Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis

Background: Lumbar Spondylitis (LS) is a common term that denotes degenerative changes that develop in trauma-center patients, specific age groups, and head injury patients. A study done on Indian population reported 60% to 90% of radiological changes of L4 at L5-S1 levels in asymptomatic individuals. These degenerative changes in the lumbar spine may remain asymptomatic or can present as pure axial lumbar pain, lumbar radiculopathy, lumbar myelopathy, or lumbar myeloradiculopathy. So, the aim of the study was to check the effectiveness of hip flexor muscle strengthening, femoral nerve muscle stretching with facet joint mobilization for lumbar spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures - RolandMorris Low Back Pain and Disability Questionnaire for disability and Visual Analog Scale (VAS). Goniometer was used for range motion of lumbar spine movements done in each group. The Subjects in Group-A were given hip flexor muscles strengthening with femoral nerve stretching for lumbar region for 45 minutes for 4 days in a week for four weeks where the subject were sitting. The Subjects in Group-B were given femoral nerve stretching with facet joint mobilization for 45 minutes for 4 days in a week for four weeks where the subjects were in supine and prone position and remain Sreenivasu Kotagiri, Neeti Mathur, Ashwin Kumar. Comparative Efficacy of Hip Flexor Muscle Strengthening with Femoral Nerve Stretching and Facet Joint Mobilization for Lumbar Spondylitis. IAIM, 2019; 6(9): 49-57. Page 50 relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and RMQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and RMQ. The overall study proved that hip flexor muscle strengthening, femoral nerve stretching with facet joint mobilization for lumbar spondylitis in improving Pain and decreasing the disability level in lumbar radiculopathy and reduce tightness subjects. Conclusion: The analysis obtained indicated that Group B (femoral nerve stretching with facet joint mobilization) showed more significant improvement when compared to Group A ( hip flexor muscles strengthening with femoral nerve stretching).

Effectiveness of lumbar stabilization exercises with laser therapy in patients with mechanical low back pain

Background: Low back pain (LBP) is the fifth most common reason for physician visits, which affects nearly 60-80% of people throughout their lifetime. The lifetime prevalence of low back pain is reported to be as high as 84%. The most common type of low back pain is Mechanical low back pain. There are various risk factors for mechanical low back pain which are usually classified into physical, physiological and psychological factors. Heavy manual work and lifting weights constitute the physical work factors. Twisting, sitting for long hours, driving and whole body vibrations are also few physical causes. Low physical fitness and trunk muscle weakness are the physiological factors. The essential factors, which should always been taken into consideration in case of pain, are the psychosocial issues such as social influence, monotonous work, low job satisfaction, stress, anxiety, fear and depression. If left untreated or delay in the treatment may lead to degenerative changes. So, the aim of the study was to check the effectiveness of Lumbar Stabilization exercises with laser therapy In Patients with mechanical low back pain. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures - RolandMorris Low Back Pain and Disability Questionnaire for disability and Goniometer was used for range motion of lumbar spine movements for each group. The Subjects in Group-A were given Laser Sreenivasu Kotagiri, Neeti Mathur, Ashwin Kumar, Anup Kumar Song. Effectiveness of lumbar stabilization exercises with laser therapy in patients with mechanical low back pain. IAIM, 2019; 6(9): 117-126. Page 118 therapy for 10 minutes along with Kinesiotaping. The Subjects in Group-B were given Lumbar Stabilization exercises with laser therapy. Result analysis was done by Results: On comparing Group A and Group B for post-treatment RMQ score, results showed a significant difference (p=0.001). The overall study proved that Lumbar stabilization exercises along with laser therapy were more significant for Mechanical low back pain in improving Pain and decreasing the disability level. Conclusion: The analysis obtained indicated that Group B (Lumbar stabilization exercises along with laser therapy) showed more significant improvement when compared to Group A (Laser therapy along with Kinesiotaping).

