extended periods of time. The intensity should be between 65%-80% of max heart rate e.g. Running, jogging, swimming, cycling, walking. The mechanism of aerobic exercises is as follows: Average healthy adult

EFFECTS OF AEROBIC EXERCISE AND RESISTANCE EXERCISE ON PATIENTS

WITH DIABETES MELLITUS II

Shilpa Kasar, Dr.Nisha Shinde, Sambhaji Gunjal

inhales and exhales about 7-8 liters of air per min and once the lungs are filled the oxygen is filtered through bronchioles until it reaches alveoli which are the microscopic sacs where oxygen diffuses and enters into the blood and id directed to the heart 4,5 .Once the heart uses the fresh oxygen, it pumps blood, oxygen and nutrients through the large left ventricle and through the circulatory system to all the organs, muscles and tissues. The normal heart beats 60-80 times per minute at rest and pumps 5ltr of blood per minute.6 This blood then reaches the muscles and certain amount of oxygen is extracted and consumed from the blood and is expressed in ml/kg/min. Muscles are like engine that run on fuel and oxygen is a key player, because once inside the muscle it is used to burn fat and carbohydrates for fuel to keep our engines (muscles) running. The more efficient our muscles are at consuming oxygen, the more fuel we can burn, the more fit we are and the longer we can exercise7.Strength training is a type of physical exercise specializing in the use of resistance to induce muscular contractions which builds the strength, anaerobic endurance and size of skeletal muscles. When performed properly, strength training can provide significant functional benefits and improvement in overall health and wellbeing, including increased bone, muscle, tendon and ligament strength and toughness, improved joint function, reduced potential for injury, increased bone density, increased metabolism, improved cardiac function, elevated HDL cholesterols. Training commonly uses the techniques of progressively increasing the force output of muscles through incremental weight increases and uses a variety of exercises and types of equipment's to target specific muscle groups. The basic principles of strength training involve a manipulation of the number of repetitions, sets, tempo, exercises and force to cause desired changes in strength, endurance or size by overloading a group of muscles. The specific combinations of repetitions, sets, exercises, resistance and force depend on the purpose of the individuals performing the exercises. Exercise selection should be limited to the basic foundation barbell movements such as squats, bench press, had lift, overhead press &bent over. A wide spectrum regimes are adopted to achieve different result but classic formula by American College of Sports Medicine is ;8-12 repetitions of a resistance training exercise for each major muscle group at an intensity of 40% -80% of one repetition max (RM) depending upon training level of participant ;2-3

minutes of rest is recommended for each muscle group. Three important variables of strength training are; intensity, volume and frequency .Intensity refers to the amount of work required to achieve the activity and is proportional to the mass of the weights being lifted. Volume refers to the number of muscle worked, exercise, sets and repetitions during single session.7,8 Frequency refers to how many training session are performed per weak. This study will emphasis on these two method of exercises and will let us known that which one is a better protocol for the type 2 diabetes patientThe purpose of this study was to find out and compare the effectiveness of aerobic exercise and resistance exercise in type 2 diabetes patients.

MethodologyStudy design: Randomized controlled trial. Sample Size: 30 participants, individuals with clinical diagnosis of Type 2 diabetes Sampling Method: Simple Random sampling by tossing the coin and allocation of the participants to the two groups: group A & Group B Equipment Used: Treadmill, Static Bicycle, Theraband and Dumbbells. Selection Criteria Inclusion Criteria were Patients diagnosed as Type 2 Diabetes and Age between 40 to 60 years. Exclusion Criteria was Patients with severe illness.Outcome Measures:1. Blood Glucose Level2. Cholesterol

ProcedurePatients were randomly allocated to both the groups and informed written consent was obtained. Impaired fasting glucose and total cholesterol of the participants was obtained before the treatment protocol and then the participants were allocated. Total 30 individuals, 15 each group divided randomly into two groups.Group A: Given aerobic exercise with 5 mins of warm up and 5 mins of cool down period then were asked to walk on treadmill for 40 minutes with warm up & cool down for 2 weeks.Group B: Resisted exercise for both upper limbs and lower limbs with therabands, dumbbells & leg press for 2 weeks

Effects of Aerobic Exercise and Resistance Exercise on Patients with Diabetes Mellitus II

02

Data analysis and Result Table no.1

Table no.2

Table - 2

By applying Student's Paired 't' test there is a significant decrease in average B.S.L. and total cholesterol after 2 Weeks of training in aerobic and resistance exercises.

DISCUSSION

Present study has shown there is significant reduction of blood sugar level and cholesterol after 2 weeks of aerobic and resistance training in a same manner.Many times we go un-noticed about the consequences of overweight and obesity or even the sedentary lifestyle due to the busy and hectic life of modern world. Also there is not much awareness of the Type 2 diabetes mellitus and its management or protocol to control it from leading to type 2 diabetes mellitus. Usually, there is the conventional treatment of aerobic exercises which is preferred for the patients having Type 2 Diabetes mellitus to control the blood sugar levels.Sigal, Kenny et al (2007)2 Carried out a study on 251 adults aged 39-70 years with type 2diabetes mellitus in which aerobic training, resistance training, or both types of exercise were performed for 3 times /week for 22 weeks and found that there was absolute change in blood glucose levels in combined exercise training group, as compared to other two groups. Ultimately, the conclusion was that there are great improvements in glycemic control with combined aerobic and resistance training. Robin Marcus et al (2008) made a study on the combination of aerobic exercise and resistance exercise

Type of Training

B.S.L.

(Pre -Training)

B.S.L

(Post -Training)

P value

Mean ±

SD

Mean ± SD

Aerobic Training

192±1.5 182±1.5 P<0.001 significant

Resistance Training

197±1.5 186±2.4 P<0.001 significant

Type of Trainin g

Cholesterol(Pre -Training)

Mean ± SD

Cholesterol(Post -Training)

Mean ± SD

P value

Total cholesterol

Total cholesterol

Aerobic Training

231±4.6

225±3.9

0.007,Significant

Resistance Training

230±5.1 224±3.6 0.0023, significant

SEJOP E-journal Volume-1, Issue -1, January 2015

03

for patients having type 2 diabetes mellitus and got significant results in the reduced B.S.L. in patients performing resistance training on an alternate day for 12 weeks along with aerobic exercises.This study also shows similar results in the diabetic patients in which one group was asked to perform aerobic exercises and other group was given resistance exercises

CONCLUSIONAerobic exercise and Resistance exercise both have a favorable effect on the B.S.L. and cholesterol in patient with type 2 diabetes mellitus.

REFERENCES1. Robin L Marcus, Sheldon Smith, et al Comparison

of combined aerobic and high force eccentric resistance exercise with aerobic exercise only for people with type 2 diabetes mellitus PHY THER,2008;88:1345-1354

2. Ronald Sigal, Glen Kenny et al Effects of aerobic training, resistance training, or both on glycemic controlling type 2 diabetes mellitus ANNALS OF INTERNAL MED,2007;147:357-369

3. Lisa Yee Is resistance training or aerobic training more effective in lowering body glucose levels in patients with type 2 diabetes? An evidence based review PHYSICAL THERAPY, 2009; 88: 1742-1751

4. Kirwan JP, Solomon TPJ, WOJTADM, etal. Effects of 7 days of exercise training on insulins sensitivity and responsiveness.

5. Type2diabetesmellitus.AmJPhysiolEndocrinolMetab.2009;297:E151---E156

6. Mathew D. Hordan David nW. Dunstan, Johannes B.Prins, Michael K. Baker. Exercise Prescription for patients with type 2 diabetes mellitus; A position statement from exercise and sports sciences Australia. JOURNAL OF SCIENCE ABD MEDICINE IN SPORTS,2012;15;25-31

7. Neil D. Eves, Ronald C. Plotnikoff et al Resistance training and type 2 diabetes: Considerations for implantation at population level. DIABETES CARE,2006;29(8):1933-1941

8. Andreas Egger, David Niederseer, Gernot Diem, Thomas Finkenzeller, E Leidl-Kurkowski, Rosennarie Forstner, Christian Pirich et al Different types of resistance training in type 2 diabetes mellitus effects of glycaemic control, muscle mass and strength. JOURNAL OF PREVENTIVE CARDIOLOGY, 2012;0(00); 1-10

Effects of Aerobic Exercise and Resistance Exercise on Patients with Diabetes Mellitus II

04

Dr Seema Saini SKNCOPTPune

INTRODUCTION

In India there is sedentary lifestyle it includes less working, sitting for long period of time, lack of exercise. Sedentary life style lead to various problems like tightness of muscles, decrease muscles length, decrease joint ROM and thereby decrease muscle flexibility hampering the daily activity of living.

