[International Journal of Physiotherapy 2016; 3(1) : 1-146] RSS



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Alyahya D, Johnson EG, Daher NS, Gaikwad SB, Deshpande S

DOI : 10.15621/ijphy/2016/v3i1/88898

Pages : 1-4

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Background: Postural control requires complex processing of peripheral sensory inputs from the visual, somatosensory and vestibular systems. Motion sensitivity and decreased postural control are influenced by visual-vestibular conflicts.The purpose of this study was to measure the difference between the postural control of healthy adults with and without history of sub-clinical chronic motion sensitivity using a computerized dynamic posturography in a virtual reality environment. Sub-clinical chronic motion sensitivity was operationally defined as a history of avoiding activities causing dizziness, nausea, imbalance, and/or blurred vision without having a related medical diagnosis.
Methods: Twenty healthy adults between 22 and 33 years of age participated in the study. Eleven subjects had sub-clinical chronic motion sensitivity and 9 subjects did not. Postural control was measured in both groups using the Bertec Balance Advantage-Dynamic Computerized Dynamic Posturography with Immersion Virtual Reality (CDP-IVR). The CDP-IVR reports an over-all equilibrium score based on subjects’ center of gravity displacement and postural sway while immersed in a virtual reality environment. Subjects were tested on stable (condition 1) and unstable (condition2) platform conditions.
Results: There was no significant difference between the two groups in terms of mean age, height, weight, body mass index in kg/m2, postural control scores for conditions 2, and average (p>0.05). However, significant differences were observed in mean postural control for condition 1 between groups (p=0.03).
Conclusions: Results of this study suggest that healthy young adults without chronic sub-clinical motion sensitivity have better postural control than those with chronic sub-clinical motion sensitivity. Further investigation is warranted to explore wider age ranges with larger samples sizes as well as intervention strategies to improve postural control.
Keywords: Motion sensitivity, motion sickness, postural control, balance, computerized dynamic posturography, virtual reality

Khaled Z. Fouda, Mona H. El Laithy

DOI : 10.15621/ijphy/2016/v3i1/88900

Pages : 5-10

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Background: Plantar fasciitis (PF) is the most common cause of heel pain and it can often be a challenge for clinicians to treat successfully. Radial shock wave therapy (RSWT) has been introduced recently for treatment of musculoskeletal disorders. Different energy levels of shock wave therapy have been used in the literatures for treatment of PF with no clear settled parameters. Therefore, the purpose of this study was intended to investigate and compare the efficacy of two different energy levels of RSWT on PF patients.
Methods: Forty patients having unilateral chronic PF were recruited for the study from orthopedic outpatient clinics of Cairo University hospitals and National Institute of Neuromotor System Cairo Egypt, with a mean age of (47.15±4.57) years. Patients were randomly assigned into two equal groups. Group (A) treated with low intensity level of 1.6 bars (0.16 mJ/mm2) RSWT and group (B) treated with medium intensity level of 4 bars (0.38 mJ/mm2) RSWT. Functional assessment of the foot based on Foot Function Index (FFI) and Present pain intensity was measured during rest by Visual Analogue Scale (VAS).
Results: There was as significant decreased in the total FFI scores from (118.42 ±6.51) to (81.37 ±3.46) for group (A) and from (118.93 ±6.85) to (58.50 ±3.22) for group (B). Also regarding VAS Scores there was as significant decreased in the pain intensity from (5.11 ±0.41) to (2.85 ±0.31) for group (A) and from (4.95 ±0.39) to (2.05 ±0.22) for group (B).
Conclusion: Radial shock wave therapy is an effective modality that should be considered in the treatment of chronic PF, while the medium energy level RSWT is better than the low energy level RSWT in regarding to the measured treatment outcomes.
Keywords: Low energy, Medium energy, Radial shock wave, Treatment, Planter fasciitis

Shireen Khanzada, Saania kanwal khanzada, Mohammad sarfaraz khan, Sufiyan shaikh, Raana ali mirza, Erum Naaz, Saifullah Khalid

DOI : 10.15621/ijphy/2016/v3i1/88901

Pages : 11-14

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Background: The prevalence of backache is increasing in children with heavy weighed school bags and abnormal sitting posture both, at home and school. The aim of this study was to determine the prevalence of this much avoided issue of back pain among school going children of Hyderabad, Sindh.
Methodology: 240 pupils (range, 7-14 years old) were recruited in their respective schools of Hyderabad city. Inclusions were all the present students on that particular day of data collecting and excluding those who were absent that day. A preformed questionnaire form was filled with all due consent, following which, examination was done to check the parameters of height, weight, BMI, weight of school bag, and posture analysis.
Result: The prevalence of back pain was 46.7% among the total 240 subjects studied. Out of which 14.4% boys and 32.3% girls were affected. The majority of affected children were age group of 10-12 years old. In our study 61% children had school bags weighing around 5 kg, which is point to be considered by high officials of Primary Education System in Pakistan.
Conclusion: The symptoms of backache were significantly visible in those students carrying heavy bags in proportion to their own weight and BMI. This was also closely related to the time duration, subjects were spending in front of computer/television. After analysis and all, it turned out that a significant number of students were affected by abnormal postures leading to backache-, which may be held equally responsible for further Alleviation of such symptoms later in life.
Keywords: Backache, Abnormal Posture, Ergonomics, BMI, Heavy bags, sedative life style

