Category: Blog

Izham Zain1, Nabilah Ahmad2, Nanthenii M.K2, Asyiqin3 Authors: 2Physiotherapy Department, School of Health Sciences, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan, Malaysia. 3Physiotherapy Department, KPJ Seremban Specialist Hospital, Seremban, Malaysia. Corresponding Author: 1Physiotherapy Department, School of HealthSciences, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan, Malaysia. Email: izham@kpjuc.edu.my

ABSTRACT

Background and objectives:The Anterior cruciate ligament (ACL) is one of a pair of ligaments in knee which provides stabilization and guiding of joints. There are varieties of graft sources have been used for ACL reconstruction over the past 30 years. Studies shows that ACL reconstruction and rehabilitation is widely conducted in other Asia countries and none were done in KPJ Seremban Specialist Hospital. Hence, this study is to determine the outcome of physiotherapy rehabilitation on ROM, pain level and muscle strength following ACL reconstruction patient in KPJ Seremban Specialist Hospital.Methods: Cross-sectional retrospective study, secondary data collection whereby studies are carried out at one time point or over a short period.Checklist form was used to determine the physiotherapy assessment and interventions. Results: A total of 122 subject were involved in this study. 88.3% male and 11.7% females undergone ACL reconstruction. Most common physiotherapy intervention used are IT and cryotherapy (90%) and combination of strengthening and mobility exercises (94.5%) and there is no significant difference in both intervention groups (p>0.05). Conclusion: Studies conducted shows there is no significant difference in the evaluation of range of motion of knee, pain scale and muscle strength could be due to the intervention used were not particular and commonly used.

Keywords: Anterior Cruciate Ligament, Physiotherapy Rehabilitation.

Received on 23rd November  2019, Revised on 30th November 2019, Accepted on 9th December 2019

DOI:10.36678/ijmaes.2019.v05i04.005

INTRODUCTION

The anterior cruciate ligament (ACL) is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads¹. It is one of the most frequently injured structures during high impact or sporting activities. The ACL does not heal when torn, and surgical reconstruction is the standard treatment especially in the field of sports medicine². The ligament is inserted medially to the anterior intercondylar of the tibia attaching partially with anterior lateral meniscus way up posteriorly, twisting on itself and spreading out to posterior medial aspect of the lateral femoral condyle^1,3.Injuries to the ACL is one of the most common and annihilating knee injuries primarily derived as the result of sports involvement apart from normal lifestyle. Studies reported, 50 to 80% of ACL injury are non-contact type are divided into four categories, namely the environmental, anatomical, hormonal as well as the biomechanical⁴.These injuries usually lead to excess accumulation of synovial fluid in or around the knee joint which commonly known as joint effusion. Based on previous study,ACL injury also contributes in weakness of quadriceps muscle and reduce functional performance. Evidence shows that surgically advances in fixationmethods and graft construction techniques have dramatically improved the outcomes of anterior cruciate ligament (ACL) reconstruction.Success rate of primary ACL reconstruction has been reported to range from 75% to 93% with excellent results on relief symptoms, restoration of functional stability, and early return to normal activity levels^5,6,7,8. Assortment of graft sources like autografts, allografts and synthetic have been used for ACL reconstruction to improve function and ACL deficient knee^4,7,8. Physiotherapy rehabilitation on post operative ACL reconstruction is vital and crucial in order to regain functional abilities. Restore joint range of motion, regain muscle strength and reduce pain are the physiotherapy objectives on post operative ACL reconstruction^5,6,8. There are numerous intervention used to ensure the successful of post operative rehabilitation. Electro physical agents were used to manage the pain and active muscle contraction were introduced immediately in order to gain muscle strength, restore knee function and gaining maximum capabilities. The interventions usedmay be adapted depending on the equipment availability at each facility, the progression outcomes of an individual’s. Therefore, the plan of treatmentis best to be individualized for optimal return to activity. Hence, the objective of this study is to determine the outcome of physiotherapy rehabilitation on ROM, pain level and muscle strength of patients following ACL reconstruction.

METHODOLOGY

This was a cross-sectional study assessing secondary data kept at the Record Department of KPJ Seremban Specialist Hospital. The data collection is using a set of structure checklist consists of 3 section. Section A is about the demographic data includes age, gender and race.Section B, pertaining to physiotherapy pre and post assessment on Range ofMotion (ROM) of knee in a numerical form (0 degree to 135 degree), pain score using Numerical Rating Scale (NRS of 0 to 10) and Manual Muscle Testing (MMT grade 0 to 5)^10,11,12. Section C is regarding types of physiotherapy intervention that used in managing post operative ACLpatients. The data was descriptively analyzed to determine the frequency of demographic data, types of physiotherapy intervention. The one way ANOVA was used to determine any significant difference between physiotherapy outcomes and treatment interventions. This study obtained the approval of study ethics from KPJ Healthcare University Research &Ethical Committee and KPJ Seremban HospitalResearch & Quality Innovation Committee.

RESULTS

A total of 111treatment card were involved in this study. Most of treatment card assessed were male (88.3%) and the remaining 11.7% was females. The highest number of subject underwent ACL reconstruction were between 25 – 29 years old (56.7%) and 43.3% were 30 – 35 years of age category (Table 1).

Most of the evidence available on usage of electro physical in post ACL reconstruction was inconclusive^5,10. However, the utilization of electro physical agents in managing the post surgery pain indicate a positive outcome ^5,10. An increase in local blood circulation has beneficial effects of electrotherapy on post-surgical acute pain and swelling¹⁰. The choice of type electro physical agents was merely on therapist clinical experience and availability of equipment. The types of electro physical agents used varies and the utmost choice of treatment were a combination of Interferential Therapy (IT) & Cryotherapy, TENS & Cryotherapy, Ultra Sound (US)& Cryotherapy representing 90.1%, 9.0% and 0.9% respectively. There is no statically difference between all electro physical agent groups but relatively, there is an improvement of post intervention pain score regardless the type of electro physical agents used (Table 2).

The usage of electro physical agents and exercise intervention has been in tandem for post ACL surgery⁵. There were numerous available evidence suggest such combination and it offered comfort and faster recovery. The combination of strengthening and mobility exercises werethe commonest (94.5%) active approach used in KPJ Seremban Specialist Hospital. Statically, there’s no significant difference between exercise groups but relatively all groups indicate an increase of strength and joint range motion at post surgery (Table 2).

DISCUSSION

Anterior Cruciate Ligament (ACL) injury occurs not only among athletes but also among sedentary adults and reconstruction has been evolved over the pass thirty years recommended for patients with functional instability either with sporting activity or activities of daily living. Interventions used in treating post-operative ACL patient in KPJ Seremban Specialist Hospital are electro physical agents and exercise therapy.Electro physical agents has an important role in physiotherapy interventions.