Those Muscle which are responsive to stress by shortening (postural muscles) comprises the following : gastronomies , soleus , hamstring, short adductor of thigh, tensor fascialata, quadrates lumborum, erector spine muscle, lattismus dorsi, upper trapezius, scalene, sternomastoid, levator scapulae, pectoralis major and flexor of arm.1

Hamstring muscle is one of the common muscle group associated with low back ache, located at the back of the thigh, associated with the movement at both hip and knee joints.2 Many people suffer with tight hamstrings and most of the time it will not cause a problem but can be more prone to tear and also limit the activity. Tight hamstring can also be responsible for postural problems and other back problems as they will tend to pull the pelvis out of the normal position and in long run can possibly influence the sacroiliac and lumbar spine dysfunction.3Use of active knee extension movement in a neural slump test posture would appear to effectively tension neural and hamstring tissues8.

Problem Statement

This study was to determine the effectiveness of non-ballistic, repetitive active knee extension movements performed in a neural slump sitting position on hamstring flexibility in uninjured subjects.

OBJECTIVES

- To find out effect of non ballistic active knee extension in neural slump position on knee flexion angle in subjects with hamstring tightness.

- To compare the pre and post effect of non ballistic active knee extension in neural slump position on knee flexion angle in hamstring tightness.

Research Design:Experimental study design

Sample:30 Subjects having hamstring tightness were selected from physiotherapy OPD.

Sampling Technique:Purposive sampling technique

Criteria for selection of sample:

INCLUSION CRITERIA- Subjects having hamstring tightness, operationally

defined by a knee flexion angle greater than 15° as measured by a screening exam using active knee extension in supine with hip flexed 90°.

- Age group- 18-25 years

EXCLUSION CRITERIA- Subject having acute or chronic low back pain.- Subject having musculoskeletal disorders.- Subject having neurological disorders.

Instruments used for the study and outcome measure:1. Full Circle Goniometer2. Active knee extension test.

EFFECT OF NON BALLISTIC ACTIVE KNEE EXTENSION IN NEURAL SLUMP POSITION

ON HAMSTRING TIGHTNESS

05

Description

Subjects qualified for the study by having hamstring inflexibility, operationally defined by a knee flexion angle greater than 15° as measured by a screening exam using active knee extension in supine with hip flexed 90°. Prior to participation, each subject read and signed an informed consent form. Subjects were placed supine with the left lower extremity in 0° of hip flexion. Subjects stabilized the right hip at 90° of flexion by interlocking the fingers of both hands at the distal thigh. Subjects were instructed to actively extend their right knee to its limit, keeping the foot relaxed in plantar flexion. The goniometer was used to measure the degrees from full (0°) extension. Subjects demonstrating a knee flexion angle greater than 15° were operationally defined as having hamstring inflexibility and allowed to participate in the study.

Active knee extension test. The subject was in supine position with hips flexed 90° and knee flexed. The pelvis was strapped down to the table for stabilization and control on accessory movements. Landmarks used to measure hip and knee range of motion were greater trochanter, lateral condyle of femur and the lateral malleolus which were marked by a skin permanent marker. The fulcrum of the goniometer was centered over the lateral condyle of the femur with the proximal arm secured along the femur using greater trochanter as a reference. The distal arm was aligned with the lower leg using the lateral malleolus as a reference. The subject was then asked to extend the right lower extremity as far as possible until a mild stretch sensation was felt. A full circle goniometer was then used to measure the angle of knee flexion. Three repetitions were performed and an average of the three was taken as the final reading for Popliteal Angle

Non ballistic active stretch.

The nonballistic active stretch was performed sitting on a sturdy table at a height which did not allow foot contact with the floor. With the thighs supported, legs flexed, and Popliteal fossae touching the table edge, the subject sat slumped as far as possible, producing full thoracolumbar flexion. The cervical spine was then fully flexed. With fingers interlocked, the subject's hands were placed on the posterior aspect of their head. Overpressure was provided to the cervical and thoracolumbar spines by the weight of the relaxed arms.

The right foot was maximally dorsiflexed. The knee was then extended to end range while dorsiflexion was maintained; End range of knee extension was operationally defined as the point where firm resistance or stretch was felt at the posterior thigh, knee, and/or calf. This end range knee extension stretch position was held for a verbal self count of "one one-thousand." The Subject then lowered the leg and relaxed the foot in plantar flexion. This stretch movement sequence was repeated rhythmically for a total of 30 repetitions. The sitting slump posture was maintained by overpressure throughout the total repetitions.

With each active knee extension repetition maintained at end range approximately I second, the total time spent at end range in the neural slump sitting position would approximate the 30 seconds.

Score Interpretation- Data were analyzed using paired t test in between a

group. - Differences from baseline were calculated for the

variables. Mean differences and 95% confidence intervals (CI) were calculated for outcome measure.

Comparison of the pre and post effect of non ballistic active knee extension in neural slump position on knee flexion angle in RT hamstring tightness.

Table 1 RT MEAN±SD t VALUE p VALUE

PRE 31.50±3.56 37.801 p<0.0001

POST 20.367±3.113

Effect Of Non Ballistic Active Knee Extension In Neural Slump Position On Hamstring Tightness

06

The above graph shows significant reduction in knee flexion angle after treatment on RT side.

Comparison of the pre and post effect of non ballistic active knee extension in neural slump position on knee flexion angle in LT hamstring tightness.

Table 2

LT MEAN±SD t VALUE p VALUE

PRE 31.267±2.959 36.248 p<0.0001

POST 20.733±2.651

The above graph shows significant reduction in knee flexion angle after treatment on LT side.

The effect was extremely statically significant with p<0.0001.Maitland implicated the loss of movement of the dura mater and nerve root sleeves within the vertebral canal as the cause of limited knee extension and ankle dorsiflexion range of motion during the slump manoeuvre8.The slump stretching has also been associated with inhibitory effect on the sympathetic nervous system, stimulation of which affects the capability of the nerve to stretch. It is also responsible for reducing scar tissue adhered to the neural tissue and surrounding structure13.If tension of noncontractile tissue limits indirect measures of hamstring flexibility then use of stretching technique that emphasizes these tissues along with hamstring may be justified8.The improved range of motion gains demonstrated by this technique may be indicative of viscoelastic and lengthening changes of the hamstring.12

CONCLUSIONFrom this study it is concluded that nonballistic active knee extension in neural slump position is effective to improve the hamstring flexibility. Bibliography1. Pope R, Herbert R, Kirwan J. A randomized trial of

pre-exercise stretching for prevention of lower limb injury2000. Med Sci Sports Exercise. 32: 271-7.

2. Michael JA. Science of flexibility: Modern view of flexibility and stretching. 3rd eds.

3. Richard L, Gajodsik, Melonie A, Rieck, and Debra K, Sulivan. Comparison of four clinical tests for assessing hamstring muscle length1993. Journal of Orthopedic Sports Physical Therapy., 18(5): 614-618.

4. Richard L. Gajdosik. Effect of static stretching on the maximal length and resistance to passive stretch of short hamstring muscles1991. Journal of Orthopedic Sports Physical Therapy., 14(6): 250-255.

5. Breig A, Troup JDG: Biomechanical considerations in the straight leg Rising lest: Cadaveric and clinical studies of the effects of medial hip rotation. Spine 4:212-250, 1979.

6. Goddard MD, Reid JD: Movements induced by straight leg rising in the lumbo-sacral roots, nerves and plexus, and in the intrapelvic section of the sciatic nerve. J Neurol Neurosurg Psychiatry 28:12-18, 1965.

7. Troup JDG: Straight leg raising and the qualifying tests for increased root tension. Spine 6:526-527, 1981.

8. Maitland GD: Movement of pain sensitive structures in the vertebral canal in a group of physiotherapy students. S Afr J Physiother 36:4-12, 1980.

9. Maitland GD: Negative disc exploration: Positive canal signs. Aust J Physiother 25:129-134, 1979.

10. Maitland GD: The slump test: Examination and treatment. Aust J Physiother 31:215-219, 1985.

11. Breig A, Marion O: Biomechanics of the lumbosacral nerve roots. Acta Radiol 1:1141-1160, 196.3

12. McHugh MP, Magnusson SP, Gleim GW, Nicholas JA: Viscoelastic stress relaxation in human skeletal muscle. Med Sci Sports Exerc 24:1375-1382, 1992.

13. Neha malik, Chitra kataria : comparative effectiveness of streight leg raise and slump stretching in subjects with low back pain with adverse neural tension : july 2012

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SEJOP E-journal Volume-1, Issue -1, January 2015

Pooja D.Patil, Dr.Pooja Deshpande, Dr.Parag Ranade

PREVALENCE OF ADHESIVE CAPSULITIS IN DIABETIC PATIENTS -

AN OBSERVATIONAL STUDY.

INTRODUCTION:Adhesive capsulitis:Ø A condition of uncertain etiology characterized by

significant restriction of both active and passive shoulder range of motion1

Ø This condition most commonly occurs in 40 to 60 years of age with higher incidence in females2

Ø It is associated with medical condition like diabetes mellitus2

Ø There are 4 stages of adhesive capsulitis

1) Pre-adhesive or painful stage:— Patient has mild shoulder pain and decreased

ROM and this stage lasts for 0-3 months.

