Active ROM Exercises Research Articles

Effects of muscle energy technique overhold relax on pain and range of motion in patients with post-surgical elbow stiffness

Background. An elbow joint that can move and is stable is important for work, play, and sports. Stiffness in the elbow after surgery is common and can make it difficult to perform daily activities. This is a significant problem for therapy. Therapeutic exercises, especially stretching exercises, are a crucial part of physiotherapy for alleviating elbow stiffness. Muscle Energy Technique (MET) is a manual therapy that uses mild isometric contractions to utilize the muscles’ energy to help with limited limb movement. On the other hand, Proprioceptive Neuromuscular Facilitation (PNF) is one of the best ways to improve motor performance and speed up recovery by increasing the range of motion and flexibility. The goal is to determine how MET over Hold‑Relax affects pain and range of motion when rehabilitating stiffness in the elbow after surgery. Methods. A quasi-experimental study was conducted on 12 patients post-elbow fracture fixation. Group A was given MET, while Group B received the Hold-Relax Technique three times a week for three consecutive weeks after the immobilization period. As baseline treatment, both groups received active ROM exercises. Pain (Visual Analog Scale) and ROM (goniometer) were assessed pre- and post-3 weeks. Results. In the third week, the two treatment groups showed a statistically significant difference in all parametric values (P < 0.05). However, Group B Hold-Relax’s mean difference and paired and unpaired t-test values were greater compared to Group A MET at the end of the third week. Conclusion. This study concludes that implementing PNF stretch (Hold-Relax) in conjunction with conventional treatment techniques in post-surgical stiffness is beneficial in enhancing the subject’s quality of life by reducing pain and restoring ROM. Hence, PNF (Hold-Relax) can be the best treatment option in physiotherapy practice.

Role of the Physical Therapy Intervention in Type 1 Spinal Muscle Atrophy: A Case Study

Background: Spinal Muscle Atrophy Type 1 (SMA1) is a hereditary neuromuscular disorder that affects the motor neuron, leading to sever muscles weakness and limited motor function. Zolgensma therapy has emerged as potential treatment option for SMA1, offering hope for improved outcomes and quality of life for affected infants. However, the effectiveness of the therapy in promoting physical development in SMA1 remains unclear1. This case study aim to explore the role of physiotherapy in improving the developmental milestones of an infant with SMA1 following gene therapy. Additionally, will utilize the Chop Intend assessment tool to assess and track the changes in infant’s motor function, strength, and over all physical development. Case discerption: 7 weeks new borne girl referred from neurology department to physical rehabilitation department, with history of SMA1. Management and outcomes: The baby was seen twice/week, assessed by CHOP-INTEND assessment tool and followed by active ROM exercises, stretching exercises and Neuro-developmental therapy for the last two years. Outcomes was measures by CHOPINTEND assessment, which improved from 45 to 64. Result: This study highlights the significant benefits of physiotherapy in improving motor milestones in patients with SMA1.

Perbandingan Efektifitas Latihan Rom Aktif Dan Akupresur Terhadap Kekuatan Otot Ekstremitas Atas Pada Pasien Stroke Non Hemoragik Di Ruang Rawat Inap Rsud Dr. Haryoto Lumajang

Stroke is a clinical syndrome that begins suddenly, progressively, in the form of focal or global neurological deficits that lasts 24 hours or more and can cause death. This is caused by nontraumatic cerebral blood flow disorders. The purpose of this study was to compare the effectiveness of active ROM and acupressure exercises on upper limb muscle strength in non-hemorrhagic stroke patients in the inpatient room of RSUD Dr. Haryoto Lumajang.
 The research method used was a pre-experimental design with the type of pre-test and post-test one group design. With a sample of 36 respondents with the Accidental Sampling technique and the test used was the Wilcoxon test.
 From the results before being given the ROM treatment, 11 respondents (61.1%) had poor muscle tone and before being given the acupressure treatment, 15 respondents (83.3%) had poor muscle tone. From the results after being given ROM treatment, 13 respondents (72.2%) had moderately good muscle tone and after being given the acupressure treatment, 14 respondents (77.8%) had poor muscle tone. The results of the Mann-Whitney analysis test obtained α = 0.003, which means that there is a comparison of the effectiveness of active ROM exercises and acupressure on upper limb muscle strength in non-hemorrhagic stroke patients.
 It is expected that patients with stroke will always try to practice ROM independently which has been taught by health workers, for the patient's family to participate and motivate patients to do ROM exercises to accelerate the healing of stroke patients.
 
