RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME AND ADDRESS OF THE CANDIDATE : / AMBIKA BDEPARTMENT OF PHYSIOTHERAPY
M.S. RAMAIAH MEDICAL COLLEGE
M.S.R.I.T.POST,
BANGALORE -54
2. NAME OF THE INSTITUTE: / DEPARTMENT OF PHYSIOTHERAPY
M.S. RAMAIAH MEDICAL COLLEGE
M.S.R.I.T.POST,
BANGALORE -54
3. COURSE OF STUDY AND SUBJECT: / MASTER OF PHYSIOTHERAPY (MUSCULOSKELETAL AND SPORTS PHYSIOTHERAPY)
4. DATE OF ADMISSION
TO COURSE: / 11.08.2013
5. TITLE OF THE TOPIC: / “COMPARATIVE STUDY ON EFFECT OF MUSCLE ENERGY TECHNIQUE Vs PASSIVE STRETCHING ON UPPER TRAPEZIUS IN FORWARD HEAD POSTURE”.
6. BRIEF RESUME OF THE INTENDED WORKS:
6.1 NEED FOR THE STUDY:
FORWARD HEAD POSTURE:
One of the most common postural problems in the cervical area is forward head posture1. It is the repetition of forward head movement combined with poor ergonomics that causes the body to adapt to forward head posture. Mood, blood pressure, pulse and lung capacity are most easily influenced by posture2.
Some evidence exists that postural positions can affect the nerve tissue by altering blood flow to the spinal cord3. People with uncorrected Forward Head Posture can potentially suffer chronic or unpleasant conditions such as pinched nerves and blood vessels, like thoracic outlet syndrome, muscle and tissue pain, syndromes like fibromyalgia, chronic strains and early degeneration and arthritis4.
In forward head posture, the head is held inches ahead of center of gravity weighs the head times the inches ahead of center of gravity (about 3-30lbs)5. Observations associated with forward head posture include measurement of distance between external auditory meatus anterior to acromion and observation of sternocleidomastoid hypertrophy6.Two types of muscle problem which are associated with forward head posture are Tightness and weakness. Stretch weakness of anterior vertebral neck flexors, and tightness of neck extensors including the upper trapezius, splenius capitis, Sternocleidomastoid and semispinalis capitis is noted7. Muscular imbalance take place in the body because of tight and weak muscles which adversely affects the normal patterns of movements6. Muscle Energy Technique uses the physiology of reciprocal inhibition and post isometric relaxation to lengthen the muscle8,9.
Muscle Energy Technique can be used to lengthen a shortened, contracted or a spastic muscle or muscle groups, to reduce oedema, relieve passive congestion , to strengthen a physiologically weak muscles and to mobilize articular structures10.In passive stretching a therapist applies an external force to move the involved body segment slightly beyond the point of tissue resistance and available ROM at a particular period of time to lengthen the tight muscle11.
Studies have been done on muscle energy technique of upper trapezius in forward head posture. Limited studies is available on the effect of passive stretching of upper trapezius muscle in forward head posture. Therefore, the present study aims to study and compare the effect of Muscle Energy Technique and Passive stretching on Upper Trapezius in Forward head posture.
REVIEW OF LITERATURE:
Ballantyne F et al have done a study on The effect of Muscle Energy Technique on hamstring extensibility.It was concluded that Muscle Energy Technique causes immediate increase in passive knee extension and there is significant increase in the ROM of knee.13
Deptee warikoo et al has done a study on effect of muscle energy technique in forward head posture: experimental study10. Their Study have proved Muscle Energy Technique is a good technique to help lengthen a tight structure.
Cesar Ferandez et al has done a study on Trigger points in the suboccipital muscles and forward head posture tension type headache14 This study shows that upper trapezius are tight in forward head posture and have proved to have trigger points in suboccipital muscles in tension type headache of forward head posture.
Fryer et al have done a study to study the influence of duration of contraction in Muscle Energy Technique applied to the atlantoaxial joint and concluded that Muscle Energy Technique using 5 second contraction produced significant increase in rotation, both restricted and non restricted side.15
Sally Raine et al has a done a study on Head and shoulder posture variation in 160 asymptomatic individuals16. Photographic method was used to assess the head and shoulder angle. They found that there were significant change in curvature of cervical spine and thoracic spine as the age increases with respect to gender.