2) Freezing stage:— Characterized by onset of an aching pain in the

shoulder and the pain is more severe at night and with the activites and this stage lasts for 6-9 months.

3) Frozen stage:— Pain at rest diminishes during stage, leaves the

patients with restricted motions in all planes this stage last for 9-15 month

4) Thawing stage— This stage is characterized by slow motion of

recovery and this stage last for 15-24 month

— Diabetes Mellitus:Ø Diabetes mellitus is a clinical syndrome

characterized by hyperglycemia caused by absolute or relative deficiency of insulin6

Ø Types of diabetes mellitus-1) Type 1-also known as Insulin Dependent

Diabetes (IDDM)72) Type 2-also known as Non Insulin-Dependent

Diabetes Mellitus (NIDDM) 8

Ø The prevalence of Frozen Shoulder in diabetes patients is higher because excess glucose can adhere to cells, damaging connective tissue which

makes up the joint.6

Ø The metabolic perturbations in diabetes including glycosyla t ion of prote ins ,microvasular abnormalities;damge to blood vessels and nerves; and collagen accumulates in the skin and periarticular structure results in changes in connective tissue.5

PROBLEM STATEMENT:To find prevalence of adhesive capsulitis in diabetic patients.

OBJECTIVES:To compare data for 1. Type of diabetes, 2. Gender 3. The side affected with adhesive capsulitis (dominant &non-dominant).

MATERIAL USED:Full circle goniometer.Paper, Pen, Pencil

METHODOLOGY:Ø Type: Observational studyØ L o c a t i o n : S K N G H d i a b e t i c o p d a n d

physiotherapy opdØ Sampling technique: Purposive samplingØ Sample size:80 Ø Duration:6 months

INCLUSION CRITERIA

— Patients who are diagnosed with diabetes- type1 and type 2.

— Both genders— Insidious onset of shoulder pain with restricted range of motion

EXCLUSION CRITERIA

— Recent surgery of shoulder, dislocation or fracture — Rotator cuff injury — Advanced cardiovascular diseases

08

— Advanced pulmonary diseases— Cervical pain radiating to shoulder— Neurological problems like stroke or Parkinson's

disease

PROCEDURE:

Ø Ethical clearance was takenØ Permission from principal of SKNCOPT and

H.O.D of Medicine Department was takenØ Patients coming to Diabetic and Physiotherapy

OPD of SKNMC was explained about the purpose of study and written consent was taken

Ø Patients were examined for pain(using visual analogue scale) and shoulder range of motion were measured (using goniometer.)

Ø Patients were having gradual onset of shoulder pain and restricted range of motion was included for the study.

STASTICAL ANALYSIS

DISCUSSION¡ Atheer Ahmed Matloub showed that the prevalence

of adhesive capsulitis in diabetic patients is 17.2% and it is more prevalent in females onto the non dominant side.(5,9)

¡ In my study the prevalence of adhesive capsulitis in diabetic patients is 26.25% might be because of the excess glucose level impacts the collagen in shoulder which is a major building block in ligament, capsule that holds bones together in a joint. When sugar molecule attaches to collagen, it can make collagen sticky that build up cause affected shoulder to stiffen.

¡ Prevalence is more in type II diabetes with 90.47% than type I.

¡ Prevalence is more onto the non dominant side(left) with 66.66% probably because of lack of exercise on the non dominant side.

¡ Prevalence is more in females that is 61.9% , the cause is unknown but it could be because most of the females are of peri-menopausal and post menopausal age so low estrogen level leads to low collagen which is building block of connective tissues that can result in adhesive capsulitis.

Prevalence Of Adhesive Capsulitis In Diabetic Patients - An Observational Study.

09

CONCLUSION® In my study of prevalence of adhesive capsulitis in

diabetic patient is 26.25% ® It is been found that the prevalence of adhesive

capsulitis is more in type II DM & it is been also found that, it is more amongst females and in non dominant shoulder.

REFERENCES1. Journal of American Shoulder and Elbow Surgeons

(Zuckerman et al., 1994).

2. Clinical orthopedic rehabilitation BrotzmanManske 3rd edition.

3. Pal B, Anderson J, Dick WC, Griffiths ID.Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus. Br J Rheumatol 1986;25: 147-51

5. Bunker TD Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg Br 1995;77: 677-83.

6. Medical journal of Babylon vol-7/2010

7. Davidson's principle and practice of medicine 21st edition.

8. Debra Manzalla R.N. (March 09, 2009) "Type 1 Diabetes Mellitus". Retrieved 4 August 2008.

9. Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Cotran, Ramzi S. ; Robbins, Stanley L. (2005). Robbins and Cotran Pathologic Basis of Disease (7th ed.). Philadelphia, Pa.: Saunders. pp. 1194-1195.

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SEJOP E-journal Volume-1, Issue -1, January 2015

Manashi Thakkar, Dr Prajakta Patil(PT)

INTER-RATER RELIABILITY OF TRIAL ERROR AND SPRING

BALANCE METHOD FOR QUADRICEPS FEMORIS

STRENGTH ASSESSMENT IN NORMAL YOUNG ADULTS

INTRODUCTION Muscle strength is a broad term that refers to the ability of contractile tissue to produce tension and a resultant force based on demands placed on muscle (1). Various methods of muscle strength assessment are available. One of the following methods is commonly used to assess muscle strength1. Tensiometry 2. Dynamometry3. One repetition maximum4. Spring balance5. MMT Out of these, the most common methods used are One Repetition Maximum and Spring Balance. They are the objective methods of muscle assessment. The main advantage of objective method of muscular assessment is that it is reliable and since the method can be applied to required degrees of accuracy, the method has wide application in clinical practice. With objective assessment small increase in muscle strength can also be demonstrated.Various literatures are available for muscle strength assessment using dynamometry. However few articles are available mentioning how to find strength by trial and error method & the spring balance method. Very few studies are been conducted comparing these two methods of muscle strength. Both methods are simple and basic tests for assessing strength. They can be used easily and are cost effective. So the study is undertaken to compare the reliability of two methods.

AimThe aim of the study was to find out the inter-rater reliability of trial error and spring balance method for Quadriceps Femoris Strength Assessment in Normal Young Adults.

MethodologyStudy Design: Observational studyStudy Population: 20 females

Study Area: Smt. Kashibai Navale College of Physiotherapy, Narhe Pune

Sampling: Purposive SamplingSample Size: 20Inclusion Criteria: 18-22 years Normal female

students Equipments: — 1 Kilogram free weights— Hanger— Rope— Pulleys— S hook— Sling— Spring balance

ProcedureEthical committee approval was obtained from Smt.Kashibai Navale College of physiotherapy. A Rater was chosen from the interns as a second rater. She was explained, demonstrated and taught to assess muscle strength of Quadriceps femoris muscle by trial error and spring balance method. Informed consent was obtained from the participants. Participants were randomly allocated into group A and group B by lottery method. The procedure was explained to the participants. The participants preferred leg was found out by asking her to kick the ball (Butler and Kemp). For both the methods of strength assessment, a warm up period of 5 minutes was included prior assessment. The warm up included stretching of quadriceps femoris. Stretching was done in standing position with support of a wall (Fig, 1) 10 repetitions were performed with a 30 seconds hold. For TRIAL ERROR method, a pulley system was arranged as shown in FIG. 2. A sling was tied to participants preferred leg above ankle. The rope of the pulley system was attached to the sling through S hook. The participant was asked to extend her knee from the 90 degrees flexed starting position in high sitting. Weights were added to the hanger and they were asked to extend the knee. The maximum weight that the participant was

11

able to extend was recorded as the muscle strength of that participant. Three trials were given and the mean was recorded as the muscle strength. For spring balance method, a spring balance was tied to a pole of the plinth such that it was parallel to the ground. This was done in order to eliminate the error of altered angle of pull due to height difference of individuals. The spring balance was tied to participant's leg using S hook and sling. They were asked to extend as much as possible. The end position was maintained for 3 seconds. The muscle strength was recorded at the end of 3 seconds. Three trials were given for this method also and the mean of three trials was recorded as muscle strength. Rater 1 carried out both the methods for group A first and Rater 2 carried out both the methods for group B. The groups were then interchanged. The 2 raters thus carried out both methods of strength assessment for all 20 subjects

Fig. 2

Fig. 3

Statistical AnalysisStatistical analysis was done using Cohen's Kappa test

Table-1

Inter-rater Reliability Of Trial Error And Spring Balance Method For Quadriceps Femoris Strength Assessment In Normal Young Adults

METHODRATERS

MEAN SD

Trial Error

Rater 1

12.3 0.35

Rater 2

13.1

0.52

Spring Balance

Rater 1 20.3 0.95

Rater 2 19.5 0.97

12

Results

Table- 2

DISCUSSION The Cohen's kappa for both trial error method as well as spring balance method for assessing strength of quadriceps femoris muscle is -0.118 and -0.180 respectively. Negative kappa value suggests that the two raters in this study do not show an agreement for readings taken by both the instruments. Also full range of motion for knee extension was not possible with spring balance because of the internal resistance of the spring balance. This disagreement could be due to the following reasons-— The readings were not taken at the same time of the

day— Fatigue factor could have also affected the

measurement

CONCLUSIONThis study does not show an inter rater reliability of trial error as well as spring balance method in assessing the strength of quadriceps femoris muscle in normal young adults.

