Category: Physiotherapy

Jibi Paul¹, Anirudh Srinivas V²

Author:

¹Professor, Faculty of Physiotherapy, DR MGR Educational and Research Institute, Deemed to be University, Chennai, India

Corresponding Author:

²Physiotherapist, Ergon Physiotherapy and fitness lifestyle, Thiruvanmiyur, Chennai, India, Mail id:  marsanirudh80@gmail.com

ABSTRACT

Background and objective of the study: Cricket is the most popular team sport in Indian subcontinent. Hand grip strength plays a vital part in all roles of cricket which may be associated with Body Mass Index. Grip strength is the force applied by the hand to pull or suspend from objects and is a specific part of hand strength. BMI is an attempt to quantify the amount of tissue mass (muscle, fat and bone) in an individual to categorize a person as underweight, normal weight, overweight or obese based on values. Objective of the study was to find out the association between BMI and hand grip strength in university level cricketers.

Methodology:   This was an experimental and cross-sectional type study carried out at Faculty of physiotherapy, Dr. M.G.R. Educational and research institute, Chennai. Total 30 male cricketers, with age group of 18 to 25 years were included in this study. Cricketers with upper limb fractures or dislocations within one year were excluded from the study. Hand grip dynamometer, weighing machine and inch tape were the materials and measurement tools used for the study.  30 University level cricketers were divided into 4 groups, Group A, Group B, Group C and Group D based on BMI level. Body Mass Index and Hand grip strength are the outcome measures. Body mass index were calculated by measuring the height and weight of the individuals. Hand grip strength was measured for their dominant side by using the hand grip dynamometer.

Result: There is a positive association and strong correlation between Body Mass Index and Hand Grip Strength between the Groups at (r = 0.523) & (P ≤ 0.05).  

Conclusion: The study concluded that cricket players with Obese Body Mass Index have more Hand Grip Strength. The study also reported a strong association of Hand Grip Strength with Body Mass Index.

Keywords:  Body Mass Index (BMI), Hand grip strength, Cricketers, Hand grip dynamometer.

Received on 22nd April 2020, Revised on 22nd May  2020, Accepted on 29th May 2020

DOI: 10.36678/ijmaes.2020.v06i02.002

Maksimus Bisa^1*

Author:

¹Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia, Jakarta, Indonesia

Corresponding Author:

*Physiotherapy Program, Fakultas Vokasi, Universitas Kristen Indonesia, Jakarta, Indonesia. E-mail id: maksimus.bisa@uki.ac.id

ABSTRACT

Background of study: The strength of a straight punch, uppercut and hook is needed by a professional boxer to knock down his opponent. Therefore, in the training program for a boxer, it is necessary to analyze the biomechanical characteristics and bio motoric components, which influence its, strength, endurance, and speed by not ignoring psychological factors and the degeneration process that occurs. Degeneration is a natural process, which occurs in every individual, from the cellular level to the level of movement. It functions since 30 years of age characterized by the disappearance of the ability of cells and tissues to repair and replace themselves and maintain normal structure, as well as resulting a decrease in all body functions for 1% every year.

Methodology: This article is a qualitative description with a literature study which analyzes various theories by experts in bio motoric components, degeneration processes, and psychological factors in the form of anxiety.

Result: A balance between physical can slow the degeneration process, psychological, and environmental factors including the life style of a boxer, the factors of strength, endurance, speed, and psychological factors in the form of anxiety influence each other, both directly and indirectly against peak performance in the achievement of a boxer.

Conclusion: Periodic measurements and evaluations of bio motoric components and mental training have to be considered, so that during the golden age, boxers can achieve optimally.  

Keywords: Bio motoric, degeneration process, golden age, professional boxer.

Received on 18th May  2020, Revised on 26th May  2020, Accepted on 29th May 2020

DOI: 10.36678/ijmaes.2020.v06i02.001

Nabilah Ahmad^1*, Siti Aishah Abdullah Suhaimi², Najiah Anuar², Dinesh Madhavan Nair², SitiNurBaait Sokran¹

Authors:

¹Physiotherapy Department, School of Health Sciences, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan, Malaysia.

²Medical Imaging Department, School of Health Sciences, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan, Malaysia.

Corresponding Author:

^1*Physiotherapy Department, School of Health Sciences, KPJ Healthcare University College, 71800 Nilai, Negeri Sembilan, Malaysia. Mail id: ucn.nabilah@kpjuc.edu.my

ABSTRACT

Background and objectives: Dynamic warm-ups prepare the body for activity by helping to increase blood flow and muscle temperature. By calculating the muscle elongation, muscle thickness and pennation angle, it will show the effectiveness of the dynamic elongation task. Ultrasound imaging involves the use of a transducer (probe) and ultrasound gel placed directly on the skin. Ultrasound images of the musculoskeletal system provide the pictures of muscles, tendons, ligaments, joints, and soft tissues throughout the body. Therefore, this study aimed to determine the changes in the muscle tendon unit displacement among healthy male subjects in dynamic task of a gastrocnemius muscle. Methods: This experimental studywas participated by 32 healthy male subjects among KPJUC students. Musculoskeletal Ultrasound (MSK Ultrasound) performed to collect the databefore and after the dynamic task. The measurement was taken for pre and post dynamic elongation task. Paired sample t-test and paired samplecorrelation were used as a statistical analysis. Results: This study shows that there is a changes in muscle architecture after the dynamic elongation task. There is significant difference in pennation angle and muscle elongation between pre dynamic elongation task and post dynamic elongation task. For muscle thickness, there is no significant different between pre dynamic elongation task and post dynamic elongation task. Conclusion: There is a change in muscle tendon unit displacement for gastrocnemius muscle between pre dynamic elongation task and post dynamic elongation task and the obvious changes can be seen in pennation angle of the muscle. Dynamic elongation task seems to be an effective stretching for rehabilitation purposes because it can produce the changes in muscle architectures.

Keywords:  MSK Ultrasound, Pennation Angle, Muscle Thickness, Muscle Elongation, Dynamic Stretching

Received on 20th February  2020, Revised on 26th February  2020, Accepted on 29th February 2020. DOI:10.36678/ijmaes.2020.v06i01.007

INTRODUCTION

Abnormal muscle tendon elongation occurs when the injury to the muscle happens. For management and prevention of the injuries there is an important components to understand of muscle tendon elongation. During any sort of movement, muscle tendon unit is the one which generates force production of a particular muscle ¹.

The force production can be either active or passive force, which relies on length of the muscle. It is based on the length amount of sarcomeres will be recruited. There is no previous study examined the pattern of elongation and structural changes at the level of muscle tendon unit. It is believed that understanding such mechanism of muscle tendon unit explains the science behind the injury mechanism. The regular elongation to a muscle contribute to a defined movement of muscle tendon and joints ^{2, 3}.

Ultrasonography is a valid tool which shows any changes in muscle tendon length properties. The drawback of the usage of ultrasonography tool is its unclear how the elongation mechanism occurs in dynamic elongation. Therefore, uncertain prevails on types of elongation task is required for rehabilitation outcome. Thus, there is a need to understand the elongation mechanism for dynamic task on a muscle. Muscle imaging was used to show that the ultrasonography could properly estimate muscle activity. They measured architectural parameters which included the pennation angle, fascicle lengths and the muscle thickness. Ultrasonography is used to understand biological and bioelectrical characteristics of muscle. An ultrasound is a proper non-invasive real time imaging for muscle structures. Collected data will answer properties of the muscle tendon unit elongation mechanism through displacement of the tendon. This study prescribes either of the elongation task for a variety of patients as well for normal subjects in order to improve social well-being ^{4, 5}.

METHODOLOGY

This experimental study was conducted in KPJ Healthcare University College (KPJUC), Nilai. A total of 32 healthy individuals was recruited and subjected to undergo the dynamic elongation technique with enough rest periods. The normal healthy individuals for this study was identified among the students who are studying in KPJUC. The subject recruitment were based on the established inclusion criteria.

The measurement was taken for pre dynamic elongation task and post dynamic elongation task. Real time ultrasound imaging (Mylab Touch, Esaote, Italy) 15-MHz linear type probe with 38 mm wide field of view (FOV) were used to measure tendon displacement, muscle thickness, pennation angle and muscle elongation. Another tool is treadmill machine, which is used to do the warming up maneuver and the metronome for monitoring the number of beats while performing dynamic elongation.

Subjects were asked to walk in the treadmill for 5 minutes as a warming up. Then, the subjects made to perform dynamic elongation on their dominant legs only then they were stand with dominant leg and to raise the entire foot off the floor, which lead to hip flexion. Then the subjects were instructed to perform active movement of foot to a rhythm of 60 beats per minutes (60 BPM) with the help of metronome and each movement was performed for 1 second. The dynamic elongation was done for 30 second and will be repeated for 5 times. Elongation maneuver pre and post measurement of the subject’s muscle-tendon unit displacement, fascicle length and pennation angle were obtained.

The measurement starting on 30 mm below the fossa popliteal and about 20 mm medial of the line separating the medial and lateral gastrocnemius muscle. In this location the muscle fibers have a distinctly visible pennation angle and muscle structure seems to be well-define. Each subject instructed to stand upright with feet parallel, looking at the same point on the front wall. Prior to stretching, the middle of the monitor display was marked with a white string. A rectangular plastic foam frame (proximal frame) through which the ultrasound probe could pass was placed onto the right calf of each subject to obtain measurements from the same location, a quarter proximal to the distance between the popliteal crease and center of the lateral malleolus.

Myotendinous junction (MTJ) was defined as where the superficial and deep aponeuroses of medial gastrocnemius (MG) met. Another rectangular plastic foam frame (distal frame) was put on the right calf where the middle of the MTJ of the MG aligned with the midline of the ultrasound monitor, which was defined as the baseline of the MTJ. After the dynamic stretching, the probe was set in the same place and the image was taken. The MTJ then calculated by measuring the distance between the white reference line and the new MTJ position. The proximal displacement of the MTJ will show in ultrasound image. The pennation angle of the MG and fascicle length (Lf) were also assessed from the images, which were taken at the proximal frame. The pennation angle of MG was measured as the angle of insertion of the muscle fiber fascicles into deeper aponeurosis. Fascicle length (Lf) was defined as the length of the fascicular path between the insertions of the fascicle into the upper and deeper aponeuroses.

RESULTS

A total of 32 healthy young man participated in the study. The demographic data obtained include male subjects who are aged between 20 – 25 years old. The male subjects who does not have any lower limb injury such as ligament or muscle tear and who have normal Body Mass Index which in range 18.5-24.9𝑘𝑔/𝑚2. Subjects was categorized into two groups; right dominant leg and left dominant leg.

