Physiotherapy and Occupational Therapy Journal

Symptoms of the upper extremity, sometimes, doesn’t co­relate with cervical radiculopathy or with peripheral nerve involvement. When an ideal examination excludes the probable diagnosis, comparing the symptoms and its history could possibly lead to the striking remembrance of T4 syndrome. According to Grieve, mobilization of the T4 vertebra, reproduces or eliminates the symptoms. The patient was a 43­year­old lady teacher, presented to the physiotherapy outpatient department, with the chief complaint of neck pain and tingling sensation in the left hand for 6 months. Her pain got aggravated while writing on the blackboard and while lifting weights. And eased with hot water fermentation. No positive findings to rule out for any cervical pathology or peripheral nerve involvement. Thoracic screw thrust technique was adopted to relieve pain and to reduce tingling sensation in the left hand for a patient with T4 syndrome. Following 5 sessions of Thoracic screw thrust technique, her scores of NRS for blackboard writing was reduced from 7/10 to 3/10 and for weight lifting from 8/10 to 3/10. And score for Neck Disability Index reduced from 46% to 35% (Driving domain was excluded). This case report describes the successful application of Thoracic screw thrust technique in T4 syndrome. It will probably establish an evidence of this manual therapy technique in T4 syndrome. This report will possibly also emphasize on the differential diagnosis for neck pain and the requirement of an ideal examination for the same.

Keywords: Neck Pain; T4 Syndrome; Screw Thrust Manipulation.

 

Introduction: Low back pain is an extremely common problem that most people experience at some point in their life Low back pain is well documented to be an extremely common health problem however, its burden is often considered trivial.The common form of low backache is mechanical type and 80­90% patients will complain of dull, achy, diffuse pain and stiffness that is confined to the low back area or may radiate to buttock nd hip which results from reflex muscle spasm from primary pain, where there may have trigger points within their muscles [1]. Quadratus lumborum muscle is an important stabilizer of the lumbar spine [2]. The quadratus lumborum, or QL, is a common source of lower back pain [3].

Purpose of the Study: To find out the effect of stretching on quadratus lumborum muscle in non specific low back pain.

Methods: Group A: Group A (15 patients) received core stability warm up and spinal extension exercise. Group B: Group B (15 patients) received the same treatment line with addition of Quadratus Lumborum stretch.

Conclusion: The study concludes to that there is significant difference on between Group A and GroupB on the basis of Oswestry Low Back Pain Disability Questionnaire. Though there is no significant difference between Group A and Group B on the basis of VAS.

Discussion: The study was an experimental study which aim to find out the effect of stretching on shortened quadratus lumborum muscle in non­specific low back pain the study designed comprised of 30 subject and they were equally divided into 2 group group A consist of 15 subjects and group B consist 15 subjects the showed an significant result on comparing between the group A and group B the result was significant.

Limitations of Study: The sample size was small consisting of 30 subjects. Other muscle components which have a significant role in causing non­specific low back pain were not taken into consideration. Marginal tightness in muscle such as Iliopsaos, Hamstring and Tensor fascia Latae was not considered. Body mass index was not controllable.

Future Scope of Study: Larger sample size can be taken. Study can be conducted for longer duration. Different age groups can be taken.

Keywords: Stability Warm Upexercise; Spinal Extension Exercise; Quadratus Lumborum Stretching; Oswestry Low Back Pain Disability Questionnaire and VAS.

 

Introduction: The term prolapsed disc means the protrusion or extrusion of the nucleus. It is not a onetime phenomenon rather it is a sequence of change in the disc which ultimately leads to its prolapsed. It is a spinal condition that can cause lower back pain as well as numbness, tightness of muscle, pins and needles sensation, and feeling of muscle weakness in the lower body.

Need for Study: There are many researches being done on the effects of core strengthening exercises and McKenzie extension exercise on low back pain separately. I want to compare both of them to derive a better and effective exercise plan for low back pain of lumbar prolapsed intervertebral disc condition.

Methods: 30 subjects were selected and divided into 2 groups randomly. The Group A subject received McKenzie extension exercise The group B subject received Core strengthening exercise. Both the group were treated for 2 weeks. The patients were treated for 6 sessions on a week. Pre intervention measurements for pain intensity using VAS, and functional disability using ODI for low back pain (both groups).