LIMITATIONSThe study was done on a very small sample size. The study could not be carried out during the same time of the day.

FUTURE SCOPEThe study can be repeated by multiple raters. The study can be done on a larger sample. Intra rater reliability can also be found out.

METHOD

KAPPA VALUE

SE

TRIAL ERROR

0.118

0.059

SPRING BALANCE

0.180

0.061

REFERENCES

1. William Mc Cardle, Frank Katch, Victor Katch, exercise physiology, seventh edition.

2. L e e B r o w n a n d J o s e p h We i r , A S E Precommendation 1:accurate assessment ofmuscular strength and Power, Journal of Exercise Physiology online(ASEP). Volume 4 no 3: 1-21

3. Carolyn Kisner and Lynn Alley Colby, Therapeutic Exercise, 5th edition

4. Izge gu¨ nal, asim taymaz : Patellectomy with vastus maedialis obliquues advancememt for comminuted patellar fractures. Jan 1997. British Editorial Society of Bone and Joint Surgery. Vol 79 b No. 1

5. Kajsa Johansson and Lars Adolfsson: intraobserver and interobserver reliability for the strength test in constant-Murley shoulder assessment. journal of Shoulder and Elbow Surgery. Vol (14), 3, 273-278.

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SEJOP E-journal Volume-1, Issue -1, January 2015

ANKITA P.JOSHI, KIRAN SATPUTE

PROPORTION OF WORK-RELATED MUSCULOSKELETAL COMPLAINTS IN

I.T. STUDENTS

ankijoshi77@gmail.com

INTRODUCTION Work-related musculoskeletal disorders (WMSD) can be defined by impairments of bodily structure such as , Muscles, Joints, Bones, Tendons, Ligaments, Nerve, The localized blood circulation system, caused or aggravated primarily by work itself or by the work environment.(1) WMSD are aggravated by work that can affect the upper & lower limb, the lower back area. (2) WMSD are related with repetitive and demanding working conditions. Most WMSDs develop over time and are caused either by the work or by the working Environment. (2.3) WMSD's are also referred as repetitive strain injuries (RSI), repetitive motion injuries (RMI), and cumulative trauma disorders (CTDs). (4) Computer operators are more prone to get develop WMSDs due to various reasons such as : 1. Increasing hours of mouse or keyboard use (6,7,8,9) 2. Sustained awkward postures, such as increasing

wrist extension and keyboard above elbow height (6,7,8,9)

3. Use of computer more than two hours In awkward postures. (6,7,8,9)

4. Repetitive tasks.(6,7,8,9)Besides the physically demanding of the jobs the

ageing of the workforce are also contribution to the widespread of WMSD , Since the propensity for developing a WMSD is related more to the difference between the demands Work and the worker's physical work capacity that decreases with age. Despite the variety of efforts to control WMSD, including engineering design changes, organizational modifications or working training programs, these set of disorders account for a huge amount of human suffering due to worker impairment, often leading to permanent, partial or total disability.

Risk Factors Of WMSD The strong correlation between the incidence of WMSD and the working conditions is well known, Particularly the physical risk factors associated with jobs e.g. Awkward postures, High repetition, Excessive force, Static work, Cold or vibration. Work intensification and stress and other psychosocial factors also seem to be factors that increasingly contribute to the onset of those disorders.

Problem statementTo determine the occurrence & to recognize the proportion of Work related Musculoskeletal complains in I.T. students of Narhe campus.

Objectives

1. To observe type of computer usage2. Total working hrs spend on computers by students

per day.3. To find out the type of their work on computer,

whether it Is continuous or with break.4. To identify Work related Musculoskeletal

complains in IT students.

Methodology

Research design: Observational cross-sectional StudySample: IT engineering students from 1st year to last year of both genders who work on computers more than 2 hours/day either in college (institution)or at home or both.Sample size: 120Location: Sinhgad college of Engineering, Narhe campus.Sampling Technique: Purposive sampling techniqueInclusion criteria:IT engineering students from 1st year to last year of both genders who work on computers more than 2

14

hours/day either in college (institution)or at home or both.Exclusion criteria:

1. Any recent trauma or fracture.2. Any congenital musculoskeletal deformities.3. Arthritic conditions4. Thyroid disease.5. Systemic illness.

Procedure

Institutional & ethical permission was taken. College was approached and prior permission was obtained from concerned authorities to conduct the study. Students were collected at one place (not more than 30 students in a single batch). Study was explained to them and questionnaire and consent form were distributed to those who were willing to participate in the study. Questionnaire have 2 parts. 1. Demographic data, identifying computer usage

pattern, Medical history as per exclusion criteria 2. Nordic questionnaire for pain assessment.

Questionnaire was explained and any queries were sorted out there at that time only. Expected time to fill up the questionnaire was given 10-15 minutes.

STATISTICAL ANALYSISAll analysis were performed by using percentage method.

Number of males and females participated

The number of s tudents reported having musculoskeletal pain

Type of work

Total working hours on computer each day GRAPH NO:1

Proportion Of Work-related Musculoskeletal Complaints In I.t. Students

15

Proportion Of Work related Musculoskeletal complains in I.T students GRAPH NO:2

DISCUSSIONVarious studies were done up till now on the

computer operators working in the different sectors.Out of that one of the study was conducted in Sweden by the Kerstin Norma in 36 different worksites. In this study they found that, the prevalence's of the symptoms were more common among women than men. In call centers person works on computer for more than 4 hrs.There is repetitive bending activity at neck -Neck pain symptoms were the most common symptom followed by shoulder region symptom.In our study , 78.12% people reported that they work continuously for 5-6 hrs on computer without taking frequent breaks. This could be main cause for WMSD. While working on computer one has to perform many activities such as typing, operating mouse, looking at desktop, but the sitting position (static posture) is maintained for longer period of time.

Our study shows higher Proportion of neck, upper back & lower back pain, this could be attributed to prolonged static posture. In static posture; muscles are tensed over long period of time. In this muscle or group of muscle is contracted without movement of corresponding joints. There is no relaxation, & continuous contraction restricts blood flow from & to contracted muscle. In our study students also reported that they are not taking frequent breaks, thus adequate relaxation doesn't occur which leads to early fatigue & overload of muscular structures & could be a potential source of pain. Static posture of shoulder while operating keypad & mouse may be one of the causes for shoulder & wrist pain.

But for operating both keyboard and mouse there is dynamical activity taking place so symptoms are found

to be less than that of the neck, upper back & lower back region

CONCLUSION

Our study shows that out of 120 students, 80% of students complained of pain. We also found that many students i.e. 78.13% of them work constantly (without frequent breaks) on computers for more than 2 hours. Pain found to be more in those who are working on laptop than desktop or those who are using both desktop & laptop.

Among these students proportion of pain was more in neck ,upper back & lower back region, little bit less than that in shoulder, elbow & wrists whereas with negligible symptoms in ankle feet ,knee ,& thigh/hip.

BIBLIOGRAPHY1. Nunes, I. L. (2009a). FAST ERGO_X - a tool for

e rg o n o m i c a u d i t i n g a n d w o r k - r e l a t e d musculoskeletal disorders prevention. WORK: A Journal of Prevent ion, Assessment , & Rehabilitation, Vol. 34(2): 133-148

2. Salik Y, Ozcan A. Work related musculoskeletal disorders, a survey of physical therapists in Izmir - Turkey. BMCMusculoskeletal Disorders 2004; 5:27.)

3. Sauter, S., Hales, T., Bernard, B., Fine, L, Petersen, M., Putz-Anderson, V., Schleiffer, L., Ochs, T. (1993). Summary of two NIOSH field studies of musculoskeletal disorders and VDT work among telecommunications and newspaper workers. In: Luczak, H., Cakir, A.& Cakir, G. (Eds.). Elsevier Science Publishers, B.V)

4. McCauley Bush, P. (2011) Ergonomics: Foundational Principles, Applications and Technologies, an Ergonomics Textbook; CRC Press, Taylor & Francis, Boca Raton, FL

5. Okunribido, O., T. Wynn (2010). Ageing and work-related musculoskeletal disorders. A review of the recent literature, HSE.)

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SEJOP E-journal Volume-1, Issue -1, January 2015

6. EU-OSHA (2008). Work-related musculoskeletal disorders: Prevention report.Available at:

http://osha.europa.eu/ en/publications/reports/en_TE8107132ENC.pdf European Agency for Safety and Health at Work

7. EU-OSHA (2011). Musculoskeletal Disorders: G e n e r a l q u e s t i o n s . A v a i l a b l e a t : http://osha.europa.eu/en/faq/ frequently-asked-questions, European Agency for Safety and Health at Work.