The basic principles on which electrotherapy function is remain simple through a wide range of applications that can be derived in acute patient care.Previous study has proven that the application of an external energy to the tissues can result in the activation, stimulation or enhancement of physiological activity in particular tissues and seems suitable to be used for acute condition^5,10.Exercise interventions are widely used and belief able to restore functional capabilities and ensure faster return to work. The current ACL rehabilitation emphasizeson the importance of immediate muscle contraction, gaining joint motion and early weight bearing in order to ensure early return to functional abilities.Most of the available evidence indicate significantresults of exercise intervention following early reconstruction procedure conducted ^5,6,9,10,. The appropriate graft choice for ACL reconstruction remains controversial however it has no significant effects on the rehabilitation outcomes. An early active rehabilitation seems crucial and aides the faster recovery and shorten the duration return to daily life^6,7,8.

The tools used to measure the outcomes seems to be subjective in nature but the reliability of such measurement is acceptable and appropriate^10,11,12. The results of this study were not comparable in gender due to small number of ACL reconstruction among female. Furthermore, it is not the scope of study to determine the difference of outcome among gender group.

Ethical Clearance: An initial application was addressed to Research Ethics Committee, KPJ Healthcare University College, Nilai, Malaysia and approval received for conduct of this study with reference number KPJUC/RMC/BPT/EC/ 2018/139, Dated 21/05/2018.

Conflict of interest: There was no conflict of interest on conduct of this study.

Fund for the study: The fund for the study was granted by KPJ Healthcare University College, Nilai, Malaysia.

CONCLUSION

The rehabilitation intervention conducted by rehabilitation department of KPJ Seremban Specialist Hospital is consistent with previous available evidence. A standardized outcome measured with more objective measurement should be introduced in order to have a more accurate reading. Future study using clinical trial should be conducted in order to determine the effectiveness of physiotherapy rehabilitation on ACL reconstruction.

REFERENCE

1. Kiapour, A., & Murray, M. (2014). Instructional Review : Knee Basic science of anterior cruciate ligament injury and repair ;3(2) : 20-31.
2. Duthon, V. B., Barea, C., Abrassart, S., Fasel, J. H., Fritschy, D., & Menetrey, J. (2006). Anatomy of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy ; 14 (3) : 204 – 213.
3. Markatos, K., Kaseta, M., Lallos, S., Korres, D., & Efstathopoulos, N. (2013). The anatomy of the ACL and its importance in ACL reconstruction : 747 – 7.
4. Allen F. Anderson, MD, Robert B. Snyder, MD, and A. Brant Lipscomb, Jr., MD. (2001).     A Prospective Randomized Study of Three Surgical Methods. The American Journal of Sports Medicine; 29 (3): 272 – 279.
5. Tovin, B. J., Wolf, S. L., Greenfield, B. H., Crouse, J., & Woodfin, B. A. (1994). Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Physical Therapy ; 74 (8) : 710 – 719.
6. Heijne, A. & Werner, S. (2010). A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomized outcome study. Knee Surg Sports Traumatol Arthrosc : 18: 805.
7. Allen F. Anderson, MD, Robert B. Snyder, MD, and A. Brant Lipscomb, Jr., MD. (2001).     A Prospective Randomized Study of Three Surgical Methods. The American Journal of Sports Medicine; 29 (3): 272 – 279.
8. Freedman K.B., Damato M.J., Nedeff D. (2003). Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta analysis Comparing Patellar Tendon and Hamstring Tendon Autografts. The Americal Journal of Sports Medicine: 13 (1); 2 – 11.
9. Holsgaard-Larsen, A., Jensen, C., Mortensen, N. H. M., & Aagaard, P. (2014). Concurrent assessments of lower limb loading patterns, mechanical muscle strength and functional performance in ACL-patients – A cross-sectional study. Knee; 21(1) : 66 -73.
10. Reid, A., Birmingham, T. B., Stratford, P. W., Alcock, G. K., & Giffin, J. R. (2007). Hop Testing Provides a Reliable and Valid Outcome   Measure   During  Rehabilitation After Anterior Cruciate Ligament Reconstruction. Physical Therapy ; 87 (3) :  337 – 349.
11. Hartrick, C. T., Kovan, J. P., & Shapiro, S. (2003). The Numeric Rating Scale for Clinical Pain Measurement: A Ratio Measure? Pain Practice;  3(4) :  310 – 316.
12. Moisala  A.S., Jarvela T., Kannus P., Jarvinen M. (2007). Muscle Strength Evaluations after ACL Reconstruction. Int J Sports Med; 28(10) : 868 – 872.

Citation:

Izham Zain, Nabilah Ahmad, Nanthenii M.K, Asyiqin  (2019).  The outcome of physiotherapy rehabilitation following ACL reconstruction at KPJ Seremban Specialist Hospital , International Journal of Medical and Exercise Science, 5 (4); 651-655.

Jibi Paul1,  P. Vijayalakshmi2 Author: 2B.P.T. Graduate,Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author: 1Professor, Faculty of Physiotherapy, Dr.MGR.Deemed to be University, Chennai, Tamilnadu, India. Mail id:  physiojibi@gmail.com

ABSTRACT

Background of the study: Core  muscle strength  training program is to prevent low back pain, to initiate limb movement for proper utilization of the muscle force and to enhance performance. This study was to compare the  effectiveness of core muscles strength training with supine bridging over prone bridging in patients with non specific low back pain. Methodology: This was an experimental study of comparative type with 40 subjects.  They were equally divided into two groups (20 in each group) by random sampling method. Study was carried out at Physiotherapy department, A.C.S Medical college and hospital, Chennai -77  for duration of 4 weeks. Subjects with the age group between 20 to 35 years with non specific low back pain were included in this study. Group  A with Prone bridging exercise received elbow plank and extended plank exercises. Group B with Supine bridging exercise received traditional bridge and alternate single leg bridge exercises. Non specific low back pain and functional disability were outcome measures of the study. VAS and ODI were used as an outcome measurement tools. Result: On comparing the mean values of Group A and Group B on Visual Analogue Scale and Oswestry Disability Index Questionnarie Group A with Prone bridging exercise showed  a mean difference of 1.95 and 8.85 on VAS and ODI respectively, which is more effective than Group B with supine bridging exercise with mean difference of  1.8 and 7.95 respectively on VAS and ODI  with significant difference at P<0.0001. Conclusion: This study concluded that prone bridging  exercise is more effective in improvement of functional activities and reducing pain than supine bridging exercise program in non specific low back pain.

Keywords: Prone bridging, Supine bridging, Low back pain, Functional disability.

Received on 28th October 2019, Revised on 24th November 2019, Accepted on 30th November 2019

DOI:10.36678/ijmaes.2019.v05i04.004

INTRODUCTION

Non-specific low back pain means, the pain is not due to any specific or underlying disease that can be found. There may be other minor problems in the structures and tissues of the lower back that result in pain. Typically the pain is in one area of the lower back, but sometimes it spreads to one or both buttocks or thighs. The pain is usually eased by lying flat. So, non-specific low back pain is ‘mechanical’ in the sense that it varies with posture or activity ^1,2.

Core strength is the muscular control required around the lumbar spine to maintain function stability. core stability refers to ability to stabilize the spine as a result of muscle activity, with core strength referring to the ability of  the musculature to then produce force through contractile forces and intra-abdominal pressure ^3,4.

