[International Journal of Physiotherapy 2015; 2(3) : 465-571] RSS



Pages : 465

Vinod Kumar .K .C, Sabitha Eunice Regima, Vikranth .G .R

DOI : 10.15621/ijphy/2015/v2i3/67016

Pages : 466-471

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Background: Recently the exercises and fitness professionals have adopted water as an alternative medium for delivering programs to improve fitness and health. When exercise on dry land our skeletal muscular, cardiovascular, respiratory and other body systems are greatly affected by the forces of gravity. When exercise in water, the effects created by the gravitational pull on the body are attenuated. Therefore the aim of this study was to determine the effectiveness of land based endurance training and aquatic based endurance training for enhancing endurance in normal individuals.
Methods: An experimental study design with 30 subjects healthy individuals between 20-30 years of both sexes currently were divided equally into 2 groups. Group A underwent land based exercises while Group B underwent aquatic based exercises. The outcome measures consist of RPP (rate pressure product), REC HR (recovery heart rate), RHR (resting heart rate) and 6MWD (6 minute walking distance) was measured before (pre-training) and after four weeks of endurance training.
Results: In this study, the mean improvement between the 2 groups of land and aquatic based endurance exercises were tested for significance using a dependent t test. The calculated t value were 43.550, 4.583, 16, 5.870 for RPP, REC HR, RHR, 6MWD for group A respectively. For group B 25.922, 12.762, 27.495,19.236 for RPP, REC HR, RHR, 6MWD for group A respectively with p<0.05. This clearly indicated that both land based exercises and aquatic based exercises will improve cardiovascular endurance significantly and there is no significant difference between land based exercises and aquatic based exercises for enhancing endurance in normal individuals.
Conclusion: It is concluded that both land based and aquatic based endurance exercises methods produce equivalent, if not same effect on the enhancement of aerobic endurance. There was no significant difference between these two exercising mediums. Nonetheless, given the benefits of aquatic medium, aquatic based endurance exercises should be considered as an alternative for land based training.
Keywords: endurance, land based endurance training, aquatic based endurance training, 6 minute walking test, rate pressure product, recovery heart rate, resting heart rate,6 minutes walking distance. 

Parneet Kaur Bedi, Narkeesh Arumugam

DOI : 10.15621/ijphy/2015/v2i3/67017

Pages : 472-482

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Background: Walking recovery is one of the main goals of patients after SCI. Walking is rated as primary goal and desire (together with bladder and bowel function) irrespective of the level of lesion. Past literature terms walking as long-term outcome or as a primary means of mobility after SCI.In patients with SCI clinical and electrophysiological examinations are directed towards predicting functional recovery.
Methods: A systematic research of all papers was made by the authors using the PRISMA 2009 guidelines. Using the various search engines 56 articles was found and 22 were selected for the present study. Out of these 17 were included for the final stage
Result: Electrophysiological measures can provide information that complements clinical assessments such as the American Spinal Injury Association sensory and motor scores in the evaluation of outcomes after spinal cord injury (SCI).
Conclusion: The authors review and summarize the literature regarding tests that are most relevant to the study of SCI recovery—in particular, motor evoked potentials and somatosensory evoked potentials (SSEPs). Both SSEP and MEP provide data clinically significant as a prognostic indicator.
Keywords: Somatosensory Evoked Potentials, Motor Evoked Potentials, Walking, Spinal Cord Injury, Electrophysiology. 

Oberoi Mugdha, Jani Kotecha Dhara, Yardi Sujata

DOI : 10.15621/ijphy/2015/v2i3/67018

Pages : 483-486

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Background: The abundance of mechanoreceptors in the cervical spine and their central and reflex afferent connections to the vestibular, visual and postural control system suggests that the cervical proprioceptive information provides important somatosensory information influencing postural stability, head orientation and eye movement control. Disturbances to the afferent input from the cervical region is thought to underlie symptoms of dizziness, unsteadiness, visual disturbances and signs of altered postural stability, cervical proprioception and head and eye movement control in people with chronic neck pain. This study aimed to assess and compare cervical joint position sense in subjects with chronic neck pain vs normals.
Methods: Total 60 subjects, divided into two groups chronic neck pain group (n=30) (12 males and 18 females with mean age of 40.7 years) and control group (n=30) with age and gender matched normal individuals were assessed for baseline data and demographic variables. Head repositioning accuracy test was used to assess cervical joint position sense in degrees.
Results: The difference in the head repositioning error values were found to be extremely significant (p<0.0001) for all the neck movements for subjects with chronic neck pain as compared to normals.
Conclusion: Cervical joint position sense in subjects with chronic neck pain is found to be altered as compared to age and gender matched normals.
Key words: Cervical joint position sense, Chronic neck pain, Haed repositioning acurracy test, Head repositioning error.   