 Keywords: Active ROM Exercises, Acupressure, Upper Extremity Muscle Strength, Non Hemorrhagic Stroke

Effect of Virtual Reality Combined with Modified Constraint-Induced Movement Therapy on Chronic Stroke Survivors

<h3>Research Objectives</h3> To evaluate the effect of virtual reality combined with modified constraint-induced movement therapy-based upper limb training on chronic stroke survivors. <h3>Design</h3> Intervention. Randomized control trial, baseline two and four-week intervention. <h3>Setting</h3> In the Hospital setting outpatients. <h3>Participants</h3> Twenty-six patients both males and females with chronic stroke for more than 6 months and dysfunction in the upper limb were included in the study. The age range between 20 to 45 years was included. Convenient sampling is used for the selection procedure. <h3>Interventions</h3> Virtual reality Group: Treatment for 20 min 3 sessions per week for 4 weeks along with the conventional therapy. The VR protocol included using a VR headset and the games. In the Rally ball game, balls approaching the player from multiple angles are hit from a chair. The Reflex Ridge game involves hitting, and grasping obstacles while sitting in a chair. The patient played each game for 10-mins per session. Conventional therapy includes passive stretching, repetitive task-specific activities, passive, active-assisted and active ROM exercises. Virtual reality combined with m-CIMT Group: Treatment for 20 min 3 sessions per week for 4 weeks along with the conventional therapy. The unaffected hand of the participant was restrained and then the same VR treatment (as above) was given to the participants. <h3>Main Outcome Measures</h3> Wolf motor function test, DASH Questionnaire, Modified Ashworth Scale, and Box & Block test. <h3>Results</h3> The treatment group significantly improved from the control group. Repeated measure ANOVA showed significant improvement for all the outcome measures (p< 0.005) within the 2 groups. The Independent t-test shows a significant difference in Gross motor function, patient self-report disability, and manual dexterity of upper limb (p< 0.005) and no significant difference in spasticity for MAS (p>0.005) between the groups. <h3>Conclusions</h3> Both treatment approaches in the control and Treatment groups are effective in managing motor functional status, spasticity level of the upper extremity, disability level, and manual proficiency of the upper extremity. Except for spasticity, both treatment approaches were found equally effective. <h3>Author(s) Disclosures</h3> There is no conflict of interest

Effects of myofascial release with tennis ball on spasticity and motor functions of upper limb in patients with chronic stroke: A randomized controlled trial.

Background:Impaired motor function and upper extremity spasticity are common concerns in patients after stroke. It is essential to plan therapeutic techniques to recover from the stroke. The objective of this study was to investigate the effects of myofascial release with the tennis ball on spasticity and motor functions of the upper extremity in patients with chronic stroke.Methods:Twenty-two chronic stroke patients (male-16, female-6) were selected to conduct this study. Two groups were formed: the control group (n=11) which included conventional physiotherapy only and the experimental group (n=11) which included conventional physiotherapy along with tennis ball myofascial release – in both groups interventions were performed for 6 sessions (35 minutes/session) per week for a total of 4 weeks. The conventional physiotherapy program consisted of active and passive ROM exercises, positional stretch exercises, resistance strength training, postural control exercises, and exercises to improve lower limb functions. All patients were evaluated with a modified Ashworth scale for spasticity of upper limb muscles (biceps brachii, pronator teres, and the long finger flexors) and a Fugl-Meyer assessment scale for upper limb motor functions before and after 4 weeks. Nonparametric (Mann–Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data statistically. This study has been registered on clinicaltrial.gov (ID: NCT05242679).Results:A significant improvement (P < .05) was observed in the spasticity of all 3 muscles in both groups. For upper limb motor functions, significant improvement (P < .05) was observed in the experimental group only. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison to the control group for both spasticity of muscles and upper limb motor functions.Conclusion:Myofascial release performed with a tennis ball in conjunction with conventional physiotherapy has more beneficial effects on spasticity and motor functions of the upper extremity in patients with chronic stroke compared to conventional therapy alone.