Raghav Monika, Yadav Joginder, Kalra Sheetal

DOI : 10.15621/ijphy/2016/v3i1/88902

Pages : 15-21

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Background: Patello femoral pain Syndrome is an over use injury and one of the commonest problems seen in adolescents who are physically active. Till date no study has been done comparing the effect of adding specific hip strengthening exercises (gluteus medius, gluteus maximus & lateral rotators) to conventional exercises in patients with Patello femoral Pain Syndrome (PFPS) while minimizing the effect of minimizing the activation of tensor fascia lata (TFL).
Methods: 30 subjects were randomly allocated using convenience random sampling into 2 Groups Group A and Group B with 15 subjects in each group. Readings were taken for Numeric Pain Rating Scale (NPRS), Manual Muscle Testing (MMT) for hip abductors, extensors and external rotators muscles quadriceps and hamstrings, and Anterior Knee Pain Scale (AKPS) on baseline and at the end of 4th week.
Results: Analysis of the data collected for NPRS, AKPS and MMT of Quadriceps, Hamstrings, Hip Abductors and Hip External Rotators of 30 subjects was done by statistical analysis tests using STATA and software version 11.2. Although improvement was seen in both the groups but group B improved better compared to group A.
Conclusion: Group B treatment protocol i.e. Hip specific strengthening (gluteus medius and gluteus maximus) in addition to conventional treatment in patients with patello-femoral pain syndrome, was found to be effective in reducing pain, improving functional status and increasing muscle strength than Group A treatment protocol i.e. Knee strengthening and stretching.
Keywords: Patello-femoral Pain syndrome (PFPS), 11-Point Numerical Pain Rating Scale (NPRS), Anterior Knee Pain Scale (AKPS), Manual Muscle Testing (MMT)

C. Janardan, K. Madhavi.

DOI : 10.15621/ijphy/2016/v3i1/88903

Pages : 22-28

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Background: Asian Indians have a higher operative and overall increased mortality following coronary bypass surgery. They also have higher rates of post operative complications and repeat surgeries. Apart from physiological complications like post-operative pain, atelectasis, deep vein thrombosis, the psychological disorders are like anxiety and stress also predominantly play a major role in the morbidity of the post-surgical conditions. The aim of study is to know the influence of music therapy and breathing exercises on post-surgical cardiac diseased individuals. To evaluate the influence of music therapy and breathing exercises on physiological parameters(BP,HR,RR) in post surgical cardiac diseased individuals by using electro cardio monitor and state-trait anxiety scale.
Methods: Subjects were randomly divided into two groups. Experimental group, where the subjects received music therapy and breathing exercises. Control group, where the subjects received breathing exercises. All the participants were assessed with STAI scale and physiological parameters like blood pressure, heart rate and respiration rate for both groups before and after the treatment. Paired sample t-test was used to compare the STAI scale and physiological parameters within the groups.
Result: Results showed a significant improvement in both the groups but, more improvement was seen in experimental group compared to control group.
Conclusion: Results suggested that music therapy and breathing exercises influences more effective than breathing exercises alone.
Keywords: STAI (state trait anxiety scale), Breathing exercises, HR (Heart rate), Cardiac disease, CVD

Intsar S. Waked, Asmaa F. Attalla, Abdel Hamid N. Deghidi

DOI : 10.15621/ijphy/2016/v3i1/88905

Pages : 29-34

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Background: Breast cancer is a prevalent disease that requires intense and prolonged treatments. Because of improved detection and treatment options, the mortality rate from breast cancer has decreased, greatly increasing the number of survivors who are living with the disease and its side effects. Fatigue is one of the most common debilitating symptoms experienced by patients with cancer. It is a persistent feeling of exhaustion and decreased physical and mental capacity unrelieved by rest or sleep. The purpose of current study was to evaluate the effect of high intensity physical training exercise program in improving breast cancer related fatigue.
Methods: Forty six patients suffering from breast cancer related fatigue, were randomly divided into two groups of equal number. Exercise group (E); received high intensity physical training program while Control group (C) received usual medical care and kept their habitual activity. The intensity of fatigue and quality of life score were measured at the beginning and after eight weeks of treatment.
Results: Results of the study showed that there was significant reduction of fatigue after eight weeks in exercise (E) group more than control group with the percentage of improvement was 53%, 2% respectively. As regard to QOL measurements, there was significant increase of QOL score after treatment in exercise (E) group more than control group with the percentage of improvement was 43%, 3% respectively.
Conclusion: High intensity physical exercise program may have beneficial effects in reduction of fatigue intensity and thereby improving quality of life in breast cancer patient.
Keywords: Breast cancer related fatigue, Exercise, Revised Piper Fatigue Scale, Functional Assessment of Cancer Therapy-Breast

Atiq ur Rehman memon, Shireen Rahat Khanzada, Kashmala khan, Jam Feroz, Hafiz Muhammad Hussain, Syed Zulqarnain Ali, Ahson Khwaja.