Majority of the healthy young man participated were right dominant leg (94%), and the remaining healthy young man were left dominant leg (6%). The p value for muscle elongation (p=0.00) which is<0.05, therefore reject the null hypothesis and there is a significant difference. There is a significant difference of mean score between Pre Muscle Elongation and Post Muscle Elongation after an intervention. The significant relationship of score between Pre Muscle Elongation and Post Muscle Elongation which is strong (0.814).The p value for muscle thickness (p = 0.606)>0.05, therefore not reject the null hypothesis and there is no significant difference.

There is no significant difference of mean score between Pre Muscle Thickness and Post Muscle Thickness after an intervention. The significant relationship of score between Pre Muscle Thickness and Post Muscle Thickness, which is strong (0.776).The p value for pennation angle (p = 0.012)<0.05, therefore reject the null hypothesis and there is a significant difference. There is a significant difference of mean score between Pre Pennation Angle and Post Pennation Angle after an intervention.

The significant relationship of score between Pre Pennation Angle and Post Pennation Angle, which is strong (0.711).

DISCUSSION

The age of subjects was fixed in the range of 20 to 25 years old because of the composition of Skeletal Muscle Mass might be stable during the age of 20 to 40 years old and at the age of 45 years old it begins to decrease significantly. Due to decreases in the amount and diameter of muscle fibers it caused the decrease in Skeletal Muscle Mass occurs with aging process as a physiological change. Dominant leg for the subjects also have to consider because of the scanning need to be done on the dominant leg. Leg dominance has been determined by which hand dominant is dominant. If the person is left-handed, the he must be left leg dominant⁶.

The definition of muscle power is the amount of work a muscle can produce per unit of time. High muscle power understood as the capacity to exert high levels of strength as quickly an explosively as possible. No statistical difference in maximal power between the dominant and non-dominant legs in healthy young adults, whether they are non-athletes or professional, single-leg-dominant athletes and the reason younger group of healthy man was chosen in my study is because muscular power development reaches its peak between 18 and 30 years of age, so theoretically I had the best chance to find asymmetries in this age range⁷.

The results shows the dynamic elongation task is an effective stretching since there is a different length of gastrocnemius muscle between pre and post, this results supported by the study of Knudson et al., 2006 which is when a muscle or muscle group is passively stretched using techniques like in static, dynamic, or proprioceptive neuro-muscular facilitation (PNF) stretching there might be some short-term changes in the muscle. The short-term or acute effects of stretching on muscle relate to the initial performance changes in the first few hours after stretching.

Therefore, the acute effects following stretching then depends on the biomechanical performance variables like a range of motion (ROM) have been shown to improve following stretching, while some of it appear to be unaffected such as stiffness and others are significantly reduced which means strength. The acute effect of the stretching on flexibility is clear. Stretching an acute increase in joint range of motion that tends to persist for 60 to 90 minutes. For rehabilitation purposes, passive stretching of the injured muscle helps elongate the maturing inter-muscular scar and prepares the muscle for strengthening. Dynamic training exercises can be added in a consecutive manner as each type of exercise is completed with painless to the patient⁸.

The muscle thickness slightly decreased after stretching was performed. A study from Simpson, Kim, Bourcet, Jones &Jakobi, et al. (2017) main findings were novel to human stretch training studies and included an increase in the thickness of gastrocnemius muscle, and increase in the fascicle lengths at both the MTJ and muscle belly with extent of the lengthening greater in the lateral gastrocnemius muscle compared with medial gastrocnemius muscle. The findings were contradict with the results from this study where the muscle thickness was slightly decreased.

The pennation angle was slightly decreased after the dynamic elongation task was performed. A review of literature of pennation angle and fascicle length of human skeletal muscles to predict the strength of an individual muscle using Real-Time Ultrasonography. found that The pennation angle defined as the pattern of arrangement of muscle fibers in relation to the axis of the force generation by the same muscle which is crucial component to determining muscle performance⁹.

The only study we found in the literature that investigating the effects of dynamic stretching exercises on muscle morphology demonstrated that dynamic stretching performed before exercise activities was not effective on fascicle length and pennation angle of the gastrocnemius muscle^10.

In this study, the correlation between each parameters were not investigated. Therefore, it is recommended for future research to measure the correlation between each parameters. The age range of this study was limited from 20 years old to 25 years old, to overcome this limitation future study should wide the age gap.

Ethical Clearance: Received approval letter from the Research Ethics Committee, School of Health Sciences, KPJ Healthcare University College  with reference number: KPJUC/RMC/ MPT/ EC/ 2018 /129 dated 19/03/2018.

Fund for the study: Research Management Center, Department of Physiotherapy, School of Health Sciences, KPJ Healthcare University College, Malasia.

Conflict of Interest: All authors have no conflict of interest to declare on conduct of this study. 

CONCLUSION

The aim of this study is to determine the changes in the muscle tendon unit displacement among healthy male subjects in dynamic task of a gastrocnemius muscle. The data was collected on pre dynamic elongation task and post dynamic elongation task. The investigation of this study show that there is a changes in muscle tendon unit displacement for gastrocnemius muscle between pre dynamic elongation task and post dynamic elongation task and the obvious changes can be seen in pennation angle of the muscle. The results may be influence by subject BMI, height, weight and daily lifestyle. Moreover, for rehabilitation purposes, this dynamic elongation task seem to be an effective stretching because it can produce the changes in muscle architectures.

REFERENCES

1. Hodges, P., Pengel, L., Herbert, R. and G andevia, S. (2003). Measurement of muscle contraction with ultrasound imaging. Muscle & Nerve, 27(6), 682-692.
2. Vaisman, A., Guiloff, R., Rojas, J., Delgado, I., Figueroa, D., & Calvo, R. (2017). Lower limb symmetry: Comparison of muscular power between dominant and nondominant legs in healthy young adults associated with single-leg-dominant sports. Orthopaedic Journal of Sports Medicine, 5(12), 232-236.
3. Knudson, Duane (2006). The biomechanics of stretching. Journal of Exercise Science and Physiotherapy, Vol. 2 : 3-12.
4. Rekabizadeh M, Rezasoltani A, Lahouti B, Namavarian N.(2016). Pennation Angle and Fascicle Length of Human Skeletal Muscles to Predict the Strength of an Individual Muscle Using Real-Time Ultrasonography: A Review of Literature. J Clin Physio Res, 1(2): 42-48.
5. Samukawa, M., Hattori, M., Sugama, N., & Takeda, N. (2011). The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties. Manual Therapy, 16(6), 618-622.
6. Miura, K., Yamamoto, M., Tamaki, H., &Zushi, K. (2010). Determinants of the Abilities to Jump Higher and Shorten the Contact Time in a Running 1-Legged Vertical Jump in Basketball. Journal of Strength and Conditioning Research, 24(1), 201-206.
7. Wattimena, R., Vitriana, V., &Defi, I. (2017). Correlation between body mass index, gender, and skeletal muscle mass cut off point in Bandung. International Journal of Integrated Health Sciences,5(2), 47-51.
8. Brukner, P., & Khan, K. Brukner& Khan’s (2002).Clinical sports medicine. Revised 2nd ed. McGraw-Hill, Australia.
9. Zhou, G., Chan, P. and Zheng, Y. (2015). Automatic measurement of pennation angle and fascicle length of gastrocnemius muscles using real-time ultrasound imaging. Ultrasonics, 57, 72-83.
10. Simpson, C., Kim, B., Bourcet, M., Jones, G., & Jakobi, J. (2017). Stretch training induces unequal adaptation in muscle fascicles and thickness in medial and lateral gastrocnemii. Scandinavian Journal of Medicine & Science in Sports, 27(12), 1597-1604.

Citation:   Nabilah Ahmad, Siti Aishah Abdullah Suhaimi, Najiah Anuar (2020). Effect of dynamic stretching on elongation of Gastrocnemius muscle, International Journal of Medical and Exercise Science, 6 (1): 713-719.

V. P. Lakshmikanth¹,  T. Yamini², N. M. Basheer Ahamed³

Authors:

²B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.

³ Professor, JDT Islam College of Physiotherapy, Kozhikode, Kerala, India

Corresponding Author:

¹Asst. Professor,  JDT Islam College of Physiotherapy, Kozhikode, Kerala, India. Mail id: laksh.anee@gmail.com

ABSTRACT

Background: In recent years, the number of smart phone users has progressively increased worldwide. Using smart phone for prolonged time will cause faulty posture or poor posture such as forward head posture and rounded shoulders.The structural problems caused by faulty posture can also lead to respiratory dysfunction. The objective of the study was to determine the effect of exercise on posture and respiratory function among smart phone users.   Methods: This study was an experimental  with conventional type. The study was carried out in faculty of physiotherapy at A.C.S Medical College And Hospital. 100 samples were taken and assessed posture and respiratory function. Subjects with poor posture and respiratory dysfunction were trained with exercise for 4 weeks. Both male and female aged between 18 -25 years using smart phone more than 4 hours were included in the study. Individuals with any cervical deformity were excluded in the study. Craniovertebral angle, Scapular index and PEFR were the outcome measures used in this study. Results: On comparing the mean values of Pre Test & Post Test on Craniovertebral Angle, it shows significant difference between Pretest (28.28) & Posttest (35.05) at P ≤ 0.001. On comparing the Pre Test & Post Test on Scapular Index, it shows significant mean difference between Pretest (70.60) & Posttest (74.91) at P ≤ 0.001. On comparing the Pre Test & Post Test on Peak Expiratory Flow Rate(PEFR), it shows significant mean difference between Pretest (191.42) & Posttest (248.57) at P ≤ 0.001. Conclusion: The study concluded that  stretching and breathing exercise has considerable effects in improving the posture and respiratory function among Smartphone users.    Keywords:  Smartphone, PEFR, Posture, Goniometer,  Stretching  exercise , Breathing  exercise

Received on 15 th February  2020, Revised on 22nd February  2020, Accepted on 29th February 2020. DOI:10.36678/ijmaes.2020.v06i01.006

INTRODUCTION

In the past decade, there has been a rapid increase in the use of mobile devices, particularly Smartphone for communication, gaming and internet browsing.  A mobile phone is no longer just a telephone and has become an integral part of modern living for many people.  Mobile phone production rise from 450 million per year in 2011 to 984 million per year in 2013 and more than 50% population in many western countries, as well as in Taiwan, own mobile phones ^1,2.

 Smartphone have become the essential mobile devices in our daily living and people demonstrate different posture while using Smartphone.  Smartphone have become not only an example of modern high-tech equipment, but also a daily necessity.     Smartphone, unlike computer features a small screen that is likely to induce a more slouched posture toward a line of sight below eye level ³.