PEMBERIAN ROM AKTIF TERHADAP TINGKAT KEMAMPUAN ADL DASAR PADA PASIEN POST OPERASI FRAKTUR EKSTREMITAS BAWAH DENGAN TINDAKAN ORIF DI RSUD DR. ZAINOEL ABIDIN BANDA ACEH

Based on data from the WHO, in 2013 there were 1.3 million people suffering from fractures due to traffic accidents. Fracture patients have limitations in carrying out their daily activities and active ROM exercises need to be done. The purpose of the study was to determine the effect of giving active ROM on the level of basic ADL ability in postoperative lower extremity fracture patients with ORIF action at RSUDZA Banda Aceh in 2018. The research design used in this study was Quasi Experiment with Static Group Comparison, Sampling in this study conducted by purposive sampling technique totaling 20 respondents. Data was collected using the basic ADL observation sheet. The results showed that the basic ADL ability scores in the intervention group were mostly in the mild dependency category, as much as 60%, while in the control group many were in the moderate dependency category, as much as 40%. Basic ADL in postoperative lower extremity fracture patients with ORIF action in Raudhah 6 and Raudhah 7 RSUDZA Banda Aceh (p = 0.008) which means Ha is accepted and H0 is rejected. The importance of doing active ROM for postoperative lower extremity fracture patients with ORIF action to help the healing process. It is hoped that nurses will provide an explanation of active ROM exercises as a permanent activity in an effort to prevent loss of body function abilities.

COMPARISION OF MAITLAND MOBILIZATION AND MUSCLE ENERGY TECHNIQUE ON PAIN, RANGE OF MOTION AND FUNCTIONS IN ADHESIVE CAPSULITIS

The adhesive capsulitis (frozen shoulder) a well-known musculoskeletal problem that affects more women and diabetic population. The restriction is in capsular pattern used to limit the daily activities of the population. Objective: To study the effectiveness of Muscle energy technique and Maitland mobilization technique on the pain, range of motion and disability index in the patients with adhesive capsulitis. Method and subjects: This quasi-experimental study consists of 30 subjects including both males and females between 40-60 years, already diagnosed with adhesive capsulitis were selected. The sample was collected using a nonprobability convenient sampling method and was assigned groups (A or B) with 15 subjects each. Group A received a moist pack for 15 minutes, active ROM exercises, and Muscle Energy Technique (MET). Group B received a moist pack for 15 minutes, active ROM exercises, and Maitland mobilization. Both the groups were treated 2 times a week for 2 weeks and were told to continue the exercises at home. All the subjects were measured for pain and disability by SPADI, and ROM using a goniometer on 1st day on the 15th day after treatment. Result: There were 20 (66.6%) male and 10(33.4%) female participants. There was significant improvement at post-treatment levels in pain and ROM and SPADI in both groups. Although ROM improvement and pain reduction was improved in both groups but statistically significant (p&lt;0.05) between group shown Maitland was superior to MET. Conclusion: Maitland Mobilization is more effective in reducing pain and increasing function and Disability among the patients having Adhesive Capsulitis as compared to MET for Pain, ROM and shoulder functions.