DOI : 10.15621/ijphy/2016/v3i1/88906

Pages : 35-38

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Background: Recently increasing concern among stress is seen during health care undergraduate students but there is lack of such studies in physical therapy students in Pakistan. Higher stress levels the students in their education the effect of stress in physical therapy students throughout is well documented in western countries. This study aims at assessing the level of perceived stress among physical therapy students of Isra University.
Method: It’s a Cross-sectional type of descriptive study that was conducted on hundred physical therapy students of Isra institute of rehabilitation sciences, ISRA University, Hyderabad. A Convenient, non-probability technique of sampling is used. All the Physical therapy students were included.
Results: Overall response rate was 100%. Moderate level of stress was found in 73% students (scored between 51-75%), severe level of stress was found in 8% students (scored >75%) whereas low level of stress was found in 19% of students (scored between 25-50%).
Conclusion: The current study presents the level of stress perceived by physical therapy students of Isra University, Hyderabad. The findings of the study revealed higher levels of stress in the physical therapy students. Majority of student perceived moderate stress and about 8% of students reported severe stress. Further detailed and generalized studies are needed to evaluate the causes, effects and coping approaches adapted by the students. Furthermore level of stress should also be correlated with academic performance of the students. Findings of such studies may help to initiate certain strategies that may help students overcome their stress and cope efficiently with the upcoming problems.
Keywords: Stress, Physical therapy, ISRA, Hyderabad.

Mona Mohamed Taha, Marwa Abd El-Rahman Mohamed, Marwa Esmael Hasanin.

DOI : 10.15621/ijphy/2016/v3i1/88908

Pages : 39-44

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Background: Postmenopausal hypertension is the most common risk factor of cardiovascular morbidity and mortality. As the exercises training conveys benefits of the setting of secondary prevention of hypertension. High intensity interval training (HIIT) emerged as a new form of physical training and presents as therapeutic alternative to patients and health care professionals. This study aimed to investigate the effect of high intensity interval training on endothelial function in postmenopausal hypertension.
Methods: Forty six mildly hypertensive postmenopausal women, their ages ranged from (45-55) years old, were randomly allocated to two groups: HIIT group (group-I; n=23) performed a high intensity interval training 3 times a week for 10 weeks at an intensity of (80-85% HR max ) for 40 minutes and control group (group-II; n=23) remains sedentary during this period. Serum nitric oxide (NO), vascular endothelial growth factor levels (VEGF) and blood pressures were measured before and after intervention.
Results: A significant reduction in both systolic and diastolic blood pressure values by 9.5% and 7 % respectively, was seen after high intensity interval training which was accompanied by increase in NO and VEGF levels by 43.3% and 15.2 % respectively, while no significant change observed in the control group.
Conclusion: High intensity interval training had obvious benefits in improving plasma No, VEGF concentrations and controlling hypertension in postmenopausal women.
Keywords: Interval training, Endothelial function, Atherosclerosis, Post menopause, hypertension, prevention.

Zakariya M P, Umama nisar shah, Nagarajan mohan, Shaikhji Saad, Nusaibath M Shaikhji.

DOI : 10.15621/ijphy/2016/v3i1/88909

Pages : 45-52

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Background: Grip and pinch strength are commonly employed indices of strength used in hand evaluations. Pinch grip and power grip strengths are used as indices of strength in hand therapy assessments. For all professions grip strength is an important criterion to be successful in their profession. Such phenomena may be explained by differences in nature of work, working environment, and objects workers handle.
Method: 200 healthy subjects, satisfying the selection criteria were included and assessed with standardized procedure for power grip and pinch grip (lateral pinch, pad-pad, and tip-tip) strength. They were divided in four groups, 50 group each according to profession i.e. medical surgeons, dentist, physiotherapists and nurses.
Results: The mean power grip strength shows highly significant difference between medical vs. dental (p>0.01) and medical vs. physiotherapy group (p> 0.05) .The mean lateral pinch strength shows there is highly significant difference (p< 0.001) between dental vs. nursing profession and dental vs. physiotherapy group. No significant difference among other groups. The mean pad-pad pinch strength shows there is significant difference between dental vs. nursing (p< 0.05) and dental vs physiotherapy group (p< 0.05). The mean Tip-Tip pinch strength shows there is significant difference between dental vs nursing profession(p< 0.05) and dental vs. physiotherapy(p< 0.05). No significant different among other groups.
Conclusion: Surgeons have highest power grip strength followed by Nursing, Physiotherapy and Dental professionals. Dentists have the maximum pinch strength in all three positions, followed by Surgeons, Nurses and Physiotherapists. Surgeons have maximum pinch strength next to Dentists.
Keywords: Surgeons, Nurses, Physiotherapists, Grip Strength, Pinch Strength, Dynamometer

Muhammad Sarfraz, Shireen khanzada, Erum Naaz, Rubina kanwal, Syed Wasif, Anum Mawani, Neelam Noor Gichki

DOI : 10.15621/ijphy/2016/v3i1/88910

Pages : 53-57

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Background: Physiotherapists as providers of primary health care are well placed in promoting physical activity and lifestyles changes, but the role and practice of physiotherapist towards its promotion among obese individuals has not been fully investigated. The objective of this study is to examine perceptions of Karachi physiotherapists regarding their role in management of obesity, the learning needs for, and hurdles facing by them in the rehabilitation.
Methods: It was cross-sectional survey that has been conducted among 100 Physiotherapists from three tertiary care hospitals & universities of Karachi from April to June 2013. There has been used Self-administered questionnaire and sampling was Convenient Purposive sampling in qualitative research. Descriptive statistics were calculated for all variables using the Statistical Package for the Social Sciences (SPSS) version 17. Questionnaire was intended to determine physiotherapist’s perceptions of their role and consisted of questions about respondent’s demographics profile, practice and domains related to management of obesity and associated conditions.
Result: In this study 93% of participants agreed that physiotherapists has role in the management of patients with obesity by developing exercise interventions.95% plays role in functional mobility and 94%in cardio respiratory training programme. In this study participants were found less aware about weight loss management. Barrier found in patient treatment is due to lack of patient motivation.
Conclusion: This study revealed physiotherapist played important role in patient rehabilitation management with obesity, especially in a area of mobility and exercise prescription for conditions associated with obesity. In future there is need to take into account the different perspectives of physical therapy and with a larger sample size representing all four states of Pakistan.
Keywords: Obesity, Physiotherapist, Perception, Health Risks, Role of Rehabilitation, Management of Obesity

