Effects of Movement Retraining and Lumbar Stabilization Exercises in Mechanical Low Back Pain: A Pilot Study.

Objective To determine and compare the effects of movement retraining (MR), lumbar stabilization exercises (LSE), and a combination of both these exercises on pain, flexibility, strength, and functional disability in chronic mechanical low back pain (CMLBP) patients. Materials and methods Fifteen CMLBP participants, aged 20-40 years, were randomly allocated into three groups. Group A (n=5) received MR, group B (n=5), LSE, and group C (n=5), a combination of MR and CSE, along with hot packs for eight weeks, thrice a week on alternate days. Outcomes used were the Numerical Pain Rating Scale (NPRS), Modified Modified Schober's Test (MMST), Pressure Biofeedback (PBU), Roland Morris Disability Questionnaire (RMDQ), and Movement Control (MC) dissociation tests to identify MC impairments and were assessed at pre-intervention, post-four weeks, and post-eight weeks. The data were analyzed using repeated measures ANOVA. The level of significance was considered at p-value<0.05. Results Participants with CMLBP significantly improved in all variables in all three groups (p-value≤0.05). On inter-group comparison, group A showed better improvement in lumbar extension range of motion than the other two groups, with a mean difference of MMST in group A of 0.62±0.30, group B of 0.52±0.22, and group C of 0.36±0.02, with a p-value ≤0.002. Group C showed more improvement in core strength, with a mean difference of 5.0±0.25 in group A, 3.2±0.56 in group B, and 5.2±0.57 in group C, with a p-value ≤0.03. A significant improvement was observed in NPRS, MMST flexion, RMDQ, and uncontrolled movements (UCMs). Conclusion All three methods of treatment are effective in the management of CMLBP. Clinically, kinetic control showed better improvement in reducing pain and improving lumbar flexion and extension range of motion. Functional disability was better improved with lumbar stabilization exercises, and core strength was improved with a combination of KC and LSE. However, a combination of MR and LSE helps improve core strength, and movement retraining improves lumbar extension.

Effectiveness of instrument assisted soft tissue mobilization versus foam rolling on trigger point release in calf muscles.

BACKGROUND: Instrument assisted soft tissue mobilization and foam rolling are two techniques that have been proven effective in treating Myofascial Trigger Points, irrespective of the type of trigger point. However, little is known about the comparative effectiveness of Instrument assisted soft tissue mobilization and foam rolling. This study proposed to evaluate the effectiveness of either technique on plantar flexors trigger points, ankle dorsiflexion, and lower limb power present in the calf muscles in non-symptomatic patients. METHOD: Forty-two subjects with bilateral calf muscle tightness, at least one trigger point in the calf muscle, and fulfilling the inclusion criteria were randomly assigned to either of the groups. Group A was treated for gastrocnemius and soleus trigger points using Instrument assisted soft tissue mobilization and Group B was treated using the Foam Rolling method. Treatment was given every alternate day, a total of 3 sessions. Subjects were evaluated on 1st and 3rd sessions for pre-post differences of ankle dorsiflexion Range of motion in weight bearing and non-weight bearing position, pressure pain threshold for gastrocnemius trigger point 1(G1), 2(G2), and soleus point 1(S1) on both sides, and lower limb power. RESULT: Within group analyses, both groups had shown statistically significant results for all parameters except gastrocnemius trigger point 2 of foam rolling. For between group comparison foam rolling had a statistically significant result in non-weight bearing ankle dorsiflexion range of motion. CONCLUSION: Both Instrument assisted soft tissue mobilization and Foam rolling were equally effective for treating calf trigger points. But foam rolling was more effective in improving ankle dorsiflexion range of motion.

Effect of myofascial cupping vs integrated neuromuscular inhibition techniques on pain and neck movement in individuals with latent trigger point in trapezius.

