RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate & address / RAGHUNANDAN NASWARIA19-b geeta coloney agra road
Bharatpur (Rajasthan)
2. / Name of the Institution / K.T.G COLLEGE OF PHYSIOTHERAPY
Hegganahalli Cross, Vishwaneedam Post,
Sunkadakatte via Magadi Road,
Bangalore-560091.
3. / Course of study and subject / MASTER OF PHYSIOTHERAPY
(Musculoskeletal Disorders and Sports)
4. / Date of Admission To Course / 25/5/2012
5. / TITLE OF THE TOPIC
“EFFECT OF KINESIO TAPING VERSUS MULLIGAN’S MOBILISATION FOR SUB ACUTE LATERAL ANKLE SPRAIN IN SCHOOL HOCKEY PLAYERS - COMPARETIVE STUDY”
6. / Brief resume of the intended work :
6.1 Need for the study:
The ankle sprain is the most frequently occurring injury in athletics resulting in a high cost of care and more lost time from competition than any other joint related injury 1
A sprained ankle is the most common sporting injury, particularly in pivoting and jumping / landing sports. It is also one of the most common injuries in hockey 2
Most serious injuries result from being struck by the stick or the ball. Epidemiological studies have consistently shown that injuries in hockey are numerous and can be serious. Players aged between 10 and 19 years account for 50% of hockey injuries 3
A major factor in the etiology of lower limb injuries can be the playing surface.64.87% injuries occurred while playing on natural grass and 35.13% occurred while playing on artificial turf.4,5
The reason for higher number of ankle sprains in India for general population and athletes can be attributed to various factors i.e. uneven or slippery walking and training surfaces, improper footgear or lack of sports specific footwear, advance sport specific training. 5
Feature of ankle sprain present with immediate inflammatory processes produce acute anterolateral pain and oedema, with avoidance of movement and weight bearing Subsequent losses of joint range, particularly dorsi flexion, and muscle strength results in significant gait dysfunction. Recent data from highlights that presence of a dorsi flexion deficit not only in the acute stage, but also in the sub acute stage 8
The athlete 'going over on' the ankle, so the sole of the foot faces inwards and results in pain, swelling, and limitation of movement. While injury to the ligaments may result in decreased mechanical stability of the ankle, neuromuscular deficits are also likely to occur as a result of injury to the nervous and musculotendinous tissue 7,8
Limitation of ankle motion or persisting pain was observed in 20–40% of patients after ankle sprains. In particular, limitation of ankle dorsi flexion is a serious problem in daily activities. For example, normal gait requires at least 10o of dorsi flexion, and descending stairs and kneeling needs more ankle motion 9
The early intervention in the lateral ankle sprains involves physiotherapy management in the form of rest ice compression elevation RICE and electrotherapy modalities to control inflammation, as well as manipulative therapy and therapeutic exercise therapy techniques to address impairment of movement and strength 11
The effectiveness of tapping in the prevention of sports injuries has only been studied in detail with regard to the lateral ligaments of the ankle. It appears that taping can protect against injury 12
Kinesiotaping is currently being used by therapists18 Functional rehabilitation is preferred over immobilization. Ankle taping is a common practice that has been used for many years as a way to prevent ankle sprains. Ankle taping restricts excessive range of motion by acting as an external ligament1,8,13
The Mobilization with movement (MWM) treatment approach for improving dorsi flexion post-ankle sprain combines a relative posteroanterior glide of the tibia on talus (or a relative anteroposterior glide of the talus on the tibia) with active dorsi flexion movements, preferentially in weight bearing. MWM technique produced significant gains in dorsi flexion range 14
The effectiveness of application Mulligan’s mobilization with movement (MWM) for talocrural dorsi flexion to sub-acute lateral ankle sprains produces an initial dorsi flexion gain, and simultaneously produces a mechanical but not thermal hypoalgesia, so studies have found the effectiveness in sub-acute lateral ankle sprain in secondary school hockey players 15
There is a lack of studies for the management strategies of patients with sub-acutely injured lateral ankle ligament complex. Thus, the purpose of this study is to examine the effectiveness of Kinesiotaping versus Mulligan’s mobilization with movement (MWM) in the treatment of sub-acute lateral ankle sprain an improve of pain and ankle dorsiflexion range of motion in secondary school hockey players 15
Research Question:
Whether the kinesio taping or mulligan’s mobilization does have an effect on improving pain and ankle dorsiflexion range of motion in secondary school hockey player sub acute lateral ankle sprain?