Muhammad Zia Ul Haq, Jeffrey Low Fook Lee, Bendri Bin Dasril, Ong Kuan Boon, Muhammad Saleem

DOI : 10.15621/ijphy/2016/v3i1/88912

Pages : 58-65

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Background: The purpose of this study was to examine the morphological characteristics and physical strength of the Malaysian cricket batsmen.
Methods: Twenty four top order batsmen from the Malaysian senior, under-19s and under-16s cricket team were recruited for the study. Twenty six anthropometric, four somatotype and two physical strength variables were measured from all participants. Stature were measured by using stadiometer, calipers for skin-fold, non-stretch tape for girth, sliding caliper for segmental lengths and circumferences (breadths) and dynamometers for hand grip and back strength. Cater and heath (1990) equation was used to find the somatotype variables of height-weight ratio, endomorph, mesomorph and ectomorph. One way analysis of variance (ANOVA) was used to analyses significant between group differences in the variables.
Results: The senior batsmen were significantly higher than under-19s and under-16s in body mass, relax and flex arm girths, forearm girth, chest girth, waist girth, calf girth, bi-acromial breadth, transvers breadth and hand grip strength. Both senior and under-19s batsmen were significantly higher than under-16s batsmen in arm span, total arm length, humerus and femur breadths. The under-16s batsmen were also significantly lesser than senior in hip girths, hand lengths and bi-ilocrist breadth, and from under-19s in sitting height and total leg length.
Conclusion: Senior batsmen were significantly higher in the anthropometric measurement of girths, breadth and lengths than U-16 because of 10 years age difference. Future research is essential to confirm the relationship between the anthropometric characteristics of batsmen with the batting technique and performance.
Keywords: Cricket batsmen, Morphology, somatotype, physical strength, Malaysia

Vishal Bharadwaj, Ujwal Bhattacharya, R. Sreekar Kumar Reddy

DOI : 10.15621/ijphy/2016/v3i1/88913

Pages : 66-70

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Background: Neck pain is increasingly becoming a common problem. Cervicobrachial disorder is a dysfunction of nerve root of the cervical spine due to its compression which leads to ischemic changes that cause sensory and motor dysfunction. Many studies has been done on SLR test which affects upper limb sensitizing response by means of doing ipsilateral and bilateral SLR. The study revealed that the abduction ROM for shoulder was greater during contra lateral SLR with ULTT-2a when compared to ipsilateral SLR.
Methods: 30 subjects (18 males and 12 females) were included in this study. The ULTT-2a is performed on each subject, following this ipsilateral and contra lateral SLR was performed. The sensitising response perceived by the subjects was recorded. Outcome measures were Range of Motion and sensation description. After the intervention the shoulder abduction and straight leg raising ranges were measured. Analysis was performed using independent t-test.
Result: Significant difference was found in shoulder abduction (p< 0.001) and SLR (P< 0.002) but no considerable difference was found on the VAS. (P> 0.11). There was no difference in sensitizing response (Tingling, Burning, Sharp shooting) during ipsilatral and contra lateral straight leg raise.
Conclusion: This study concludes that in order to obtain the same sensitizing response during ULTT-2a of contra-lateral SLR as during ULTT-2a of ipsilateral SLR, the angle of SLR and shoulder abduction during ULTT-2a of contra lateral SLR will be greater. This finding will be proved beneficial in the treatment of patients with cervico brachial disorders.
Keywords: CBD-Cervicobrachial disorders, ULTT 2A-Upper Limb Tension Test-2a, SLR-Straight Leg Raising

Abeer Farag Hanafy

DOI : 10.15621/ijphy/2016/v3i1/88915

Pages : 71-77

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Background: Patellar taping is used for pain relief in patients with patello-femoral pain syndrome (PFPS). Yet, there is lack of knowledge regarding its effect on the functional performance. The purpose of the study was to examine the effects of therapeutic patellar taping on the Visual Analogue Scale (VAS) pain scores, number of bilateral squats, and stair climbing time in patients with PFPS.
Methods: 30 female patients with PFPS with mean age 20.3± 1.46 years, weight 66.1± 9.68 kg, height 165.83 ± 3.89 cm and BMI 23.91 ± 3.50kg/m2 participated in the study. The subjects were tested randomly under three taping conditions;namely therapeutic, placebo and no-tape. The tested limb was determined to be the affected limb in patients with unilateral affection, and the symptomatic limb in patients with bilateral affection. Data was collected using the Visual Analogue Scale (VAS), Bilateral Squat Test and Timed Stair Ambulation Test.
Results: Repeated measures Multivariate Analysis of Variance (MANOVA) revealed that the number of bilateral squats increased significantly (p<0.05) and the VAS scores and stair climbing time decreased significantly with the use of therapeutic tape compared with the other two tested tape conditions. Additionally, the VAS pain scores decreased significantly with placebo tape use compared with no tape, with no significant difference (p>0.05) in between for the number of bilateral squats and stair climbing time.
Conclusion: The findings indicated that therapeutic patellar taping is effective in improving functional performance and reducing pain in patients with patellofemoral pain syndrome (PFPS).
Keywords: Patellofemoral pain syndrome, Patellar Taping, Pain, Functional Performance.