Ujwal Bhattacharya, R. Sreekar Kumar Reddy

DOI : 10.15621/ijphy/2015/v2i3/67020

Pages : 487-490

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Background: Patello femoral pain syndrome is one of the most common musculoskeletal disorders and is reported to affect 15% - 33% of an active adult population and 21%-45% of adolescents thereby decreasing the work capacity of an individual. Patello femoral pain syndrome as implicated is due to inappropriate neural control of the quadriceps femoris muscle. Since Vastus medialis muscle is regarded as the dynamic medial stabilizer of patella so it’s important to understand the activation of Vastus Medialis Oblique’s in patients with patello femoral pain syndrome The purpose of this study is to assess the activation of Vastus Medialis Oblique’s at different knee angles between closed kinetic chain position and open kinetic chain position and the information thus gained can be used to design training program aimed at controlling patello femoral joint dysfunction.
Methods: Thirty subjects with patello femoral pain syndrome (assessed through history and examination) were assigned to two groups. Group A was made to perform open kinetic chain activity(i.e. sitting on high plinth) and Group B was made to perform a closed kinetic chain activity(i.e. standing) The outcome measure were amplitude and duration. Analyses were performed using independent t-Test.
Results: Significant difference was found between the groups for amplitude and duration at varying angles. Amplitude: 0 degree (p=0.004), 60 degrees (p=0.015), 90 degrees (p=0.004). Duration: 0 degree (p=0.007), 60 degrees (p=0.008),90 degrees (p=0.002)
Conclusion: Based on the outcome of the study it’s concluded that there is greater activation of Vastus Medialis Oblique’s muscle while performing close kinetic chain activity than in open kinetic chain.
Key words: PFPS - Patello femoral pain syndrome, CKC - Close kinetic chain position,OKC - Open kinetic chain position, AKP- anterior knee pain. 

K. Vadivelan, Ms. Gowthami kiyanduru

DOI : 10.15621/ijphy/2015/v2i3/67021

Pages : 491-501

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Background: Flatfoot may exist as an isolated pathology or as part of a larger clinical entity. These entities include generalized ligamentous laxity, neurologic and muscular abnormalities, genetic conditions, collagen disorders and structural disorder. Flat foot is found to be associated with pronated foot. The objective of the study is to compare the effectiveness of foot taping versus custom-made medial arch support on pronated flatfoot in school going children.
Methods: 60 students out of 130, aged 10 to 12 years were selected on the basis of inclusion criteria and divided into three groups from two different higher secondary schools at Srikalahasti, in Chittoor district, Andhra Pradesh. Group-A received custom-made medial arch support and foot strengthening exercises, Group-B received kinesio taping and foot strengthening exercises , Group-C received foot strengthening exercises for 4 weeks. The values of navicular drop test were taken after 4 weeks of study. The pre and post-test values were compared and results were tabulated.
Results: All three groups showed significant improvement in navicular drop separately. No significant difference was found in the post-test values of group-A, group-B, group-C (p>0.05). However, the reduction of navicular drop was slightly more in group-B subjects treated with kinesio tape and foot strengthening exercises when compared with other two interventions.
Conclusion: The study concluded that foot taping, custom-made medial arch support and foot strengthening exercises were found to be effective on pronated flatfoot in school going children aged 10 to 12 years.
Key words: Flatfoot, navicular, flat foot, medical arch, pesplanus.