IMPACT OF TREADMILL RUNNING ON BLOOD GLUCOSE LEVEL OF TYPE 2 DIABETES MELLITUS PATIENTS IN GHURKI TRUST AND TEACHING HOSPITAL

Type 2 diabetes mellitus were define by WHO (world health organization) that “It is a metabolic syndrome which is characterized by prolonged increase in blood glucose level due to any abnormality in insulin action or release of insulin. It is also known as noninsulin dependent diabetes mellitus (NIDDM)”According to American diabetic Association (ADA) in 2004, the symptoms of long term increase glucose level in blood includes frequent urination, increase thirst, excessive hunger and blurry sight. Methodos: Quasi Experimental study design without control group,the duration for the study was 4 months.The study was conducted at Physiotherapy Department, Ghurki trust and teaching hospital. Blood glucose level, Glucose meter and treadmill runningwere outcome measures. Convenient sampling technique was used, 42 subjects were included in study. They were recruited from Ghurki Trust and Teaching Hospital. Diagnosed patients of diabetes mellitus type 2 were eligible. Patients, who fulfil the inclusion criteria, were interviewed and examined by the diabetic clinician in Ghurki trust and teaching hospital. By using convenient sampling method the subject was selected to perform the task. The experimental procedure last for half an hour includes 5 minutes warm up 20 minutes treadmill run and 5 minutes of cool down. In warm up and cool down period mild stretching exercise, active ROM and breathing exercise for 5 minutes Selected Individuals was run on treadmill at a speed of 8km/hour (5miles per hour) for 20 minutes after doing warm up exercise. Conclusion: The aerobic exercise intervention is an effective tool to control the noninsulin dependent diabetes mellitus as it lower the blood glucose level but exercise must be performed regularly to have good results. Most of the patients with controlled diabetes are able to perform aerobic exercise safely as long as some precautionary measure is taken. Increase physical activity is a key for good health in patients with type 2 diabetes

PENGARUH RANGE OF MOTION ROM ) AKTIF TERHADAP FLEKSIBILITAS SENDI LUTUT PADA LANJUT USIA

Perubahan fleksibilitas sendi pada lanjut usia dapat ditangani dengan menggunakan latihan Range of Motion (ROM) aktif. Beberapa penelitian menunjukkan bahwa latihan ROM aktif secara signifikan meningkatkan fleksibilitas sendi lutut sebesar 35° pada 43,75% responden dari total sampel. Penelitiam ini bertujuan untuk menganalisa pengaruh latihan ROM aktif pada ekstremitas bawah terhadap peningkatan fleksibilitas sendi lutut pada lansia. Metode penelitian ini menggunakan pendekatan quasy-eksperiment dengan pendekatan one group pre-test and post-test design.Teknik sampling menggunakan total sampling yaitu sebanyak 25 lansia. Pengkuran dilakukan pada saat hari ke-1, hari ke-4 dan hari ke-8 penelitian dengan menggunakan alat ukur goniometer. Hasil analisa data pada hari ke-1 menunjukkan bahwa rata-rata fleksibilitas sendi lutut pada responden adalah sebesar 117,52o. Selanjutnya analisa pada hari ke-4 menunjukkan adanya peningkatan rata rata fleksibilitas sendi lutut yaitu menjadi 122,24o (meningkat menjadi 4,72o). Pengukuran terakhir juga meperlihatkan adanya peningkatan rata rata fleksibilitas sendi lutut yaitu menjadi 125,88 o (meningkat sebesar 8,36o apabila dibandingkan dengan fleksibilitas sendi lutut hari ke-1yang meningkat sebesar 3,64 o apabila dibandingkan dengan hari ke-2) sehingga dapat disimpulkan bahwa latihan ROM aktif dapat meningkatkan fleksibilitas sendi lutut pada lansia. AbstractChanges of joint flexibility in the elderly can be treated by using active ROM (Range of Motion) exercises. Several studies have shown that active ROM exercises significantly increase the flexibility of the knee joint by 35° among 43.75% of the total sample. The aim of this study was to analyze the effect of active ROM exercises on the lower extremities on increasing the flexibility of the knee joint in the elderly. The Study employed a quasi-experimental approach with One group pre-test and post-test design and ulitilized total sampling method. The Measurrement is carried out on the 1st day, 4th day and 8th day of the study using a goniometer instrument. Data analysis on the 1st day showed that the average ROM among respondents was 117.52o. Furthermore, the analysis on the 4th day showed an increase in the average knee joint ROM, which was 122.24o (increased to 4.72o). The last measurement also showed an increase in the mean angle of the knee joint ROM which was 125.88o (increased by 8.36o when compared to the 1st day ROM and increased by 3.64o when compared to the 2nd day). It can be concluded that active ROM exercise can increase the range of joint motion in the elderly.