Saima Aziz, Saleem Ilyas, Syed Imran, Faisal Yamin, Ayesha Zakir5, Atiq-ur-Rehman, Syed Adnan

DOI : 10.15621/ijphy/2016/v3i1/88916

Pages : 78-85

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Background: In this advanced era, neck and back pain has become a common musculoskeletal problem. These symptoms have a high prevalence in the community and now they are affecting even our adolescents leaving a major impact on youth’s functional and educational activities. Nevertheless, the burden of these musculoskeletal pains, which relates not only to its prevalence but also to increase in physiological and psychological stress among them, distressing their creativity. Madrassa students have a daily exposure to neck and back pain due to poor posture. The McKenzie method is a popular treatment for back and neck pain among physical therapists. So, the intention of this study is to test the effectiveness of McKenzie exercises in neck and back pain, because hardly any data is available on McKenzie technique and its outcome in Pakistan. The objective of the study is to determine the effectiveness of McKenzie exercises in reducing
neck and back pain among madrassa students.
Methods: The students were recruited from Madrassa Darul Akram (Baldia town) and Jamia Ashraf-ul-madrassa (Gulshan-e-Iqbal) Karachi. One sixty three students aged between 12–18 years of both genders who were fulfilling the inclusion criteria were selected from Madrassa Darul Akram (Baldia town) and Jamia Ashraf-ul-madrassa (Gulshane-Iqbal). The participants received McKenzie exercises programs intervention for three consecutive weeks. Outcome Measure: Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Index (ODI) and Numeric Pain Rating Scale (NPRS)
Results: The present study showed significant results in all three scales in both genders (p<0.001).Among sections, the Hafiz students revealed greater score in all 3 scales before treatment as compared to ‘Alim/Alima’ and ‘Nazra’ students and after treatment showed significant results in all 3 domains (p<0.001).
Conclusion: Findings of this study revealed that madrassa students were more prone to develop neck and back pain. This might be either because of strict enforcement by teachers or usual poor sitting habit. Most of the time, it is difficult for students to come regularly for therapy sessions. It is concluded that McKenzie exercises had significantly reduced the neck and back pain among madrassa students.
Keywords: Neck pain, Back pain, Ergonomics, McKenzie, Neck and back Pain, Teacher.

Ayesha Zakir, Syed Imran Ahmed, Saima Aziz, Faisal Yamin, Attiq-ur-Rehman

DOI : 10.15621/ijphy/2016/v3i1/88918

Pages : 86-93

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Introduction: Among musculoskeletal disorders knee Osteoarthritis (OA) is exceedingly prevailing articular disorder affecting people and it is a major cause of disability and socioeconomic burden. It is more common in women than men. Entities with knee OA must often undergo a variety of problems, such as pain and tenderness in joints, movement limitation, crepitus on movement, swelling, recurrent effusion, and local inflammation which ultimately leads to limitation in physical function, like lack of ability to perform Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL). For reducing knee pain in osteoarthritis several conventional treatment methods are used world
widely but most extensively used in our country are pharmacologic and physical therapy. The objective of the study is to find out the effectiveness of Manual therapy verses Exercise therapy for the management of knee osteoarthritis.
Methods: Sixty patients including both male and female with mean age (51years) and SD of (5.1) were enrolled in the study and divided randomly in to two groups. Those who were assigned as group A had received Manual therapy and those who were assigned as group B had received Exercise therapy. Participants had received three treatment sessions of 30 min per week for consecutive 4 weeks. OUTCOME MEASURE: WOMAC index score for pain, stiffness and physical function was used to evaluate the baseline score and treatment effects after 12 therapy sessions.
Results: Study showed significant improvement in both groups before and after the treatment but in comparison manual therapy group showed significant results with respect to pain subscale (p=0.003) and physical function subscale (p=0.004).
Conclusion: Significant difference found between manual therapy and exercise therapy treatment approaches in treating knee osteoarthritis. Findings of this study revealed the fact that short term treatment sessions of manual therapy were superior to exercise therapy in terms of alleviating pain, stiffness and functional limitation.
Keywords: Osteoarthritis, Manual therapy, Exercise therapy, WOMAC index.