Ahenkorah Josephine, Snowdon Nicola

DOI : 10.15621/ijphy/2015/v2i3/67022

Pages : 502-512

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Background: Implementation of patient-centered care (PCC) in health-care has been shown to improve safety, trust, health outcomes and adherence. There is however a dearth of literature on perspectives around PCC with specific regard to physiotherapy. This study aimed at investigating the perspectives of Ghanaian physiotherapists on patient-centered care in relation to its meaning, attitude and limitations.
Methods: A questionnaire design was used. A questionnaire comprising both closed and open-ended questions was used to collect data from Ghanaian physiotherapists via post and e-mail. A response rate of 60% was recorded. Data was analyzed using descriptive statistics and framework analysis.
Results: Majority (97%) of physiotherapists indicated practicing a PCC approach is important. Nine (9) themes arose regarding the meaning of PCC. Superficial understanding was present across most respondents. Misinterpretation of the meaning of PCC was also recorded from few respondents. Communication and education were the perceived most important and practiced PCC approaches. The least practiced approaches were determining number of treatment by patient preferences and departmental standards and administering patient preferred treatment choice. Twelve (12) themes arose from the limitations to PCC. The greatest limitation to PCC was found to be poor therapist-to-patient ratio.
Conclusion: Ghanaian physiotherapists perceive PCC to be an important approach. Well known aspects of PCC are practiced and aspects regarding consideration of patient preferences are not practiced. The Ghanaian physiotherapist-patient experience is largely paternalistic. An increased awareness and understanding of PCC might translate into better implementation of PCC.
Keywords: Patient-centered care, physiotherapists, meaning, attitude, limitation. 

Venkata Naga Prahalada Karnati, Ammar Mohammed Ali Mohammed

DOI : 10.15621/ijphy/2015/v2i3/67023

Pages : 513-517

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Background: Stretching used as a technique for injury prevention in the clinical settings, the study aimed to determine the early findings of hamstring tightness with both groups in the population, now a days the sedentary activities like prolonged sitting might cause hamstring tightness and change in path kinematics of gait intern lead to postural defects and back pain, understanding of the stretching helps clinician to make decisions for rehabilitation.
Methods: Across-sectional study, counterbalanced with repeated-measures , one group with static stretch – (double hamstring stretch and hurdlers stretch) for 3 times,30seconds subsequently in another group PNF contract relax(agonist contraction) technique for 10 seconds position and 10 seconds stretch repeated for 3 times.
Results: The results from data and statistical analysis by using t-test, SPSS obtained by using goniometer are tabulated in terms of mean, standard deviation and p-value in both groups. In experimental group flexion with PNF showed improvement 9.27±1.91(right side), 9.53±2.42(left side) and static stretching showed 7.8±2.91(right side), 7.47±1.96(left side) this proves that PNF has consistent improvement than static stretching.
Conclusions: Static and proprioceptive neuromuscular facilitation stretching both have produced greater improvement but compared with PNF contract relax(agonist) stretching showed significant change in hamstring flexibility compared with control group . The effect sizes, however corresponding to these stretching-induced changes were small, which suggests the need for practitioners to consider a risk-to-benefit ratio when incorporating static or proprioceptive neuromuscular facilitation stretching.
Keywords: Static stretching, PNF Contract relax-agonist stretching, 90-90 SLR test, Tripod sign, Sit-reach box, Universal goniometer 

Nusaibath M Shaikhji, Abdul Rahim Shaik, Shaikhji Saad, Padmakumar Somasekaran Pillai

DOI : 10.15621/ijphy/2015/v2i3/67024

Pages : 518-523

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Background: Musculoskeletal disorders are common amongst dental personnel including dental students when they are still in educational programs due to their work in a static posture. The objective of the study is to identify work-related musculoskeletal disorders in terms of perception of pain and stiffness experienced by the dental students and interns and to find the association between pain, stiffness and selected socio demographic variables.
Methods: A total of 236 subjects were selected from Yenepoya Dental College, Manipal Institute of Dental Sciences and A B Shetty Memorial Institute of Dental Sciences, Mangalore. The subjects were selected by using convenience method and were given closed-ended questionnaire to find perception of pain and stiffness experienced.
Results: The study revealed that 51.3% of dental students sometimes had pain in lower back and 44.4% in neck. 20.3% of subjects complained of having sometimes stiffness in neck and 19.9% of them had in lower back. It was observed that number of workdays per week had significant association (p=0.01) with increase in frequency of pain. Frequency of stiffness was significantly associated with height (p= 0.02) and weight (p= 0.02). There was also significant association between intensity of pain and average number of work days per week (p= 0.017) and average number of patients treated per day (p= 0.012).
Conclusion: The study revealed that WMSDs are prevalent in dental students and interns. A significant association was found between musculoskeletal symptoms and socio-demographic variables like gender, height, weight, number of workdays per week and number of patients treated per day.
Keywords: Musculoskeletal disorders, frequency of pain, frequency of stiffness, intensity of pain, dental students, interns. 