Pengaruh Range of Motion (ROM) Aktif Terhadap Fleksibilitas Sendi Lutut Pada Lanjut Usia

ABSTRACTBackground : Joint flexibility decreases in old age due to a degenerative process resulting in changes in joints, connective tissue and cartilage in the elderly. Decreasing flexibility is also due to reduced elasticity of muscle fibers, where connective tissue in muscle fibers increases (Mariyam, 2008).Objective : The aim of this study was to analyze the effect of active exercise (ROM) on the lower extremities on increasing the flexibility of the knee joint in the elderlyMethods : This study using a quasi-experimental approach with One group pre-test and post-test design. The sampling technique uses the Slovin method of 42 people, obtained a sample of 25 elderly. Exercise is done twice a day for 8 days. Measurements were made on day 1, day 4 and day 8 of the study using a Goniometer measuring instrument..Result : The results of measurement I average of the right knee joint 117.52o, measurement II = 122.24, measurement III = 126, 36o. From the analysis with Paired simple t-Test between the measurements I and II, it was found that the different test measurements I and II t count value was equal to -1.908 with 0.068. Because sig 0.05, it can be concluded that Ho is accepted, meaning that the average angle of ROM before and after training is the same (not different). In the different test measurements II and III the value of t count is equal to -2.152 with sig 0.042.Conclusion : Because sig 0.05, it can be concluded that Ho is rejected, meaning that there is a difference in ROM angle after training between days 4 to 8 with the first day to day 4. Thus it can be stated that active ROM exercises affect the angle of ROM of the knee joint elderly after exercise ROM between day 4 to day 8. Keywords: active ROM exercise, flexibility of knee joint, elderly.

EFEKTIVITAS RANGE OF MOTION (ROM) AKTIF TERHADAP KEKUATAN OTOT EKSTREMITAS ATAS DAN EKSTREMITAS BAWAH PADA LANSIA

Lansia mengalami perubahan fisiologis dan morfologis pada system muskuloskeletal khususnya otot yaitu adanya penurunan kekuatan otot dan massa otot. Mengetahui analisis efektifitas ROM aktif terhadap kekuatan otot ekstremitas atas dan ekstremitas bawah pada lansia di Panti Tresna Werdha Teratai KM. 6 Palembang.Penelitian ini menggunakan desain Quasy Experiment dengan pendekatan Pre-Post Test Non Equivalent Control Grup terhadap 18 responden dengan teknik total sampling. ROM aktif dilakukan 3 kali dalam seminggu dengan durasi 30 menit dan diulang sebanyak 3 kali pada tiap ekstremitas. Friedman dan Mann-Whitney digunakan untuk analis bivariat.Mayoritas dalam kelompok intervensi memiliki skala kekuatan otot 4 dan 5 dan kelompok kontrol memiliki skala kekuatan otot 4.Uji Friedman menunjukkan perbedaan yang signifikan pada ekstremitas atas (p=0,001) dan ekstremitas bawah (p=0,008). Uji Mann-Whitney menunjukkan perbedaan yang signifikan pada ekstremitas atas (p=0,03) setelah intervensi ROM aktif, tetapi tidak signifikan pada ekstremitas bawah (p=0,058). Lansia dan Panti Tresna Werdha Teratai diharapkan dapat melakukan latihan ROM aktif dan memprogramkan secara rutin karena latihan ini terbukti dapat meningkatkan kekuatan otot.