Result: Student t test was used to compare the data of the two groups. The subject’s conditions were similar between the groups, with regard to all variables selected. There was significant difference observed with respect to V.A.S. and O.D.I between McKenzie extension exercise and Core strengthening exercise. Hence McKenzie extension exercise were found to be more effective in comparison to core strengthening.

Conclusion: The present study concluded that McKenzie extension exercise protocol was more effective in comparison to core strengthening in low back pain with PIVD condition. 

Keywords: Visual Analogue Scale; Prolapsed Lumabar Intervertebral Disc; Owestry Disability Index; Short Wave Diathermy; Transcutaneous Electrical Nerve Stimulation.

 

Introduction: Shoulder pain is a common problem it is the third most common musculoskeletal complaint in the general population, and accounts for 5% of all general practitioner musculoskeletal consultation [1]. Frozen shoulder is a common cause of shoulder pain affecting 2–5% of the general population [2]. The term ‘‘frozen shoulder’’ was first coined by Codman and was subsequently defined as an idiopathic condition of the shoulder characterized by the spontaneous onset of pain in the shoulder with restriction of mobility at the glenohumeral joint in every direction [3,4]. Mobilization techniques can be performed as physiologic movements or accessory movements. In Maitland classification system, a concept of management in which accessory and physiologic passive movements of the joint are applied at various grades of intensity depending on a subject’s pain and joint stiffness [7].Massage has been used for alternatives therapy on musculoskeletal system a modern systematic and clinical technique called friction massage was employed by Cyriax [10].

Need of Study: To best of our knowledge no studies have been done on comparison of high grade mobilization and cyriax manipulation in subjects with frozen shoulder.

Methodology: Each subject was assigned into two groups by random sampling one Group A treated with High grade mobilization technique grade III & IV) with ultrasound and Group B receives Cyriax manipulation with ultrasound.

Conclussion: The study could be concluded as” There is no significant difference produced between the High grade mobilization technique and cyriax manipulation in reducing pain & increasing shoulder abduction and external rotation in frozen shoulder”.

Limitation: 1. The follow­up to see the long term effects of training is not done. 2. There is need to make an specific inclusion criteria to be developed that can identify which patients will most benefit from the HGMT. 3. This study has not taken into consideration of other than grade III & IV of Maitland mobilization grades. HGMT is not suitable for all kinds of patients. 4. Our sample size was small, and data were collected at only one hospital. 5. No control group. 

Future Research: 1. Future Studies should investigate whether HGMTs is effective in earlier stages of frozen shoulder in decreasing pain and improving ROM. 2. The duration of benefits from the cyriax manipulation may also be an important area for future study. 3. Sample size can be increased with inclusion of more number of subjects to generalize the effect in larger population. 4. Future study should consists of Randomized control TRAIL needed to know the long term effects of Cyriax over Maitland grade III and IV mobilization in frozen shoulder.

Kyewords: High Grade Mobilization Technique; Cyriax Manipulation; Therapeutic Ultrasound Machine; Universal Goniometry; Visual Analogue Scale & Ultra­Sonic Gel.

 

Introduction: Stroke is the leading cause of long term disability among adults and hemiparesis is the most common impairment after stroke. Longitudinal studies of recovery after stroke suggest that on 50% of patients with significant arm paresis recover useful function [1] WHO estimated that in 1990, out of a total of 9.4 million deaths in India, 619,000 were due to stroke. This gives a stroke mortality rate of 73 per 1000,000 (estimated total population 849 million). It is estimated that 600,000 Americans suffer a first stroke each year, and the nation’s nearly 4 million stroke survivors are living with consequences [2]. Patient diagnosed with stroke often present with a combination of muscle weakness or muscle imbalance, decreased postural control, muscle spasticity, poor voluntary control, and body mal­alignment [3].

Aims of the Study: To analyze the effectiveness of combine motor rehabilitation protocol to improve upper extremity motor recovery in post stroke subjects.

Methods: On the basis of inclusion and exclusion criteria 30 subjects were randomly divided into two groups. 15 subjects in experimental group (Group A) given mirror therapy and thermal stimulation and 15 subjects in controlled group (Group B). Given general exercises of upper extremity for flexors and extensors were carried out for 4 weeks including active exercises and functional training.