If people have used a smart for a long time, a video terminal such as a Smartphone might therefore induce an improper posture or slouched posture or rounder shoulders.  Forward head posture is defined as a posture that adopts upper cervical extension and lower cervical flexion ^{4, 5}.

Forward neck posture is become increasingly common, as it is becoming leaning forward posture, particularly with popularization of smart phones.  Forward head posture is one of the most common deviation from normal cervical posture and may lead to a n increase in gravitational load and mechanical stress to cervical facet joints, altered neck extensors muscles activity and length of cervical muscles⁶.

In recent years, the number of smart phone users has progressively increased worldwide. Using smart phone for prolonged time will cause faulty posture or poor posture such as forward head posture and rounded shoulders.The structural problems caused by faulty posture can also lead to respiratory dysfunction. The objective of the study was to determine the effect of exercise on posture and respiratory function among smart phone users.  

METHODOLOGY

This study was an experimental  with conventional type. The study was carried out in faculty of physiotherapy at A.C.S Medical College And Hospital. 100 samples were taken and assessed posture and respiratory function. Subjects with poor posture and respiratory dysfunction were trained with exercise for 4 weeks. Both male and female aged between 18 -25 years using smart phone more than 4 hours were included in the study. Individuals with any cervical deformity were excluded in the study. Craniovertebral angle, Scapular index and PEFR were the outcome measures used in this study.

Procedure: Subjects using smart phones for more than 4 hours were selected based on inclusion and the exclusion criteria.  They were assessed for forward head posture and respiratory dysfunction by using craniovertebral angle and peak flow meter. 

The subjects were asked to sit comfortable on back supported arm less chair with both feet flat on floor, hip and knees positioned at 90 degree angle and buttock positioned against the back chair.  The subjects were asked to rest their hands on their lap and to keep their shoulder against the back of the chair.  Adequate exposure of neck up to shoulder level to clearly define anatomical landmark was done.  The most prominent spinous process at the base of the cervical spine was palpated.   Skin over the anatomical landmark was wiped with cotton soaked in spirit to remove skin secretions for proper fixation of adhesive markers.  Anatomical landmarks were marked with marker pen, thereafter adhesive markers were fixed over the anatomical landmark.  Then the craniovertebral angle was measured by angle between midpoint of the adhesive marker at the tragus of right ear and midpoint of the reflective marker at C7.

After the subjects were assessed for Scapular index by using inch tape.  The resting position the scapula was determined by measuring the distance from the midpoint of the sternal notch to the medial aspect of the coracoids process (the length of the chest side) and the horizontal distance from the posterolateral angle of the acromion to the thoracic spine (the length of the back side).

Then the subjects were assessed for respiratory functions by peak flow meter.  By blowing hard through a mouth piece on one end the peak flow meter can measures force air in liters per minute and gives the reading on a built in numbered scale.

EXERCISE INTERVENTION

1. For posture deviation:

Forward head posture:

Chin tuck exercise: Ask the subject sit upright, gently tuck the chin and to feel a gentle lengthening sensation at the back of the neck. Make sure that the eyes and jaw stay level and move the head horizontally backwards and hold for 5 seconds with 30 repetitions.

2. For Rounded shoulder:

Stretching exercises:

Pectoralis stretch: Ask the subject to stand in the middle of a door way with one foot in front of the other and bend the elbow to 90-degree angle and place the forearms on each side of the doorways. And shift weight on to the front leg, leaning forward, until feel a stretch in the chest muscles.

Upper trapezius stretch: Ask the subject to sit upright, tuck the chin in to your chest and look down. Place the palm of the hand on the back of the head and press downward. Hold for 30 seconds. Then rotate the right ear down slightly, maintaining the download pressure with the hands, to stretch the left side. Hold for 30 seconds. Then rotate the left ear down, maintaining download pressure to stretch the right side. Hold for 30 seconds. Repeat the sequence for three times.

3. For Respiratory Dysfunction:

Breathing exercise:

Diaphragmatic breathing: Ask the subject to sit comfortably, with the knees bent and the shoulders, head and neck relaxed. Breathe in slowly through the nose.so that the stomach moves out against the hand. The hand on the chest should remain as still as possible. Place one hand on the upper chest and the other just below your rib cage. This will allow to feel the diaphragm while breathing. Tighten stomach muscles, letting them fall inward while exhale through pursed lips. The hand on the upper chest must remain as still as possible.

Pursed lip breathing: ask the subject to sit comfortably, and to relax the neck and shoulder muscles and breath in for 2 seconds through the nose, by keeping the mouth closed and then instructed to breath out twice through pursed lips.

Data Analysis : The collected data were tabulated and analyzed using both descriptive and inferential statistics. All the parameters were assessed using statistical package for social science (SPSS) version 24. Paired t-test wasadopted to find the statistical difference within the group.

RESULTS

On comparing the Mean values of Pre Test & Post Test on Craniovertebral Angle, it shows highly significant Mean differences between Pretest (28.28) & Posttest (35.05) at P ≤ 0.001.

On comparing the Mean values of Pre Test & Post Test on Scapular Index, it shows highly significant Mean differences between Pretest (70.60) & Posttest (74.91) at P ≤ 0.001.

On comparing the Mean values of Pre Test & Post Test on Peak Expiratory Flow Rate(PEFR), it shows significant Mean difference between Pretest (191.42) & Posttest (248.57) at P ≤ 0.001.

DISCUSSION

The present study was conducted to find out the effect of exercise on posture and respiratory function among smartphone users.  The study measured CVA, SI and PEFR as parameters to demonstrate the effect of prolonged smartphone use on change in posture and respiratory function.       

Previous study performed in other context and population, support our results FHP and rounded shoulder after an training protocol^7,8. 

Studies have reported decreased PSs in elite swimmers after an 8 week intervention including stretching of anterior musculature and strengthening of scapula stabilizers ^{9, 10}.

This study indicates that a targeted exercises program, can result in the improvement of posture and respiratory functions.  The mean values of CVA, SI and PEFR were analyzed ^11,12.

The pre-test mean value of CVA was 28.28 and the post-test mean value was 35.05.The pre-test mean value of SI was 74.91 and the post-test mean value was 70.60.The pre-test mean value of PEFR was 191.42 and the post-test mean value was 248.57.

The result showed that statistically highly significant difference in the values of CVA, SI and PEFR.

Limitation of the study:  Small sample size was analysed in this study. The duration of the study was short. Long term follow up of the subject was not possible.

Ethical Clearance: Ethical clearance has obtained from Faculty of Physiotherapy, DR. MGR Educational and Reasearch Institute, Chennai to conduct this study with reference number: IV B/ PHSIO/ IRB/ 2017-2018dated 08/01/2018.

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

Fund for the study: It was aself financed study.

CONCLUSION

The study concluded that  stretching and breathing exercise has considerable effects in improving the posture and respiratory function among Smartphone users.

REFERENCES

1. Liang H-W et al, (2016). Mobile phone use behaviours and postures on public transport systems. PLOS ONE 11(2): 0148419.
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3. Yong- Soo Kong et al (2017). The effect of modified cervical exercise on smartphone users with FHP, J. Phys. Ther Sci., 29(2): 328-331.
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9. Okuro RT et al (2011). Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children. J Bras pnemol., 37:471-479.
10. Repacholi MH. (2001). Health risks from the use of mobile phones. Toxicol Lett., 120   (1-3) : 323-31.
11. Hakala P T, Rimpela A H, Saarni L A, Salminen J J. (2006). Frequent computer-related activities increase the risk of neck-shoulder and low back pain in adolescents. Eur J Public Health., 16(5): 536-41.
12. Kim GY, Ahn CS, Jeon HW, Lee CR. (2012). Effects of the Use of Smartphones on Pain and Muscle Fatigue in the Upper Extremity. J Phys Ther Sci., 24(12): 1255-8.

Citation:   

V. P. Lakshmikanth,  T.Yamini, N.M. Basheer Ahamed (2020). Effect of exercise on posture and respiratory function among smartphone users, International Journal of Medical and Exercise Science, 6 (1): 706-712.

Novlinda Susy Anrianawati Manurung¹, Tarsicius Sunaryo², Indra Gunawan², Lucky Anggiat³

Authors: 2Lecturer,Post Graduate Studies, Master of Management Program, Universitas Kristen Indonesia, Jakarta, Indonesia 3Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia Corresponding Author: 1Lecturer, Faculty of Vocational Studies, Physiotherapy Program, Universitas Kristen Indonesia, Jakarta, Indonesia, email : novlinda.manurung@uki.ac.id

ABSTRACT Background: Physiotherapy service standards are used as a basis for risk management in preparing strategies to anticipate unexpected events that appear in the management of the physiotherapy process. This research aims to improve the quality of physiotherapy services through the calculation of the risk of the physiotherapy process and risk mitigation measures using the Workload Indicator Staffing Need (WISN) method from the World Health Organization (WHO). Methods: The research uses the stages of risk management as a method of analysis and WISN as a method for risk mitigation. Risk analysis begins with the identification of risks and then measures the risks by calculating the probabilities and impacts of these risks and designing risk management as mitigation. Results: Based on the research that has average 50-60/day, which is not proportional to the number of only 4 physiotherapists. In addition, there is a lack of physiotherapy intervention tools. Conclusion: In this research it has concluded that to improve the qualityof physiotherapy services must be done by making policies to mitigate unexpected events and reducing the probabilities such as: increasing the number of physiotherapists and arranging the separation schedule of examination days for physiotherapy been done, events with the highest risk are found in the stages of examination and measurement, documentation, and physiotherapy intervention where there is an opportunity to reduce the type and duration of long or unsuccessful healing interventions. The trigger for the occurrence of potential risks is the number of patients on measurements from intervention days and increasing the number of physiotherapy intervention tools. Keywords: Physiotherapy Process, Workload Indicator of Staffing Need, Risk Management

Received on 15 th February  2020, Revised on 22nd February  2020, Accepted on 29th February 2020, DOI:10.36678/ijmaes.2020.v06i01.005

INTRODUCTION

The role of human resources (HR) in a company or hospital is very important because HR is the main implementer of activities in order to meet the objectives of the company or hospital ^1,2,3.

One of the human resources in the hospital is physiotherapists^4,5. As a profession that carries out physiotherapy service activities, a physiotherapist uses references as the basis for carrying out their duties and functions as stipulated by the Minister of Health in the Regulation of the Minister of Health of the Republic of Indonesia number 65 of 2015 concerning physiotherapy service standards containingthe duties and functions of a physiotherapist as well as physiotherapy personnel service standards in the form of the stages of the process of implementing physiotherapyor physiotherapy action is a normal service of a physiotherapist, which can then be calculated and determined as a guide or measuringtool to determine the need for physiotherapists in hospitals⁷.