Background: Pain is the most common symptom for seeking therapeutic alternative to conventional medicine. Trigger points (TrP) being the most debilitating cause of nonspecific neck pain, are found to be more prevalent in trapezius muscle. Various instrument-based and other manual therapy techniques are effective in the treatment of TrP. Objective: To compare the effect of Myofascial Cupping (MFC) and Integrated Neuromuscular Inhibition Technique (INIT) on the upper trapezius latent TrP on pain intensity, pressure pain threshold (PPT) & cervical range. Method: A randomized trial controlled on 40 individuals aged 20-40 years, both gender with latent TrPs in upper trapezius excluding ones who have taken treatment for upper trapezius TrPs within 6 months. Participants were randomly allocated into 2 groups by chit method, one group received MFC and other INIT. Pre- and post-intervention assessment was done using NPRS, pressure algometer and goniometer. Result: Within group, pain has significantly reduced after MFC and INIT with mean difference of 6.05±0.8 and 4.95±0.7, respectively (p<0.001). PPT increased in both groups (p<0.001) with mean difference of 0.63±0.3 and 0.28±0.11, respectively. Comparison between the groups showed significant difference in pain intensity (p=0.003) suggesting MFC was more effective in reducing pain. However, a PPT (p=0.606) and neck lateral flexion to the contralateral side of TrP (p=0.74) were not significant. Conclusion: MFC was more effective than INITs in improving pain, however both interventions showed similar effect on PPT and neck lateral flexion on latent TrP in trapezius.

Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery.

Purpose: : The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS). Methods: A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared. Results: The mean age of all the patients was 66.22 ± 8.05 years. BCVA of at least 6/18 or better at 12 weeks post-operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D ± 0.22D, in Group S was 0.97D ± 0.29D, and in Group F was 0.575D ± 0.25D. Conclusion: SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.

Re-inventing the straight incision with a single central suture in manual small-incision cataract surgery to minimize surgically induced astigmatism.

Purpose: To calculate the surgically induced astigmatism (SIA) in MSICS through a superiorly placed straight scleral incision closed with a single, central, perpendicular 10-0 polyamide suture and to document any suture-related complaints and complications. Methods: A retrospective, hospital-based study was carried out in 50 cases of uncomplicated senile cataract (>50 year) with nuclear sclerosis ≥ grade 4, "with the rule" astigmatism who underwent MSICS through a superior, straight incision with a single, central, perpendicular 10-0 nylon suture. Patients with "against the rule" astigmatism, keratoconus, pre-existing corneal opacity, astigmatism >2D, distorted or oblique mires, and previous ocular surgeries and unwilling to participate were excluded. Results: The mean age of the patients was 64.81 + 2.824 years, with a male: female ratio of 1.38:1. The mean SIA at day 7, week 6, and 12 weeks was 0.539 + 0.118, 0.529 + 0.134, and 0.524 + 0.129, respectively. Only 6 patients (12%) complained of foreign body sensation. No patient developed any suture-related complications. Conclusion: SIA is significantly reduced in straight incision by applying a single, central, and perpendicular 10-0 polyamide suture, as compared to a straight incision without a suture.

Correlation of parental and childhood myopia in children aged 5-16 years in North India.

Purpose: The aim of this study was to determine the correlation of parental and childhood myopia among school children aged 5-16 years in North India. Methods: This study included a total of 1400 children aged 5-16 years in a district in North India. Visual acuity was measured using a Snellen's chart. Children with myopia after retinoscopy were worked up in detail in our institute and a history of parental myopia was taken. Results: A total of 1400 students studying in class 5-10, aged between 5 and 16 years, were screened. A total of 487 students had myopia. Of the 487 myopes, 220 (45.2%) had parental myopia, of which 115 (30.1%) had myopia in both parents, 64 (19.3%) had mothers with myopia, and 41 (13.3%) had fathers with myopia. The prevalence of paternal (P = 0.001) and maternal (P = 0.002) myopia in myopes compared to parental myopia in emmetropes was found to be highly significant. There was a highly significant statistical correlation between maternal myopia and myopia in the child, when compared to the presence of myopia in both the parents (P = 0.007). Conclusion: There was a statistically significant correlation between myopia in the parents and children, which was more significant in the mothers of the children.

Association of near work and dim light with myopia among 1400 school children in a district in North India.

Purpose: The aim of this study was to determine the association of near work and dim light with myopia among school children in a district in North India. Methods: This study included a total of 1400 children of either sex studying in classes 5-10 in various schools of a district in North India, after taking consent from their guardians. Visual acuity was measured using Snellen's chart. Myopes were called to our institute where wet retinoscopy was done and spectacles were prescribed. Results: There was a highly statistically significant correlation between myopia and increase in reading hours (P=0.001). There was a statistically significant correlation between myopia and >6hours of using mobile phones /week, more hours spent on using mobile phones correlated with an increased prevalence of myopia (P< 0.01). There was a statistically significant correlation between myopia and increasing hours of playing video games (P<0.01). We found a highly statistically significant positive correlation between the prevalence of myopia and reading in dim light (P=0.0006). Conclusion: There was a positive association between myopia and hours of doing near work. The prevalence of myopia increased with increased hours of doing near work (reading, playing video games and using mobile phones). The study showed a correlation between reading in dim light and myopia. Prevention of myopia may be possible by avoiding these risk factors.