The core stabilization exercises include the so-called  quadruped, pelvic tilt,  and bridging exercises.The bridging exercise is commonly used for improving lumbo pelvic stabilization. It is a comfortable and typically painless posture for improving the coordination of the core Muscles ^5,6.

Stability of the core play roles in the elderly and individuals with disabilities, not only in maintaining an upright bodyposture, but also in helping to change positions when sitting, standing, and walking. The bridge exercise was widely used in the clinic to train large muscles and local muscles to coordinate in an appropriate ratio.The bridge exercise, increases the muscular strength of the hip joint extensor group and improves trunk stability^7,8.

Aim of the study: The aim of the study was to compare the  effectiveness of core muscles strength training with supine bridging over prone bridging in patients with non specific low back pain.

Need for the study: Core  muscle strength  training program is to prevent low back pain, to initiate limb movement for proper utilization of the muscle force and to enhance performance. There was  lack  of literature support in normal  subjects of core endurance in daily activities.

METHODOLOGY                  

This was an experimental study of comparative type with 40 subjects.  They were equally divided into two groups (20 in each group) by random sampling method. Study was carried out at Physiotherapy department, A.C.S Medical college and hospital, Chennai -77  for duration of 4 weeks. Subjects with the age group between 20 to 35 years with mechanical low back pain were included in this study.

Group  A  with Prone bridging exercise  received elbow plank and extended plank exercises. Group B with Supine bridgingexercise received traditional bridge and alternate single leg bridge exercises. Subjects with spinal and disc pathologies,past history of abdominal surgery,any previous or current experience in core strengthening, any heart disease were excluded from this study. Mechanical low back pain and functional disability were outcome measures of the study. VAS and ODI were used as an outcome measurement tools.

Procedure: Subjects with clinical diagnosis of non specific low back pain were randomly allocated to two groups.Group A prone bridging exercise was received elbow plank and extended plank exercise and Group B supine bridging exercise was received traditional bridge and alternate single leg bridge exercise done with repetition of 6 times in 1^st week, 9 times in 2^nd week,12 times in third week, 15 times in fourth week, with holding time 10 seconds. Pain and functional disability were assisted before and after the intervention session using the measurement tool.

Group A: Prone Bridging Exercise

Received elbow plank and extended plank exercises done with repetition of 6 times in 1^st week, 9 times in 2^nd week,12 times in third week, 15 times in fourth week, with holding time 10 seconds.

Group B: Supine Bridging Exercise:

Received traditional bridging and alternate single bridging exercises done with repetition of 6 times in 1^st week, 9 times in 2^nd week,12 times in third week, 15 times in fourth week, with holding time 10 second.

Elbow Plank:

Assume a front support position resting on your fore arm with your shoulders directly over your elbows.Straighten your legs out behind you and lift up your hips to form a dead straight line from your shoulders to your ankles. You should be balanced on your forearms and toes with your abdomen and back working to keep your body straight and hold for 10 second.

Extended Plank:

Performing the exercise with the arms further away from the body will progessively increase the difficulty assume a pushup position with hands about 8 in front of your shoulder your body should form a straight line from ankles to shoulder hold for 10 sec.

Traditional  Bridging:

Lie face up on the floor with your knees bend and feet flat on the ground keep your arms at your side with your palms down lift your hips of the ground until your knees hips and shouldrs forms a straight line. Contract your glute muscles and abdomen  hold the bridged position for 10 second  before easing back down.

Alternate single leg bridge:

Lie on your back with your knees bent and your feet flat on the floor lift your pelvis so that youform a bridge  position with a straight line running from your shoulder to your knees.lift your right leg off the floor and extend it so that it continues the straight line. You should be able to feel your left buttock, your back and lower abdomen working to keep the positionhold for 10 seconds then repeat on the other leg.

RESULT

Group A: Prone  Bridging Exercise

The above table 1 shows significant difference on VAS and ODI within Group Awith P value <0.0001.

Group B: Supine Bridging Exercises

The above table 2 shows significant difference on VAS and ODI within group B with P value <0.0001.

Comparative Study

The above table 3 shows significant difference on VAS and ODI between Supine bridging over prone bridging Exercise groupwith P value <0.0001.

Group A Intervention is more effective with mean difference 1.95 and 8.85 of compare to mean difference of 1.8 and 7.95 in Group B.

Total 20 samples were participated in  each group. Group A  (Prone bridging)  received elbow plank and extended plank exercises and Group B (Supine bridging) received traditional bridging and alternate single leg bridge exercise.

Low back Pain (VAS Scale) has been decreased in both the groups with significant difference P<0.0001. Mean difference in outcome was  1.95 and 8.85 within Group A  and  1.8 and 7.95 within  Group B  rspectively on VAS and ODI.  

On comparing the mean values of Group A and Group B on pain (VAS) and Functional disability (ODI) of both  groups showed significant difference with p<0.0001. Group A (prone bridging exercise) shows 1.95 and 8.85 which is higher mean difference value than Group B (supine bridging exercise) 1.8 and 7.95 respectively.

DISCUSSION

A Total samples of  40  with the  age group of 20-35  were participated in the study. On comparing the mean values of Group A and Group B on Oswestry Disability Questionnaire  and VAS, both the groups showed significant difference with P<0.0001.

A Oswestry disability index (ODI) is a self reported based outcome measure used to quantify extend of disability related to low back pain. The ODI tool has been adapted for use by patients in several non-english speaking nations ^9,10.

The prone bridge (plank) is one of the most frequently used exercises to strengthen the abdominal muscles. However, in the prone bridge, the muscle action is isometric, working in co-contraction to control the pelvis. During the prone bridge exercise,the external oblique demonstrated greater muscle activation.

Studies have reported that prone bridging exercise can improve postural control and can reduce low back pain. Smaller base of support in prone bridg exercise need more muscle effort, which can improve muscle strength and low back stability inturn can reduce low back pain. Prone bridge exercise can also improve coordination of low back and pelvic floor muscles ^11,12.

Prone bridge exercise have shown more effect on joint reposition sense and improved joint proprioception than conventional bridge exercise on securing the stability of the body trunk. It has also proved more higher level effect on balance and motor control than a conventional bridge exercise ^{13, 14}.

Ethical Clearance:  Clearance was obtained from the Institutional ethical committee ofFaculty of Physiotherapy, Dr MGR Deemed to be University, Chennai with Ref No.A-58/ PHYSIO/IRB/2018-2019, Dated: 07/01/2019.

Conflict of Interest: No conflict of interest to conduct this study.

Source of Fund: It was aSelf financed study.

CONCLUSION

This study concluded that the subjects in group A performed prone bridging  exercise have shown more improvement in reducing pain and improving functional activities than in Group B (supine bridging exercise) program in non specific low back pain.

The study shows Group A and group B with prone and supine bridging exercise has effective approach in reducing pain and improving functional activities and bring back them to the normal.