Fulfillment of physiotherapy human resources in health care facilities is based on workload analysis and/or the ratio of patient/client services per workday, i.e. 1 physiotherapist : 8-10 patients/clients per workday taking into account the need for appropriate qualifications of physiotherapists ⁶.

Based on physiotherapy service standards, the elements of the physiotherapist’s workload in the physiotherapy process should be observed. In the physiotherapy process management, there are several stages of action, such as: Assessment of the Patient, Making of Diagnosis, Intervention Planning, Intervention, Evaluation/Revaluation, Communication and Education as well as Documentation ^4,6. From assessment to evaluation, the physiotherapist must also carry out the report writing stage simultaneously which serves to document the data and becomes the basis and the most important part in fulfilling the final stage called physiotherapy documentation ⁶. The physiotherapy documentation process serves as an integrated information tool from the physiotherapist to all health workers involved in the process of handling a patient.

Documentation is also an accurate tool in providing work quality information as well as a legal protection tool for a physiotherapist. With the implementation of the National Health Insurance system by the government to realize the mandate of the 1945 Constitution no. 28 part H, there is an increase in the number of patients in the medical rehabilitation installation unit with a physiotherapist as a service provider⁷. Increase in the number of patients is closely related to an increase in the amount of service time per day in the hospital ⁹. To avoid decreasing quality of services with an increase in the number of patients, it is necessary to analyze the need for physiotherapists in connection with the workload and the length of time of the implemented physiotherapy process in one workday⁸.

The need for physiotherapists can be analyzed by measuring the physiotherapy workload using the “Workload Indicator of Staffing Need”(WISN) method ^7,10. The WISN method uses a measure or working time as an assessment indicator at each stage of the human resource working process⁷.WISN is a tool used to measure the workload of health workers released by WHO⁷. This method is used to set the appropriate standard of the number of workers needed in each working unit ¹⁰. Meeting the appropriate workforce requirements will improve performance, service quality and service risk mitigation.

A physiotherapist’s workload isall activities carried out by the physiotherapist in the course of their assignment in a physiotherapy service unit. The method that can be used as a measurement for health workers is the Workload Indicator of Staffing Need. This tool in its application uses analysis of the length of time in carrying out a work activity of each HR in accordance with their duties and functions ¹¹. The WISN method helps to determine how many specific types of health workforce are needed according to the workload provided or available at a health facility and measures the workload pressure of a health worker at that health facility ^10,11.

 The guidelines for using WISN software explain the description of the application, and provide step-by-step instructions to meet or complete a variety of tasks or data requirements. The tasks or data to be analyzed and measured in WISN consist of: facilities, labor facilities, time needed to do the work, workload statistics, activity standards, labor comparisons, and calculation of remuneration costs¹⁰.

The WISN method is a tool stipulated in the Minister of Health Decree Number: 81/ MENKES/ SK/ 2004 concerning Guidelines for Preparation of Health HR Planning at Provincial, Regency/City and Hospital Levels to calculate HR needs at Hospitals.Through the application of the WISN method, it is likely to know the working unit and its HR categories, available working time for each HR category, workload standards, tolerance standards, quantity of main activities and finally, the HR needs in the working unit can be known ¹².

Through the above review, this research aims to analyze the risks of the physiotherapy process by analyzing the need for human resources, which in this case are physiotherapist in order to prevent the risks that may occur.

RESEARCH METHODOLOGY

This research is descriptive qualitative, by measuring the probabilities and impacts of time reduction in the physiotherapy process and measuring the need for human resources based on the Workload Indicator of Staffing Need method for risk mitigation.

a. The Risk Management Analysis Technique is carried out by means of; risk identification, risk measurement  and risk management.

 b. Population and Sampling Technique;

1. The population of the research is the physiotherapists and medical records of patients in 2017 in the period of 3 months from April to June 2017.
2. The sampling technique is all 4 physiotherapists and data of medical records. The research samples are medical recordswith the data of 62 patients per day.

c. Place and Unit of Research.

The place of research is one of the general hospitals of Universitas Kristen Indonesia in the medical rehabilitation installation unit, physiotherapy unit, Jakarta, Indonesia.

d. Data and Sources of Data

1.  Data of physiotherapy process (medical records)

2. Data of probabilities of unexpected events (physiotherapy questionnaire)

3.  Data of physiotherapy process impacts (review of medical records)

e. Data Collection Technique.

The instrument used was a questionnaire to physiotherapists, interviews and observations of physiotherapy management directly and through medical record documentation. The physiotherapy service process data is taken from the physiotherapy process in the hospital for 3 months from April to June 2017.

1)  Observation

This method is done by finding and collecting data directly from the source by direct research on the physiotherapy process in the hospital.

2)  Interview

In order to obtain complete information in this study, the authorsconducted a question and answer processwith physiotherapists directly about the physiotherapy service process in the physiotherapy unit.

3) Documentation of physiotherapy process results in the hospital

In this process, various physiotherapy service activities are recorded and documented as evidence of the implementation of the physiotherapy process.

4)  Library Study

This is the search for data with the library study method as a guideline for collecting and reviewing existing data.The library study method is done by reading the literature relating to government regulations, especially those of the minister of health concerning the physiotherapy service process standards in hospitals, theories about the workload measuring tools and the need for health workersin the hospital, notes and books relating to the risks of health services to produce maximum quality health services.

RESULTS AND DISCUSSION

The results of analysis and observation of the physiotherapy process in four respondents showed

that the management of physiotherapy has about 80% of direct contact with patients where the time is included in the weight category or an indication of danger.

Based on the time calculation in the physiotherapy workload diagram it appears that the average time required is 101.75 minutes by a physiotherapist to carry out physiotherapy services for one patient. The time is quite long with the number of 40-60 patients per day, an indication of the physiotherapy process with the risk of danger. These results are in Table 3.

Observation of Physical Examination Sheets of Physiotherapy and Interview

Reports on the results of examination and measurement are not written in full with the type of examination and value of the measurement results before and after therapy as well as the results of the evaluation. The process of implementing physiotherapy interventions is not carried out in full according to the intervention plan because it is limited by the quota of funding for treatment of patients by the National Health Social Security Board, the waiting time for therapeutic measures and the availability of intervention equipment facilities that are not proportional to the number of patients who need the same tools and also the implementation of interventions that takes a minimum of 15 minutes per tool.

The biggest condition is musculoskeletal cases and in the next sequence is neuromuscular condition, where both conditions require at least 45 minutes of physiotherapy services for long-standing patients with musculoskeletal problems who are only undergoing therapy but still need to undergo a momentary examination, while patients with neuromuscular problems must get complete exercise that takes a minimum of 60 minutes.

In contrast to old patients who come only to continue therapy, patients who have just arrived for the first time will take longer examination if the physiotherapy process is carried out in full according to the physiotherapy service standards.

Analysis of Workload Indicator of Staffing Need

Based on the physiotherapy workload that is in the hospital’s medical rehabilitation installation unit, the need for physiotherapists must be calculated in order to achieve optimal performance in the implementation of physiotherapy services. The measuring instrument used to analyze the need for physiotherapists is WISN with a measurement method using components or elements of assessment, such as: the number of physiotherapists available to carry out activities as physiotherapists, the time required for each type of action or physiotherapy work activity, the total time available for each physiotherapist, the amount of time needed to complete the actions carried out by the physiotherapist and the number of patients and patient visits (Table 1 and Table 2).

Based on the WISN method which divides the length of time to do activities by the amount of time available for the physiotherapist and compared to the number of patients and referring to the Minister of Health Regulation No. 65 of 2015 concerning physiotherapy service standards, and based on the analysis of workload and/orservice ratio of patients/clients per working day (1 physiotherapist : 8-10 patients/clients per working day) with the assumption that the available working time is 8 hours per dayand 1 hour of physiotherapy processfor 1 patient ^4,6,7. When seen from the data in the indicator diagram based on the WISN method, then a calculation is made based on the formula, by stating the total number of 40 patients per day in 1 year (average visit), the result shows that the need for physiotherapists per day is16.75 or rounded to be 17 in the medical rehabilitation unit of the Hospital (Table 3).

Based on the results of review of the writing of the intervention time dose on the patient card compared to the theory about the time of use of the physiotherapy intervention device, there is a quite big differencein the implementation of the intervention with the device, ranging from preparation, testing of equipment, up to the intervention, as well as the provision of motion exercises, and each experienced a reduction in time during the process by an average of 15 to 20 minutes^4,6,13. This happens to address all patient needs in a relatively short period of time (5 working hours per day).

After looking at the tables and risk interpretation diagrams interpretasiobtained from interviews, questionnaires and review of patient medical records as well as observation of intervention tools, figures are obtained indicating potential risks in the physiotherapy processwith interpretation there is the influence of the number of patients/workload on the physiotherapy process.

Likewise, with the results shown in the conclusion table on the calculation of need for HR, the result is obtained in the form of the amount of physiotherapists needed in the medical rehabilitation unit of the Hospital X, with interpretation there is a need for increased physiotherapists. Likewise, regarding the physiotherapy device facilities specified in the Minister of Health Regulation number 65 of 2015 for Type B Hospitals and workload diagrams, there is a need for increased physiotherapy intervention device facilities ^6,8,13.

CONCLUSION

Based on the measurement of risks in the stages of examination and measurement, there is high risk of probabilities in the absence of examination and measurement as well as in the mistake of report writing on the physiotherapy process; whereas in the intervention stage,there is also high risk of probabilities in the reduction of type and time of intervention with the impact of long or unsuccessful healing process.

Based on the workload calculation of the physiotherapy process with the Workload Indicator Staffing Need, the mitigation policy taken is to add 13 physiotherapists so that the number of physiotherapists is 17 and supported by arrangements for inspection days and the addition of intervention tools.

Recommendation: Hospitals are expected to analyze risks and work requirements using theWorkload Indicator Staffing Needboth in the physiotherapy unit and in other units. Analyzing this can reduce the risk of mistakes in patient documentation and adjust the workload of physiotherapists or other health professionals to work optimally.

Ethical Clearance: Ethical aproaval letter receivedfrom the Director of General Hospital,Universitas Kristen Indonesia to conduct this study with reference number 295/DR/RSU UKI/05.2017 dated 19/05/2017.

Conflict of Interest: The Author has no conflict of interest to declare.

Fund for the study: The study was fully  funded by Universitas Kristen Indonesia.

Acknowledgement: The Author would like to thank the General Hospital of Universitas Kristen Indonesia. Also, we would like to thank the Universitas Kristen Indonesia which funded this study. Lastly, we extend our gratitude to all physiotherapists who participated in this research.