Comparison of functional results after early controlled motion for surgical repair of acute and chronic ulnar collateral ligament injury of the thumb

Injuries to the UCL can lead to functional impairment. Rehabilitation is very important for functional results. Early motion after surgery is avoided. Usually the controlled motion starts after the 6th week. The aim of this study was to evaluate functional results of early controlled motion before 6th week. Nineteen patients (18♂/1♀) had an acute UCL rupture, 25 patients (23♂/2♀) had a chronic UCL rupture. Two soft anchors (Mini 1.0 mm) were used to repair ruptured UCL to bone insertion at the acute UCL injury group. For chronic UCL injury group, 3.0 mm bone tunnels were prepared to proximal and distal insertion of UCL and than tendon graft was passed through the tunnels. The tendon graft was stabilized by placing 3.0-mm bioabsorbable suture anchors within the tunnels. The motion was restricted in the 2 week with thumb spica. Dynamic splint and passive ROM exercises were started after 2 week. Active ROM exercises were started after 4 week. There were no significant differences between the two groups in the men/women ratio, mean age, mean follow-up period. All patients regained full stability at MCP joint in acute UCL injury group; 21 patients regained full stability and 4 patients presented with mild laxity (< 10° laxity) in chronic UCL injury group. The ROM of injured MCP joint of thumb was regained at 8–10 week as good as healthy extremity MCP joint of thumb. There were no significant differences between operated and healthy thumb MCP joint in both groups in the grip and pinch strength, flexion, extension, radial deviation, ulnar deviation motions at final control. Glickel grading scale was excellent for 19 patients for acute UCL injury group; it was excellent for 21 patients and good for 3 patients in chronic UCL injury group. Early controlled motions affect functional results positively. Repair with 1-mm soft anchors in acute UCL injury and reconstruction with tendon graft which stabilized by 3-mm bioabsorbable suture anchors within the tunnels in chronic UCL injury provides adequate stability for early controlled motion.

Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone.

Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament. Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated. Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively. Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74°/60°. There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67° to 55°. The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results.

Reconstruction of the Scapholunate Interosseous Ligament Using Bone-capitohamate Ligament-bone: Level 4 Evidence

The biomechanical property of the capitohamate (CH) ligament is equivalent to the SL ligament. We reconstructed torn SL ligament using the bone-CH ligament-bone substitute. Indications of this procedure are unrepairable complete disruption of the SL ligament (Fig 1A). Scapholunate joint was reduced by manual or joystick maneuver, then temporary fixed with 2 K-wires and the scaphocapitate interval was fixed with 1-2 K-wires. The dorsal portion of the SL ligament was refreshed and the 5 mm×10 mm×5 mm (width, length, depth) cubic gutter was made at the exact position of the dorsal portion of the SL ligament by a chisel. Proximal half of the CH ligament with capitate bone and hamate bone (bone-CH ligament-bone) was harvested as same size as the gutter made at the SL ligament, then grafted, fixed firmly with 1.2 mm diameter titanium screws to the scaphoid and lunate to reconstruct the SL ligament (Fig 1B and C). Since 2008, 15 wrists of 14 patients with an age of 38 years (range 25 to 75) underwent this procedure with at least 1-year follow. There were 14 male and 1 female, 11 rights, 2 left and 1 bilateral wrists. Thirteen wrists indicated dissociation of SL joint gap more than 3 mm and two indicated complete SL ligament disruption with severe DISI deformity. K-wires were removed 8 weeks after the surgery and active ROM exercise began. We evaluated pain (VAS), wrist motion (angle), radiographic characteristics, such as SL gap (mm), SL angle, and modified Mayo wrist score. VAS was improved to postoperative 77 from preoperative 12. We obtained average wrist extension/flexion of 74/60 degrees. There was no ossification of reconstructed SL. SL gap was improved average 4.8 mm to 2.1 mm and SL angle was changed from 67 to 55 degrees (Fig. 2). Modified Mayo wrist score was improved to 82 points postoperatively from preoperative 47. Clinical outcome was 8 excellent, 6 good and 1 fair with modified Mayo-wrist score. We obtained excellent radiographic and clinical results of complete disruption of the SL ligament by reconstruction using bone-CH ligament-bone substitute.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Unexpected Injury During Jumping Exercise