REFERENCE

1. Rebecca J. Guthrie et al (2012).The effect of traditional bridging or suspension exercise bridging on lateral abdominal thickness in individuals with low back pain, journal of sport rehabilitation,21;151-160.
2. Crystian B. Oliveira et al (2018). Clinical practice guidelines for the management of non specific low back pain in primary care: an updated overview Eur spine journal 27:2791-2803.
3. Akuthota V. Nadler et al (2009). Motor Control exercise for chronic low back pain: a randomized placebocontrolled trial. Phy ther.,89: 1275-1286.
4. Angela E. Hibbs et al (2008). Optimizing perfomance by improving core stability and core strength. Sports med. 38(12): 995-1008.
5. Paul W. Hodges et al (2003). Core stability exercise in chronic low back pain. Orthop clin N Am 34,245-254.
6. Wen-Dien Chang, PhD, Hung-Yu Lin, PhD et al (2015).Core strength training for patients with chronic low back pain J. Phys. Ther. Sci. 27: 619–622.
7. Shih-Lin Hsu, PTS, Harumi Oda, PTS et al (2018). Effects of core strength training on core stability J. Phys. Ther. Sci. 30: 1014–1018.
8. Wontae Gong, PhD, PT et al (2018). The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults, J.Phys.Ther.Sci. 30: 921-925.
9. Min Yong Eom, MPH, PT, Sin Ho Chung, PhD et al (2013). Effects of Bridging Exercise on Different Support Surfaces on the Transverse Abdominis J. Phys. Ther. Sci. 25: 1343–1346.
10. Gregory J Lehman, Wajid Hoda et al (2005).Trunk muscle activity during bridging exercises on and off a Swissball Chiropractic & Osteopathy, 13:14.
11. Roland van den Tillaar, Atle Hole Saeterbakken et al (2018). Comparison of Core Muscle Activation Between a Prone Bridge and 6-RM Back Squats Journal of Human Kinetics volume, 62; 43-53.
12. Yong Soo Kong et al (2015). The effects of prone bridge exercise on trunk muscle thickness in chronic low back pain patients J. Phys. Ther. Sci. 27: 2073–2076.
13. Yong Soo Kong et al (2013). Changes in the Activities of the Trunk Muscles in Different Kinds of Bridging Exercises J. Phys. Ther. Sci. 25: 1609-1612.
14. Yong Soo Kong et al (2015). The effects of prone bridge exercise on the Oswestry disability index and proprioception of patients with chronic low back pain J. Phys. Ther. Sci. 27: 2749-2752.

Citation:

Jibi Paul, P. Vijayalakshmi (2019).Comparative effect of core muscles strength  training with supine bridging over prone bridging in patients with non specific low back pain, International Journal of Medical and Exercise Science; 5 (4): 644-650.

Jibi Paul1, Prabakaran.P2 Author: 2B.P.T. Graduate,Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author: 1Pofessor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Mail id:  physiojibi@gmail.com

ABSTRACT

Background of the study: The core musculature in concludes the muscle of the trunk and pelvis that are responsible for the maintenance of stability of spine and pelvis help in generation and transfer of energy from large to small body parts during for the cricket players in cricket. Objective of the study was to determine the effect of pelvic core exercise training on gluteus strength among college level cricketers. Methodology: This was an observational study with convenient sampling of pre and post experimental study design. Forty male cricket players were recruited from the students at Dr.MGR Deemed University with the age group of 18 to 25 years. Cricket players were included after specific selection criteria for the study. Pelvic core exercise was given to the participants for 6 weeks. Single leg pelvic bridging test used to measure the strength of gluteus muscle before and after the training. The core exercise training will give to all cricketers. The prescribed exercise performed for 4 days in a week for 30 minutes and this were followed for 6 weeks. At the end, they were assed with single leg pelvic Bridging test. Paired T-test analysis used to find the significant difference between pre and post test measurement. Results: Pelvic core exercise training found significant effect on improving the strength of gluteus muscles among college level cricketers with mean difference of 6.68 and P<0.0001. Conclusion: This study concluded that Pelvic core exercise training can improve the strength of gluteus muscles among college level cricketers.

Keywords: Cricketers, Pelvic core exercise, Gluteus strength, Single leg pelvic bridging test

Received on 26th October 2019, Revised on 22th November 2019, Accepted on 29th November 2019

DOI: 10.36678/ijmaes.2019.v05i04.003

INTRODUCTION

Cricket is an international game. This game was played by many people professionally and non-professionally. In a team there are 10 players with batsman, keeper and fielder. Mostly running, throwing and forceful trunk rotation occurs. Therefore core muscles play an important role on cricket players^1,2.

The core musculature in concludes the muscle trunk and pelvis that are responsible for maintenance of stability of spine and pelvis. The core strengthening required for cricket, throwing, bowling, batting events in cricketers. Some of the core muscles they are thoracolumbar fascia, paraspinalis, abdominalis, hip gridle musculature, diaphragm and pelvic floor muscles they are mostly involved in sports activities of cricketers^3,4.

Spines and pelvis are centrally located to be able to perform many of the stabilizing functions that body will require in order for the distal segments. To do specific function providing the proximal stability for distal mobility and function of limbs ^5,6.

Core muscle strengthening training is widely practised by professionals with the goals entrancing core stability and increase core muscular strength there by improves performance of cricketers^7,8.

Pylometric and isometric core strengthening is widely used as a method of developing explosive strength capacity in those sports that require jumping ability such as athletics, basketball and volley ball.

Aim of the study: The aim of the study is to determine the effect of pelvic core exercise training on gluteus strength among college level cricketers.

 Need of the study: Core muscles play an important role in cricket players. According to that, plyometric and isometrics are used to improve explosive power and agility by core strengthening. Advanced technique such as plyometric training protocol has proven more effect on sports events. But not many studies did to assess its effectiveness on events such as on cricketers.

METHODOLOGY

This was a study with Quasi experimental design and  a cross sectional pre-post study. Study was conducted in physiotherapy department of A.C.S. Medical College and Hospital, Chennai. Total 40 Subjects were selected for this study. Convenient Sampling Method used to select the samples. Total duration of the study was 6 Weeks. Male subjects with 18-25 Years of age and Collegiate Cricket players were included for this study. Patients with any neurological disorder, Systemic disease, Stopwatch, Single leg pelvic bridging test, Strength of Gluteus muscle, Couch were ecluded from the study.

Procedure: Players volunteered to participate in the training program were selected from Dr. M.G.R. Educational and Research Institute, Chennai. A total of 40 players were selected and explained about the study. Informed consent was obtained from the subjects.

Exercises such as abdominal crunch, reverse crunch, single leg crunch, double leg crunch were given to the cricket players. The pre and post test values were measured using single leg pelvic bridging test.

The Single Leg: Step 1: Lay on your back with your knees bent. Step 2: Kick one leg out straight. Step 3: Pick your hips up and hold this bridge for 10 seconds.

The above table 1 shows the mean value ofAge, Height, Weight and BMI with 20.78, 167.7, 62.18 and 22.27 respectively.