REFERENCES

1. Andini, S, 2013, Analisa Kebutuhan Tenaga Keperawatan di Instalasi Hemodialisa Rumah Sakit Umum Pusat Persahabatan Berdasarkan Beban dan Kompetensi Kerja, Faculty of Public Health, Hospital Administration Study Program, University of Indonesia, Depok.
2. Krisna, M 2012, Analisis Beban Kerja dan Kebutuhan Tenaga di Instalasi Farmasi Rumah Sakit Jiwa Daerah Provinsi Lampung Tahun 2012, Faculty of Public Health, Hospital Administration Study Program, University of Indonesia, Depok.
3. Guspianto, 2012, Analisis Penyusunan Rencana Kebutuhan Sumber Daya Manusia Kesehatan Puskesmas di Kabupaten Muaro Jambi, Proceedings of National Seminar on Health, Department of Public Health, Faculty of Medicine and Medical Science, Universitas Jenderal Soedirman, Purwokerto.
4. Ministry of Health. 2015. Minister of Health of the Republic of Indonesia, Regulation No. 80 of 2013 concerningOperation of the Work and Practice of Physiotherapists.
5. American Physical Therapy Association. 2013.Guide to Physical Therapist Practice, Second Edition, Virginia.
6. Ministry of Health. 2015. Minister of Health of the Republic of Indonesia, Regulation No. 65 of 2015 concerning Physiotherapy Service Standards.
7. World Health Organization 2016, Workload indicators of staffing need (WISN): selected country implementation experiences, (Human Resources for Health Observer, 15), World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
8. Ministry of Health. 2004. Pedoman Penyusunan SDM Kesehatan Di Tingkat Propinsi, Kab/Kota serta Rumah Sakit. Jakarta: Ministry of Health of the Republic of Indonesia.
9. Winarti, W 2015, Hubungan Beban Kerja Perawat Dengan Pelaksanaan Dan Pendokumentasian Asuhan Keperawatan Di ICURS PKU Muhammadiyah Yogyakarta.
10. World Health Organization 2010, Software Manual Workload Indicators of Staffing Need, Multilingual version, 2.2.169.1, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
11. Ministry of Health of the Republic of Indonesia and Deutsche Gesellschaft für Technische Zusammenarbeit 2009, Perlengkapan Kerja WISN (Workload Indicators of Staffing Need).
12. Ministry of Health. 2004. Minister of Health of the Republic of IndonesiaDecree Number: 81/MENKES/SK/2004 concerning Guidelines for Formulation of Health HR Planning.
13. Behrens B, Michlovitz S, 2006, Physical Agents: Theory and Practice, 2nd ed. Philadelphia, PA: FA Davis Company.

Citation: Novlinda Susy Anrianawati Manurung, et al (2020). Analysis of the need for physiotherapists in private hospitals in Indonesia using the workload indicator of staffing need referring to the implementation of the physiotherapy process as risk mitigation of services, International Journal of Medical and Exercise Science, 6 (1): 697-705.

S.Ramachandran1, C.J.Sivadharsini2, Jibi Paul3 Author: 1,3Pofessor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author: 2B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.Mail id: shivadharshini189@gmail.com

ABSTRACT Background of the study: Obesity refers to a condition of excessive amount of body fat. The commonly known obesity are Central Obesity which occur due to the excess accumulation of fat in abdominal area. Various exercise  have been designed for obesity but in particular exercise designed for abdomen are using mat, swiss ball and theraband exercise.  Hence the study was to evaluate the effect by  comparing mat, swiss ball and theraband exercise on abdominal obesity. Methodology: It was an experimental study with comparative pre-post type. Study setting was conducted at Faculty of physiotherapy A.C.S Medical college and hospital, Chennai. 30 Subjects were randomly allocated equaly in to three groups. The sudy conducted for a duration of 12 weeks. Abdominal obesity female students ranges between the age of 18yrs-25yrs were selected for the study. Mat, Swiss ball, Theraband were used as materials for the study. Group A received mat exercise, Group B received swissball exercise and Group C received Theraband exercise. Body Mass Index (BMI), Waist circumferences were outcome measures for this study. Result: On comparing Mean values of Group A, Group B & Group C; the Body Mass Index (BMI) shows significant decrease in the Post test Mean values. MAT Exercise with Group A shows mean value of 24.44 which is  less effective than Theraband Exercise Group C  value of 26.13  and Swiss Ball Exercise Group B with value of 40.09  shows significant difference between the group with P ≤ 0.001. On comparing Mean values of Group A, Group B & C on Waist Circumference shows significant decrease in the Post test Mean values; On MAT Exercise shows 95.50 which is lower mean value than Theraband Exercise Group C with 96.00 and Swiss Ball Exercise Group B with 96.50  shows significant difference between the group with P ≤ 0.001. Conclusion: The study concluded that BMI and waist circumference of Group A shows better reduction when compared to Group B and C. Keywords:  Body Mass Index, Waist Circumference, Obesity, Exercise Mat, Swissball, Theraband Received on 12 th February  2020, Revised on 19th February  2020, Accepted on 28th February 2020, DOI:10.36678/ijmaes.2020.v06i01.004

INTRODUCTION

The term obesity is defined as cluster of non-communicable diseases called “New World Syndrome” creating an enormous socio-economic and public health burden in poorer countries. Abdominal obesity is also known as central obesity is where excessive abdominal fat around the stomach and abdomen has built up to the extent that it is likely to have negative impact on health ¹.

Visceral fat is composed of several adipose depots including mesentric epididymal white adipose tissue (EWAT) and prenatal fat. An excess of visceral fat called central obesity the “Pot Belly”or “Bear Belly” effects in which the abdomen protrudes excessively. The body type is known as “apple shaped as Opposed to pear shaped” in which the fat particularly develop in the hip region and buttock region ².  

The obese are at increased risk for cardio-vascular diseases and type 2 diabetics however, somewho are affected with metabolic abnormalities. The regular exercise would have a value rather than on scientific evidence and to reduce the risk for metabolic disease through numerous mechanism ³. 

The regular exercise would have a value rather than on scientific evidence and to reduce the risk for  metabolic disease through numerous mechanism. There are various exercise have been designed for obesity such as aerobics exercise , yoga, palates  etc ⁴.

Aim of study: The aim of the study is to compare the effect of mat, Swiss ball and theraband  exercise on reducing abdominal obesity among college going female students.

Need of the study: The obesity refers to the condition of having an excessive amount of body fat .The  upper body fat is particular of carried with in the abdomen various exercise have  been designed for obesity such as aerobics exercise, pilates ,yoga,and others. Obesity  also reduced by mat exercises,swiss ball and theraband exercises.The study aim is to compare the effect of mat ,swiss ball, theraband exercises on abdominal obesity patients.

METHODOLOGY

It was an experimental study with comparative pre-post type. Study setting was conducted at Faculty of physiotherapy A.C.S Medical college and hospital, Chennai. 30 Subjects were randomly allocated equaly in to three groups. The sudy conducted for a duration of 12 weeks. Abdominal obesity female students ranges between the age of 18yrs -25yrs were selected for the study. Mat, Swiss ball, Theraband were used as materials for the study. Group A received mat exercise, Group B received swissball exercise and Group C received Theraband exercise. Body Mass Index (BMI), Waist circumferences were outcome measures for this study.

Procedure : subject with 30 abdominal obesity female were selected and they were divided into two group and each group contain 10 members.

GROUP A: MAT EXERCISES

1.Plank Exercise: Position: Quadriped position initially or an exercise mat. Technique: From the starting position the patient drops the buttock on the legs and extend the arms the a child position.Then with palms and toes bearing the enhance weight, the head and trunk are from the plank and this is repeated. Progression: 5-10 times per session and can be progressed to 15-20 times  as the patient gains confidence.

2.Scissor Kicks : Position: Supine lying in an exercises mat with legs fully extended and arms resting near the trunk . Technique: Alternate legs are raised at a time in such a way that it resembles a scissoring action the knees should not flex.

Progression: 20-25 times and then can be progressed 30-40 times  per session .Thus exercise help to strengthen the obliques.

3.Crunch Exercise: Crunches are performed to strengthening the core musculature. Position: Supine lying on a mat is the starting position. Technique: The knees are flexed in such a way that crook lying position attained. Hands are clapped around the chest or behind the neck.The patient tries to lift the shoulders from the floor and hold the position for a peak time. Progression: Initially performmed 8-10 times as the core gains strength the same can be repeated to 15-20 times.

4.Oblique Crunch Exercise : Position: Initially the position is side lying with one leg on the other and the knees slightly bent.Technique: In this position , the patient tries to lift one shoulder,trying to lateral rotate the trunk and the position is held for a peak time. Progression: Initially performed 8-10 times as the core gains strength , the same can be repeated to 15-20 times. 

GROUP B:  SWISS BALL EXERCISES

1.Plank on Swiss Ball: Subjects lie in prone position with fore arm supported on swiss ball.

2.Back Extension on Swiss Ball: Subjects lie on prone lying swiss ball will be kept under  abdomen. Arm should clasped behind head. Subjects is instructed to trunk flexion and extension. This exercises is repeated for 5 times per day.

3.Swiss Ball Crunch: Subject will be allowed in supine lying where swiss ball under lumbo sacral region with 90 degree of knee flexion, Arms should  kept along body crossed on top of the chest.Lowering the torso into stretch position with stationary neck will be starting position.Subjects will be instructed to flex the hip by contracting abdomen and getting back into starting position.

4.Exercise Ball Abdominal Curl Up In Supine: Subjects will be allowed in supine lying where leg should placed on swiss ball.Hands are clasped in chest region .Subjects is allowed to lift  the trunk upward until the shoulder region off, from the floor.

GROUP C: THERABAND EXERCISES

1.Theraband Abdominal Crunch In Supine: The subjects is asked to lie back and knees bent with the elbows straight and lift the shoulder blades off the floor.The subjects is asked to hold 10 seconds and then  relax practiced twice a day for 10 days.

2.Therabandabdominal Oblique Crunch In Supine: After attaching the ends of the band on the object .The subject is asked to extend one arm in front and grasp the middle of loop,by keeping elbows straight .The subject is asked to hold 10 sec and then relax practised twice a day for 10 days .

3.Theraband Trunk Rotation In Sitting: The patient is askedto lifting the chair grasp the one end of the band and the other band at chest level. And asked to rotate the shoulders. The subjects is asked to hold for 10 sec and then relax practised twice a day for ten days.

4.Theraband Trunk Extension in Long Sitting: The patient is asked to sit in long sitting grasp the both end of bands with the hands at the chest .The patient should keep the lumbar spine straight by extending the hips .The subjects is asked to hold 10 seconds and then relax practised twice a days for 10days.