Vikranth .G .R, Vinod Kumar .K .C, Lawrence Mathias

DOI : 10.15621/ijphy/2015/v2i3/67025

Pages : 524-530

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Background: Carpal tunnel syndrome (CTS) is a constellation of symptoms associated with compression of the median nerve at the wrist in carpal tunnel. The Purpose of this study is to find the comparative effective of carpal bone mobilization and neural mobilization in improving pain, Functional Status and Symptom Severity in patients with CTS.
Method: An experimental study design, 30 subjects with carpal tunnel syndrome were randomized into 2 groups with 15 subjects each in Group A and Group B. Subjects in Group A received carpal bone mobilization and subjects in Group B received median nerve mobilization. The duration of intervention was for two weeks. Outcome measurements such as pain using VAS, The Functional Status Score (FSS) and Symptom Severity Score (SSS) using the Boston’s questionnaire for CTS were measured before and after two weeks of intervention.
Results: Analysis using paired ‘t’ test found that there is a statistically significant improvement (p<0.05) in pain, Functional Status score and Symptom Severity score within the groups. Comparative analysis using independent ‘t’ test found that there is no statistically significant difference in improving pain, Functional Status score and Symptom Severity score between both the groups.
Conclusion: It is concluded that median nerve mobilization and carpal bone mobilization shown to be effective on improving pain, Functional Status and Symptom Severity in the treatment of patients presenting with carpal tunnel syndrome. However there is no significant difference in improvements obtained between the neural mobilization and carpal bone mobilisation.
Key words: Carpal tunnel syndrome, neurodynamics, neural mobilization, carpal bone mobilization, pain, Functional Status, Symptom Severity, Functional disability. 

Dr. Khyati Kothary, Ayesha Shaikh

DOI : 10.15621/ijphy/2015/v2i3/67026

Pages : 531-534

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Background: Pulmonary Tuberculosis (PTB) leads to many physical impairements which can affect the daily physical tasks. Giving neuromuscular electrical stimulation (NMES) to quadriceps muscle can improve the functional status without causing fatigue and compromising oxygen status. The aim of the study was to study the effect of NMES on quadriceps muscle strength and six minute walk distance in Pulmonary tuberculosis.
Method: This was an interventional based study conducted in K.J.Somaiya Medical Hospital. 26 patients suffering from pulmunary tuberculosis were taken in the study. Strength assessment of quadriceps muscle was assessed by 1RM and six minute walk distance was assessed by six minute walk test. NMES is given to quadriceps muscles bilaterally for continuous 10 sessions in 11 days.
Result: Wilcoxon signed rank test, ‘t' test and mann whitney test were done to analyse the data. There was significant increase in 1RM (1.808kgs->2.885kgs) and 6MWD (405.23m->493.65m) post NMES training.
Conclusion: Therefore the study performed suggest that NMES training performed prior to endurance training is useful for strengthening peripheral muscles, which in turn may augment gains in body weight and improves quality of life, further reductions in ventilation requirements during exercise. Despite the ability to cure tuberculosis, there remains a significant impact on the patient’s health status in physical, psychological and social aspects. The study showed significant improvement by giving NMES in 6MWD and 1RM.
Keywords: Neuromuscular electrical stimulation, sputum negative pulmonary tuberculosis, six minute walks distance, quadriceps strength. 