8. EUROFOUND (2007). Musculoskeletal disorders and organisational change. Conference report. Lisbon, European Foundation for the Improvement of Living and Working Conditions.

9. HSE (2002). Upper limb disorders in the workplace. Available athttp://www.hseni.gov.uk/upper_limb_disorders_in_the_workplace.pdf. Healthand Safety Executive.

Proportion Of Work-related Musculoskeletal Complaints In I.t. Students

17

Dr.Ankita Chitre(PT), Dr.Pooja Deshpande(PT), Dr.Chandan Kumar(PT)

THE EFFICACY OF ANTERIOR VERSUS POSTERIOR

JOINT MOBILIZATION ON FUNCTIONAL

ACTIVITY IN PATIENTS WITH ADHESIVE CAPSULITIS

INTRODUCTIONAdhesive Capsulitis is characterized by pain, stiffness, and limited function of the glenohumeral joint, which adversely affects the entire upper extremity. It develops in three stages: Freezing-In the "freezing" stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Lasts from 6 weeks to 9 months. Frozen-Painful symptoms may actually improve during this stage, stiffness remains. During the 4 to 6 months of the "frozen" stage, ADLs may be very difficult. Thawing-Shoulder motion slowly improves during the "thawing" stage. Complete return to normal or close to normal. Mobilization is a low velocity passive movement performed by the clinician to an affected joint within or at the limits of joint range of motion at a speed slow enough that the patient can stop the movement [14.

AimTo determine the effectiveness of direction of mobilization (anterior / posterior) in improving external rotation range of motion and functional activity in patients with adhesive Capsulitis.Objectives— To study the effectiveness of glides on the

functional activity and range of motion by using Shoulder Pain and Disability Index (SPDI) and Visual Analogue Scale(VAS) respectively. To compare the effects of anterior versus posterior glide mobilization on functional activity ofshoulder.

MethodologyAn Experimental study in SKNCOPT OPD for a duration of 3 months on a sample size of 20 by purposive sampling using Universal goniometer, Therapeutic US, VAS & SPDI.

Inclusion criteria—— Age group- 40-60 years. — Painful stiff shoulder at least for 3 months.— Both genders.— Left and right dominant people.

Exclusion criteria— Previous upper limb surgeries— Secondary adhesive capsulitis — Shoulder girdle motor control deficits associated

with neurological disorders— Injection with corticosteroids in the preceding four

weeks.

ProcedureSPDI was selected, translated in Marathi and the face validity was obtained. The reliability & validity of VAS & SPDI was confirmed. Ethical clearance was obtained. Patients Diagnosed with primary Adhesive Capsulitis were explained the purpose of the study and a written informed consent was taken. Each patient was individually interviewed with VAS and SPDI. Evaluation of pre & post parameters of External ROM, VAS & SPDI was carried out. 20 subjects who were diagnosed with primary AC were randomly assigned to either group: Anterior & Posterior mobilization group. All patients received 6 sessions of therapy consisting of US, joint mobilization, capsular stretches, shoulder ROM exs.

Anterior mobilization group:Randomly, 15 subjects will be selected for anteriorly directed kalternborn mobilization.i. Ultrasound - frequency 3 MHz, Intensity 1.5 W/Cm2, Duration 10 Min ii. Mobilization techniques: Kalternborn mobilization grade III at e n d range position which is held for at least 1 min.stretch mobilizations for a total of 15 min. Glides used were- Anteriorly directed glide, iii.

Diagnosed as primary idiopathic AC.

18

Exercise program: codmann pendular exercise, finger stepping exercise, wand exercises, active range of motion exercises.Exercises repeated 10 to 15 repetitions 2 to 3 sets with a rest interval of 30 to 60 Sec between sets.

Posterior mobilization group:i. Ultrasound - frequency 3 MHz, intensity 1.5

W/Cm2, Duration 10 Min Mobilization techniques : Kalternborn mobilization grade III at end range position which is held for at least 1 min.Stretch mobilizations for a total of 15 min. Glides used are posteriorly directed glide

iii. Exercise program: Codmann pendular exercise, finger ladder exercise, wand exercises, active range of motion exercises.

Exercises repeated 10 to 15 repetitions 2 to 3 sets with a rest interval of 30 to 60 Sec between sets.

Anterior mobilization

Results & analysisThe difference between the pre & post parameters was calculated and thereby the mean & S.D. were found. Statistical analysis were done by using "paired t test" to compare the parameter within the group and a "unpaired t test" was performed to compare the post treatment parameter between the 2 groups. Group comparison was made by considering the differences between pre and post values of each parameter in both groups and found significant in external rotation range of motion (P<0.0001) and SPADI score (P=0.0022) in posterior mobilization compared to anterior mobilization group, but for VAS (Pain) there was no significant difference between posterior mobilization group and anterior mobilization group. (P > 0.05).

Posterior mobilization

The Efficacy Of Anterior Versus Posterior Joint Mobilization On Functional Activity In Patients With Adhesive Capsulitis

19

DISCUSSION

The statistical analysis of this study shows there is

significant improvement in external rotation range of

motion and functional activity measured by SPADI

score in the posterior mobilization group than the

anterior mobilization group. There was no significant

difference between pain measured by VAS score before

and after treatments between both the groups. The

results are in consistent with the findings of Roubal et al

and Placzeck et al. The mobilization positions chosen

for the study were taken from physical therapy text

books for the initial and progression positions. Norotny

et al studied the glenohumeral joint in vitro using

techniques in which only the capsule and articular

surface contact controlled the motion of humerus, they

found that at low moments the humeral head initially

translates across the glenoid surface in the direction

opposite to the motion due to joint surface as consistent

with concavo-convex rule. Then with increasing

moment and angle of rotation the humeral head changes

in direction as the capsule tightens pushing the humeral

head back along the glenoid surface. Thus it is thought

that the tension in the capsular tissue rather than joint

surface geometry controls the translatory movements of

the humeral head. Ludwig and Cook found that the

patients with shoulder symptoms showed greater

anterior translation of the humeral head in 30degrees to

60degrees in the scapular plane elevation of the

humerus and a decrease in the mean posterior

translation of the humeral head in higher elevations

60degrees to 120degrees as compared to an

asymptomatic comparison group. In patients with

adhesive capsulitis capsular contractures develops

usually in the area of rotator cuff interval. Roubal et al

suggest that these anterior capsular structures may draw

the humeral head to its anterior most excursions thus

limiting anterior and posterior glide and effecting

external and internal rotations. Harryman et al found in

their cadaver studies that altering the capsule

(tightening) affects the translation of humeral head in

the glenoid during physiological movements of the

humerus. The results of this study are not at odds with

the concavo convex rule, do the results well support the

concept that the capsule plays an important role in

dictating the humeral head translation possibly in the

opposite direction to the expected effect of joint

geometry if restricted. In this study the stretch

mobilizations are performed for a total of 15 minutes at

the end range external rotation and abduction during

each treatment session with the intention to elongate the

glenohumeral capsular contracture.

LIMITATION

Smaller sample size. Multidirectional exercises. Can be

done either on diabetics or non-diabetics. Caudal glide

not given. Analgesic effect excluded.

Conclusion

The group treated with posterior mobilization has

shown a very significant improvement in shoulder

external range of motion and a significant improvement

in functional activity when compared to the anterior

mobilization group, but no improvement in VAS.

REFERENCES

1. Andrea J. Johnson, Joseph J. Godges, The effects of

anterior versus posterior glide joint mobilization on

external rotation range of motion in patients with

shoulder adhesivecapsulitis, Journal of

Orthopaedics and Sports Physical therapy, 37,

(2006)

2. Nevaiser R.J. and Nevaiser T.J., The frozen

shoulder diagnosis and management, Clinical

Orthopedic Rehabilitation, 59-64 (1987)

3. Henricus M. Vermeulen Piet M. Rozing Wim

Robermann, Comparison of High grade and low

grade mobilization techniques in the management

of adhesive capsulitis of the shoulder,

journal of American physical therapy association,

80(12)(2000)

4. Donatelli - Physical therapy of the shoulder; 3rd

edition, 257-273 (1996)

5. Mao Cy, Jaw WC, Cheng: Frozen shoulder -

Correlation between response to physical Therapy

and follow-up shoulder arthrography Archives

Physical medicine and rehabilitation., 857-859

(1997)

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SEJOP E-journal Volume-1, Issue -1, January 2015

6. Lori B. Siegel et al: Adhesive Capsulitis - A sticky

issue. American family Physician, 59(7) (1999)

7. Fitz Patrick MT, Powell SE. The anatomy,

pathology and definitive treatment of rotator

Interval lesions, current concepts. Arthoscopy, 19,

70-79 (2003)

8. Nicholson GG, the effects of passive joint mobilization on pain and hypomobility associated with adhesive capsulitis of the shoulder,Journal of Orthopedic SportsPhysical therapy., 238-246 (1985)

9. J.F. Bridgemann; Periarthritis of the shoulder and diabetes mellitus: Ann rheum Dis., 31, 69 (1972)

10. Siegel L.B., Cohen Nj, Adhesive capsulitis a sticky issue,American family, physician, 59, 1843-1852 (1999)

The Efficacy Of Anterior Versus Posterior Joint Mobilization On Functional Activity In Patients With Adhesive Capsulitis

21

Ms. Shruti D Dr. Sonali N (PT) Dr. Sharmishtha G(PT)

COMPARISON BETWEEN QUADRICEPS AND HAMSTRINGS MUSCLE STRENGTH IN DOMINANT AND NON- DOMINANT

SIDE IN FEMALES OF AGE 20-40 YEARS- CROSS SECTIONAL STUDY.

