Effectiveness of Faradic and Russian currents on plantar flexor muscle spasticity, ankle motor recovery, and functional gait in stroke patients.

BACKGROUND AND PURPOSE: Spasticity is a major disabling symptom in patients post stroke. Though studies have demonstrated that electrical stimulation (ES) can reduce spasticity and improve passive ankle range of motion (ROM), not many studies have evaluated the effectiveness of ES on active ankle ROM. The purpose of this study was to determine the effectiveness of Faradic and Russian currents in the reduction of ankle plantar-flexor spasticity and improving motor recovery in patients post stroke. METHODS: Eighty-three patients (29 females and 54 males; mean age of 57.12 years) were randomly assigned to Group 1 (task-oriented exercises), Group 2 (Faradic current for 10 min and task-oriented exercises), and Group 3 (Russian current for 10 min and task-oriented exercises) for a period of 5 sessions per week for 6 weeks. All patients were assessed for soleus and gastrocnemius muscles spasticity measured by modified modified Ashworth scale; active and passive range ROM measured by goniometer; and functional ambulation measured by modified Emory Functional Ambulation Profile at the time of recruitment to study and after 6 weeks. RESULTS: Both the types of stimulation and exercises were not associated with improvements in modified Emory Functional Ambulation Profile (p > 0.05). The results showed that all the groups are effective in improving passive ankle ROM (p < 0.05) and reducing soleus and gastrocnemius muscles spasticity (p < 0.05). Though all the groups were effective in improving active ankle ROM, no group was found to be superior to another after treatment CONCLUSION: Adding ES to exercises are associated with low to medium effect sizes (<0.5) in reducing spasticity and improving ankle ROM.

Effect of stretching of piriformis and iliopsoas in coccydynia.

Pain in the coccyx is referred as coccydynia. The pain aggravates in weight bearing i.e. sitting. Total 48 persons with coccydynia diagnosed clinically were recruited and randomly assigned into one of the 3 groups. Experimental group I were treated by stretching of piriformis and iliopsoas muscles, experimental group II were treated by stretching of piriformis and iliopsoas muscles and Maitland's rhythmic oscillatory thoracic mobilization over the hypomobile segments and the conventional group were treated by seat cushioning + Sitz bath + Phonophorosis. All participants underwent an initial baseline assessment for Pressure Pain Threshold (PPT) by using modified syringe algometer and pain free sitting duration. All the subjects were advised to minimise sitting posture and use a seat cushion. Treatment was given for 3 weeks, 5 sessions per week and post-treatment evaluation was done after completion of 3 weeks. Follow up evaluation was done after 1 month. DATA ANALYSIS: The data was analyzed by using 3 × 3 ANOVA. Tukey's HSD post-Hoc analysis was used for all pair wise comparison. RESULTS: The overall results of the study showed that there was significant improvement in pain pressure threshold and pain free sitting in both the experimental groups with treatment and improvement continued after cessation of therapy, whereas the conventional group did not improve significantly.

Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points.

Studies have shown a clinical relationship between trigger points and joint impairments. However the cause-and effect relationship between muscle and joint dysfunctions in trigger points could not be established. The purpose of this study was to investigate effects of mobilization and ischemic compression therapy on cervical range of motion and pressure pain sensitivity in participants with latent trigger point in the upper trapezius muscle. Ninety asymptomatic participants with upper trapezius latent trigger point were randomized in to 3 groups: mobilization, ischemic compression and a control. The outcomes were measured over a 2 week period. Repeated measures ANOVA showed statistically and clinically significant pre to post improvement in both the interventional groups compared to control (p < 0.05). However the effect sizes between the intervention groups were small (<0.3) revealing minimal clinical detectable difference.

Mobilisation of the thoracic spine in the management of spondylolisthesis.

INTRODUCTION: Segmental instability due to lumbar spondylolisthesis is a potential cause of chronic low back pain. Hypomobility of the spine results in compensatory segmental hypermobility of the segment above or below restricted segments. Therefore, the aim of the study is to determine the effects of mobilisation of the hypomobile upper thoracic spine along with conventional flexion exercises and stretching of short hip flexors on the degree of slippage and the functions of the persons with lumbar spondylolisthesis. METHODOLOGY: All patients with spondylolisthesis were randomly assigned into two groups: Group I - Experimental group, treated with mobilisation of the thoracic spine along with the conventional physiotherapy and Group II - Conventional group, treated with conventional stretching, strengthening, and lumbar flexion exercise programme. RESULTS: The experimental group treated with mobilisation of the thoracic spine shows a significant reduction in the percentage of vertebral slip from pre-treatment to post-treatment measurements. CONCLUSION: Low back pain due to spondylolisthesis may be benefited by mobilisation of the thoracic spine along with stretching of short hip flexors, piriformis, lumbar flexion range of motion exercises, core strengthening exercises, etc.

Effects of unilateral posteroanterior mobilization in subjects with sacralized lumbosacral transitional vertebrae.