Odunaiya N.A et al hav done a study on the Effects of Static Stretch Duration on the Flexibility of Hamstring Muscle12.This study showed that passively stretching the tight hamstrings for any duration between 15 and 20 seconds on alternate days for 6 weeks would significantly increase its flexibility.
Lenehan KL et al has done a study on The effect of Muscle Energy Technique on gross trunk Range Of Motion was studied. They concluded that study supports the use of Muscle Energy Technique to increase restricted spinal rotation ROM16.
7. OBJECTIVES OF THE STUDY
7.1. Aim of the study
To compare the effect of passive stretching over muscle energy technique on upper trapezius with asymptomatic forward head posture.
7.2 NULL HYPOTHESIS
There is no significant difference between the effect of passive stretching over Muscle Energy Technique on trapezius tightness.
7.3. ALTERNATE HYPOTHESIS
There is significant difference of effectiveness of passive stretching over Muscle Energy Technique in asymptomatic forward head posture.
8. MATERIALS AND METHOD:
8.1 SOURCE OF DATA
Department of Physiotherapy, M.S Ramaiah hospitals, Bangalore and other rehabilitation centres located in Bangalore.
8.2. METHOD OF COLLECTION OF DATA
8.3. STUDY DESIGN:
This is a study of pre-test and post-test experimental research design.
8.4. STUDY SAMPLE DESIGN
Selection of samples is done by random sampling method.
8.5. SAMPLE SIZE: 30
Group A: Muscle energy technique is given to thirty individuals.
Group B: Passive stretching is given to same thirty individuals after 48 hours.
9.INCLUSION CRITERIA
Age 18-40 years (both males and females).
People with Asymptomatic forward head posture.
10.EXCLUSION CRITERIA
Patient less than18 years and more than 40 years of age.
Cervical spondylosis or related cervical pathology.
Fractures of cervical spine.
Infectious and Metabolic diseases around the cervical spine.
Any congenital abnormalities.
Patient with any CVS or Neurological diseases.
Pain more than 8 on VAS.
Vertigo and Dizziness.
11.INTERVENTION/ ASSESSMENT TO BE DONE
11.1 MEASUREMENT TOOLS
Video camera
Markers for the joint
Video/ photograph software.
Scale.
Pencil/pen.
Protractor.
Chair.
Screen.
12.METHOD:
Subjects will undergo screening as per the inclusion and exclusion criteria. All procedures will be explained, prior to any screening measurements and informed consent will be taken from all subjects involved in the study. Passive stretching will be given to 30 individuals. Muscle energy technique is given to 30 individuals after 48 hrs. Pre and Post Treatment assessment will be taken in both the technique.
13.OUTCOME MEASURES:
Photographs.
C7 tragus angle.
14.STATISTICAL ANALYSIS: All the quantitative variables in the present study will be summarized in terms of descriptive statistics like mean and standard deviation. All the qualitative variables will be expressed in terms of proportion.
15.ETHICAL CLEARANCE
Ethical clearance will be obtained from the ethical committee of the institution.
16. Does the study require any investigations or interventions to be conducted on the patients or other humans or animals?
Yes
17. Has ethical clearance been obtained from the institution in case of 16?
Yes
LIST OF REFERENCES
1. Deepak sebastein, Principles Of Manual therapy, Cervical spine, Musculoskeletal system, jaypee brothers, 2005, pg 54.
2. John Lennon, C.Norman Shealy, Roger K. Cady, William Matta, Richard Cox and William F. Simson, Postural and Respiratory Modulation of Autonomic Function, Pain & Health, AJPM Vol 4., No 1 January 1994.
3. Adams CBT, Logue V. Studies in cervical spondylotic myelopathy part I: movements of the cervical roots, dura, and cord and their relation to the course of the extrathecal roots. Bra
in 1971;94:557-568.
4. Dontelli R, Wooden M, Orthopedic physical therapy. New York, Steve Kraus Publication,Churchill Livingstone inc., 1989
5. Kirk Eriksen, Upper Cervical Subluxation Complex, A Review of the Chiropractic and Medical Literature, Page 232.
6. Warren Hammer, Muscle Tightness, Dynamic Chiropractic, January 15, 1993, Volume 11, issue 02.
7. Micheal Clark, Scott Lucett, Essentials of Corrective Exercise Training, National Academy of Sports Medicine - 2010 - pg 67.