Discussion: In the present study, aspect of somatosensory stimulation and mirror illusion of normal movement is taken as a point of reference for treatment in hemiplegic with functional dependence on the basis of UEFI. [5,8]. There is a significant change in post intervention in Group A p ï‚£ 0.05 which approves improvement in functional activity according to UEFI. The use of mirror therapy creates the mirror illusion of normal movement of the affected hand may substitute for decreased proprioceptive information, thereby helping to recruit the premotor cortex and assisting rehabilitation through an intimate connection between visual input and premotor areas. Clinically this study demonstrated that by using mirror therapy and thermal stimulation as a treatment tool, the improvement was seen in upper extremity functional activity of post stroke hemi paretic subjects.

Conclusion: Mirror therapy and thermal stimulation was found to be effective in improving functional independence in upper limb post sub­acute stroke. When mirror therapy and thermal stimulation is administered to patients suffering from sub­acute stroke over a period of 4 weeks, it results in an improvement in reaching forwards, grasping, manipulating objects and also improves other fine motor functions of the hand. 

Future Research: 1. Further studies are recommended to minimize these limitations in such a way that larger sample sizes of both the sexes that include various age groups of people are studied. 2. The duration of study can be increased. 3. The inclusion criterion can be improved so that all the subjects show similar functional independence in upper limb at the beginning of the study. 4. Various outcome measures can be used in order to record the functional independence in a better way. 5. Study can also be done to improve lower extremity functions. 6. Study can be done on chronic patients.

Limitations of the Study: 1. The duration of study was only 4 weeks, so further prognosis and long term benefits could not be recorded. 2. Home exercises were not prescribed to the subjects. 3. Training depends on functional level of patients. 4. Task specificity and stroke severity are important factors in rehabilitation of upper limb. 5. It is difficult to maintain constant temperature. 6.
Thermal stimulation cannot be performed on patients with sensory loss. 

Keywords: Mirror Therapy; Thermal Stimulation Medium Size Ball; Suitcase; Shirt With Buttons; Comb; Plinth; Mirror; Hot and Cold Packs; Medium Size Jar; Chair; Towels & Shoes With Laces.

 

Introduction: The Q­ angle is the angle formed by the encounter of two lines, one that starts at the anterior superior iliac spine and goes to center of the patella and another that goes from the tibial tuberosity to the center of the patella [1]. Many experts favor closed chain over open chain exercises. They do so under the assumption that they are safer and more functional. The terms open and closed kinematic chain have frequently ed to polarizing and contradictory discussions both in scientific literature & in everyday practice of various therapists clinicians and trainers.Controversial arguments for and against open kinetic chain and closed kinematic chain exercise [4]. One of the methods currently used in clinical practice is measurement of the navicular drop. Depending of the foot size the dynamic navicular drop for healthy persons is on average 5.3 mm (±18mm) but can vary up to 15 mm in problematic cases [10].

Need of the Study: Compare the effectiveness of and close kinematic chain exercises Open kinematic chain exercises on Gluteus maximus, Q angle and navicular drop in the knee joint for improve the strength of Gluteus maximus muscle and quadriceps muscle. I want to diagnose & compare of Q angle and navicular drop at the fatigue level exercise.

Methods: It is an experimental study design. Subjects were randomly assigned into two groups. A and B. Group A subjects received close kinematic chain and Group B open kinematic chain exercises at the fatigue level.

Conclusion: In present study we found that both type of exercise protocols either close kinematic chain or open kinematic chain exercise are equally effective. Therefore data from present study support our null hypothesis.

Discussion: This study was designed to obtain more thorough understanding of the effect of exercise induces fatigue in the CKC and OKC on the Q­ angle, and navicular drop. The study is done to compare the CKC and OKC on Q­ angle and navicular dropping after exercise and before exercise in the dominant lower extremity. Before implementing the experiment, the pre values of various ranges of the two group were compared between them using independent ‘t’ –Test and the result shown to be non significant which forms the baseline of this study.

Study Limitations: How­ever despite of best effort and state of the class facilities this study to had some limitations such as small sample size, gender limitations, non specific study population which provides just a glimpse of possibilities with more accurate and better rehabilitation outcomes. Future studies should include patient focused population, large sample size, specific study population
i.e. athletes from various discipline of sports.

Keywords: Close Kinematic Chain Exercise (CKC); Open Kinematic Chain Exercise (OKC); Q­ Angle and Navicular Drop.