The Effectiveness of Muscle Energy Technique and Mobilization to Improve the Shoulder Range of Motion in Frozen Shoulder

Background: Frozen shoulder is defined as an idiopathic condition of the shoulder characterized by the spontaneous onset of pain in the shoulder with restriction of movement in every direction. Prevalence of frozen shoulder was found to be 3.06% in a regional community based study. Frozen shoulder is a discrete clinical diagnosis for painful restriction of shoulder motion that results from capsular fibrosis. It is usually present in age group between 40-60 years. Muscle Energy (MET) technique is very much beneficial in this condition. Muscle energy techniques are class of soft tissue osteopathic manipulation consisting of isometric contraction design to improve musculoskeletal function and reduce pain. MET combined along with scapular Mobilization gives much better effect. So, the aim of the study is to check the effectiveness of muscle energy technique and mobilization to improve shoulder range of motion frozen shoulder. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures VAS, Shoulder pain and disability index (SPADI) and Goniometer was used for assessing range motion of shoulder movements for each group. The Subjects in Group-A were given muscle energy technique. The Subjects in Group-B were given maitland technique. Then the Result analysis was done. Sreenivasu Kotagiri, Neeti Mathur, Vadana, Gayathri Balakavi, Anup Kumar Songa. The Effectiveness of Muscle Energy Technique and Mobilization to Improve the Shoulder Range of Motion in Frozen Shoulder. IAIM, 2019; 6(10): 64-73. Page 65 Results: On comparing Group A and Group B for post-treatment VAS and SPADI score, results showed a significant difference (p=0.001). The overall study proved that MET is beneficial in improving Pain and decreasing the disability level. Conclusion: The analysis obtained indicated that Group A (Muscle energy Technique) showed more significant improvement when compared to Group B (Mobilization).

Effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty

Background: Knee osteoarthritis is the occurrence of osteoarthritis (OA) in the knee joint. Osteoarthritis involves the degradation of joints, including articular cartilage and subchondral bone. Osteoarthritis is the most common disease of joints adults suffer from worldwide. The most common procedures done for the treatment of osteoarthritis of knee is a surgical procedure called Total knee arthroplasty (TKA) or total knee replacement (TKR) which is mostly done in advance cases. It is usually starts from age group of 40 and slowly progresses. The most common age group in which its seen is between 50-60 years. They slowly start losing balance after the TKR. Balance is an important aspect of mobility and physical function. Patients with severe OA who are awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) are reported to have a higher incidence of falls compared to the general population. Balance Training Exercises with Conventional Therapy gives much better effect. So, the aim of the study is to check the effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of TUG for each group. The Sreenivasu Kotagiri, Neeti Mathur, Swapna, I Venkateshwarlu, Anup Kumar Songa. Effectiveness of balance training to improve function in patients in post-operative phase following total knee arthroplasty. IAIM, 2019; 6(10): 56-63. Page 57 Subjects in Group-A were given Conventional Therapy. The Subjects in Group-B were given Balance Training Exercises with Conventional Therapy. Then the Result analysis was done. Results: On comparing Group A and Group B for post-treatment TUG score, results showed a significant difference (p=0.001). The overall study proved that Balance Training Exercises with Conventional Therapy is beneficial in improving functional activities and decreasing the disability level. Conclusion: The analysis obtained indicated that Group B (Balance Training Exercises with Conventional Therapy) showed more significant improvement when compared to Group A (Conventional therapy).