AIM OF THE STUDY: To find out the efficacy of unilateral posteroanterior (PA) mobilization over type IA and type IIA sacralized lumbosacral transitional vertebrae in patients with low back pain with or without leg pain. RESEARCH DESIGN: experimental randomized control study. SAMPLE SIZE: 30 subjects, SAMPLING: simple random sampling. GROUP A - 15 subjects - self lumbar mobility and stretching exercises + Unilateral PA mobilization + hot pack. GROUP B - 15 subjects - self lumbar mobility and stretching exercises + hot pack. Before initiating treatment, subjects were assessed for dependent variables: Pain intensity by VAS, Forward bending and side bending ROM by modified finger to floor method with the help of an inch-tape and functions by Modified Oswestry Functional Disability Questionnaires. Post test measurements were taken after completion 2 weeks of therapy. The results of the study suggest that unilateral PA pressure is an effective mobilization method in reducing low back pain, improving ROM and related disability as compared to impairment based exercises alone in patients with low back pain with or without radiation to lower limbs having abnormally large transverse processes and hypomobile type IA and IIA lumbo-sacral transitional vertebrae.

Effect of Transcutaneous Electrical Nerve Stimulation on Plantar Flexor Muscle Spasticity and Walking Speed in Stroke Patients.

BACKGROUND AND PURPOSE: Spasticity is a major disabling symptom in patients post stroke. Although studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) can reduce spasticity, the duration of single session TENS is a subject of debate. The purpose of this study was to determine the sustainability of the effects of TENS applied over common peroneal nerve in the reduction of ankle plantar-flexor spasticity and improving gait speed in patients post stroke. METHODS: Thirty patients (11 women and 19 men) (mean age of 46.46 years) were randomly assigned to group 1 (task oriented exercises), group 2 (TENS for 30 min and task oriented exercises) and group 3 (TENS for 60 min and task oriented exercises) for a period of five sessions per week for 6 weeks. All patients were assessed for ankle plantar-flexor spasticity, passive ankle dorsi-flexion range of motion, clonus and timed up and go test at the time of recruitment to study, at 3 and 6 weeks of therapeutic intervention. RESULTS: The overall results of the study suggest that there was a decrease in ankle plantar flexor spasticity, ankle clonus and timed up and go score in all the groups. A greater reduction of spasticity was seen in TENS groups (groups 2 and 3) when compared to control. No significant improvement was found in timed up and go test (TUG) scores between groups. CONCLUSION: Both 30 min and 60 min of application of TENS are effective in reducing spasticity of ankle plantar flexors, improving walking ability and increase the effectiveness of task related training. Based on the effect size, we would recommend a longer duration application for the reduction of spasticity. Copyright © 2015 John Wiley & Sons, Ltd.

Effectiveness of mobilization therapy and exercises in mechanical neck pain.

OBJECTIVES: While studies have looked into the effects of Maitland mobilization on symptom relief, to date, no work has specifically looked at the effects of Mulligan mobilization. The objective of this work was to compare the effectiveness of Maitland and Mulligan's mobilization and exercises on pain response, range of motion (ROM) and functional ability in patients with mechanical neck pain. METHODS: A total sample of 60 subjects (21-45 years of age) with complaints of insidious onset of mechanical pain that has lasted for less than 12 weeks and reduced ROM were randomly assigned to: group I - Maitland mobilization and exercises; group - II Mulligan mobilization and exercises; and group-III exercises only, and assessed for dependent variables by a blinded examiner. RESULTS: Post measurement readings revealed statistical significance with time (p < 0.00) and no significance between groups (p > 0.05) indicating no group is superior to another after treatment and at follow-up. The effect sizes between the treatment groups were small. CONCLUSION: Our results showed that manual therapy interventions were no better than supervised exercises in reducing pain, improving ROM and neck disability.

Effect of electrical stimulation to long head of biceps in reducing gleno humeral subluxation after stroke.

BACKGROUND: Glenohumeral subluxation is the most frequent complication in post stroke hemiplegia and its reduction has been considered an important goal. Though it has been demonstrated that cyclical electrical stimulation of posterior deltoid and supraspinatus muscles can reduce subluxation, the role of biceps has not been given due consideration. OBJECTIVE: The purpose of this study was to determine whether electrical stimulation to the long head of biceps could more effectively reduce gleno humeral subluxation. METHODS: 24 patients were selected and consecutively assigned to group 1 (electrical stimulation to supraspinatus & posterior deltoid) and group II (electrical stimulation to supraspinatus, posterior deltoid & long head of the biceps) along with routine physiotherapy and occupational therapy for a period of 5 weeks. All patients were assessed for shoulder subluxation, pain and shoulder active abduction range of motion at the time of recruitment to study and after 5 weeks of therapy. RESULTS: Both the groups showed significant improvement in parameters measured. Tukey's post hoc analysis showed the results were more significant in Group II. CONCLUSIONS: Electrical stimulation to biceps along with the supraspinatus and posterior deltoid can more effectively reduce shoulder subluxation.