Hypothesis:
Null hypothesis:
There will be no significant effects between kinesio tapping versus mulligan’s mobilization in the treatment of sub acute lateral ankle sprain on improving pain and ankle dorsiflexion range of motion in secondary school hockey player.
Experimental hypothesis:
There will be significant effects of kinesio tapping and mulligan’s mobilization in the treatment of sub acute lateral ankle sprain on improving pain and ankle dorsiflexion range of motion in secondary school hockey player.
6.2 Review of Literatures:
Review on sub acute lateral ankle sprain:
Dr. Gopal Nambi S et al (2012) The classic ankle sprain occurs with inversion of the plantar flexed ankle when the forefoot is bearing weight. Maximum elongation and tension of the ATFL occurs in plantar flexion. Forced inversion while in plantar flexion can increase ligament stress and strain beyond the yield point (stretch or partial tear) or even the ultimate failure strain (complete tear) 15
P.Firer et al (2009) When fracture is ruled out, specific special tests should be performed in order to correctly diagnose if the problem is a ligamentous injury. The anterior drawer test and the talar tilt test were the two common tests to assess the integrity of the anterior talofibular ligament, and could be useful in diagnosing the grading of the tear of the ligament 12
Ivins D. et al (2006) Initial care involves PRICE (protection, rest, ice, compression, and elevation). Use of elastic bandages, braces (figure 8, stirrup), casts, and crutches depends on the severity of the injury. Ice (15 to 20 minutes every few hours for two to three days), compression (pressure wrap), and elevation (above the heart) help control swelling and pain 20
Khatri S. et al basics of electrotherapy 1st edition jaypee brother’s (2003) Ankle injury is one of the most common musculoskeletal injuries in athlete and sedentary persons, however in many patients in ankle injury do not seek medical attention. The most common acute injury is a lateral ankle inversion sprain 16
Norkin C C et al Measurement of joint motion, a guide to goniometry 2nd edition (1998) Generally ankle sprain divided in to three grades: - first grade (mild) sprain is a lateral ligament injury without macroscopic tearing very little functional loss and weight bearing is possible. Second grade sprain (moderate) in lateral ligament has a partial macroscopic tear and weight bearing ability is very limited. Third grade sprain (severe) in lateral ligament is complete macroscopic tear. Complete functional loss.17
Pamela K. Levangie Norkin. 4th Edition: “Joint structure and function The Anterior Talo fibular Ligament - ATFL provides stability against excessive inversion of the talus; the Posterior Talo fibular Ligament PTFL resists ankle dorsiflexion, adduction ("tilt"), medial rotation, and medial translation of the talus and the Calcaneo fibular Ligament - CFL provides stability against maximum inversion at the ankle and Subtalar joints18
David J. Magee. Anterior drawer test the patient supine lies with the foot relaxed. The therapist stabilizes the tibia and fibula, and draws the talus forward in the ankle mortise. Sometimes the dimple appears over the area of the anterior talofibular ligament on anterior translation, if pain and muscle spasm are minimal. In the planter flexed position, the anterior talo fibular ligament is perpendicular to the long axis of the tibia, by adding inversion, which gives an anterolateral stress; the therapist can increase the stress on the anterotalofibular ligament and the calcaneofibiular ligament. A positive anterior drawers test may be obtained with a tear of only the anterior talofibular ligament, but anterior translation is greater if both ligaments are torn, especially if the foot is tested in dorsiflexion. If straight anterior movement or translation occurs, the test indicates both medial and lateral ligament insufficiency. 19
Review on mulligan’s with mobilization:
Rogier M van Rijn et al (2007) Several reviews indicate that conventional treatment (early mobilization, including mobilization instructions and early weight bearing combined with or without the use of external support) is the preferred treatment strategy. External support used is tape, bandage, or a brace, but never a plaster cast.8
Bill Vicenzino et al (2006) This preliminary study demonstrated an initial ameliorative effect of MWM treatment techniques on posterior talar glides and dorsi flexion range of motion in individuals with recurrent lateral ankle sprain. They concluded that this technique should be considered in rehabilitation programs following lateral ankle sprain 23
Merlin DJ Et al (2005) The results showed that after sustaining a sprain of the lateral ligament complex and undergoing the MWM technique an increase in the range of dorsi flexion, an increase in balance ability and a cephalad movement of the fibula occurred.22
