Comparison between effects of instrument-assisted soft tissue mobilization and manual myofascial release on pain, range of motion and function in myofascial pain syndrome of upper trapezius - A randomized controlled trial.

Background: Myofascial pain syndrome (MPS) is a muscle pain disorder characterized by the presence of Myofascial Trigger Point (MTrP) within a taut band, local tenderness, referral of pain to a distant site, restricted range of motion, and autonomic phenomena. The upper trapezius is the muscle most often affected by MTrPs. Manual myofascial release (MFR) and Instrument-Assisted Soft Tissue Mobilization (IASTM) are techniques of soft tissue release that are used to resolve MPS. Fifty six percent of physiotherapists complain of pain in multiple areas due to the massage and manual therapy that they have to perform. Objective: The objective of this study is to find whether IASTM is better than manual MFR in treating patients with MPS in upper trapezius. Methods: This study was a single-blinded randomized controlled trial that included 31 participants, both males and females between the age groups of 18-50 years. Participants were randomly divided into two groups. Three sessions were given over a period of one week for both groups. Group A received IASTM along with conventional treatment and Group B received Manual MFR along with the conventional treatment. The outcome measures evaluated were pain, cervical range of motion, pain pressure threshold (PPT) of trigger points, and the neck disability index. Pre- and post-measurements were taken and the analysis was done. Results: Both the treatment methods significantly reduced pain, improved PPT, range of motion, and function. The effects between the groups showed that IASTM was significantly better than manual MFR to reduce pain. The improvement in PPT, range of motion and function were equal in both the groups. Conclusion: IASTM and manual MFR both are effective individually as treatment procedures for pain, PPT, range of motion, and function. Neither of the treatment options can be considered better that the other. The clinician can decide based on the availability of the instrument, training, patient's preference, and his/her comfort whether which of the two treatment methods should be used.

Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache - a protocol of a pragmatic randomized controlled trial.

BACKGROUND: Non - pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH. METHODS: This pragmatic trial is designed as a prospective, three-armed randomised controlled trial in a clinical setting provided at a general hospital physiotherapy department. Two hundred ninety-seven participants with a diagnosis of migraine, TTH or CGH based on published headache classification guidelines will be included. An assessor blind to group allocation will measure outcomes pre-and post-intervention as well as 3 and 6 months after commencement of treatment. Participants will be allocated to one of the three groups: MMT and exercise; placebo and exercise; and exercise alone. The primary outcome measure is headache frequency. Secondary outcome measures are headache duration and intensity, medication intake, pressure pain threshold (PPT), range of motion recorded with the flexion rotation test, and headache disability recorded with Headache Activities of Daily Living Index (HADLI). The intention-to-treat principle will be followed for statistical analysis. Between groups differences for all outcome measures at baseline and at reassessment points and 95% confidence intervals will be calculated using a mixed model ANOVA. Post hoc tests will be conducted to identify any significant difference between groups and over time. DISCUSSION: This pragmatic study will provide evidence for the effectiveness of MMT when compared with a placebo intervention and exercise on headache frequency, intensity, and disability. Limitations are that baseline evaluation of headache parameters may be affected by recall bias. External validity will be limited to the population with a minimum 1-year history of headache. The HADLI is not yet extensively evaluated for its psychometric properties and association between PPT and headache parameters is lacking. Performance bias is inevitable as a single therapist will be delivering all interventions. TRIAL REGISTRATION: The trial was registered prospectively under the Clinical Trial Registry India (Registration number: CTRI/2019/06/019506 , dated on 03/06/2019). .

Headache symptom modification: the relevance of appropriate manual therapy assessment and management of a patient with features of migraine and cervicogenic headache - a case report.

OBJECTIVES: People who suffer from headache frequently present with multiple headache forms and the precise diagnosis of the dominant headache form can be challenging. This case report describes a headache symptom modification approach in the diagnosis and management of a patient presenting with combined features of chronic migraine and cervicogenic headache (CGH). METHODS: A 28-year-old female presented with combined features of chronic migraine and CGH diagnosed according to guidelines published by the International Headache Society. Her main complaints were frequent and severe headache along with frequent neck pain and disability. Symptom modification based on the Mulligan Concept was utilized for assessment of musculoskeletal dysfunction associated with headache which identified upper cervical articular impairment. Impairments were also identified in craniocervical muscle control and endurance. Interventions comprised six sessions of Mulligan manual therapy to address cervical spine impairments, exercise for craniocervical control and endurance, as well as patient education. RESULTS: Headache frequency at 6 months follow up was reduced from 16 to 3 days per month and intensity from 72 to 23 on Visual Analogue Scale. Clinically relevant improvements were also found in headache duration, pressure pain thresholds, medication intake and Headache Activities of Daily Living Index post-treatment and continued up to 6 months follow-up without adverse events. DISCUSSION: This case report illustrates the use of a manual therapy symptom modification approach in the management of headache. Improvement in headache symptoms and disability suggests that the musculoskeletal impairments and headache symptoms were more a feature of CGH rather than migraine. The mechanisms underlying these changes in symptoms and impairments are discussed.

Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: A randomized controlled trial.

BACKGROUND: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM). OBJECTIVE: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness. METHODS: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks. RESULTS: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being 11 . 7 ± 2 . 8 , 95%CI(5.9,17.4) and 8 . 5 ± 2 . 0 , 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being 1 . 2 ± 0 . 2 , 95%CI(0.6,1.8) and 18 . 2 ± 2 . 2 , 95%CI(13.5,22.8) for VAS and DASH scores, respectively. CONCLUSION: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

Assessment of cervical range of motion, cervical core strength and scapular dyskinesia in violin players.

BACKGROUND: Playing the violin can lead to asymmetric postures which can affect the cervical range of motion, cervical core strength and scapular stability. OBJECTIVE: The objective of the study was to assess the cervical range of motion, cervical core strength and scapular dyskinesia in violin players and non-players of the same age group. METHODS: An inclinometer was used to assess the cervical range of motion, pressure biofeedback was used to assess cervical core strength and scapular dyskinesia was also assessed in 30 professional violin players (18-40 years) compared with 30 age-matched non-players. Analysis was done using an unpaired t test. RESULTS: Significant change was seen with respect to extension (p = 0.051), cervical core strength (p = 0.005), right (Rt) superior angle 0° (p = 0.004), Rt superior angle 45° (p = 0.015) and Rt inferior angle 90° (p = 0.013). CONCLUSION: This study shows a significant difference in extension range of motion and cervical core strength of violin players. Also, there was scapular dyskinesia seen at 0° and 45° right-side superior angle of the scapula and 90° right-side inferior angle of the scapula.

Effect of Butler's neural tissue mobilization and Mulligan's bent leg raise on pain and straight leg raise in patients of low back ache.

Low back ache (LBA) is a common musculoskeletal disorder sometimes associated with a positive limited Straight leg raise (SLR) test. Mulligan's bent leg raise (BLR) and Butler's neural tissue mobilization (NTM) are commonly used techniques for the treatment of low back ache where SLR is limited. The aim of this study was to evaluate the effect of both the techniques on pain and limited SLR in patients with LBA. Thirty one patients with LBA with radiculopathy were randomly allocated into 2 groups; BLR [n = 16] NTM [n = 15]. The outcome measures i.e. visual analogue scale (VAS) for pain and universal goniometer for measuring SLR range of motion (SROM) were assessed at the baseline, post intervention and after 24 h (follow up). Within group analysis using paired t-test revealed a significant difference between pre-treatment and post-treatment VAS and SROM score(p < 0.05). However no difference was seen between pre-treatment and follow up (p > 0.05). The study showed that both techniques produce immediate improvement in pain and SLR range but this effect was not maintained during the follow up period.

Effects of Yogasanas on osteoporosis in postmenopausal women.

BACKGROUND: Osteoporosis is commonly encountered by postmenopausal women. There is an increased need for a low cost and efficient treatment alternative to address this population. AIMS: To study the effects of integrated yoga on bone mineral density (BMD) in postmenopausal women with osteoporosis. SETTINGS AND DESIGNS: Experimental pre-post study conducted in a community setting. MATERIALS AND METHODS: 30 females in the age group of 45-62 years suffering from postmenopausal osteoporosis with a dual-energy X-ray absorptiometry (DEXA) score of ≤-2.5 underwent a 6 months fully supervised yoga session. All the participants completed the study. Pretraining and posttraining BMD was calculated. OUTCOME MEASURE: DEXA score at the lumbar spine. STATISTICAL ANALYSIS: The study was statistically analyzed using paired t-test to see the significance of pretraining and posttraining effects of a yoga session. RESULTS: Improvement in T-score of DEXA scan of -2.55 ± 0.25 at posttraining as compared to a pretraining score of -2.69 ± 0.17. CONCLUSIONS: Integrated yoga is a safe mode of physical activity which includes weight bearing as well as not weight bearing asanas, Pranayama, and suryanamaskar, all of which helps induce improvement in BMD in postmenopausal osteoporotic females.

Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial.

BACKGROUND: Mechanical neck pain is one of the common musculoskeletal disorders. Muscle energy technique (MET) may be a useful intervention for treating such disorder. OBJECTIVE: The aim of this study was to compare the effect of MET with passive stretching on pain and functional disability in people with mechanical neck pain. METHODS: A randomized controlled trial was undertaken. Sixty patients with mechanical neck pain were randomly allocated to either the MET group or control group. The former group received MET, and the latter group received static stretching. Both groups received conventional therapy. Treatment was given once a day for 6 days. A visual analogue scale (VAS) was used to measure the intensity of pain, and functional disability was assessed using the neck disability index (NDI) was immediately before treatment and again on the 6th day. RESULTS: VAS and NDI scores showed a significant improvement in both MET and stretching groups on the 6th day postintervention (p < 0.05). However, both VAS and NDI scores showed better improvement in the MET group as compared to the stretching group (p < 0.025). CONCLUSION: Muscle energy technique was better than stretching technique in improving pain and functional disability in people with mechanical neck pain.