Bridge test

Abdominal crunch: Abdominal crunches are simple to perform. Begin flat on your back with your knees bent and the heels of your feet only a few inches from your buttocks.

Reverse crunch: Lie down on the floor with your legs fully extended and the arms to the side of your torso with the palms on the floor. While inhaling, legs are moved towards the torso as you roll the pelvis backwards. At the end of this movement your knees should touch the chest.

Single leg crunch: While keeping abdomen tense lean backwards and bring the raised knee towards the chest. Bring raised knees back down and switch to the other leg to complete one repetition.

Double leg crunch: Lie flat on your back and place your hands behind your head. Bring your feet close to your glutes so your knees are bent and place your flat on the ground.

RESULTS The above table 1 shows the mean value ofAge, Height, Weight and BMI with 20.78, 167.7, 62.18 and 22.27 respectively. The above table 2 shows the Paired t Test for pelvic core exercise training on gluteus strength among college level cricketers. Pelvic core exercise training found significant effect on improving the strength of gluteus muscles among college level cricketers with mean difference of 6.68 and P<0.0001.

The above table 2 shows significant difference in pelvic core exercise training on gluteus strength among college level cricketers with mean difference of 6.68 and P<0.0001 

DISCUSSION

The above table 1 shows the mean value of Age, Height, Weight and BMI with 20.78, 167.7, 62.18 and 22.27 respectively

The above table 2 shows the Paired t Test for pelvic core exercise training on gluteus strength among college level cricketers with mean difference of 6.68 and p<0.0001 .

Proximal stability is important for distal mobility, a proximal to distal patterning of generation of force, and the creation of interactive moments that move and protect distal joints⁹.

Marshall And Murphy core stability is a generic description for the training of the abdominal and lumbopelvic region. Local stability refers to the deep intrinsic muscles of the abdominal wall, such as transverse abdominus, and multifidus. These muscles are associated with segmental stability of the lumbar spine during gross whole body movements¹⁰.

Core stabilization training for middle and long distance runners’’ discussed the theory behind the core training for injury prevention and improving a distance runners efficiency and performance. For runners whose event involve balance and powerful movements of the body^11,12.

In this study the pelvic core exercise training found significant effect on improving the strength of gluteus muscles among college level cricketers with mean difference of 6.68 and P<0.0001. Sothe study rejecting the null hypothesis and accepting the alternative hypothesis.

Ethical Clearance:  Clearance was obtained from the Institutional ethical committee ofFaculty of Physiotherapy, Dr MGR Deemed to be University, Chennai with Ref. No. IV C-030/ PHYSIO/IRB/2017-2018, Dated: 08/01/2018.

Conflict of Interest: No conflict of interest to conduct this study.

Source of Fund: It was aSelf financed study.

CONCLUSSION

The study concluded that there is significant improvement in strength of gluteus muscles among college level cricketers. Hence  the study rejects the null hypothesis and accepts the alternate hypothesis.

REFERENCES

1. Brain wilt, steven WC. (2001).The effects of plyometric circuit training on strength on muscle capalities of trunk; 28(5)1145.
2. Adams and Throgmartin D. (1992). An investigation of selected demands of plyometric training on exercise on muscular leg strength and power.Track and Field Quarterly Review. 84(1):36-40.
3. Rimmer k and Sleivert (2008).Effects of plyometric intervention program on splint performance; journal of strength and conditioning research 14;295-301.
4. Micheal G, Twist G. (1997). Agility training methods and preventing techniques of injury. Vol 129; issue 5.
5. Lachance P F. (1995). Plyometric exercise. Journal of strength and conditioning Research, 8:16-23.
6. Shea, cristopher D. (2013). Principles of agility training and preventive measures, 471- 492.
7. Terese A Stone. (2006). Sports injuries mechanisms prevention and treatment, 1^st edition: 17-21.
8. Parson, Miller, Erdman (1998). Principle of plyometric training and technique  vol7, p 55-64.
9. Nalk.V., Patil, P.& Chikaraddi, V. (2013). Action event retrieval from cricket video using audio energy for event summarization. International Journals of computer engineering & technology, 4(4), pp.267-274.
10. Rolf, S. and Rhondda, J. (2012). The effect of core and lower limb exercises on trunk Strength and lower limb stability on Australian soldiers. Journal of Military and Veterans’ Health, 20, pp. 4.
11. Kim, H. Y. (2012). Effects of plyometric training on ankle joint motion and jump Performance. Korean Journal of Sports Medicine, 30, pp. 47-54.
12. Athanasios, K. and Eleftherio, K. (2009). Effects of small-sided games on physical Conditioning and performance in young soccer players. Journal of Sports Science And Medicine.,8, pp.374-380.

Citation:

Jibi Paul, Prabakaran.P (2019).  Effect of pelvic core exercise training on gluteus strength among college level cricketers , International Journal of Medical and Exercise Science; 5 (4): 639-643.

Dhanalakshmi.M.R1, Prashanth V Mangalvedhe2, Jibi Paul3 Authors: 1B.P.T. Graduate,  JSS College of Physiotherapy, JSS Hospital Campus, Mysuru, Karnataka,India.    3Professor,Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author: 2Lecturer, JSS College of Physiotherapy, JSS Hospital Campus, Mysuru, Karnataka,India. Mail id:  dhanuphysio7@gmail.com

ABSTRACT

Introduction: Moberg pickup test (MPUT) is a standardized test for hand dexterity developed by Erik Moberg, in 1958. This test also assesses cognition, stereognosis, and comprehension. Aim of the study was to find the normative values for the Moberg pickup test and to find the  impact of gender and handedness on hand dexterity among carpel tunnel syndrome patients. Method: This was aCross-sectional study, conducted at JSS College of physiotherapy, Mysuru, Karnataka for a duration of 2 months. This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Test objects were placed on the table on the same side of right and left hands being tested with eyes open and closed, whereas the container was placed on the opposite side of the hand being tested. Three trials were done and the best out of the three was taken for analysis to obtain the normative values for Mobergpickup test. Result: The results show that the hand dexterity of the subjects was significantly good. Eyes open and close on dominant hand and Non dominant hand with mean values of 7.735, 12.806 and 9.206, 14.327 respectively. Conclusion: Females performed the test faster than males, and task performance with the dominant hand was faster than the non-dominant hand.

Keywords: Hand dexterity, Moberg Pick-Up Test, Carpel tunnel syndrome, Normative values

Received on 26th October 2019, Revised on 22th November 2019,Accepted on 27th November 2019

DOI: 10.36678/ijmaes.2019.v05i04.002

INTRODUCTION

Dexterity is usually defined as a function of control, the coordination of muscle movements usually in synchronization with the eyes, and it can also be defined as the quality of motor skills of hands and fingers.  Dexterity in each person is qualitatively different and unique^1,2.

Moberg pickup test (MPUT) is a standardized test for hand dexterity developed by Erik Moberg, in 1958. This test also assesses cognition, stereognosis, and comprehension. Moberg defines functional sensation as tactile gnosis, specifically sensiti­vity present at the fingertips, which allows a significant awareness of the external object^3,4.