GROUP A: MAT EXERCISE

GROUP B: SWISS BALL

GROUP C: THERABAND EXERCISE

Data Analysis : The collected data were tabulated and analyzed using both descriptive and inferential statistics. All  the parameters were assessed using statistical package for social science (SPSS) Version 24. One way ANOVA includes of following test (Test Homogeneity of variance, ANOVA , post Hoc test Tukey HSD) (Multiple comparison) was adopted to find statistical difference between three groups .

RESULTS
On comparing Mean values of Group A, Group B & Group C on Body Mass Index (BMI) shows significant decrease in the Post test Mean values,  but MAT Exercise in Group A shows mean value 24.44, which has the Lower Mean value is effective than Theraband Exercise in Group C shows mean value 26.13 and followed by Swiss Ball Exercise in Group B  shows mean value  40.09  at P ≤ 0.001.

On comparing Mean values of Group A, Group B & Group C on Waist Circumference shows significant decrease in the Post test Mean values,  but MAT Exercise in Group A shows mean value 95.50, which has the Lower Mean value is effective than Theraband Exercise in Group C with mean value 96.00 and followed by Swiss Ball Exercise in Group B  with mean value 96.50  at P ≤ 0.001.

DISCUSSION

The present study was to compare the effects of twelve week training program for reducing abdominal obesity between Group A with Mat with Group B with Swiss ball and Group C with Theraband exercise.The purpose of this study was take an indepth look at the use of weight control behaviours among overweight and obese people Overweight adolescent were less likely to engage in vigrous physical activity or to report healthy eating patterns behaviours that create positive implication for weight management. In the present study age group of 18-25 years which are divided into three group. And each group assigned 10 members i.e Group A with Mat exercise contain 10 members, Group B Swiss ball contain 10 members and Group C with Theraband exercise contain 10 members.

Metabolic health risk was considered to include only categories of BMI, Hence keeping the objective the present study into consideration waist circumference and BMI measurement are considered as more valid and reliable outcome measures. The most important findings of the study is to measure the abdominall obesity demonstrated a strong response to effect of the mat, swiss ball and theraband exercise by reducing abdominal fat⁵.

Mat exercise which was performed to reduce abdominal obesity and strengthens the abdominal muscles and the subjects showed significant reduction in abdominal fat.

Swiss ball exercise are performed on unstable surface the level of muscle activity increases and in order to stabilize the spine muscle co-activation takes place. The subjects shows better benefit in the study. Performing curl up and back extension on swiss ball be a better method of strengthening core muscle and resulting in increases the muscle activity^6,7.

The theraband exercise which is performed on reducing abdominal fat could be because of the elastic resistance which does not rely on gravity and that it provides continuous tension to the muscle being trained. Another unique benefit could be the elastic resistance offers a linear variable resistance. Resistance training requires more energy expenditure as a result it helps in reducing and breaking of the abdominal fat. Maintanence of negative net energy balance promotes weight loss. Hence theintensity of exercise has to be increased progressively which was done in present study^8,9.

In table 3 it reveals the Mean, Standard Deviation (S.D), Homogeneity variance, ANOVA test, degree of freedom(df), F -value & P value of the Pre & Post BMI score between Group A, Group B & Group C in post test weeks. This table shows that there is no significant difference in pre test values of the BMI score between Group A, Group B  & Group C. This table shows that there is in pre test weeks (P > 0.05) a significant difference in post test values of the BMI score between Group  A,  Group  B  &  Group  C in  post  test  weeks  (P ≤ 0.05).

In table 6 reveals the Mean, Standard Deviation (S.D), Homogeneity variance, ANOVA test, degree of freedom(df),F -value & P valve of the Pre & Post waist circumference score between Group A, Group B & Group C in post test weeks. This table shows that there is no significant difference in pre test values of the waist circumference between Group A, Group B & Group C in pre test weeks  P > 0.05.

This table shows that there is a significant difference in post test values of the waist circumference between Group A ,Group B & Group C in post test weeks P ≤ 0.05.

The outcome measure of the study group namely mat, swiss ball,and theraband exercise group showed significant difference. When compared to pre and post test. The stastics shows effectiveness of Group A with Mat exercise which reduce the abdominal obesity. Thus present study was hypothesized that the mat exercise showed more effective than the theraband and the Swiss ball.

Ethical Clearance: Ethical clearance has obtained from Faculty of Physiotherapy, DR. MGR Educational and Reasearch Institute, Chennai to conduct this study with reference number: IV B/ PHSIO/ IRB/ 2017-2018dated 08/01/2018.

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

Fund for the study: It was aself financed study.

CONCLUSION

 The result of the study concluded that 12 weeks exercises program on mat, Swiss ball and theraband exercises are constitute to reduce in abdominal obesity.

On comparing the post mean value of BMI and waist circumference of Group A shows significant reduction when compared to Group B and C. Hence this study suggest that mat exercises more effective /beneficial to abdominal obesity patient.

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Citation:   S.Ramachandran, C. J. Sivadharsini, Jibi Paul (2020). Comparative study between Mat, Swiss Ball and Theraband exercises on reducing abdominal obesity among college going female students, International Journal of Medical and Exercise Science,  6 (1); 686-696.

Jibi Paul1,  Louis Christy Maxwell2*, Ena Dulom2, B D Mark Raj2, Moorthy A3

Author: 1Pofessor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. 2B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India 3Asst.Professor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India. Corresponding Author:        2*B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.Mail id: louismaxo336@gmail.com

ABSTRACT

Background of the Study: Shoulder is a very complex joint crucial to many activities of daily living. Decrease shoulder mobility is a serious clinical finding in Frozen shoulder or Adhesive capsulitis, which affects 2-5% of the population and is most common in 40-60-year age group. The aim of the study is to compare the aquatic training exercise over free exercise on shoulder function among pa patients.

Methodology:  This was an Experimental study with 30 male and female players. They were divided into two groups by simple sampling method, 15 players in each group.  Age group of the subjects was 40 to 60 years. Group A players were trained with aquatic training.  Group B players were trained with the free exercise.  Both the group players are trained for 4 weeks and 3 sessions in a week. Aquatic training was done in swimming pool at Rajiv Gandhi stadium, Chennai and free exercise therapy executed at Physiotherapy department ACS Medical College and Hospital, Chennai. Outcome Measures were, Range of Movement measured by Goniometer, Pain measured by Visual Analog Scale and Function was measured by (SPADI) Shoulder pain and disability index.

Result: On comparing Pre-test and Post-test within Group A & Group B on Visual Analog Scale, SPADI & Shoulder Range of Motion shows significant difference in Mean values at P ≤ 0.001.

Conclusion: Study concluded that the subjects treated with Aquatic training showed more improvement than Free Exercise  in shoulder pain, range of movement and function.

Keywords: Frozen Shoulder, Aquatic Training, Range of Movement, Shoulder Pain And Disability Index

Received on 12 th February  2020, Revised on 19th February  2020, Accepted on 26th February 2020

DOI:10.36678/ijmaes.2020.v06i01.003

INTRODUCTION

The shoulder is a very complex joint that is crucial to many activities of daily living. Decrease shoulder mobility is a serious clinical finding. Frozen shoulder or Adhesive capsulitis affects 2-5% of the population and is most common in 40-60-year age group ^1,2.

Adhesive capsulitis is a condition characterized by progressive loss of both active and passive range of motion. The patients with adhesive capsulitis experience more pain compared to other shoulder conditions. The movements are usually restricted to a characteristic pattern with proportional greater passive loss of shoulder shoulder external rotation and abduction than any other movement ^3,4.

The Frozen shoulder can be due to idiopathic or post traumatic causes, but the term adhesive capsulitis includes female gender, age older than40years, diabetes, thyroid disease, strokes, presence of autoimmune disorders^5,6.

Three stages of adhesive capsulitis are; 1) Freezing Stage:  Mainly characterized by severe pain in the shoulder even at rest.  There is also decrease in shoulder external rotation and abduction ROM. 2) Frozen Stage:  Pain is no longer present at rest but only with movement. Pain gradually subsides but stiffness is marked lasting 4 to 12 months.  3) Thawing Stage:  There is slow but progressive recovery of ROM. The freezing stage in this stage pain becomes worse and range of motion becomes more restricted. This phase lasts between 3 to 9 months and is characterized by an acute synovitis of the glenohumeral joint⁷.

The second stage is called the frozen or transitional stage in this there is a lack of synovial fluid, which normally helps the shoulder joint, a ball and socket move by lubricating the gap between the humerus and the socket in the shoulder blade. The shoulder capsule thickens, swells, and tightens due to bands of scar tissue (adhesions) that have formed inside the capsule. As a result, there is less movement in the joint for the humerus, making movement of the shoulder stiff and painful. The thawing stage is the final stage during which range of motion gradually improves over several months to years^8,9.

METHODOLOGY

This was an Experimental study with 30 male and female players. They were divided into two groups by simple sampling method, 15 players in each group.  Age group of the subjects was 40 to 60 years. Group A players were trained with aquatic training exercise.  Group B players were trained with free exercises.

Both the group players are trained for 4 weeks and 3 sessions in a week. Aquatic training was done in swimming pool at Rajiv Gandhi stadium, Chennai and free exercise therapy executed at Physiotherapy department ACS Medical College and Hospital, Chennai. Outcome Measures were, Range of Movement measured by Goniometer, Pain measured by Visual Analog Scale and Function was measured by (SPADY) Shoulder pain and disability index.

Intervention

Group B trained with Free Exercise For Periarthritis

1.ShoulderPendulum Stretch: Procedure: Relax your shoulder, Stand and lean over slightly, allowing the affected arm to hang down. Swing the arm in a circle about a foot in diameter. Prefer 10 revolution in each direction ,over a day.

2.Towel Stretch : Procedure:Hold one end of a three –foot long towel behind your back and grab the opposite end withyour other hand. Hold the towel in horizontal position.Use the good arm to pull the affected arm upward to stretch it.Do this 10 to 20 times a day.

3.Finger walk : Procedure: Face a wall three quarters of an arms length away. Reach out and touch the wall at waist level with the finger tips of the affected arm.

4.Cross Body Reach : Procedure: Patient in sit or standing position. Use patients good arm to lift the affected arm at the elbow and bring it up and across your body,exerting gentle pressure to stretch the shoulder. Hold the stretch for 15 to 20 seconds .do this 10 to 20 times per day.

 5.Armpit stretch: Procedure: Using your good arm to lift the affected arm out a shelf about breast high. Gently bend your knees ,opening up the armpit. Deepen your knees bend slightly ,gently stretching the armpit and then straighten

6.Outward Rotation : Procedure: Hold a rubber exercise band between your hands with your elbow at a 90 degree angle close to your sides.Rotate the lower part of the affected arm outward two or three inches and hold for five seconds.repeat 10 to 15 times in a day.