Michael W. Wolfe Et al (2001) Early manipulative treatment and therapeutic exercise techniques to address impairments of movement and strength. The Mobilization with movement (MWM) treatment approach for improving dorsi flexion range of motion in ankle joint after post-ankle sprain combines a relative posteroanterior glide of the tibia on talus (or a relative anteroposterior glide of the talus on the tibia) with active dorsi flexion movements, in weight bearing. Mulligan’s techniques significantly improved in dorsi flexion range 21
Review on tapping:
Todd E Davenport et al (2010) Numeric Pain Rating Scale (NPRS) and Pain Diagram The 11-point NPRS will be used to structure 3 measurements of subjects’ pain intensity, including the levels at best in the past 24 hours, at worst in the past 24 hours, and the current level of pain. The NPRS ranges from “No Pain” and “Worst Imaginable Pain.” NPRS measurements are reliable and valid for use in clinical trials [48]. A pain diagram will be used to record the location and nature of a patient’s ankle and foot symptoms by drawing it on the diagram of a human figure 26
Rogier M van Rijn et al (2007) Participants were encouraged to start these activities as early as possible, and to increase their activity level gradually. In general practice the ankle was protected by a tape or bandage if considered necessary by the physician, and in the emergency department the ankle was protected with a brace (Active Ankle Trainer, Louisville, US) 8
M. Meena et al (2007) One of the most utilized methods for the ankle sprain prevention is the functional taping. However, despite its effectiveness in the limitation of the ankle’s ROM (range of movement) its effect on the ROMs during the specific sports techniques involved in the mechanism of injury is not clear, because most of the studies on the mechanical effects of ankle taping have used static tests for the measurement of ROM. The effectiveness of taping decreases during the exercise because of the tape loosening and the loss of tape adherence to skin 24
Rogier M van Rijn et al (2007) Several reviews indicate that conventional treatment (early mobilization, including mobilization instructions and early weight bearing combined with or without the use of external support) is the preferred treatment strategy 8
Bennell KL et al (1998) This study aimed to evaluate the inter-rater and intra-rater reliability of a weight-bearing dorsi flexion (DF) lunge in 13 healthy subjects. Our raters with varying clinical experience tested all subjects in random order. Two of the raters repeated the measurements one week later. Two methods were used to assess the DF lunge: (i) the distance from the great toe to the wall and (ii) the angle between the tibial shaft and the vertical using an inclinometer. The average of three trials was used in data analysis. Intra-rater intraclass correlation coefficients (iccs) ranged from 0.97 to 0.98. Inter-rater ICC values were 0.97 (angle) and 0.99 (distance). Results indicate excellent reliability for both methods of assessing a DF lunge 27
Pierre P. Menfroy et al (1997) According to some investigators, ankle taping appears to lower injury rates 11 and does not hinder athletic performance 25
Objectives of the study:
1. To find out the effectiveness of kinesiotaping for sub-acute lateral ankle sprain in school hockey players by analysis pain and range of motion.
2. To find out the effectiveness of Mulligan’s mobilization (MWM) in sub-acute lateral ankle sprain in school hockey players by analysis pain and range of motion.
3. To compare the effects of Kinesiotaping over Mulligan’s mobilization (MWM) for sub-acute lateral ankle sprain in school hockey players.
7. Materials and Method:
7.1 Study Design:
Experimental Study design with two groups- Group A and Group B
7.2 Methodology:
Sample size
The study will be carried on 30 subjects.
Source of data:
Study will be carried out in KTG Institution, Sports Department, Bangalore
Sampling Method:
Simple random sampling method in both groups.
Study Duration:
Thrice a week for two weeks.
Sample Selection:
Inclusion Criteria:
· Subjects with age of 13 to 17 year. 28
· Both male and female subjects 29
· After 10 days to 7 weeks of injury 30
· Tenderness restricted to the lateral ligament 30
· Stendard dorsiflexion range for normal walking 7
· Positive anterior drawer or inversion stress maneuver suggesting ligamentous laxity 31
Exclusion Criteria:
· Current assisted ambulation (e.g., cane or crutches) 31
· Acute or healing fracture and Medial ankle instability 32
· Gross ligamentous mechanical instability (grade III ankle sprains) 33
· Syndesmosis injury and Inflammatory arthritis 32
· A sprain sustained in the previous 12 months 34
· Benign joint hyper mobility syndrome 32