Objectives:The purpose of this case presentation is to report the results of physical therapy and conservative treatment of a rare clinical entity, isolated subtalar dislocation that occurred during triple jumping during which maximum compression forces act on the foot.Methods:A 20 years old national triple jumping athlete fell during daily sports exercises which consist of jumping to the medial and lateral side trying to catch a sports ball bouncing from the wall while his right foot was inverted and in plantar flexion. The patient was admitted to our emergency service. The physical examination revealed that the hindfoot was displaced medially. The neurological examination was intact and there was no sign of dermal injury. After the radiological examination the diagnosis was isolated subtalar dislocation. The dislocation was reduced with longitudinal traction with the knee was in flexion. The MR imaging did not reveal any chondral damage. The choice of treatment was conservative. After 4 days as the edema subsided, a short leg cast was applied for four weeks. Then, the cast was removed and active range of motion exercises were initiated. The first 25 days consisted of exercises with rubber band, bottle rolling under the foot. The second phase included walking in the pool and the patient was asked to start weight bearing partially. The patient went on with proprioception and strengthening exercises. Later, kinesiologic taping was also added to the therapy. He changed his jumping foot and started his routine training program with the team after 170 days. He participated in his first official competition 16 months after the injury. At the 28. month, he broke the national record in the National Interuniversities Athletics Games. 2 months later, he got the third place in the World Athletics Championship.Results:The follow up period was 4 years. AOFAS score was 76 at second month and 83 at the fourth. At the first and at the fourth year, AOFAS score was 100. No dermal lesions or joint stiffness or signs of arthritis was observed. Avascular necrosis of talus or complex regional pain syndrome was not encountered.Conclusion:Early return to sports activities is of tantamount importance as early reduction. Reduction can be carried out in an open or closed manner. For prevention of joint stiffness, immobilization period has to be short and active ROM exercises has to be initiated with partial weight bearing as soon as the joint stability and strength is adequate.

The results of modified distraction arthroplasty for degenerated osteoarthritis of the ankle

Purpose: In the treatment of degenerated osteoarthritis of the ankle, we obtained good results in terms of preserving the joint functions and relieving pain by performing a procedure to reconstruct the anatomical structure of the ankle, accompanied by ROM exercises undertaken with the joint space kept pulled apart with a conventionally used external fixator. Methods: A total of 43 patients (45 ankles; 28 ankles in 28 male patients and 17 ankles in 15 female patients) who underwent the procedure from 1998 to 2012 were enrolled in the study. The patients were 18-72 years old, with a mean age of 56 years at the time of the procedure. In regard toTakakura’s classification, 6 ankles were classified as Stage 2, 21 as Stage 3a, 12 as Stage 3b, and 6 as Stage 4. The patients underwent debridement by the conventional method, including removal of bone spurs and synovectomy, combined with low tibial osteotomy, osteochondral graft, drilling and/or reconstruction of ankle lateral ligaments. As post-treatment, patients were started on active ROM exercises from the day after the surgery and started partial weight bearing at 6-8 weeks after the surgery. The external fixation device was removed to allow total weight bearing at 3 months. Follow-ups were performed for 1-8 years, with a mean of 4 years and 7 months. Results: The pain severity did not change in 2 ankles. For the remaining 43 ankles in which the pain improved, no problems in daily life activities, but inability to undertake sports activities were observed for 31 ankles, while no problems in either physical work or sporting activities for 12 ankles. None of the patients took painkiller. Improvements of the ROMwere seen in 10 ankles, while no change of the ROMwas observed in the remaining 35 ankles. There were no patients who needed additional operations such as arthrodesis during the follow-up period. Conclusions: Procedures such as arthrodesis, total ankle replacement and low tibial osteotomy are performed to treat degenerated osteoarthritis of the ankle, but each of these is associated with problems, including those related to the qualifying age, durability, and range of motion. It is difficult to select a proper treatment option, especially for relatively young patients. In contrast, there is no age requirement for the procedure described in this study, because joint functions are preserved by restoring the patients’ own tissue and the patients suffered only mild postoperative limitation of the ADL. As demerits, this procedure is less effective for pain relief than arthrodesis and more abundant experience is required, because several kinds of surgical procedures have to be performed. However, it can be indicated for young patients in whom preservation of the joint functions and higher activity potential are required. In addition it is well applicable to degenerated osteoarthritis of the ankle that arises at a relatively early age, because future joint replacement or arthrodesis will not be difficult in patients who undergo this procedure.

