Nishanth Synopsis Latest

8/4/2019 Nishanth Synopsis Latest

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1 NAME OF

CANDIDATE

Nishanth O

2 GUIDE Mrs.Aparna. MPT(ortho)

3 INSTITUTION

Co-operative Institute of

Health Science, Thalassery

4 COURSE

Master of physiotherapy

Elective: Musculoskeletal

and sportsInjuries

5 DATE OF

ADMISSION


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TITLE

EFFECTIVENESS OF MUSCLE

ENERGY TECHNIQUE IN PATIENT

WITH ACUTE LOW BACK PAIN


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INTRODUCTION

Low back pain (LBP) is posterior trunk pain between the

ribcage and the gluteal folds. It also includes lower extremity

pain that results from low back disorder (sciatica/radiating low

back pain), whether there is trunk pain or not.

Acute LBP: Back pain 6 weeks but 3 months 1


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Acute low back pain(pain


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Another common treatment for acute low back pain is the use of manual

therapy. While under the broad umbrella of manual therapy, Muscle

Energy Technique (MET)2 does not fall into the subcategories ofmanipulation or mobilization

MET is an active technique in that the patient, instead of the

care provider, supplies the corrective force.

Greenman3 defined MET as a manual medicine treatment procedure

that involves the voluntary contraction of patient muscle in a precisely

controlled direction, at varying levels of intensity, against a distinctlyexecuted counterforce applied by the operator. It has been hypothesized

that MET can be used to lengthen and strengthen muscles, to increase

fluid mechanics and decrease local edema, and to mobilize a restricted

articulation.


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NEED OF THE STUDY

To determine whether patients with acute low back pain would demonstrate

a greater reduction in disability (disability is any restriction or lackresulting from an impairment of ability to perform an activity in the manner

or within the range considered normal for a human beingby UN )as assessed

by Oswestry Disability Index

To improve lumbar side bending restriction

AIM OF THE STUDY

To study the effect of MET in reducing pain and correcting the disabilityin patients with acute low back pain

To improve trunk side bending restriction


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REVIEW OF LITERATURE

1)Journal of Orthopedics & Sports Physical Therapy (JOSPT)

Capt. Eric Wilson, PT, DSc, OCS, SCS, CSCS1

Otto Payton, PT, PhD, FAPTA2

Lisa Donegan-Shoaf, PT, PhD3

Katherine Dec, MD4

stetes thatMET combined with supervised motor control and resistance

exercises may be superior to neuromuscular re-education and resistancetraining for decreasing disability and improving function in patients with

acute low back pain

2) Clinical application of neuromuscular techniques

Vol 2Leon Chaitow

Judit Walker DeLany

Explained the technique of MET in lumbar region


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3)Greenman20 defined

MET as a manual medicine treatment procedure that involves thevoluntary contraction of patient muscle in a precisely controlleddirection, at varying levels of intensity

Greenman P.Principles of Manual Therapy. 2nd ed.

Baltimore, MD: Williams & Wilkins; 1996.

4) ObjectiveAssessment with Establishment of Normal Valuesfor Lumbar Spinal Range of Motion

G. KELLEY FITZGERALD, KEVIN J. WYNVEEN, WENDY RHEAULT,

and BRUCE ROTHSCHILD

Described an objective and reliable method for measuring lumbar spinal range ofmotion and established normal values according to age for this method as indicatedby a 95 percent confidence interval.

5) University of Michigan Guidelines for Health System Low Back PainGuideline Team

Described the classification and treatment of low back pain according to severity of

back pain


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OBJECTIVES

1. To find out the efficacy of Muscle EnergyTechnique (MET) in correcting disability andimproving lumbar side bending restriction inpatients with acute low back pain

2. To find out efficacy of neuromuscularreeducation and resisted exercise in back pain


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HYPOTHESIS

NULL HYPOTHESIS

There is no significant effect of MET along with resisted exercise in

correcting the disability and improving lumbar side bending restrictionin patient with low back pain

ALTERNATE HYPOTHESIS

There is significant effect of MET along with resisted exercise in

correcting the disability and improving lumbar side bending restriction

in patient with low back pain


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MATERIALS AND METHOD

SOURCE OF DATA : CO-OPERATIVE INTITUION OF HEALTH SCIENCES

THALASSERY

SAMPLE SIZE : 30 patients (15 in each group)

RESEARCH DESIGN : pre test- post test

OUTCOME MEASURE : Oswestry Disability Questionnaire

Lumbar side bending Range of Motion

MATERIALS REQUIRED

1. Inch tape

2. Long lever goniometry

3. Oswestry Disability Questionnaire4. Dumbbells

5. Pulley exerciser with resistance


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METHODS OF COLLECTION OF DATA

Patients were placed into either the

experimental group or the control group upon

entering the study.A coin toss determined the

group placement of the first patient to enter the

study. Further patients were either randomlyassigned or matched to patients already

participating in the study according to initial

ODI score and side bending restriction.