INTRODUCTION Strength: It is a broad term that refers to the ability of contractile tissues to produce tension and a resultant force based on the demands placed on the muscles.

Muscle strength is the greatest measurable force that can be exerted by a muscle or muscle group to overcome resistance during a single maximum effort.Dominance: pertaining to the normal tendency for one side of the body or of one of a pair of organs to dominate or be used in consistent persistence than the other. The hamstring and quadriceps muscle group are one of the most complex sets of muscles in the body, intricately involved in both locomotion and stability of the lower extremity (Coole and Greck, 1987).

The knee is frequently prone to traumatic and degenerative afflictions and hence is a common site of pain requiring physical therapy interventions. During the process of rehabilitation, comparisons are usually made with the contralateral knee vice-versa the knee muscle torques as a criterion reference.

Aim To compare between strength of hamstrings and quadriceps muscles in dominant and non-dominant side in females.

ObjectivesThe objectives of this study were to find out dominant and non-dominant side. To measure and compare the strength of hamstrings and quadriceps muscles of both dominant and non-dominant side.

MethodologyIt was a cross sectional study. This study was conducted in Kashibai Navale College of physiotherapy OPD. The inclusion criteria were all the females of age 20-40 years of age. Exclusion criteria was radiculopathies, any limb discrepancy or any limb injuries. It was

convenient sampling with sample size 120. The equipments which were used were plinth, stabilizing belt, spring balance and rope.

PROCEDURE Written consent from Principal sir of SKNCOPT was taken in order to carry out the study.The aims and objectives of the study were explained to the subject assuring them that there are no hazards of the study and a written consent was signed.The study will be carried out in following way - According to the test of Dominance: identification of dominant side in lower limb was carried out.After finding out the dominancy of lower limb 1RM protocol was used to find out strength of Hamstrings and Quadriceps with the help of spring balance. As per the 1 RM protocol; strength of hamstrings and quadriceps muscles of both dominant and non-dominant side was found out.1 RM will be found by spring balance method.

22

For finding quadriceps strength position of the subject: In sitting positions stabilisation: thighs will be stabilised by stabilising belt.

For finding hamstring strength:position of the subject: in prone position. stabilisation: pelvis will be stabilised by stabilising belt .

Results Unpaired t test was done in order to: Compare the strength of quadriceps in dominant and non-dominant leg in females of age group 20-40 years.Compare the strength of hamstrings in dominant and non-dominant leg in females of age group 20-40 years.

Mean and standard deviation was also calculated of age, quadriceps dominant and non-dominant, hamstrings dominant and non-dominant.Table : 1

Table-2Graph 1: Comparing Mean Strength of Quadriceps Dominant and Non Dominant

Graph 2: Comparing Mean Strength Of Hamstrings -Dominant And Non Dominant

Graph 3: Comparing Strength of Quadriceps and Hamstring Muscles

23

Comparison Between Quadriceps And Hamstrings Muscle Strength In Dominant And Non- Dominant Side In Females Of Age 20-40 Years- Cross Sectional Study.

Graph 4: Comparing All the Means of Both the Muscle Groups

DISCUSSIONThe study done by Lanshammar K, Ribom E showed that in dominant leg quadriceps muscle group was stronger than the hamstrings muscle group whereas in nondominant leg hamstring muscle group is stronger.In contrast, this study showed that both in dominant and nondominant leg quadriceps group of muscle was stronger

CONCLUSIONThere is significant change in the strength of dominant and nondominant quadriceps and hamstrings muscle group.The strength of quadriceps in dominant leg is greater than in nondominant leg. The same results were found in hamstrings group of muscles. The strength of quadriceps muscle group is greater than the hamstring group of muscles in females of age 20-30 years.

REFERENCES1. Phys Ther Sport. 2011 May;12(2):76-9. doi:

10.1016/j.ptsp.2010.10.004. Epub 2010 Nov 27

2. Summary of an article by Simone Kosog in the science section of the 'Süddeutsche Zeitung Magazin' 1999

3. Kajsa Johansson and Lars Adolfsson, Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment, 2005, Journal of Shoulder and Elbow Surgery, (14), 3, 273-278

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SEJOP E-journal Volume-1, Issue -1, January 2015

Ms. Shruti D Dr. Sonali N (PT) Dr. Sharmishtha G(PT)

COMPARISON OF SHOULDER ROTATION RANGE OF MOTION IN SCAPTION AND IN FRONTAL PLANE.

INTRODUCTION The shoulder joint complex is a synovial ball and socket type of a joint comprising of mass of muscles crossing the joint held together by strong capsules and ligaments. The proper variations in the tension combined with the efforts applied bring about movement desired for the apt functions of day to day activity.

Range of motion (ROM) has long been recognized as an important part of the musculoskeletal examination. ROM measurements assist in diagnosis, impairment evaluation, monitoring treatment effects, and outcome analysis.

Rotations ranges are important to carry out various daily activities. Overhead activities along with flexion abduction ranges also require rotations. The restricted shoulder ROM affects Activities of Daily Living.

Medial and lateral rotation occurs about a long axis parallel to the shaft of humerus and passing through the center of the humeral head.

The Scaption plane is in between frontal and sagittal plane more towards the frontal plane 30 degrees from it. It is also known as the plane of scapula.In Scaption it is observed that the ROM of External rotation is more than in frontal plane as the greater tuberosity is free to move under subacromian arch as there is less twisting of capsule and movement of shoulder rotations are purely Glenohumeral movements.

The ranges of rotations of the humerus are seen varying with position of humerus with respect to scapula.

Hence with ROM measurements by standard techniques it is noted that Scapulothoracic motion occur along with shoulder rotation movements. That is

because the scapula is relatively free to move with these techniques.

A study is indicating that measuring Internal Rotation PROM in side lying will avoid scapulothoracic motion.But patients with acute shoulder pathology are any not able to lie on the affected shoulder. Thus, if this technique of measurement yield better results can be used as standard method for measuring rotation ranges rather than the usual one.

Aim

The aim of this study is to compare Rotation Range of Motion of Shoulder Joint in Scaption and Frontal plane.

Objectives1. To measure shoulder rotation range of motion in

Scaption2. To measure shoulder rotation range of motion in

Frontal Plane3. To compare both the measurements.

Methodology

Study Design: Comparative study

Study Population: Males and Females of all age groups

Study Area: Smt. Kashibai Navale College of Phys io the rapy Outpa t i en t Depar tmen t o f Physiotherapy

Sampling: Convenient Sampling

Sample Size: 30

25

Inclusion Criteria: Males and Females of all age groups

Exclusion criteria:1. Individuals having pathological conditions of

shoulder joint, spine.2. Individuals having cognitive problems.3. Individuals having difficulty in lying in supine

position.4. Tightness of shoulder girdle muscles.5. Hearing deficiency.6. Paralysis or weakness of shoulder girdle muscles.7. Positive upper quadrant neural tissue testing.

Equipments: 1. Full Circle Goniometer.2. Artificial Scapular plane. (Wedge- 30 degrees

angled)3. Writing materials.4. Plinth

Fig no. 1

PROCEDURE: Written consent was obtained from subjects who fulfilled the inclusion criteria and who volunteer to participate in this study.The demographic data of the subjects was documented. Measurements were taken three times and the average of the readings was considered. All the ranges were passively taken.

To measure rotation in Frontal plane:Starting position: Arm stabilized in 90 degree of abduction and flexed at 90 degree at the elbow.

To measure rotation in Scaption:Position - supine on plinth with the arm in Scaption with the help of artificial wedge angled 30 degrees.The subjects arm in flexed 90 degrees at elbow.

Outcome variables:1. External rotation of upper limb in Frontal and

Scaption plane.2. Internal rotation of upper limb in Frontal and

Scaption plane.

Statistical AnalysisThe Unpaired t test was done to compare:

1. Shoulder Internal Rotation in Frontal Plane and Scaption.

2. Shoulder External Rotation in Frontal Plane and Scaption.

RESULTS: Table no. 1

Table no. 2

AGE IR in Frontal plane and

Scaption

ER in Frontal plane

and Scaption

mean 30 85.34 76.41 86.99 87.23

S.D 5.13 4.341 4.263 6.509 6.499

T value

df

Sig

(2 tailed)

Mean

Diff.