K. Vadivelan, S. Sudhakar

DOI : 10.15621/ijphy/2015/v2i3/67027

Pages : 535-543

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Background: Football is the world’s most popular game and is played by men, women and children of all ages and levels of ability. Success as a player requires an appropriate mixture of mental, physical, technical and tactical ability. Many decisive moments are defined by anaerobic activities such as sprinting, jumping & contests for the football. Agility is an ability of the neuromuscular system to coordinate explosive changes of direction of an individual and/or multiple body segments in all planes of motion. Plyometric Training has been advocated for sports that require the athletes to have explosive power and agility. Similarly previous sprint training studies have shown improvement in the dynamic athletic lower body performance. Advanced technique such as plyometric training protocol has proven more effective but not much studies have been done to assess its effectiveness over Plyometric Training, namely Lower Body Power and Agility
Methods: A total of 30 collegiate football players were taken with a mean age of 21.5 with a standard deviation of one. They were randomized into two groups (Group A – Sprint Training & Group B – Plyometric Training). Each group consist of 15 players were selected based on their selection criteria. Informed consent was obtained from the subjects. The study was conducted for six weeks (12 sessions) with both the Groups. Evolution parameters are vertical jump height, 40 yard dash, illinois agility Test.
Results: Independent t test was used to analysis data. On comparing VJH, Plyometric Training shows (49.26) which have the higher mean value is more effective than Sprint Training (44.93).On comparing Anaerobic power Plyometric Training shows (4150.8) which has the higher Mean value is more effective than Sprint Training (3782.4), on comparing 40 yard dash Plyometric Training shows (5.335) which has the lower Mean value is more effective than Sprint Training (5.490). Illinois Agility Test Plyometric Training shows (15.38) which have the lower mean value is more effective than Sprint Training (16.80).
Conclusion: Superiority of Plyometric Training Group over Sprint Training Group is particularly evident for improvements in Anaerobic Power and Agility. These results suggest that Plyometric Training is advantageous for developing lower body Explosive Power and Agility. Explosive activities are required in many sports and physical activities; coaches and participants should therefore consider a Plyometrics training program that incorporates specific exercises according to the needs of individual’s athletic performance as part of the overall training program.
Key words: Plyometric training program, Anaerobic power, Agility, Football players, Anaerobic power. 

Vikranth .G .R, Lawrence Mathias, Mohd Meraj Ghori

DOI : 10.15621/ijphy/2015/v2i3/67029

Pages : 544-551

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Background: Motor control exercises are isolated strengthening exercise for the deep spinal muscles (transverse abdominus, multifidus) whereas Core stability is achieved by global strengthening of the core muscles. There are not much studies available in the literature done or studied the short term effect of the motor control and core stabilization on subjects with low back pain. Therefore, the purpose of this study to find the comparative effect of motor control exercises versus core stabilization exercises on improvement of pain and disability in subjects with mechanical low back pain.
Method: An experimental study design, 30 subjects with non-specific mechanical low back pain were randomized into 2 groups with 15 subjects each in Group A and Group B. Subjects in Group A received Motor control exercises and subjects in Group B received Core stability exercises. Both the group received conventional exercises. The duration of intervention was given for two weeks. Outcome measurements such as pain using VAS, Functional disability using Oswestry Disability Index Questionnaire were measured before and after two weeks of intervention.
Results: Analysis using paired ‘t’ test and wilcoxon signed rank test found that there is a statistically significant improvement (p<0.05) in pain, functional disability within the groups. Comparative analysis using independent ‘t’ test and Mann Whitney U test for comparison of difference in improvement in VAS and ODI between two groups, it was found that there was significant difference in improvement of VAS and ODI between groups. Group-A showed better improvement in VAS and ODI compared to Group B with an effect size of 1.47 and 0.99 respectively.
Conclusion: It is concluded that the Motor control exercises showed statistically significant improvement in reducing back pain and disability when compared to the Core Stabilization exercises. Thus, performing Motor Control exercises reduces pain and disability significantly compared to Core stabilization among non specific mechanical low back ache subjects.
Key words: Motor control exercises, Mechanical low back pain, Core stability exercises, pain, functional disability, visual analogue scale, Oswestry Disability Index. 

