Effect of Muscle Energy Technique on Piriformis Tightness in Chronic Low Back Pain with Radiation

Low back pain is a common condition in India. 90 % of Indian population experience low back pain at least once in their lifetime. Studies show that 98 % low back pain is because of mechanical disorder of spine. Piriformis tightness is one of the most misdiagnosed causes for low back pain or sacroiliac joint dysfunction. Various manual therapy approaches have been studied for reducing muscle tightness. We wanted to assess the effectiveness of muscle energy technique that is post-isometric relaxation technique on piriformis muscle tightness, its effectiveness in relieving low back pain with radiation, and increasing range of motion. METHODS60 patients were included in the study as per inclusion and exclusion criteria from Ravi Nair Physiotherapy College, Sawangi Meghe, and were randomly assigned in to two groups. The duration of study was 12 days (6 sessions / week) and follow up was taken on 27th day. Subjects in muscle energy technique experimental group were treated with post isometric relaxation technique (PIR), subjects in control group were given simple passive stretching of piriformis. All subjects were educated about proper ergonomics. RESULTSBoth interventions post isometric relaxation and simple stretching techniques were effective in terms of pain reduction, ROM (Range of Motion) improvement, piriformis tightness, disability with p < 0.05 with post isometric relaxation technique superseding simple stretching. Moreover, post isometric relaxation technique in muscle energy technique had sustained effects on follow-up in terms of relieving pain, disability and tightness for longer period of time. CONCLUSIONSMuscle energy technique gives immediate relief of pain improving ROM and decreasing tightness of piriformis and disability and has longer lasting effects.

Comprehensive Physiotherapy Rehabilitation on a Complex Case of Combination of Subcoracoid, Subacromial, Subdeltoid, and Supraspinatus Tendinitis

The shoulder can be considered as one of the largest and most flexible joints in the human body. Bursa is a liquid-filled sac that can be found between tissues (bone, skin, tendons and muscle). Bursa reduces the pressure and tension between the tissues. If the bursa isn't disturbed, joints work quickly and without discomfort. So, if it becomes bloated and inflamed, patient will experience pain during physical activity.1Subcoracoid bursa is located between the scapula's coracoid process and the shoulder joint capsule. Subcoracoid bursitis should be seen as a potential cause of painful snapping of the anterior shoulder.2 Inflammation of the sub acromial - sub deltoid bursa (SASD) has lately been indicated as a key radiological predictor indicating shoulder joint discomfort and chronic restriction in operation in both operated patients and general patients. The SASD bursa is an extra-articular synovial gap between the tendons of the rotator cuff and the under surface of the acromion, the acromioclavicular joint and the deltoid muscle, which forms the bicipital groove. Friction between the neighbouring structures or rotator cuff impingement can result in inflammation and bursitis.3 Supraspinatus tendinitis is also one factor that allows discomfort to radiate over the shoulder. Supraspinatus tendinitis progresses to tendinitis supraspinatus, specific impingement location arises in both the cycles of acromion and the bursa.4Physiotherapy modalities and manual techniques are the preferred choice of management in such musculoskeletal disorders. The shoulder can be considered as one of the largest and most flexible joints in the human body. Occurrence of shoulder discomfort in individuals is enhanced as different pathologies exist in shoulder joint systems. Shoulder bursitis is a debilitating form with shoulder joint inflammation. It is natural, treatable and found more in the young and middle-aged population. In this case, the recorded pain progression had been gradual; there was no history of fall or trauma. Pain was sharp during external rotation, abduction and flexion of the left shoulder and reported NPRS was 9 / 10 on activity. The patient was managed conservatively with PRP therapy and physiotherapy. The patient underwent 4 weeks rehabilitation and follow up for 2 weeks period in preparation for return to normal daily activities.

Translation and Validation of Patient Activation Measure (PAM R-13) in Kannada Language

In a country like India with a large population, with diverse culture, socioeconomic status and educational levels, there is a need to translate a Patient Activation Scale Measure (PAM®13) into a regional language which will reduce the language barrier, increases the understanding of patient’s disease condition, and improves their self-management skills. Hence, a reliable and validated instrument ‘Patient Activation Measure (PAM®13)’ is used for evaluating patient’s awareness, skills, and trust in self-management of disease. We wanted to translate and validate the PAM®-13 questionnaire in Kannada language and assess activation levels in diabetes mellitus patients. METHODSA cross-sectional analysis done among 200 adults with diabetes mellitus who speak Kannada. Patients of diabetes mellitus, aged 18 - 85 years from both sexes were included in the study. The PAM®-13 – was translated as recommended by World Health Organisation’s procedure for cross-cultural validation and adaptation of self- report measures. This involved forward translation, synthesis, backward translation, pre-testing and the final version which was performed by the professionals of Kannada and English language. Data was analysed using SPSS ver. 24.0 for mean, median, standard deviation, Pearson’s correlation and Spearman’s correlation. Stata 14 was used to analyse internal consistency using Cronbach’s Alpha, inter-item, inter-rest, inter-test correlation. RESULTSWe found that the mean of the Kannada version of the PAM®-13 was 55.68. The level of internal consistency was good (α=0.8357). CONCLUSIONSPAM® -13 in Kannada language has been demonstrated to be a valid and reliable measure of patient activation in the diabetic population and the present study suggests good psychometric properties.

COVID-19 Pandemic- A Curse to the Physical Well-Being of Every Individual in Lock-Down

The 2019 novel coronavirus (COVID-19) has rapidly spread from its origin in Wuhan City of China to other countries. In response to the rapid spread of COVID-19, preventive measures such as social distancing have resulted in the global closure of all means of entertainment or recreational activities. Owing to the lockdown phase and more tendencies for sedentary lifestyle than earlier, there is a higher probability of the population to suffer from musculoskeletal issues during this phase. This can further result in various physical health issues in terms of reduced endurance, reduced muscle strength, obesity, and metabolic problems associated with decreased physical activity (PA), etc. Aerobic exercise has shown that the peripheral number of lymphocytes in the blood is significantly raised; precipitating the idea that exercise helps to "stimulate" the immune system during exercise. PA has various health benefits including reduced incidence of disease and decreased systemic inflammation. A physically active lifestyle has a direct impact on an individual's state of well-being, quality of life, and cognitive function. Thus, PA is related to a decreased chance of cognitive decline and dementia. Previous studies have shown that daily PA leads to lower death rates and infection incidence rates. Both physical activity and exercise are positively related to beneficial metabolic and immunological health outcomes. Besides, they have proven to be effective with direct effects on physical health for most of the chronic diseases. Routine exercises improve the improve physical wellbeing. Therefore, individual prescription and guidance are required to establish an effective exercise program aimed in sustaining or enhancing the key health-related components of physical fitness. This article gives an overview of the musculoskeletal awareness in lockdown phase owing to increased sedentary lifestyle during the lockdown phase.