Standard error of difference

IR

frontal plane

v/s Scaption

7.871

54

0.001

9.23

1.17

ER frontal plane v/s

Scaption

0.981

54

0.331

1.64

1.64

Comparison Of Shoulder Rotation Range Of Motion In Scaption And In Frontal Plane.

26

DISCUSSION The current study conducted to compare the range of motion of shoulder rotations in scaption and frontal plane showed results that the range of motion of shoulder internal rotation range were less when compared to the standard method of measurement. This was because the normal anatomical position of scapula is 30 degree inclined from the frontal plane. Thus, stabilization of the scapula in its normal anatomical position gives purely Glenohumeral motion. A study was conducted to check "Reliability of Shoulder Internal Rotation Passive Range of Motion Measurements in Supine versus Side Lying positions" carried out by Jason B. Ludin et al. The results showed that Side lying is more reliable and valid method than Supine. Thus the current study is found effective and can be used as an alternative technique in patients with acute shoulder pathology who find it difficult to lie in side lying position. The external rotation range remained unchanged thus proving that the glenohumeral positioning does not affect the range.

CONCLUSION The study shows that there is decrease in internal rotation range in Scaption when compared in Frontal plane. The average of the internal rotation range was 76.41 degrees. But also it reveals that there is no change in External rotation range irrespective of placing it in Scaption or Frontal plane.

REFERENCES:

1. Pamela Teys, Leanne Bisset, Bill Vicenzino; Manual Therapy 13 (2008) 37-42

2. Raza Awan, MD, Jay Smith, MD, Andrea J. Boon, MD. Arch Phys Med Rehabil Vol 83, September 2002; 1229-1233

3. Jason B. Lunden, DPT, SCS1,2 o Mike Muffenbier, MPT, SCS3 o M. Russell Giveans, PhD4 o Cort J. Cieminski, PT, PhD, ATR5. journal of orthopedics & sports physical therapy | volume 40 | number 9 | September 2010 | 589-594

4. David K Kuechle, Stephen R. Newan, Eiji Itoi, Glen L Niebur, Bernard F Morrey, Kai- Nan An. The Relevance of the Moment Arm of The Shoulder Muscles with Respect to Axial Rotation of the the Glenohumeral joint in four positions, Clinical Biomechanics, Vol. 15, Issue 5, June 2000, Pgs 322-329

5. Evan V. Hellwig, PT, ATC , David H. Perrin, PhD,

ATC. A Comparison of Two Positions for Assessing Shoulder Rotator Peak Torque: the Traditional

Frontal Plane Versus the Plane of Scapula. Isokinetic and Exercise Science, 1 Pgs 1- 5

6. Xinning Li, M.D.; Zakary Knutson, M.D.; Daniel Choi, M ENG: Daniel Lobatto, MSc; Joseph Lipman, MS; Edward V. Craig, M.D.; Russell F. Warren, M.D.; Lawrence V. Gulotta, M.D.: Effects of Glenosphere positioning on Impingement- free Internal and External Rotation after reverse Total Shoulder Arthroplasty. Journal of Shoulder and Elbow Surgery, Vol 22, Issue 6, June 2013; Pgs 807- 813

7. N. K. Poppen, P. S. Walker: Normal and Abnormal Motion of the Shoulder. The Journal of Bone and Joint Surgery Am. 1976; 58 : 195-201

8. Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B: Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999 Oct;29(10):574-83; discussion 584-6.

9. Paula M. Ludewig, PT, PhD; Vandana Phadke, BPTH; Jonathan P. Braman, M.D.; Daniel R. Hassett, PT; Cort J. Cieminski, PT, PhD, ATC, CSCS; Robert F. LaPrade, MD, PhD: Motion of Shoulder Complex during Multiplanar Humeral Elevation. J Bone Joint Surg Am. 2009; 91: 378- 89

10. Jonathan P. Braman, M.D., Sean C. Engel, M.D., Robert F. LaPrade, M.D., PhD, Paula M. Ludewig, PT, PhD: In Vivo Assessment of Scapulohumeral Rhythm during Unconstraied Overhead Reaching in Asymptomatic Patients. J Shoulder Elbow Surg. 2009; 18 (6): 960- 967

11. Vandana Phadke, BPTH, PhD; Jonathan P. Braman, M.D.; Robert F. LaPrade, MD, PhD; Paula M. Ludewig, PT: Comaprison of Glenohumeral Motions using Different Rotation Sequence. J Biomech. 2011, Feb 24; 44(4): Pgs 700- 705

12. Kronberg, M. M.D.; Brostrom, L.-Å. M.D.; Soderlund, V. M.D. Clinical Orthopedics and Related Research . April 1990

13. Greenfield BH, Donatelli R, Wooden MJ, Wilkes J. Physical Therapy Associates of Metro Atlanta, Jonesboro, GA 30369.

14. Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Sports Med. 2009;39(8):663-85. doi: 10.2165/00007256-200939080-00004

15. Jules Rothstein, Serge Ray, Steren Wolf: The Rehabilitation Specialist's Handbook. 3rd edition: 102

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SEJOP E-journal Volume-1, Issue -1, January 2015

Vaibhavi Mehendrakar, Dr.Senthil Kumar E.

CHANGES OF RATE-PRESSURE PRODUCT IN 6 MINUTE

WALK TEST AND STEP TEST IN NORMAL INDIVIDUALS-

PROSPECTIVE PILOT STUDY

vaibhavism@yahoo.co.in

INTRODUCTIONRate pressure product is a measure of the stress put on the cardiac muscle based on the number of times it needs to beat per minute (HR) and the arterial blood pressure that it is pumping against (SBP). It will be a direct indication of the energy demand of the heart and thus a good measure of the energy consumption of the heart. Rate pressure product, also known as Cardiovascular Product or Double Product, is used in cardiology and exercise physiology to determine the cardiovascular risk of subjects.Rate Pressure Product (RPP) = Heart Rate (HR) * Systolic Blood Pressure (SBP) The tool of the Study has 2 Test-1. 6 Minute Walk Test2. 3 Minute Step Test[1] 6MWT is a sub-maximal exercise testing performing 60-80% of the maximum heart rate and it simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.

Step Test: The 3-Minute Step Test measures your sub maximal aerobic (cardiovascular) fitness. [2}Since, both the studies are sub maximal exercise testing, but which is more implicative to find out the oxygen demand taken by the heart.

MethodologyStudy Design:- Pilot observational Study.Sampling- Stratified Random samplingSample Size:- 30 Arbitrary sample size of 30 for conducting pilot study.Study Population-Student population in Narhe campus Sinhgad Institute.Duration: 3Months. (Data collection)

Aim and Objectives-

To compare rate-pressure product in 6

minute walk test and step test for same individuals.

Inclusion Criteria-— Age group-18-25years.— Both the genders.

Exclusion Criteria-Subject who is having any co-morbid conditions such as: Orthopaedic Disorders, Cardio-vascular diseases, Neurological Disorders, Gynaecological disorders which will affect the test.Equipments-1. Hallway free of obstacles. 2. Stopwatch3. BP apparatus4. Step box (height = 16.25 Inch )

Procedure— Consent was taken from the student.— Ethical Clearance from the Institution.— Selection of subjects based upon criteria as

mentioned above.— Basic demographic data was collected such as age

and Gender.— Measurement of parameters-Blood pressure (only

systolic) & heart rate.— These measurements were taken prior and post to

test.

6 Minute Walk Test- — As per ATS (American Thoracic society)

guidelines, 6 minute walk test was performed and rate pressure product was evaluated.

Step Test-— As per ACSM (American council of sports

medicine), ACSM Guidelines, Queen's college step test was performed.

Equipment Required: 16.25 inches / 41.3 cm step, stopwatch and metronome.

28

Procedure: The Subjects steps up and down on the platform/Step box at a rate of 22 steps per minute for females and at 24 steps per minute for males. The subjects are to step using a four-step cadence, 'up-up-down-down' for 3 minutes.