Need For the Study

Normative value for Moberg Pick-Up Test is important to check hand dexterity. Present available are from western population. Characteristics of Indian population may differ from the western population.

Hence, the need of this study was to establish the normative values of Moberg pickup test in young adults of age 17- 25years in Indian population.

Objective:  Primary objective was to find the normative values for the Moberg pickup test. Secondary objective was to find the difference on normative values of Moberg pickup test between male and female on their hand dexterity.

METHODOLOGY

This was a Cross-sectional study conducted at   JSS College of physiotherapy, Mysuru, Karnataka.This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Duration of the study was 2 months.

Inclusion Criteria:  Both genders willing to participate were selected with age group 17 to 25 yrs.

Exclusion criteria: Participants with neurological illness, Any congenital deformity of hand, Participants with recent hand injuries and fractures, Participants with visual impairment, Behavioural abnormality that interferes with the test were excluded from the study.

Materials: Small container, stop watch, screw, safety pin, cap nut, washer, bolt, key, 2 coins, long hexagon nut, square nut, small hexagon nut, nut and bolts.

Procedure: Permission from JSS College of Physiotherapy was obtained.  Informed consent from the participants was taken before including the participants in the study. Based on inclusion and exclusion criteria the participants were recruited for the study. Hand dominance is ascertained by asking each subject which hand they used to perform skilful activities like writing, eating etc.  

Hand dexterity was measured bilaterally. Twelve objects were spread randomly on a table, next to the container. Objects includes – Screw, Safety pin, Cap nut, washer, bolt, key, 2coins, long hexagon nut, small hexagon nut, nut and bolt, square nut. Test objects were placed on a table and a container was kept on the opposite side to the hand being tested. Participants were asked to drop the items as fast as possible in a box placed nearby. Stopwatch was used to record the time for the Performance.

This test was performed in 2 phases: both dominant and non dominant hand has been tested with open and closed Eyes. The test was repeated three times to obtain an average. First tested the writing ability was tested with the dominant hand followed by non dominant hand was tested. In the second phase: first, the participants were asked to hold the container with the opposite hand and they were made to close their eyes.  Second, when only 2 or 3 objects where remaining on the table the participants were informed the number of objects remaining to perform the task.

RESULT

The outcome value obtained from the data collection was tabulated for the statistical analysis of the data; mean, median and standard deviation of the collected data done.

DISCUSSION

The normative values of Moberg pick up test in the Indian population are not available. Hence, this study was done to find the normative values of Moberg pick up test in young adults of JSS College of Physiotherapy, Mysuru.

Previous studies have been conducted on subjects with carpal tunnel syndrome, comparison between young adults and middle aged persons, and older population, and a survey of comparison between button test and Moberg pick up test ^5,6.

This study was done on a population of 171 typical young adults comprising of 37 males and 134 females with an age group between 17 and 25 years. Three trials were done and the best out of the three was taken for analysis to obtain the normative values for Moberg pickup test. The present study confirmed that the performance of this test shows major difference between the male and the female population.

Many studies have done to find the score grading for pinch strength, grip strength, fine motor skill and depression among population with carpal tunnel syndrome ^7,8,9.

There is clear evidence from earlier studies that females performed faster than males and this study has also showed similar results. It was observed that the dominant hand was faster in executing this test than the non-dominant hand with the eyes open.

CONCLUSION

Moberg pick-up test has been a reliable tool to test hand function. The time duration and the dominance of hand show the comparison of reaction in individuals. The results show that the hand dexterity of the subjects was significantly good. Task performed with dominant hand was faster than the non-dominant hand.  Females performed the test faster than males.

Future Recommendations: The future studies should include individuals with equal number of males and females for better efficacy of results. Standardized setting can be used to perform the Moberg test.

REFERNCES

1. Amirjani N, Ashworth N, Olson J, Morhart M, and Chan K. (2011). “Discriminative validity and test–retest reliability of the Dellon-modified Moberg pick-up test in carpal tunnel syndrome patients”, Journal of the Peripheral Nervous System. 16;51–58.
2. Amirjani N, Ashworth N, Gordon T, Edwards C and Chan K (2007). “Normative Values and the effects of age, gender, and handedness on the Moberg Pick- Up Test ”, Muscle Nerve35;788-792 .
3. Marcolino AM, Barbosa RI, Souza DNA, Rebelo R B, Delgado PM, Mazzer N, et al., (2012). “Correlation between Moberg Pick-Up test and sensation threshold test after median nerve reconstruction”,ActaFisiatrvol 19(4);216-21.
4. Stamm T, AlexanderP, Klaus M, and Josef S. (2003). “Moberg Picking-Up Test in Patients With Inflammatory Joint Diseases: A Survey of Suitability in Comparison With Button Test andMeasures of Disease Activity”, Arthritis & Rheumatism (Arthritis Care & Research), Vol. 49(5); 626-632.
5. Amadio P C, Silverstein M D, Ilstrup D M, Schleck C D, Jensen L M.  (1996). Outcome assessment for carpal tunnel surgery: the relative responsiveness of generic, arthritis-specific, disease-specific, and physical examination measures. J Hand Surg Am., 21: 338– 346. 
6. Atroshi I, Lyrén PE, Gummesson C. (2009). The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res.  18: 347-358.
7. Atalay NS, Sarsan A, Akkaya N, Yildiz N, Topuz O. (1984). The impact of disease severity in carpal tunnel syndrome on grip strength, pinch strength, fine motor skill and depression,120(4): 517-9

• Baker NA, Moehling KK, Desai AR, Gustafson N P.(2013).Effect of carpal tunnel syndrome on grip and pinch strength compared with sex- and age-matched normative data. Arthritis Care Res (Hoboken). ; 65: 2041-2045.
• Bland JD. ( 2000).  A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve., 23: 1280-1283.

Citation:

Dhanalakshmi.M.R, Prashanth V Mangalvedhe, Jibi Paul (2019). Normative values of moberg pickup test in young adults, International Journal of Medical and Exercise Science; 5 (4): 634-638.