8. Berne, Robert M., Levy, Matthew N., Principles of Physiology, Second Edition, Mosby, 1996.
9. Chaitow, Leon, Muscle Energy Techniques, Second Edition, Churchill Livingston, 2001.
10.Deptee warikoo et al and Mirza ambreen beg..effect of muscle energy technique in forward head posture: experimental study, Lambert academy publication,20 dec 2010.
11.Carolyn Kisner, Lynn Allen Colby, Therapeutic Exercise: Foundation and Techniques, Jaypee Brothers, New Delhi: Fourth edition 2002, pp 171-211.
12. Odunaiya N.A., Hamzat T.K., Ajayi O.F.,The Effects of Static Stretch Duration on the Flexibility of Hamstring Muscles, African Journal of Biomedical Research, Vol 8 (2005);79-82.
13. Ballantyne F, Fryer G, McLaughlin P., The Effect of Muscle Energy Technique on Hamstring Extensibility, The Mechanism of Altered Flexibility, Journal of Osteopathic Medicine.2003; 6(2):59-63
14. Cesar Fernandez, Trigger points in suboccipital muscle and forward head posture in tension type-headache, American Headache society, Headache 2006; 454-460.
15. Fryer, Gary, Ruszkowki, The Influence of Contraction Duration in Muscle Energy Technique Applied to Atlanto-Axial Joint, Journal of Osteopathic Medicine. 2004;7(2):79-84.16. Sally Raine, PhD, Lance T. Twomey, PhD,Head and shoulder posture variation in 160 asymptomatic women and men, Phy Med Rehab 1997;78; 1215-
16. Lenehan KL, Fryer G, McLaughlin P., The effect of muscle energy technique on gross trunk range of motion, Journal of Osteopathic Medicine. 2003; 6(1):13-18
18. SIGNATURE OF THECANDIDATE:
19. NAME AND DESIGNATION OF Mrs SOUMYA .G
GUIDE: ASSISTANT PROFESSOR
DEPARTMENT OF PHYSIOTHERAPY
M.S.RAMAIAH MEDICAL COLLEGE.
20.SIGNATURE OF GUIDE:
21.NAME AND DESIGNATION OF Ms. PAYAL DHAKKAPPA
CO-GUIDE: LECTURER
DEPARTMENT OF PHYSIOTHERAPY
M.S.RAMIAH MEDICAL COLLEGE.
22. SIGNATURE:
22.1. HEAD OF DEPARTMENT: Prof. SAVITA RAVINDRA
HEAD OF DEPARTMENT
DEPARTMENT OF PHYSIOTHERAPY
M.S.RAMAIAH MEDICAL COLLEGE
23. REMARKS OF THE CHAIRMAN
AND THE PRINCIPAL:
24. SIGNATURE:
ANNEXURE 1
INFORMED CONSENT
In my language, I have been informed by Mrs AMBIKA B that, a study has been undertaken to study “COMPARATIVE STUDY ON EFFECT OF MUSCLE ENERGY TECHNIQUE Vs PASSIVE STRETCHING ON UPPER TRAPEZIUS IN FORWARD HEAD POSTURE”. I have been explained the need of the study, i.e. the effect of Muscle energy technique and passive stretching on upper trapezius in subjects with forward head posture. I understand that this study is purely for academic / problem solving purpose. I have been explained about the entire procedure of stretching and assessment. Any queries that I will be having during the course of study will be explained.
I have been explained that my participation is voluntary and I can withdraw at any time, hence I am satisfied with the same.
I hereby give my consent to be included in the study.
SUBJECT NAME : DATE:
SIGNATURE
INVESTIGATOR NAME: DATE:
SIGNATURE
ANNEXURE 2
ASSESSMENT PROFORMA
Ø DEMOGRAPHIC DATA:
· NAME-
· AGE-
· SEX-
· DOMINANCE-
· OCCUPATION-
· LEISURE ACTIVITIES-
· ANY OTHER CONTRIBUTING FACTORS-
PRE-TEST MEASUREMENT
HEAD ANGLE-RIGHT / HEAD ANGLE-LEFT / NORMALGROUP A
GROUP B
POST-TEST MEASUREMENT
HEAD ANGLE- RIGHT / HEAD ANGLE- LEFT / NORMALGROUP A
GROUP B