Statistical Analysis & Results -Table 1-Descriptive Statistics

Table 2- Independent Sample T-Test

Graph .1

DISCUSSIONIn the study from table one of descriptive statistics the mean age was found to be 18 from 18-25years. And its standard deviation was 1.37.The Body mass index was 22.16 which is normal in my study for both males and females. The pre parameters of rate pressure product for 6 minute test were 97.57 which were normal for all the subjects. Whereas the post parameters in 6minute walk test was increased by 168.05.The pre parameters of Step test was 97.33 and immediate post values were 197.08 which was higher as compared to 6minute walk test for both males and females. The Second table tells us about the independent sample t test where there were comparison of pre and post values of 6minute walk test and step test in the T-Value for PRE6MINUTE WALK TEST AND STEP TEST was 0.164 and the P-VALUE for the same was 0.4333 and the Post values for 6MINUTE WALK TEST AND STEP TEST T-value was 12.29 and P value was less than 0.001.From the above results, there is an high RPP in Step test as compared to 6MWT because it is a External paced test compared to self paced 6MWT.In this study there was a equal rise in rise in RPP in both males and females using 6Minute Walk test and step test as compared to a study on Aging and Gender effects on Rate-Pressure Product it had been observed that there is a high significant variation in RPP in men from 18-65years.Highly significant inverse correlation between advancing age and RPP observed in men but no significant variation in RPP in Women in 18-65 years. In a Study of Aging and Gender effects on rate pressure product demonstrate that in healthy men there is an age related decline in myocardial oxygen consumption. In healthy women an insignificant decline in myocardial oxygen consumption was observed with aging. This age related decline in myocardial oxygen consumption could be due to age related decline in the resting heart rate, as

29

Changes Of Rate-pressure Product In 6 Minute Walk Test And Step Test In Normal Individuals- Prospective Pilot Study

heart rate is one of the determinants of myocardial oxygen consumption. But in my Study there was no such comparison between men and women in rate pressure product and they showed a equal rise in rate pressure product in both males and females.

CONCLUSION The Rate-Pressure Product in Step test is more as compared to 6 MWT.

REFERENCES1. Ramón c. hermida, circadian rhythm of double

(rate-pressure) product in healthy normotensive young subjects 2001, vol. 18, no. 3, pages 475-489

2. W.D Mcardle et.al (1972) reliability and interrelationships between maximal oxygen uptake, physical work capacity and step test scores in college women. Medicine and science in sports, Volume 4.Page no.182-186.

3. Hinderliter A, Miller P, Bragdon E, et al: Myocardial ischemia during daily activities: the importance of increased myocardial oxygen demand. J Am Coll Cardiol1991; 18:405- 412.

4. Cheitlin MD, Sokolow M, McIlroy MB: Anatomy & physiology of the circulatory system, in Clinical Cardiology. Appleton & Lange, Norwalk, Connecticut, 1993, pp 1-38.

5. Wasserman K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of exercise testing and interpretation, 3rd edition. Philadelphia: Lippincott, Williams & Wilkins; 1999.

6. Klabunde RE. Cardiovascular Physiology Concepts. 2nd Ed. Lippincot Williams and Wilkins; 2011.

7. Peterson RL, Soto FP, Herrero P, Schechtman BK, Dence C, Gropler RJ. Sex differences in myocardial oxygen consumption and glucose metabolism. Nucl Cardiol 2007; 14(4):573- 581.

8. Kannel WB, Wilson P, Blair SN: Epidemiological assessment of the role of physical activity and fitness in development of cardiovascular disease. Am Heart J 1985, 109:876-885.

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SEJOP E-journal Volume-1, Issue -1, January 2015

31

Miss. Hetal S. Desai, Dr. Rahul Singh Bisen (PT)

LUMBAR FLEXION RELAXATION PHENOMENON IN PATIENTS WITH ACUTE AND SUBCUTE MECHANICAL

LOW BACK PAIN AND NORMAL SUBJECTS

INTRODUCTION:Mechanical low back pain is the general term that refers to any type of back pain caused by strain on muscles of the vertebral column and abnormal stress. 1 It can be caused by: Lifting heavy objects, Levered postures (bending forward), Static loading of the spine (prolonged sitting or standing). Based on duration, Low back pain can be:Acute - < than 4 weeks, Subacute - 4 to 12 weeks,,Chronic - > than 12 weeks During normal trunk flexion in standing the trunk extensor muscles act eccentrically & are considered myoelectrically "active" until a distinct point in flexion ROM where the lumbar paraspinals relax. During this time of "relaxation," the paraspinal muscles of trunk are considered myoelectrically "quiet" or electrically reduced. This is described as the "Flexion Relaxation Phenomenon".EMG is the recording of the electrical activity of the muscle and in essence, the study of motor unit activity. The tool used is the non-invasive technique that allows the evaluation of muscle activity and the output may be i n f o r m o f A u d i o ( S o u n d s ) o r D i g i t a l (Graphs).Electrodes used to record the EMG signal like: Surface electrode (Recording electrode), Reference electrode. Surface Electrodes are used frequently as they generally are considered adequate for monitoring large superficial muscles or muscle group.

Audio Output Digital Output

Problem Statement"To study the lumbar flexion relaxation phenomenon in the patients with acute and sub acute mechanical low back pain and normal subjects."

ObjectiveTo examine the myoelectrical activity of erector spinae muscle in patients with acute and sub acute mechanical low back pain and normal subjects. Research Design Observational study design Sample:30 patients, 15 MLBP & 15 Normal Subjects from Smt.Kashibai Navale General Hospital., Pune.

Sampling Technique:Convenient Sampling technique.

Criteria for selection of sample: Inclusion Criteria:Ø MLBP & Normal Subjects.Ø Those who have registered in physiotherapy OPD

before any PT treatment or any other treatment for MLBP.

Ø Subjects between ages of 20 - 50 yrs.Ø Both genders.

Exclusion Criteria:Ø Infective condition of spine.Ø Spinal surgery.Ø Disc herniation and prolapsed disc condition and

with cauda equine syndrome. Ø Pregnant women.Ø Patients who are taking medication for low back

pain. Ø Instruments used for the studyØ EMGApparatus;EMG Electrodes : Ground

electrode ,Surface electrode;Conducting gel;Micro pore.

ProcedureØ

taken. Ø Steps to perform the movements were taught.Ø The EMG Electrodes were placed approx. 2.5 cm

lateral to the spinous processes of T12 and L5 & reference electrode - below wrist.

Ø Participants were asked to flex their trunk forward as far as they were able without bending their knees for a count of 6, hold the final position for count of one second & return to upright stance for a count of 6.

Ø This movement was paced by a computer running a program that produced a series of audible beeps. First trial was done and then 3 times were performed & best of it was taken

ResultStatistical Analysis was done with unpaired t-test

Ethical clearance & Consent from patient was

COMPARISON OF AMPLITUDE BETWEEN MLBP PATIENTS AND NORMAL SUBJECTS

COMPARISON OF DURATION BETWEEN MLBP PATIENTS AND NORMAL SUBJECTS

COMPARISON OF TIME BETWEEN MLBP PATIENTS AND NORMAL SUBJECTS

DISCUSSIONIn Normal individuals the amplitude, duration & time should be at relax or resting state, that is at base level (i.e. amplitude between 0 - 9 micro volts, duration between 0 - 412 micro second, and time between 0 - 0.8 milli seconds - in normal individual).With study it was found that there was increase in activity of the muscle in MLBP patients when it should be electrically silent, which was observed by the increase in the amplitude, time & duration value on the EMG graph. This is because the lumbar paraspinal muscle activity is increased when the muscle should be silent electrically. One theory proposes that LBP may be the result of

Lumbar Flexion Relaxation Phenomenon In Patients With Acute And Subcute Mechanical Low Back Pain And Normal Subjects

32

muscle asymmetries. Literature suggests that the paraspinal muscles of patients with LBP act sub maximally and there is reduced activity during trunk movements.Also, Hides et al. (1994) suggest that arthrogenic muscle inhibition is likely in the paraspinal muscles in the presence of LBP. Such changes can potentially affect the EMGs measured in these subjects and patients. In this study, our findings did support changes in muscle activation in the presence of muscular low back pain.

CONCLUSIONThe study suggested that there is increase in the Amplitude, Duration & Time in FLEXION RELAXATION PHENOMENON in Acute and Sub acute Mechanical Low Back Pain patients when compared to Normal Subjects.

REFERENCES1) Moffett J.K. Randomized controlled trial of

exercise for low back pain: clinical outcomes, costs, & preferences. BMJ.1999;319:279-83 (Level of evidence 1B)

2) Ruth L. Solomon John. Preventing dance injuries.2005. p.93

3) M. Descarreaux, D. Lafond, R. Jeffrey-Gauthier H. Centomo,and V. Cantin, "Changes in the flexion relaxation response induced by lumbar muscle fatigue," BMC Musculoskeletal Disorders, vol. 9, article 10, 2008.

4) Physical Rehabilitation 5th edition, Susan B O'sullivan.

5) L.A.Danneels,G.G.Vanderstraeten, D. C. Cambier, E. E.Witvrouw,H. J. De Cuyper, and L. Danneels, "CT imaging oftrunk muscles in chronic low back pain patients and healthy control subjects," European Spine Journal, vol. 9, no. 4, pp. 266-272, 2000.

6) T. Sihvonen, J.;Partanen ,O. Hanninen ,and Soimakallio,"Electric behavior of low back muscles during lumbar pelvic rhythm in lowback pain patients and healthy controls," Archives of PhysicalMedicine and Rehabilitation, vol. 72, no. 13, pp. 1080-1087, 1991.

7) P. J. Watson, C. K. Booker, C. J. Main, and A. C. N. Chen,"Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio," Clinical Biomechanics, vol. 12, no. 3, pp. 165-171, 1997 .

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