P. Sathya1, Hannah D’souza2 Author: 2B.P.T. Intern, D.Y. Patil deemed to be University, School of Physiotherapy, Nerul, Navi Mumbai, India  Corresponding Author: 1Associate Professor, D.Y. Patil deemed to be University, School of Physiotherapy,Navi Mumbai, India. Mail id: drsathyagp@gmail.com

ABSTRACT

Introduction: Musicians just like any other occupation are prone to injuries. Every type of work requires certain bodily movements and positions to be used in a repetitive manner. These injuries/disorders then in turn affect the ability of the musician to play his instrument most efficiently. The purpose of this study was to find out prevalence of Upper Limb Problems in Instrumental Subjects using the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Methodology: A cross sectional survey was conducted on 100 Subjects from Mumbai, aged 15 to 30 years who were right hand dominant and had a minimum of 3 years of experience playing a musical instrument. Demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further analyzed. Result: The subjects playing Keyboards were mostly affected on dominant side by DASH score with mean value 11.086. Symptoms on the dominant and non dominant sides were 40.23% and 45.95% respectively with functional disability on the dominant side 31.42%.Percussionist were most affected in the psychological aspect with 33.33%, where string players were more affected in Music Module Domain with mean value 14.305. Conclusion: The study concluded that the subjects playing Keyboards were mostly affected in most domains of DASH Scale. Percussionist were the most affected in Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain in DASH scale. Methodology: A cross sectional survey was conducted on 100 Subjects from Mumbai, aged 15 to 30 years who were right hand dominant and had a minimum of 3 years of experience playing a musical instrument. Demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further analyzed. Result: The subjects playing Keyboards were mostly affected on dominant side by DASH score with mean value 11.086. Symptoms on the dominant and non dominant sides were 40.23% and 45.95% respectively with functional disability on the dominant side 31.42%.Percussionist were most affected in the psychological aspect with 33.33%, where string players were more affected in Music Module Domain with mean value 14.305. Conclusion: The study concluded that the subjects playing Keyboards were mostly affected in most domains of DASH Scale. Percussionist were the most affected in Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain in DASH scale.

Keywords: Musicians, Upper Limb Problems, Disability of Arm, Shoulder and Hand (DASH) scale

Received on 23rd October 2019, Revised on 20th November 2019, Accepted on 26th November 2019

DOI: 10.36678/ijmaes.2019.v05i04.001

INTRODUCTION

Everybody loves music. Listening to music induces pleasure but making music is a distinct experience in itself. The number of musicians we have now is much more than we ever had before. Being a Musician could be a passion, a hobby or a career. However, musicians just like any other occupation are prone to injuries. Every type of work requires certain bodily movements and positions to be used repetitively. Musculoskeletal occupational disorders result from an interaction between the individual worker, his tools and his environment. In the case of the instrumental musician, his tools are the instruments¹.

Musculoskeletal problems in musician occurs due to the repetition of certain movements, incorrect posture, prolonged practice hours, lifting of heavy instruments, holding the instrument in place for a long time, psychological pressure, etc. Because of these symptoms the musician may not be able to play their instrument effectively. The musician may also have difficulty performing ADLs due to the symptoms.  Several researches have been done in the past on different body sites where in a musician could be affected. Each category of instrument uses the upper limb the most, leading to an increase risk of injury. Examples of these could be tendinitis, weakness, stiffness, etc.

According to Zaza et al., the definition of Playing-Related Musculoskeletal Disorders (PMRDS) is Pain and other symptoms that are chronic, beyond your control, and that interfere with the ability to play your instrument at the usual level².According to Lederman et al., With carefully designed treatment, the majority of instrumental musicians can return to full and pain free playing.³ Correct diagnosis of the problem and physiotherapy techniques to prevent or reduce these symptoms can be given in order for the musician to play his/her instrument in the most optimum way without any hindrance. Hence, the purpose of this study was to find out prevalence of upper-limb problems in musicians.

METHODOLOGY

The Target Population was Instrumental Musicians.A cross sectional survey was conducted on musicians from Mumbai from all categories namely Strings, Keyboards, Brass, Percussions and Woodwind.  100 subjects aged 15 to 30 years who were right hand dominant and had a minimum 3 years experience of playing their instruments were included in the study. The nature and purpose of study was explained and prior consent was obtained from the participants. The demographic data was collected and the subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire  for the Dominant as well as the Non Dominant Upper Limb. The Data collected was further taken for statistical analysis ⁴.

RESULT

According to the Data Obtained, most subjects in the sample were Males.

The Instruments played by the subjects in this research were Trumpet (Brass Category), Keyboard, Piano and Harmonium (Keyboards category), Cajon, Djembe, Drums and Tabla (Percussion Category), Bass Guitar, Guitar, Sitar and Violin (Strings category), Flute and Saxophone (Woodwind category)

There were 41 String players, followed by 21 Keyboard players, 21 Percussionists 15 Woodwind players and 2 Brass players. The subjects had between 3-16 years of training. Sitting position was preferred as compared to Standing. The formula provided in the Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to calculate the scores.

Inference (Table 1) The non-dominant side total score is more than the dominant side. The Keyboards category scored highest followed by percussion, strings, brass, woodwind on the dominant side. Brass was the highest followed by Keyboards, percussions, strings, woodwind on the non-dominant side.

Inference (Table 2.1) Thekeyboard category had the highest percentage followed by percussion, strings, brass, woodwind on the dominant as well as the non-dominant side

Inference (Table 2.2) Thekeyboards category had the highest percentage followed by percussion, strings, brass, woodwind in pain last week, pain on activity, and stiffness. For Tingling- The keyboards had the highest percentage followed by percussions, brass, strings and woodwind. For Weakness- The keyboards had the highest percentage followed by brass, strings, percussions and woodwind.

Inference (Table 3)- Thekeyboard category has the highest percentage followed by percussion, strings, brass, woodwind on the dominant side. Brass was the highest followed by Keyboards, percussions, strings, woodwind on the non-dominant side.

Inference (Table 4) The percussion category has the highest percentage followed by keyboards, strings, brass and woodwind.

Inference (Table 5) The strings category has the highest score followed by percussions, keyboards, strings, brass and woodwind.

DISCUSSION

In this study 100 musician playing different musical instrument were taken. The subjects were asked to fill the Disability of Arm, Shoulder and Hand (DASH) questionnaire. The study reveals that the DASH questionnaire scores varied for each instrument category from Dominant to Non-Dominant extremity. Overall the Non Dominant Upper Limb had higher DASH scores compared to the Dominant Upper Limb (Table 1).

The DASH question numbers 24-28 were used to assess the Severity of Symptoms. The questions were based on the symptoms of pain, tingling, weakness and stiffness. On the Dominant as well as the Non-Dominant sides, the subjects playing Keyboards were the most affected. This was followed by the subjects playing Percussions and Strings respectively. The Brass and Woodwind subjects were the least affected on both the sides. Higher the scores, more the intensity of the symptoms experienced. With the Data obtained, it was noticed that each category showed varying symptoms. The analysis was done by comparing the scores of each symptom individually.

The Brass category showed higher symptoms of Pain, Tingling and Weakness. The Keyboardists complained of Pain and Stiffness. The Percussionists had Pain and Tingling while the Woodwind players had the highest scored symptom of Weakness among other symptoms. (Table 2.1 and 2.2) According to a study, musicians due to the competitive work environment felt forced to play despite their symptoms, motivated by a concern for reprisal or dismissal. Despite their symptoms, the professional musicians, therefore, will be inclined to perform at rehearsals and concerts, and play less when practicing alone, where reducing their effort can aid their recovery without compromising their colleagues.⁵ The stress-inducing movements in playing can be Isotonic or Isometric. Isotonic movements are those in which fast movements are done to obtain sound in the instrument. These create stress on the surrounding tendons and over time can lead to pain due to chronic tendinopathy. e.g. striking the keyboard keys, bowing the violin. Isometric movements are those in which there is prolonged  periods of static unstable postures to support the instrument or hold it in place. These result in muscle imbalance, which may further lead to chronic myofascial pain⁶.