The efficacy of Treatment Program Focusing on Specific Stabilizing Exercises in Antenatal Period for Treatment of Pregnancy Related to Low Back and Pelvic Girdle Pain: A Randomized Controlled Trial

Aim: This study is designed to evaluate whether the efficacy of treatment program focusing on Specific Stabilizing Exercises in antenatal period for treatment of pregnancy related to low back and pelvic girdle pain reduces pain and improves functional status. Study design : Experimental study, Randomized Control Trial. Method: 40 pregnant women during their antenatal period were recruited into two groups. Experimental Group (n=20) received Physical Therapy with Specific Stabilizing Exercises which included Lumbar stabilization exercises along with clinical exercises as Pelvic floor muscle exercises, Stretching exercises for tight muscles of upper& lower limb, Active ROM exercises ( Cervical spine, upper and lower limb), Strengthening exercises for weak muscles, Ordinary physical activities , Relaxation exercises and Ergonomic advice. Control Group (n=20) received clinical exercises alone which included Pelvic floor muscle exercises, Stretching exercises for tight muscles of upper& lower limb, Active ROM exercises ( Cervical spine, upper and lower limb), Strengthening exercises for weak muscles, Ordinary physical activites , Relaxation exercises and Ergonomic advice with detailed evaluation including NPRS scores and Modified ODI scores were taken at baseline as well as after 4 week of treatment. Results: Both the groups showed clinically and statistically significant improvement in NPRS scores and Modified ODI scores at the end of 4-weeks of treatment session. NPRS scores had improved by 48% in experimental group and 21% in control group. Modified ODI scores had improved 55% in experimental group and 15% in control group at the end of 4-weeks of treatment session in both the groups. Conclusion : There was significant improvement in both the groups; however the Physical Therapy with Specific Stabilizing Exercises group was more effective in reducing pain and improving functional status for patients with Pregnancy-related low back and pelvic girdle pain in antenatal period as compared to Physical Therapy without Specific Stabilizing Exercises group.

Comparative Study on the effectiveness of Maitland Mobilization Technique Versus Muscle Energy Technique in Treatment of Shoulder Adhesive Capsulitis

Objective: Different treatment approaches have been advocated for adhesive capsulitis, but there is not much scientific evidence to support the standard treatment. The purpose of this study is to establish best and efficient protocol for treatment of idiopathic adhesive capsulitis. Method and subjects: 30 subjects including both sexes between 40-60 years, Diagnosed adhesive capsulitis were selected and with lottery random sampling method were assigned in two groups (A or B) with 15 subjects each. Group A received moist pack for 15 minutes, active ROM exercises and Maitland mobilization. Group B received moist pack for 15 minutes, active ROM exercises and Muscle Energy Technique (MET). Both the groups were treated 6 times a week for 2 weeks and were told to continue the exercises at home. All the subjects were measured for pain by VAS, for all shoulder movements by goniometer on first day before starting treatment and on 15th day after treatment. Result: There was significant improvement from pre-treatment levels in pain and ROM in both groups. Although the ROM improvement was seen more in Maitland mobilization group and reduction in pain was seen more in MET group. Conclusion: MET is more effective in reducing pain so when pain of an acute or chronic nature, makes controlled contraction of involved muscles difficult, the therapeutic use of the antagonists by MET can patently be of value and as soon the pain subsides Maitland mobilization can be incorporated to increase ROM.

Outcomes of Nonoperatively Treated Displaced Scapular Body Fractures

Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

압박 긴장대 방법을 이용한 구상 돌기 골절의 견고한 고정과 조기 운동을 통한 주관절 기능의 향상

Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O`Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was (range: ), the mean flexion was (range: ), the mean pronation was (range: ) and the mean supination was (range: ). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.