7.Inward Rotation: Procedure:-stand nexr ro a closed door and hook one end of a rubber exercise band across the locknob.hold the other end with the hand of the affected arm,holding your elbow at a 90 degree angle.pull the band towards your body two or three inches and hold for two seconds

Group A trained with Aquatic Exercise

1.Aquatic exercise for Gleno-humeral joint restricted abduction: Position of the Patient was in Prone lying. Position of The Therapist was stand by side of the patient, places her hand over the top of the shoulder to palpate for the motion.

Procedure: Therapist makes the patient to move his/her shoulder passively to the restricted position. Therapist stabilized the shoulder joint, holds along the restricted position and contracts away from the Barrier. the therapist ask the the patient to move the affected limb in the restricited side.till the target is achieved.

2.Aquatic Exercise For Gleno Humeral Joint Restricted External Rotation: Position of The Patient was in Prone lying.  Position of The Therapist was stand by side of the patient.

Procedure: Make the patient to move his/her shoulder passively to the restricted position. Therapist stabilized the shoulder, holds along the restricted position I.e. towards external rotation and contracts away from the barrier. Ask the patient to bring it for internal rotation with 1/3 of maximal effort. Hold for 6-7 secs and allow the patient to relax for 2 secs and then repeat the same after every 2 minutes for  consecutive weeks.

This table shows that there is significant difference in Pre-Test and Post-Test values between Group A and Group B (P > 0.05).

This table shows that there is significant difference in pre-test values between Group A & Group B (P>0.05).

There is a statistically significant difference between the pre-test and post-test values within Group A    ( P ≤ 0.001).

There is a statistically significant on pre-test and post-test values within Group B( P ≤ 0.001).

This table shows NO statistically significant difference in pre and post-test values between Group A & Group B  (P ≤ 0.05). But higher mean difference in Group A (6.33, 2.26) Shows better effect than Shows better effect than mean difference Group B (6.26, 2.13). 

This table shows statistically significant difference in pre and post-test values between Group A & Group B  (P ≤ 0.05). Group A  with mean difference 33.630, shows better effect than Group B  mean difference 26.53.

There is NO statistically significant difference between the pre-test and post-test values between Group  A and B ( P ≤ 0.05).  But Group A  with mean difference 24.2, 15.47, shows better effect than Group B  mean difference 22.8, 13.08. Respectively on abduction and external rotation.

RESULT

On comparing the Mean values of Group A & Group B on Visual Analog Scale, both the groups showed decrease in the pain intensity based on post-test Mean values in which (Group A ) shows 2.26 & (Group B) 2.13 Therefore no significant difference was found between post-test mean values at P> 0.05 (Table 1).

On comparing the Mean values of Group A & Group B on SPADI score, both the groups showed significant decrease in the post-test Mean values but (Group A ) shows 29.69 which has the Lower Mean value is effective than (Group B ) 37.34 at P ≤ 0.05 (Table 2).

On comparing the Mean values within the Group A & Group B on Shoulder Range of Motion (Abduction & External Rotation) both the group showed increase in the post-test Mean values in which Group A shows 107.26 & 42.33 degree (Group B) 106.53 & 40.26 degree respectively. Therefore no significant difference was found between post-test mean values at P> 0.05 (Table 3 and 4).

On comparing Pre-test and Post-test within Group A & Group B on Visual Analog Scale, SPADI & Shoulder Range of Motion shows significant difference in Mean values at P ≤ 0.001.

Table-5. Comparison of Visual Analog Scale score on pre and post test between Group-A and Group-B. This table shows NO statistically significant difference in pre and post-test values between Group A & Group B  (P ≤ 0.05). But higher mean difference in Group A (6.33, 2.26) Shows better effect than Shows better effect than mean difference Group B (6.26, 2.13). 

Table -6. Comparison of SPADI score on pre and post test between Group  A and Group  B. This table shows statistically significant difference in pre and post-test values between Group A & Group B  (P ≤ 0.05). Group A  with mean difference 33.630, shows better effect than Group B  mean difference 26.53.

Table-7. Comparison of ROM on Pre and Post test values between Group  A and B. There is NO statistically significant difference between the pre-test and post-test values between Group  A and B ( P ≤ 0.05).  But Group A  with mean difference 24.2, 15.47, shows better effect than Group B  mean difference 22.8, 13.08. Respectively on abduction and external rotation.

DISCSSION

This study is done to investigate, to find the effectiveness of aquatic training and free exercise on functional ability, pain and Range of motion of shoulder in patients with phase II Adhesive capsulitis.

In Adhesive capsulitis, there is loss of range of motion in all planes and pain persists for months. In subacute stage pain during movement of shoulder joint is more evident. In this study pain was measured on VAS Scale, range of motion by Goniometer and functional impairment was measured on Shoulder Pain and Disability Index.

The result of the study stated that there is statistically significant improvement in VAS, Range of motion and functional disability after 15 days training on aquatic training and free shoulder exercise. The study observed that on comparing both the Groups, there was statistically difference between Group A and Group B in Shoulder pain, ROM and functional disability index .

The age of participants was taken between 40-60 years both male and female in both the groups. The mean age in group A is 54.83 ±4.31 and in Group B it was 53.05± 5.02.

According to Robert Marske et al in the second or subacute stage of adhesive capsulitis shoulder pain does not necessarily worsen but there is pain at end of ROM, use of arm is limited causing muscular disuse. The primary role of mobilization is to restore joint play and facilitate joint movement by restoring arthrokinematics. The biomechanical effect manifests itself when forces are directed towards resistance but within limit of patient’s tolerance ^10,11.

The Mechanical changes may include breaking up adhesion in capsule, collagen realignment and improving interfibre glide when specific movement stress the specific part of capsular tissue ¹².

The aquatic exercise has an effect in reducing pain, increasing ROM and functional ability in patients with Adhesive capsulitis ¹³.

The aquatic exercise can stretches were effective in treating Range of motion especially external rotation and abduction in patients with periarthritis shoulder ¹⁴.

The study shows that aquatic exercise beneficial for decreasing pain, has vast effect on increasing Range of motion and functional ability in patients with periarthritis of shoulder ¹⁵.

Ethical Clearance: Ethical clearance has obtained from Faculty of Physiotherapy, DR. MGR Educational and Reasearch Institute, Chennai to conduct this study with reference number: C-21/ PHSIO/ IRB/ 2018-2019dated 08/01/2019.

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

Fund for the study: It was aself financed study.

CONCLUSION

The Study concluded that the subjects treated with Aquatic Exercise And Free Exercise showed more effective in improvement of shoulder pain, function and range of movement. Free exercise also shows improvement in shoulder pain and Range of motion (ROM) and functional disability .

Limitation of the Study: The sample size of this study was small. The study was for a Short duration and performed only for subjects with Periarthritis shoulder.

Recommendation of the Study:  This study can conduct with different age groups. The sample size can be increased in upcoming studies.

REFERENCES

1. Pink MM, Tibone JE. (2000).The painful shoulder in the swimming athlete. Orthop Clin North Am., 31:247–61.
2. Wolf BR, Ebinger AE, Lawler MP, et al. (2009). Injury patterns in division I collegiate swimming. Am J Sports Med., 37:2037-42.
3. Bak K. (2010). The practical management of swimmer’s painful shoulder: etiology, diagnosis, and treatment. Clin J Sport Med., 20: 386- 90.
4. Wanivenhaus F, Fox AJ, Chaudhury S, et al. (2012).Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health, 4: 246-51.
5. Tate A, Turner GN, Knab SE, et al. (2012). Risk factors associated with shoulder pain and disability across the lifespan of competitive swimmers. J Athl. Train., 47: 149–58.
6. McKenna L, Straker L, Smith A. (2012). Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers? J Sports Sci., 30: 1767-76.
7. Wymore L, Fronek J. (2015). Shoulder functional performance status of national collegiate athletic association swimmers: baseline Kerlan-Jobe orthopedic clinic scores. Am J Sports Med;43:1513–7.
8. Beach ML, Whitney SL, Dickoff-Hoffman S. (1992). Relationship of shoulder flexibility, strength, and endurance to shoulder pain in competitive swimmers. J Orthop Sports Phys Ther., 16: 262-8.
9. Heinlein S A, Cosgarea A J. (2010).  Biomechanical considerations in the competitive swimmer’s shoulder. Sports Health, 2: 519-25.
10. Hill L, Collins M, (2015). Posthumus M. Risk factors for shoulder pain and injury in swimmers: a critical systematic review. Phys Sports Med., 43:412–20.
11. Hibberd EE, Laudner K, Berkoff DJ, et al. (2016).Comparison of upper extremity physical characteristics between adolescent competitive swimmers and nonoverhead athletes. J Athl Train., 51: 65-9.
12. Bak K, Magnusson SP. (1997). Shoulder strength and range of motion in symptomatic and pain-free elite swimmers. Am J Sports Med., 25:454-9.
13. Harrington S, Meisel C, Tate A. (2014). A cross-sectional study examining shoulder pain and disability in division I female swimmers. J Sport Rehabil, 23: 65-75.
14. McMaster WC, Roberts A, Stoddard T. A (1998) Correlation between shoulder laxity and interfering pain in competitive swimmers. Am J Sports Med.,26: 83-6.
15. Zemek M J, Magee D J. (1996). Comparison of glenohumeral joint laxity in elite and recreational swimmers. Clin J Sport Med., 6: 40-7.

Citation:     Jibi Paul,  Louis Christy Maxwell, et al (2020).  A comparative study of aquatic training exercises over free exercise technique on shoulder function among periarthritis shoulder patients, International Journal of Medical and Exercise Science; 6(1); 677-685.

Reena R¹, Jibi Paul², Praveen Kumar³

Authors:
²Pofessor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.
³Asst. Professor, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.
Corresponding Author:
¹B.P.T. Graduate, Faculty of Physiotherapy, Dr.MGR. Deemed to be University, Chennai, Tamilnadu, India.
Mail id: reenamol193@gmail.com

ABSTRACT

Background of The Study: Hamstring is one of the commonest muscles often get tight as the biomechanics of hamstrings are complex because they pull over hip and knee joints. Stretching methods often define the development and improves body’s range of motion. Goal of all stretching relaxation is to provide joint mobility while maintaining joint stability. Hold relax is a technique of facilitating normal muscle sensation and muscle awareness. It is a relaxation technique to obtain lengthening reaction of muscle whose action is antagonist to movement limited in range. It is effective, simple and pain-free. PNF is used to supplement daily stretching and employed to quick gain in ROM, decreases in fatigue, prevent overuse injuries. The main objective of this study is to compare the effectiveness of passive stretching over PNF hold relax technique on hamstring tightness in young individuals. Materials And Methods: 100 normal male and  female subjects were recruited for the study with age group of 18-25 yrs and divided into two groups. Group A (n=50) treated with passive stretching Group B (n=50) treated with hold relax PNF technique. Outcome measures of the study were Finger Tip to Floor test, Back Saver Sit and Reach test. Result: The study shows there is statistical significant difference with P≤0.001 between Group A and B. When compare the two groups, Group B with PNF Hold relax gives more effective than the Group A with Passive stretching with Back Saver Sit and Reach test. Conclusion: The study concluded that PNF Hold Relax technique showed greater improvement than Passive Stretching on hamstring flexibility .    Key words: Hamstring flexibility, Passive stretching, PNF hold relax, Finger Tip to Floor test, Back Saver Sit and Reach test.