The Symptoms in the subjects may have caused difficulty in performing daily functions. This was assessed by DASH question numbers 1-23. This Domain differed based on Dominance. Thesubjects playing Keyboards were the most affected followed by percussion, strings, brass and woodwind on the dominant side.  The subjects playing Brass instruments were most affected followed by Keyboards, percussions, strings and woodwind on the non-dominant side. (Table 3) This suggests that because of the symptoms of pain, tingling, stiffness, weakness, etc. the musician has difficulty performing day to day functions at ease.

According to Rietveld AB et al., Musicians experience upper limb injuries such as impingement syndromes eg. painful arc, supinator syndrome, intersection syndrome. frozen shoulder, tennis elbow, golfers elbow, neuropathies including median and ulnar nerve, trigger finger, hypermobility and focal dystonia.⁷ According to another study done on Orchestra musicians, The musicians reported changed or impaired way of playing, difficulties in daily activities at home, in leisure time activities and in sleep as common consequences of musculoskeletal symptoms⁵

Psychological aspect was assessed by DASH question numbers 29,30. Q. 29 was based on Sleeping difficulty due to symptoms and Q. 30 was based on feeling less confident or useful because of the symptoms. The subjects playing Percussions seemed to be most affected. It was followed by the Keyboards, though there is only a slight difference between scores of Percussion and Keyboards subjects. This was then followed by the subjects playing Strings, Brass and Woodwinds. (Table 4).

Injuries occur as a result of physical stress which in turn induces psychological stress. Fears of a musician are thoughts of missing notes, not playing correctly, leaving a bad impression, losing their job and ending up in poverty. These thoughts produce physical reactions such as sweating, constricted breathing, tense muscles, which lead to the likeliness of a performance being unsuccessful⁸.

According to a study using the Bergen Insomnia Scale (BIS) musicians had higher prevalence of insomnia symptoms compared to the general population⁹. This shows that Psychological factors also play a great role in musicians. Often musicians fail to find help for curing their injuries and this can lead to the end of one’s career, which leads to a downward spiral of anxiety and depression⁸. Challenges faced were related to bad and abusive teachers, entry into a conservatoire, music industry demands, unsupportive environments, comparison and competition socially, injury, psychological aspects, balancing work and personal life⁷.

To assess the Music Module, DASH Music/Sports module was used. The questions were based on the impact of your arm, shoulder or hand problem on playing the musical instrument. The subjects playing Strings were the most affected followed by Percussions, Keyboards, Brass and Woodwind. However, the subjects playing Keyboards and Brass had a minute difference in scores.

Subjects playing Woodwind instruments was the least affected in this domain as well. This shows that a because of the symptoms, the musician is not able to play his instrument in the usual way or in a way in which the musician would like to. This also results in spending lesser time in playing the instrument. Musculoskeletal symptoms resulted in an impaired way of playing the instrument⁵. According to a study; ability to play to their optimum level was affected due to the symptoms associated¹⁰. 

The problems experienced by musicians depend on the physical demands of that particular instrument. Keyboardists play a répertoire of movements that require great amplitude of abduction of the fingers. Techniques of octaves and chords and small hand size were associated with symptoms¹¹.  Intersection syndrome is seen in Drummers⁷. Brass players may have the highest risk of developing carpal tunnel syndrome¹². Prolonged static posture is required such as static abduction of the upper-arm in violin and flute.

In these two instruments the left shoulder is adducted resulting in a ‘wringing out’- phenomenon of the rotator-cuff: the poor blood supply of the ‘critical zone’ in the supraspinatus tendon is further impaired by the squeezing effect of this tendon being stretched over the head of the adducted humerus⁷.   The posture of Guitarists and Bassists provoke an extreme flexion of the fretting wrist and fingers that possibly may result in the fretting hand injuries that is the Non-Dominant hand¹³.

Ethical Clearance:  Clearance was obtained from the Institutional ethical committee ofD.Y. Patil Deemed to be University, School of Physiotherapy, Navi Mumbai.

Conflict of Interest: No conflict of interest to conduct this study.

Source of Fund: It was aSelf financed study.

CONCLUSION

This study concludes that the subjects playing Keyboards were the most affected in most domains of DASH scale except Psychological and Music Module Domains, both in the Dominant and Non Dominant side.

This study also concludes that the subjects playing Percussions were the most affected in the Psychological Domain and the subjects playing Strings were most affected in the Music Module Domain of DASH scale.

REFERENCES

1. Elbaum L. Musculoskeletal problems of instrumental musicians. (1986). Journal of Orthopaedic & Sports Physical Therapy, 8(6):285-7.
2. Zaza C, Charles C, Muszynski A. (1998).The meaning of playing-related musculoskeletal disorders to classical musicians. Social science & medicine,47(12):2013-23.
3. Lederman RJ. (2003). Neuromuscular and musculoskeletal problems in instrumental musicians. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine., 27(5):549-61.
4. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, (2001). Bombardier C. Measuring the wole or the parts?: Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. Journal of Hand Therapy.,14(2):128-42.
5. Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N. (2011). Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a cross-sectional study. BMC musculoskeletal disorders., 12(1):223.
6. Lee HS, Park HY, Yoon JO, Kim JS, Chun JM, Aminata IW, Cho WJ, Jeon IH. (2013).  Musicians’ medicine: musculoskeletal problems in string players. Clinics in orthopedic surgery.,5(3):155-60.
7. Rietveld A B. (2013). Dancers’ and musicians’ injuries. Clinical rheumatology., 32(4):425-34.
8. Viinalass JJ. (2016). The Physiological and Psychological Impact of Music on the Performing Artist, Physical Education and Sport; Thesis; 1-44.
9. Vaag J, Saksvik-Lehouillier I, Bjørngaard JH, Bjerkeset O. (2016). Sleep difficulties and insomnia symptoms in Norwegian musicians compared to the general population and workforce. Behavioral sleep medicine., 14(3): 325-42.
10.  Kenny DT, ATCL D. (2012). Musculoskeletal pain and injury in professional orchestral musicians in Australia. Medical Problems of Performing Artists.,27(4):181.
11. Corrêa LA, dos Santos LT, Paranhos Jr EN, Albertini AI, Parreira PD, Nogueira LA. (2018). Prevalence and risk factors for musculoskeletal pain in keyboard musicians: A systematic review. PM&R., 10(9):942-50.
12. Jones Jr S, Hernandez C. (2010). An Investigation of the Prevalence of Upper Limb Neuropathies in Different Types of College Musicians by Use of Neurometrix Device. International Journal of Biology, 2(1):132.
13. Rigg JL, Marrinan R, Thomas MA. (2003). Playing-related injury in guitarists playing popular music. Medical Problems of Performing Artists.,18(4):150-2.

Citation:

P. Sathya, Hannah D’souza (2019). A study to find prevalence of upper limb problems in Musicians, International Journal of Medical and Exercise Science; 5 (4): 625-633.