Jay Indravadan Patel, Prem Kumar B N, Ravish V N

DOI : 10.15621/ijphy/2016/v3i1/88919

Pages : 94-99

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Background: Lumbar radiculopathy is a disease of the spinal nerve root generally accompanied by radicular pain in dermatomal distribution and/or neurologic symptoms. The previous studies were focusing on finding the disability and pain caused due to Lumbar Radiculopathy. This study is focusing on the disability, pain, range of motion of the spine and SLR. The objective of the study is to evaluate the effectiveness of Mckenzie method with TENS on reducing symptoms and disability of Lumbar radiculopathy.
Methods: In the present prospective study patients with Lumbar radicular pain due to disc herniation or prolapse at level L4, L5 & S1 were randomized into two groups – Group A and Group B. the study included 40 patients, with 20 in each group. The selection criteria was based on the following - with age group 22-55years, both sexes – male and female, with radicular pain in L4, L5 & S1 dermatomes, disabling leg pain for 6-12 weeks duration, evidence of disc herniation confirmed on MR imaging. The radicular pain was measured using the SLR test, pain was measured using the VAS scale of 0 – 100, disability was measured using the MODI and Lumbar Spine ROM was measured using the MMST. Group-A were treated with McKenzie methods with TENS and Group-B were treated with general exercise
with TENS.
Results: This study showed that there was a significant reduction of pain on the VAS, improvement in SLR, lumbar spine range of motion using MMST and disability using MODI for both the groups. The statistical analysis found that experimental group showed earlier control of all the outcome measures when compared to controlled group at the end of the 6th week.
Conclusion: After 6 weeks of Mckenzie method with TENS intervention for 30 minutes for 5 days in week the statistical analysis concluded that the experimental group had significantly faster rates of reducing the symptoms of lumbar radiculopathy and reducing the disability due to lumbar radiculopathy.
Keywords: Lumbar radiculopathy, Disc herniation, Mckenzie Method, TENS (Transcutaneous Electrical Nerve Stimulation),L4, L5

Fazli Azim, Saifullah Khalid, Faisal Yamen, Iram Iqbal Shamsi, Shireen Khanzada, Rajesh Kumar, Attiq-Ur-Rehman, Absar Ullah

DOI : 10.15621/ijphy/2016/v3i1/88920

Pages : 100-105

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Introduction: Musculoskeletal Disorders (MSD) are the disorders that have been developed due to disadvantageous work settings and work related issues. It may involve different regions of body like upper extremity, lower extremity, cervical, back regions etc. The onset of these problems need to be known where as it is a common belief that it is caused by overuse. Madrassa simply means the school does in the English language where students gathered to learn and acquire knowledge whether Muslim, non-Muslim, or secular. Usually teachers in madrassa adopted to sit in some positions in which musculoskeletal system is placed under load. The objective of the study is to determine “The Prevalence of Musculoskeletal Disorders among Madrassa Teachers.”
Methods: It was a cross sectional study. 109 madrassa teachers participated in the study; the study was conducted in Karachi. Self-assessment questionnaire was use to collect data. Data was analyzed using SPSS version 20.
Results: A total of 109 madrassa teachers taken part in this research study almost all participants were male. There were two types of madrassa teachers; one is full time teachers (73.4%) and part time (26.6%). (58.7%) madrassa teachers were suffering from discomfort during teaching and 41.3 didn’t feel any discomfort, coming to pain regions 37 said they had back pain (33.9%), 35 said they had shoulder pain (35%), 37 said they had knee pain (24.8%) and four said they had heel pain (3.7%).
Conclusion: The result showed that the madrassa teachers have high prevalence of Musculoskeletal Disorders. This comprises different regions of body like shoulder, back, knee and heel. This leads to the conclusion that these teachers are not at all aware of the consequences of MSD nor they are aware of the causes of these disorders. Also this was found that the facilities provided to these teachers were not up to the mark. When it comes to the working environment the technology of ergonomics has proved a lot, in minimizing the development of MSD. There is a need to provide education on ergonomics for madrassa teachers.
Keywords: Madrassa teachers, musculoskeletal disorders, Ergonomics.

Pradeep Shankar, Prabhakaran Jayaprakasan, Renuka Devi

DOI : 10.15621/ijphy/2016/v3i1/88921

Pages : 106-110

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Background: Abnormal altered scapular position during rest or motion have been termed as Scapular Dyskinesia. Scapula Dyskinesia Type-2 is one type of dyskinesia in which there is a visual prominence of entire medial border of scapula that occurs due to weakness of the serratus anterior and tightness of posterior shoulder joint capsule that results in reduction in glenohumeral flexion and abduction, resulting in decreased acromial elevation. This type of dyskinesia is commonly seen in Secondary impingement of shoulder. Rehabilitation generally begins and focused on axio-humeral and scapula- humeral than axio-scapular muscle. Early application of closed kinetic exercises on scapular stabilization and its effect of application on scapular dyskinesia type 2 is unknown. The study was proposed to find the effect of
scapular stabilization exercise for type 2 Scapular Dyskinesia in subjects with shoulder impingement.
Methods: An experimental study design, 7 male patients with mean age 37 years diagnosed with Shoulder impingement associated with Type 2 scapular dyskinesia were included in the study. The protocol includes closed kinematic chain exercises (scapula clock), Black burn exercises, Sleepers stretch, and thera band exercises aimed to balance force couple of upper, lower trapezius and serratus anterior. Duration of intervention was 3 sessions per week for 2 weeks. Outcome measurements such as Lateral scapular slide test and SPADI were measured pre and post interventions.
Results: Analysis using Paired ‘t’ test as a parametric test found that there is statistically significant difference p<0.000 when pre to post interventions means were compared within the groups showing significant improvement in post SPADI and lateral scapular slide test.
Conclusion: It is concluded that Scapula stabilization exercise protocol found to be effective in Scapular type-2 Dyskinesia.
Keywords: Impingement syndrome, Scapular Dyskinesia, Scapular stabilization exercises, Serratus anterior, lateral scapular slide test, Shoulder disability.