Received on 10 ^th February  2020, Revised on 19^th February  2020, Accepted on 25^th February 2020
DOI:10.36678/ijmaes.2020.v06i01.002

INTRODUCTION

Hamstring tightness is common in normal individual because of immobilization in a shortened position results in adaptive shortening. Tightness could make the musculo-tendinosus unit more susceptible to injury, increases resistance to anatomical structures, which may leads to overuse syndrome. Muscle tightness affects the normal length tension relationship. Muscle tightness also cause reciprocal inhibition ¹.

The hamstring flexibility is defined as the ability to move a joint or series of joints through full, unrestricted, pain-free range of motion.    Flexibility is a key component for Prevention of injury and rehabilitation, stretching decreases injury and improves performance in sports for overall fitness. Increased flexibility: While stretching your hamstring can increase flexibility and improve your range of motion in your joints. Improved hamstring flexibility which will be able to perform everyday activity like climbing stairs, lifting or bending over with greater ease. Reduced hamstring muscle flexibility has been implicated in lumbar spine dysfunction, with number of studies showing positive correlation between decreased hamstrings, flexibility and low back pain ^{2, 3}.

The hamstring muscle refers to those muscles that lie on the back of upper leg and thighs. They are strong muscles that can stretch up to 1.5 times their size, with regular stretching exercises.These muscles are used in almost all physical activity and keeping them stretched and goes a long way in improving overall flexibility and strength.Hamstring stretch are popular stretch used by gymnast, runners and sprinter to improve the flexibility of their muscles and to get ready with a warm up stretches with just the wall or a study chair for support loosen up tight muscles and improves blood flow to the lower limbs. Hamstring muscles make more flexible, preventing injury and tearing of the muscles ⁴.

Passive stretching: Passive stretching is also referred to as relaxed stretching. A passive stretch is a stretch where an individual will assume a position and hold it with the help of therapist/partner. The specificity of movement that a person performs in regular physical activity and stretching method often define the development and improve body’s range of motion. Goal of passive stretching programme is to provide joint mobility while maintaining joint stability.

PNF Technique: PNF is defined as exercises that enhance a neuro muscular response through the proprioceptors. Proprioceptive neuro- muscular facilitation is used as inhibition technique to assist with muscle elongation. PNF is used to supplement daily stretching when employed to quick gain in range of motion; it decreases fatigue and prevents overuse injuries. Hold relaxtechnique involves lengthening a tightened muscle and asks the patient to isometrically contract the muscle for several seconds. As the patient relaxes, after the contraction, the therapist lengthen the involved muscle further and holds the stretch at the end range of motion. Hold relax is a technique of facilitating normal muscle sensation and muscle awareness, used in treating hyper tonicity or motor dysfunction. It is often applied when there is muscle tightness in one side of joint and when immobility is the result of pain. PNF stretching was found to decrease muscle force in the hamstring muscles in response to the application of sudden stretch as might occur during functional activity.                          

Need of the study: Hamstring is one of the commonest muscles often get tight. The biomechanics of hamstrings is complex because they are two joints (hip & knee). Goal of passive stretching relaxation should be provided for joint mobility and maintaining joint stability.PNF Hold relax is a technique for facilitating normal muscle sensation, muscle awareness and decreases fatigue to prevent overuse injuries. The main aim of this study is to compare the effectiveness of passive stretching and PNF hold relax technique on hamstring tightness in young individuals. 

METHODOLOGY

This is an experimental study with Pre and Post Comparative test.  The study was conducted at Physiotherapy department, ACS Medical college and Hospital campus, Chennai. 100 normal subjects with age group of 18-25 yrs were recruited for the study and divided into two groups. Random sampling method used to allocate the samples in each group. Group A (n=50) treated with passive stretching Group B (n=50) treated with hold relax PNF technique. The study conducted for a duration of 2 months. Subjects with Recent fractures, Spinal deformity, TB spine, Psychological disorders were excluded from this study. Outcome measures of the study were Finger tip to floor test, Back saver sit and reach test.  Materials used for this study were informed concent, Inch tape, Scale, Couch Mark sheet.      

Intervention      

Finger -Tip- To Floor Test:  The patient stands comfortably with the feet facing forward and is asked to bend forward. The instruction is to bend  forward without  bending their  knees, attempt to touch the floor with your fingertips, go only as far as you can”.

Distance between the patient long finger and the floor is measured in inches. The process is performed once, the best effort is measured.

Back saver sit and reach test: The variations of the traditional sit and reach test is to measure the flexibility of the left and right legs separately.  This is the procedure used for the Fitness Gram Program.                This test measures the flexibility of the lower limb and hamstring muscles. Back Saver Sit And Reach Test is extremely high ^5,6.                                             

Group A: passive stretching.

Procedure: The patient in supine position. The therapist  should  kneel  down  on  the  mat  and  place the patients  heel    against  own  shoulder  and  placed  both  hands  along  the  anterior  aspect  of  distant  thigh  to  keep  knee  extended,  opposite  extremity  is  stabilized  in  extension  position  and  therapist  knee  place  by  with  in  0 degree  extension,  hip  in  neutral  position  and  then  investigator  flexes  the  hip  as  far  as possible. The stretching duration for 30 seconds.

Group B: PNF hold relax technique.  

Procedure: The patient in supine lying position.  For  each  stretching, therapist  give  passive  stretching  until  the patient  reports  mild  stretching  sensation  and  hold  that  position  for 30 seconds  by  asking     his / her  leg to push  back  towards   against  resistance  of therapist shoulder,  after  contraction and relaxation  for  30  seconds, measurement should be taken. 

RESULT

In Table 1 with group a, ftf and bssr have significant difference between the pre test & post test (p≤ 0.001).

In table 2  with Group B, FTF and BSSR have significant difference between the pre & post test value (P≤0.001).

This table shows that there is no significant difference in the pre test value between Group A and Group B (P≥0.05). This table shows that there is no significant difference in the post test value between Group A and Group B (P≥0.05).

This table shows that there is no significant difference in the pre test values in the score between Group A and B. This table shows statistically significant difference in post test values in BSSR score between Group A & Group B (p≤0.001).

DISCUSSION

The present study compared the effectiveness of passive stretching and PNF Hold Relax technique on hamstring tightness in young individuals. In this study suggested that Group B [PNF Hold Relax technique] showed greater improvement than Group A .

There is another study which shows there is no significant difference in ROM in standing & supine hamstring stretching as they are equally effective conducted by “Decoster LC (2004) ^7,8.

In Table 1,it shows significant increase in post test mean value of Group A [passive stretching] which has more effective mean value than pre test. In table-1 shows statistically highly significant difference in BSSR & FTF between pre test and post test (p ≤ 0.001).

In Table 2 shows significant increase in post test value of BSSR compare to FTF in Group B [PNF Hold Relax technique]. The pre test reduces compared to post test in BSSR of Group B shows significant between pre and post test (p ≤ 0.001).

In Table 3 shows effective increases in Group B compared to Group A, but it shows a negative pattern between pre and post test. Sharman Malanie who found that propioceptive neuromuscular facilitation produces superior ROM ^9,10,11.

 In Table 4 shows significant increases in Group B compared to Group A (P≤0.005). Therefore the use of PNF hold relax technique in Group B (p≤0.001) shows greater effective than Group A which will reduces the hamstring tightness.

A number of studies have demonstrated that stretching muscle tissue can increase joint range of motion ^12,13,14.

Ethical Clearance: Ethical clearance has obtained from Faculty of Physiotherapy, DR.MGR Educational and Reasearch Institute, Chennai to conduct this study with reference number: 025/ PHSIO/ IRB/2016dated 06/02/2016.

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

Fund for the study: It was aself financed study.

CONCLUSION

The result suggested that PNF Hold Relax technique showed greater improvement   than Passive Stretching. This study reveals that there is a significant difference between passive stretching and PNF Hold Relax technique. In the end of this study, PNF Hold Relax Technique is found to be more effective and reduces the tightness of hamstring muscles compared to passive stretching groups.

Limitation of the Study: The sample size of this study was small.   

Recommendation of the Study:  This study can conduct with different age groups. The sample size can be increased in upcoming studies. Different outcome measures recommended.

REFERENCES

1. Carter, AM :Kinzey, ss, chitwood, LF, et al : (2009). PNF decreases muscle activity during the stretch reflex in selected posterior thigh muscles.  Jo sports Rehabilitation  :9 (4) 249-278.
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5. Hui S.S., Yuen P.Y. (2000) Validity of the modified back-saver sit-and-reach test: a comparison with other protocols. Medicine and Science in Sports and Exercise 32, 1655-1659.
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7. Decoster L C. (2004). Standing & supine hamstring stretching are equally effective. Journal of Athletic training 39(4); 330-334.
8. Len Karvitz, P.H.D., (2000). Vivian H Heyward, Flexibility Training Journal of Fitness Training, 7:18-20.
9. Worrell, T., T. Smith, and J. Winegardner. (1994). Effects of hamstring stretching on hamstring muscle performance. JOSPT 20: 154-159.
10. Ross, M. (1999). Effects of lower extremity position & stretching on hamstring muscle flexibility. J. strength cond., Res. 13: 124-129.
11. Tanigawa MC. (1972). Comparison of the hold-relax procedure and passive mobilization on increasing muscle length phys. Ther., 7; 725-35.
12. Malanie S. (2006). PNF stretching mechanism & clinical implication. Journal of sports medicine 36(11) : 929-939.
13. Malanie S. (2006). Proprioceptive neuro-muscular facilitation stretching Mechanism and clinical implication. Journal of Sports Medicine, 36(11): 929-939.
14. Worrell TW, Smith TL et al. (1994). Effect of hamstring stretching on hamstring muscle performance. Journal of Orthopaedic Sports, 20(3):154-159.

Citation:  

Reena R, Jibi Paul, Praveen Kumar (2020). To compare the effectiveness of passive stretching versus pnf hold relax technique on hamstring tightness in young individuals  , International Journal of Medical and Exercise Science; 6 (1); 669-675.