Ashlesha Sirari, Kajal Patel

DOI : 10.15621/ijphy/2015/v2i3/67030

Pages : 552-556

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Background: Flexibility helps with injury prevention, the reduction of soreness following a workout, and a general sense of well-being. There are different stretching techniques and protocols for improvements in calf extensibility and flexibility. The purpose of the study was to investigate the effectiveness of two techniques i.e. CYCLIC and PNF stretching which improves calf flexibility. This study was done to find the effectiveness of calf Cyclic and PNF stretching technique to improve calf flexibility.
Methods: 30 subjects with age group 21-22 years were randomly allocated to 2 groups equally. Group 1(n=15) were given CYCLIC and group 2(n=15) were given PNF stretching technique. Plantar flexion was used to measure the calf tightness which was done before and after the treatment. Treatment was given for 7 days and on the 7th day the calf tightness was again measured.
Results: The mean difference of the CYCLIC is 4.6 and mean difference of PNF is 4.7 which indicate that CYCLIC and PNF both are effective to improve calf flexibility but PNF is more effective than CYCLIC to improve calf flexibility.
Conclusion: The neurophysiological basis of PNF, stating that the excitatory efficient of the neuromuscular spindle or the inhibitory afferent of the Golgi tendon organ (GTO) or both are responsible for the effects. During PNF stretch and isometric contraction of stretched agonists for extended period may cause activation of its neuromuscular spindle. The increase in tension created during the isometric contraction of the pre – lengthened agonist contracts concentrically. Both the fascia & the spindle of the agonist adjust to the nearly lengthened position. These impulses travel via causing post synaptic inhibition of the motor neuron to agonist increasing the tension from the GTO. These impulses can override the impulses coming from the neuromuscular spindles arousing the muscle to reflexly resist to the change in length, thus helping in lengthening the muscle.PNF stretching is more effective than cyclic stretching.
Keywords: Cyclic and PNF stretchimg, calf stretching, cyclic stretching, PNF stretching, Cyclic Vs PNF stretching, Calf stretching in school going girls, calf flexibility. 

Barnali Bhattacharjee, Pravin Aaron, Subin Solomen, Prabhu .C .G

DOI : 10.15621/ijphy/2015/v2i3/67031

Pages : 557-562

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Background: Air pollution as a trigger for exacerbation of COPD has been recognized for more than 50 years. Nowadays, in the cities like Bangalore, most of the people need to ride the bike for their occupational demand and move around. The purpose of this study is to find out the prediction of COPD using the BODE index in motor bike riders in Bangalore.
Methods: An exploratory cross sectional study has been done on 100 subjects who uses motor bike as their mode of transport for their occupational demand, to study the hours of bike riding with the chances of COPD based on BODE index.
Results: Analysis using spearman rank correlation found that there is statistically significant correlation (p < 0.05) between hours of bike riding and the BODE index. Chi square test found that more than 4 hours of bike riding was associated with the chances of COPD.
Conclusion: Based on the result, it is concluded that more than 4 hours of bike riding is associated with the chances of developing COPD even in non-smokers. Therefore there is significant susceptibility of COPD among bike riders in Bangalore.
Key words: COPD, BODE Index, Air pollution, BMI, Bike riders, Exercise Capacity. 

Gopi Parth Mehta, Vinod Babu .K, Akshata Akalwadi, Sai Kumar .N

DOI : 10.15621/ijphy/2015/v2i3/67032

Pages : 563-571

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Background: PNF stretching and chest mobility exercises found to be effective in elder patients, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Hold-relax PNF stretching technique for pectoralis muscle combined with chest mobility exercises on improvement of chest expansion and pulmonary function for elderly subjects.
Method: An Experimental study design, 30 subjects with age group above 60 years were randomized 15 subjects each into Study and Control group. Control group received Supervised Active Assisted Exercise Program while Study group received Hold-relax PNF Stretching for pectoralis muscle, Chest Mobility Exercises Program and supervised Active Assisted Exercise Program for a period of one week. Outcome measures such as chest expansion at axilla and xiphisternum and pulmonary function test such as FEV1, FVC and FEV1/FVC were measured before and after one week of treatment.
Results: Analysis using paired ‘t’ test within the group found that there is no statistically significant difference within control group where as there is a statistical significant difference within study group. Comparative analysis of pre-intervention means shown that there is no statistically significant difference between the groups. Comparative analysis of post-intervention means shown that there is a statistically significant difference in means of Chest expansion, FEV1/FVC and there is no statistical significant difference in FEV1 and FVC between study and control groups.
Conclusion: It is concluded that one week of combined Hold-relax PNF stretching for pectoralis muscle with chest mobility exercises shown significant improvement in chest expansion and pulmonary function test such as forced expiratory volume and forced vital capacity than only active assisted exercise program for elderly subjects.
Key words: PNF stretching, chest mobility exercises, elderly, chest expansion, pulmonary function test, forced vital capacity, forced expiratory volume, hold-relax technique.