Iram Iqbal Shamsi, Sadaf Subhi, Faisal Yamin, Atiq Ur Rehman, Fazli Azim, Rajesh Kumar, Shireen khanzada

DOI : 10.15621/ijphy/2016/v3i1/88923

Pages : 111-114

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Background: Conservative treatment remains the standard of care for treating nonspecific mechanical low back pain which is very common problem all around the world. In Pakistan, physiotherapists encounter this problem frequently in clinical practice. Despite a wide variety of treatments, 100 percent results have been unachievable. The purpose of this study was to establish a Standard and Uniform Physiotherapy Protocol for mechanical low back pain.
Methods: To achieve the objective of this study, a questionnaire with structured and open ended questions were designed and distributed to hospitals and private clinics. 139 questionnaires were distributed from 1st March 2009 to 30th May 2009. By the end of July 5, 2009, 101 were filled and returned. The data was analyzed using descriptive statistics.
Results: Results have shown that McKenzie (25%), combination of McKenzie and Maitland (9%) were among the preferred techniques. However, 14% did not use a specific technique. The preferred physical agents were hot packs (22%), combination of hot packs, ultrasound, TENS (22%). However, 4% did not prefer any physical agent. Out of 101 subjects per week, 20 subjects were treated for 7 days, 11 were treated for 5 days, 53 were treated for 3 days, 6 were treated for 2 days and 11 were treated for 1 day. The recurrence rate was 32.14% for those who were treated for six days, 34.75% for those treated for 5 days, 33.55% for those who were treated for 3 days, 31.25% for those who were treated for 2 days, and 37.55% for those who were treated for one day. 39% did not consider ergonomical issues while 27% did not advice regarding the patient nutritional facts. Average depression among patients was 24.7%.
Conclusion: This study shows that the results for mechanical low back pain were not as effective with combination of techniques and modalities. If the physiotherapists had taken the psychological factors, ergonomical approach and nutrition into consideration, the results would have improved to a significant level.
Keywords: methods of treatment, physiotherapy, mechanical low back pain.

Sadaf Subhi, Iram Iqbal Shamsi, Faisal Yamin, Atiq Ur Rehman, Fazli Azim, Rajesh Kumar, Shireen Khanzada.

DOI : 10.15621/ijphy/2016/v3i1/88924

Pages : 115-118

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Background: Chronic low back pain remains a major health problem. Unfortunately, the majority of treatments for this condition produce small effects because not all patients respond to each treatment. It appears that only 25–50% of patients respond to exercise. At present, however, there are no guidelines regarding the best treatment to help clinicians. As a result, time and money are wasted on treatment which ultimately fail to help the patient. A backache is described as annoying and gripping pain. It can be caused by poor posture, lack of manual handling skills, change in the center of gravity due to expanding abdomen, lack of exercise, or the weight of the baby and the stretching ligaments. Pelvic floor muscle weakness is one of the major cause of chronic backache. Weakness in the pelvic floor muscles is common in females which can lead to debilitating urinary symptoms, affect sexual function and cause chronic backache.
Methods: In 3 months, 31 female subjects with mean age of 28 who had taken treatment for their chronic backache, were improvised with pelvic floor strength at our setup, with dramatically good results. 31 subjects with non-responsive chronic back pain who had taken conventional physiotherapy were included in the study. Both married and unmarried were included. Any sign of radiculopathy or inflammation were excluded. After assessing pain using Visual Analogue Scale, the Dr Glazer’s program and Kegel’s contractions were taught.
Results: There was significant improvement by 50% on reassessment after 7 days. Then exercises for transverse abdominals were included to get a better response. On completion of the treatment sessions, reduction in pain was 92% on VAS and functional abilities increased by 89%. There was a significant improvement in the quality of life and in pelvic-floor muscle strength.
Conclusion: Non-responsive chronic back pain in females when treated with pelvic floor muscle strengthening program showed 40% improvement. This can be implemented in routine practice for the benefit of the patients.
Keywords: pelvic floor muscles, pelvic floor strengthening, back ache.

Ferkhanda Imdad, Farhan Ishaque, Samreen Yasmeen, Wakash Lal, Saeed Ahmed Sheikh, Umair Nawaz, Dr. Fazleazim, Shireen Khanzada.

DOI : 10.15621/ijphy/2016/v3i1/88925

Pages : 119-123

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Background: LBP is a condition with a high prevalence and recurrence rate. This condition has the potential to create a major impact on the individual over extended periods of time. Numerous reasons and factors for lower back pain have been suggested; including age, gender, body mass index (BMI) and physical activity of the patient. There are different treatments and techniques being implemented, however their effects are minimal. Students at University level are at high risk of LBA due to prolonged sitting and standing hours.
Methods: Research was conducted on 190 students of ISRA University, Karachi Campus. The duration of the study was 6 months, the participants were randomly selected, who were studying in ISRA University, Karachi Campus and self-administered questionnaires with consent forms were distributed to all the participants. Participants were asked to complete the questionnaire and return it to the concerned person after one week.
Results: 71.6% had history of low back pain whereas 28.4% did not have history of low back pain. 84.7% students used computer whereas 15.3% did not use computer. 65.3% left the class room due to low back pain whereas 34.7% did not leave the class room. 61.6% students had prevented normal work from 1-7days due to low back pain during last 12 months, 26.8% prevented normal work from 0 days whereas 11.6% students had prevented normal work from 8-30days due to low back pain during last 12 months.
Conclusion: The overall aim of this study was to analyze the prevalence of low back pain among the undergraduate students of ISRA University, Karachi Campus. The study provided a detailed awareness about the level of prevalence of lower back pain among the undergraduate students. The results of this study showed that most of the students were experiencing lower back pain, and it was also found that it is directly related to their work.
Keywords: prevalence, low back ache, university students.