Effect of Yogasanas Versus Gaze Stability and Habituation Exercises on Dizziness in Vestibular Dysfunction.

BACKGROUND: Dizziness is a typical manifestation of vestibular pathologies. Clinical studies have shown that it affects 1.82% of young adults to more than 30% older adults. Habituation and compensation are some traditional rehabilitation protocols. OBJECTIVE: Yoga is also known to have a significant effect on vestibulopathy. Hence, a need arises to compare the above two maneuvers. MATERIALS AND METHODS: Participants were recruited (n = 32) after screening using the Dix-Hallpike and head impulse test. They were then divided into two groups (n = 16). The first one, Group A, received yogasanas, and the second one, Group B, received gaze stabilization and habituation exercises for 4 days a week for 3 weeks. Pre- and post intervention outcome measures were taken using the motion sensitivity quotient (MSQ) score and Dizziness Handicap Inventory (DHI) scale. RESULTS: In reducing symptoms of dizziness, the between-group comparison shows that Group A has shown greater improvement (12.37% ±1.43%) in MSQ and Group B has shown greater improvement (16.12 ± 3.56) in DHI. Within-group comparison shows that both the interventions are effective in reducing symptoms of dizziness (P < 0.05). CONCLUSION: Both gaze stabilization along with habituation exercises and yogasanas are effective in improving the symptoms of dizziness in patients with peripheral vestibular dysfunction. When compared between the groups, yogasanas had a superior hand in the MSQ score, whereas gaze stabilization and habituation exercises had a superior hand in the DHI scale.

Instrument assisted soft tissue mobilization in adhesive capsulitis: A randomized clinical trial.

INTRODUCTION: Shoulder adhesive capsulitis is a common pathology in middle aged population, physical therapy being the mainstay treatment for it. Various conventional treatment modalities have been proven to help in this condition. Instrument Assisted Soft Tissue Mobilization (IASTM) is a considerably new technique, which is being used widely for various sports related injuries for a faster recovery. This study proposes to evaluate the effect of IASTM as an added treatment for improving pain, range of motion and functional ability in patients with adhesive capsulitis. METHOD: 30 shoulders were randomly allocated into two groups- Group A (IASTM + conventional treatment) and Group B (conventional treatment). Treatment was given for 12 sessions, 3 sessions per week for 4 weeks. Participants were evaluated pre treatment, post 6th session and post 12th session. Outcome measures was Numerical Pain Rating Scale, Shoulder Pain And Disability Index, Shoulder Range of Motion, Apley's scratch test. RESULTS: Pain and Disability scale had shown improvement within the group only. However, in experimental group significant improvement was seen in active and passive mobility including functional performance. CONCLUSION: IASTM along with conventional protocol was able to improve mobility and function among adhesive capsulitis patients.

Recent trends: Medical management of infectious keratitis.

This review article highlights the newer diagnostic modalities and approaches in the medical management of infectious keratitis. A Medline literature search conducted to March 2014 has been included. Recent studies or publications were selected from international indexed journals using suitable key words. Development of specular microscopy and polymerase chain reaction (PCR) has a promising role as diagnostic modalities in infectious keratitis, especially in refractory cases. Previously fortified antibiotics have been the mainstay of treatment for bacterial keratitis. Recently, the advent of fourth-generation fluoroquinolones monotherapy has shown promising results in the management of bacterial keratitis. Corneal collagen cross-linking is being considered in the refractory cases. Topical natamycin and amphotericin B should be considered as the first choice anti-fungal agents in suspected filamentous or yeast infection respectively. Voriconazole and newer routes of administration such as intrastromal and intracameral injection of conventional anti-fungal agents have demonstrated a positive clinical response. Ganciclovir is a newer anti-viral agent with promising results in herpes simplex keratitis. Thus, introduction of newer diagnostic modalities and collagen cross-linking along with fourth-generation fluoroquinolones and newer azoles have a promising role in the management of infectious keratitis.

Biotinidase deficiency with hypertonia as unusual feature.

We report 3 cases of biotinidase deficiency presenting in early infancy with neurological and cutaneous manifestations. All of them had hypertonia (spasticity). Response to oral biotin was excellent. One of the cases showed 7D3I biotidase deficient mutation.