Cardio vascular response to core stability exercises in healthy individuals

Background: Low back pain is the most common problem which is present among 60 to 80 percent of population in the world at least once in their life time. It is considered as the most influencing aspect of health of an individual as well as their daily living status. Objective: To examine the cardiovascular responses (Heart Rate, Systolic Blood pressure and Rate Pressure Product) in the abdominal techniques that are (bracing and hollowing) used in core stability exercises. Core stability exercises have been used in the management of low back pain. The cardiovascular effects of exercises that involve postural stabilization, arms and exercises in a lying position are well known. Therefore, the purpose of this study was to examine the cardiovascular effects of 6 core stability exercises on cardiac patients which were used commonly for the treatment of low back ache. Materials and methods: This was a descriptive study which was conducted on a single group of 40 healthy males and females volunteers between age group of 18-25 years. With the mean age group of 21.12+1.042. Subjects were undergraduate students of MNR Sanjeevani College of physiotherapy, Sangareddy and were taken on the basis of convenient sampling. Prior to the participation all subjects were explained briefly about the aims and objectives of the study, health benefits of the core stability exercises and about the procedure of measuring Heart rate (HR), Systolic Blood pressure (SBP) and Rate Pressure product (RPP). All subjects were screened and a detail medical history was taken to exclude any serious illness. Health screening tool questionnaire (AACVPR) was used to identify the serious illness in the subject. One day before to the exercise session subjects were taken to the Gayathri Balakavi, Sreenivasu Kotagiri, Anup Kumar Songa, S. Purna Chandra Shekhar. Cardio vascular response to core stability exercises in healthy individuals. IAIM, 2019; 6(10): 35-42. Page 36 experimental room for familiarization of the procedure. The selected core stability exercises were demonstrated and subjects were instructed not to eat an hour before and not to wear tight clothes, Exercise protocol was designed properly and perfectly for the subjects so that they will be able to perform the exercises easily and effectively and the subjects were asked to participate in the exercise sessions after taking all the necessary measures. Pre and post exercise measurements of Systolic Blood pressure (SBP), Heart rate (HR) and Rate pressure product (RPP) values were measured. Before starting the exercise session subjects were made to relax for 15- 20 minutes, then the initial parameters of cardiovascular performance Systolic Blood pressure (SBP) were measured using automatic BP apparatus Omron M 10. BP cuff was tied to the left arm and patient was in high sitting position with arm supported at heart. Heart rate (HR) and Rate pressure product (RPP) were also measured at the same time along with (SBP). Subjects were asked to do 5 repetitions of all the exercises without any rest period. Post exercise Heart rate (HR), Systolic Blood pressure (SBP), and Rate Pressure Product (RPP) were recorded immediately after they finish the exercise. Now they were made to take rest till resting heart rate (RHR) was achieved. So for the given exercise sessions Systolic Blood pressure (SBP), Heart rate (HR) and, Rate Pressure Product (RPP) were measured for pre and post exercises. Results: There was marked increase in the cardiovascular parameters (heart rate, Systolic Blood pressure, and Rate Pressure Product). After exercise was performed, all the exercises were hemodynamically demanding. The study was done on single group of 40 healthy subjects with the mean age of 21.12 ± 1.04 in which 20 were males and 20 were female subjects. The baseline systolic blood pressure was 110.30 ±11.00 and baseline rate pressure product was 8797.15 ± 1419. The study was done with the aim to measure the acute cardiovascular responses to the core stability exercises. Repeated measures of ANOVA were used as the statistical tool. Conclusion: Core stability exercises can have cardiovascular effects in people with no cardiovascular or cardiopulmonary conditions. These cardiovascular effects may be important with respect to cardiac work, in Cardiac patients for whom these exercises are indicated. So, There was a significant increase in the cardiovascular parameters (Heart Rate, Systolic Blood Pressure, Rate Pressure Product) after the entire exercise session was performed by the subjects of the study.

Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis

Background: Cervical Spondylitis (CS) is a common term that denotes degenerative changes that develop with of trauma-centre patients, specific age groups, and head injury patients. A study done on Indian population reported 78% of radiological changes of CS at C5-C6 and C6-C7 levels in asymptomatic individuals. These degenerative changes in the cervical spine may remain asymptomatic or can present as pure axial neck pain, cervical radiculopathy, cervical myelopathy, or cervical myeloradiculopathy. So, the aim of the study was to check the effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. Materials and methods: 60 patients were included in the study which was divided into two groups ; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group A pre-test measurement with the help of two measures - Northwick Park Neck Pain Questionnaire (NPNPQ) for disability and Visual Analog Scale (VAS) Inclinometer for a range of Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Nazz Sulthan. Effectiveness of Mulligans Mobilizations with Upper Limb Movement and McKenzie Exercises with Neural Mobilizations in Patients with Cervical Spondylitis. IAIM, 2018; 5(5): 146-155. Page 147 motion cervical spine movements was done in each group. Subjects in Group-A were given Mulligan Mobilization with Upper Limb Movement for cervical regain for 45 minutes 4 days for one week in four weeks subject were sitting Subjects in Group-B was given McKenzie Exercises with Neural Mobilization for 45 minutes 4 days for one week in four weeks subject were in supine position and remains relaxed with the feet uncrossed. Result analysis was done by Wilcoxon Sum Rank Test (Mann Whitney U Test). Results: On comparing Group A and Group B for post-treatment VAS score and NPNPQ score, results showed a significant difference (p=0.001) in improvement in terms of VAS and NPNPQ. The overall study proved that both Mulligan mobilization with upper limb movement and McKenzie exercises with neural mobilization were effective in improving Pain and decreasing the disability level in cervical radiculopathy subjects. Conclusion: McKenzie exercise with neural mobilization is better than mulligan mobilization with upper limb movements in cervical radiculopathy. Results supported that McKenzie exercise with neural mobilization was more effective than mulligan mobilization to improve pain and disability in a patient with cervical radiculopathy.

Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit

Background: The glenohumeral joint consists of dynamic and static stabilizer, which works, in concert to allow for stability and mobility through a large arc of motion, in recent years there has been significant focus on shoulder motion, particularly in overhead throwing athletes. Glenohumeral internal rotation deficits (GIRD) are common physical impairments in evaluated both adolescent and overhead sports such as baseball, cricket, and tennis. Therefore the aim of the study firstly was to determine the effectiveness of mobilization with exercise in patients with glenohumeral internal rotation deficit and secondly to determine whether mulligan internal rotation MWM with stretching in patients with glenohumeral internal rotation deficit. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. All the subjects were randomly selected and assigned to each group. A pretest measurement with the help of two measures - Oxford Shoulder Instability Score (OSI) for disability, and inclinometer for an internal range of motion shoulder was Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Jaideep Lad. Effectiveness of Mobilization with Exercise V/S Mulligan Internal Rotation MWM with Stretching in Patient with Glenohumeral Internal Rotation Deficit. IAIM, 2018; 5(5): 138-145. Page 139 done in each group. Subjects in Group-A were given mobilizations with stabilization exercise for capsule for a total of 12 minutes a minimum of 4 times per week over a 4-week period and Group-B were given mulligan mobilization with Posterior Capsule Stretching As follows, 1st day 3 glides, 2 nd day 3 sets of six glides, 3rd day 3 sets of 10 glides were given and 4th day again 3 sets of 10 was given. A patient who failed to come for 4 days with stretching performed 3–5 repetitions each repetition was held for 30 seconds, four days a week for four weeks total 16 sessions. Results: On comparing Group A and Group B for post-treatment OSI score, results showed a significant difference (p=0.001) in improvement in terms of OSI. On comparing Group A and Group B for post-treatment inclinometer score, results showed a significant difference in improvement in terms of the inclinometer. This study showed that Mulligan MWM along with stretching exercises was more effective to that patient as compared to mobilization with strengthening exercises given to a patient with glenohumeral internal rotation deficit. Conclusion: The study showed a significant difference between both the groups when the values obtained were analysed. It indicated that Group B in Range mulligan mobilization with Posterior Capsule Stretching of Motion in internal rotation and external rotation. Their scores in Index Oxford Shoulder Instability Score (OSI) have reduced which indicates the decreased level of disability and better functional ability.