Andre Vieira

DOI : 10.15621/ijphy/2016/v3i1/88927

Pages : 124-131

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Background: More than 77% of stroke survivors have upper limb dysfunction. The scientific evidence for interventions in upper limb rehabilitation in stroke has shown variable results. To improve health care treatments in this domain it is needed to know what modalities are actually being used by physiotherapists.
Methods: A national web-based survey focused in characterizing the profile of Portuguese physiotherapists working in post-stroke upper limb rehabilitation was conducted in 237 health institutions (n= 462 physiotherapists). The recruitment was conducted from August to December 2014. Analytic and descriptive analysis were used.
Results: A total of 179 physiotherapists from 64 different locations from Portugal answered the survey, with a rate of response of 38.7%. The average age of respondents was 29.25±6.4 years old and predominantly finished the graduation or bachelor degree between 2001 and 2010. More than half hadn´t carried out any specialization in neurologic rehabilitation area. The top 5 modalities most used in the rehabilitation of upper limb in acute stroke are Goal Oriented Tasks (93.4% n=141), Motor Learning (89.4% n=135), Passive Mobilization (88.7% n=134), Task Repetition (87.4% n=132) and Bobath/Neurodevelopmental Therapy (86.9% n=131).
Conclusions: The main modalities used for physiotherapists in upper limb rehabilitation in acute stroke have sparse levels of evidence. It is important to alert teachers, formers, physiotherapists and students for interventions with supported scientific results.
Keywords: Upper Limb Rehabilitation, Physiotherapy, Survey, Portugal

Jyoti Rinku Dilip, Vinod Babu. K, Sai Kumar. N, Akshata Akalwadi

DOI : 10.15621/ijphy/2016/v3i1/88928

Pages : 132-139

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Background: Frozen shoulder is a painful condition with gradual restriction of all planes of movement in the shoulder joint. The purpose of the present study is to evaluate the effect of Gong’s Mobilization versus Mulligan’s Mobilization on Shoulder pain and Shoulder Medial Rotation mobility in subjects with Frozen shoulder.
Methods: An Experimental study design, 40 subjects with unilateral frozen shoulder were selected and randomized 20 subjects into each of two groups- Gong’s mobilization and Mulligan’s mobilization respectively. Gong’s group received the Gong’s mobilization technique with conventional therapy while Mulligan’s group received Mulligan’s mobilization along with conventional therapy. The duration of intervention was 5 treatment sessions per week for two weeks. Outcome measures such as shoulder medial rotation was measured using a Goniometer and pain was measured using a VAS scale before and after two weeks of intervention.
Results: Analysis using Independent ‘t’ test and Mann Whitney U test found that there is statistically significant difference p<0.000 when pre to post interventions means were compared within the groups. When post intervention means were compared between the Gong’s and Mulligan’s groups there was no statistically significant difference in Active and Passive Range of Shoulder Medial Rotation but there was statistically significant difference in VAS when compared between the groups.
Conclusion: It is concluded that both Gong’s mobilization with conventional therapy and Mulligan’s mobilization with conventional therapy are effective in improving Shoulder Medial Rotation Mobility in Frozen Shoulder. However Gong’s mobilization shown greater percentage of effect in reducing pain and Mulligan’s Mobilization shown greater percentage in improving ROM.
Keywords: Gong’s mobilization, MWM, Frozen shoulder, shoulder mobility, Pain, ROM, Conventional therapy, Internal rotation, Mulligan’s mobilization.

Begum Affrin Zaman, V. Kiran, Barnali Bhattacharjee, Abhijit Dutta

DOI : 10.15621/ijphy/2016/v3i1/88929

Pages : 140-146

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Background: The initial days following CABG is a crucial period as it imposes a high risk of pulmonary complications and morbidity. In an effort to increase lung volume following surgery, various deep breathing manoeuvres have been implemented as a main component in the care of the postoperative patient. The rationale for Deep Breathing Exercises with PEP and Incentive Spirometry is that they prevent postoperative complications (PPC), thereby improving cardiorespiratory function. Various studies to substantiate the effectiveness of Deep Breathing Exercises with PEP devices and Incentive Spirometry on preventing pulmonary complications following CABG surgery have been done. The need to study immediate effects of both techniques is yet to be studied.
Methods: 30 subjects undergoing CABG and fulfilling the inclusion criteria were selected for the study. They were randomly assigned into two groups: Group A and Group B having 15 subjects each. Group A received Deep Breathing Exercises with a positive expiratory pressure (PEP) device and Group B received Incentive Spirometry with Expiratory Positive Airway Pressure (EPAP).
Results: The value of F = 45.729 to find the difference in PEFR in Group B is significant (p=0.00). It has been found that PEFR increased significantly after application of incentive spirometer with EPAP to the patients after 4th day. On Day 4, t = 3.750, which is significant (p = 0.001) implying that deep breathing exercise with PEP device is more effective to increase PEFR as compared to incentive spirometer with EPAP.
Conclusion: PEP device is more effective than Incentive Spirometry with EPAP in preventing postoperative complications following CABG surgery. It can be inferred that deep breathing exercise with PEP device is more effective than incentive spirometer with EPAP in improving SPO2 and PEFR in both the groups.
Keywords: Complications of CABG, Positive expiratory pressure device, Expiratory Positive Airway Pressure device.