Epidemiological evaluation quality of life in patients suffering from early rheumatoid arthritis: a pragmatic, prospective, randomized, blind allocation controlled of a modular program group intervention.

OBJECTIVES: Epidemiology has taken on new roles in the management of health care services. In this study, we developed a non-pharmacological self-management modular program group intervention and evaluated its efficacy as an adjunct therapy in patients suffering from early rheumatoid arthritis (RA). METHODS: Patients were randomized to either participate in a non-equivalent intervention group along with the standard of care or only receive standard-of-care treatment at a community rheumatology center. The outcomes measured were a pain visual analog scale (VAS), patient general health (GH) on a VAS, and the Short Form 36 Health Survey version 2 scale measuring quality of life. These parameters were evaluated in the first week to obtain baseline values, and at 20, 32, 48, and 60 weeks to evaluate the efficacy of the intervention group. RESULTS: The patients were randomized, with 100 patients in the intervention group and 106 in the control group. The intervention and control groups were similar with regard to the percentage of women (86% vs. 89.6%), tobacco usage (25% vs. 19.8%), mean age (42.6±13.2 years vs. 46.6±10.9 years), and disease duration (15.3±6.7 months vs. 14.5±6.6 months). The mean outcomes were significantly different between the two groups, and post-hoc pairwise analysis demonstrated significant deterioration in the control group in contrast to improvement in the intervention group at the second, third, fourth, and fifth evaluations. Improvements were often seen as early as the 12-week and 24-week follow-up visits. CONCLUSIONS: Epidemiology contributes to the evaluation of how well specific therapies or other health interventions prevent or control health problems. The modular program group intervention implemented in this study appears to be a suitable and feasible method to facilitate much more comprehensive management of early RA in socioeconomically challenged communities.

Inter and intra-rater reliability of mobile device goniometer in measuring lumbar flexion range of motion.

BACKGROUND: Evaluation of range of motion (ROM) is integral part of assessment of musculoskeletal system. This is required in health fitness and pathological conditions; also it is used as an objective outcome measure. Several methods are described to check spinal flexion range of motion. Different methods for measuring spine ranges have their advantages and disadvantages. Hence, a new device was introduced in this study using the method of dual inclinometer to measure lumbar spine flexion range of motion (ROM). OBJECTIVES: To determine Intra and Inter-rater reliability of mobile device goniometer in measuring lumbar flexion range of motion. METHOD: iPod mobile device with goniometer software was used. The part being measure i.e the back of the subject was suitably exposed. Subject was standing with feet shoulder width apart. Spinous process of second sacral vertebra S2 and T12 were located, these were used as the reference points and readings were taken. Three readings were taken for each: inter-rater reliability as well as the intra-rater reliability. Sufficient rest was given between each flexion movement. RESULTS: Intra-rater reliability using ICC was r=0.920 and inter-rater r=0.812 at CI 95%. Validity r=0.95. CONCLUSION: Mobile device goniometer has high intra-rater reliability. The inter-rater reliability was moderate. This device can be used to assess range of motion of spine flexion, representing uni-planar movement.

Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty.

BACKGROUND: Amongst various modalities of post operative rehabilitation in a total knee replacement (TKR) surgery, this study focuses on evaluating the effect of additional yoga therapy on functional outcome of TKR patients. MATERIALS AND METHODS: A comparative study was done to compare the effects of conventional physiotherapy and additional yoga asanas, on 56 patients undergoing total knee arthroplasty due to osteoarthritis. After obtaining written informed consent, the patients were alternately assigned to two groups: Conventional and experimental. Baseline WOMAC scores for pain and stiffness were taken on third post operative day. The subjects in conventional group received physiotherapy rehabilitation program of Sancheti Institute where the study was conducted, the experimental group received additional modified yoga asanas once daily by the therapist. After discharge from the hospital, patients were provided with written instructions and photographs of the asanas, two sets of WOMAC questionnaire with stamped and addressed envelopes and were instructed to perform yoga asanas 3 days/week. Subjects filled the questionnaire after 6 weeks and 3 months from the day of surgery and mailed back. The primary outcome measure was WOMAC questionnaire which consists of 24 questions, each corresponding to a visual analog scale, designed to measure patient's perception of pain, stiffness and function. RESULTS: The results suggest that there was a significant change (P<0.05) for all the groups for pain, stiffness and function subscales of WOMAC scale. The pain and stiffness was found to be less in experimental group receiving additional yoga therapy than in conventional group on 3(rd) post operative day, 6 weeks and 3 months after the surgery. CONCLUSION: A combination of physiotherapy and yoga asana protocol works better than only physiotherapy protocol. Larger and blinded study is needed.