Patients were matched by initial ODI score

according to the categories originally

described by Fairbank : moderate (20%-40%)


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INCLUSION CRITERIA

Inclusion criteria included

1. Low back pain of no more than 6weeks duration at the time of examination,2. A subject age range of 18 to 35years old, male patients

3. Initial ODI score of 20% to 40%,

4. Physical therapy diagnosis of low back pain without radiating symptoms.

5. The final inclusion criterion was a lumbar side bending restriction measured as

described by Fitzgerald et al.

EXCLUSION CRITERIA

Exclusion criteria included

1. Radiating pain, paresthesia or numbness into the buttocks or lower extremities,

2. Motor weakness, absent or diminished muscle stretch reflexes (MSRs),

3. Spondylolisthesis,

4. Chronic low back pain of more than 12 weeks, and

5. Previous back surgeries.

6. in co-operative patient


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VARIABLES OF THE STUDY

DEPENDENT VARIABLE

The dependent variable is

1. ODI

2. Lumbar side bending range of motion

INDEPENDENT VARIABLE

The independent variable is MET


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METHODOLOGY

Male patients diagnosed with acute low back pain were randomlyassigned. Patients were matched according to initial Oswestry score.

Lumbar side bending restriction was measured as described byFitzgerald et al.

The patient stood erect with feet shoulder-width apart and hands byhis/her side prior to performing 3 repetitions of maximal trunk side

bending, flexion, and extension. The mean of the 3 measures was usedto determine if an asymmetry existed in side bending. A subjectivereport of pain greater with flexion than extension was considered a

positive finding.

The control group received supervised placebo manual therapy andresistance training while the experimental group received resistancetraining coupled with MET. Both groups received the selectedtreatment 8 times over a 4-week period (2 times per week). Patientscompleted an Oswestry Disability Index on their first and eighthvisits and change scores were calculated.


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MET applicationby Leon Chaitow


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PROCEDURE

1)Patient lies on right side. Examiner palpates lumbar

spinous process and extends patients legs until motion ispalpated at restricted lumbar vertebra.

2)Examiner flexes patients trunk superiorly until motion

is palpated at restricted lumbar vertebra.

3)Examiner flexes trunk inferiorly until motion is

palpated restricted lumbar vertebra.

4)Examiner rotates patients trunk until motion is

palpated at restricted lumbar vertebra.


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Cont..

5)Examiner side-bends patients trunk until motion is

palpated at restricted lumbar vertebra. Upon command,

patient pushes her legs down into examiners hand for a

5-second isometric contraction. Entire process isrepeated 4 times. Restricted lumbar vertebra is re-

evaluated for alignment


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Placebo manual

therapy

The placebo manual therapy was performed for 2 reasons.

First, patients in both groups were informed that they were

participating in a manual therapy study at the time of inclusion.

The placebo treatment sought to control for the laying-on of

hands effect often associated with manual therapy research

Second, it was hoped that this would decrease any potential bias in the

subjects by further masking them to their group assignment.

Side-lying passive range of motion was selected as the placebo

manual therapy because it most closely mirrored the MET

intervention without resulting in any perceived therapeutic effect.The patient was instructed to lay on the side opposite of the

restriction diagnosed during the initial evaluation while the primary

investigator passively moved the patients lumbar spine into flexion

and rotation and side bending into the direction of the restriction.


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Resisted Exercises Performed

1 Drawing-in maneuver

Patient supine with hips/knees slightly flexed (20). Instructed

to draw the navel in towards the spine and cephalad towards

the head. To be held while respiration occurs until fatigue.

2 Standing extension stabilization

Utilizing a high pulley, the patient grasps the bar with hands

shoulder width apart. Performs drawing-in maneuver then anisometric gluteus maximus squeeze and holds these as the patient

extends his/her shoulders (elbows extended) bringing the bar to

the waist. Patient raises the bar to the starting position and relaxes

buttocks, then abdomen. 50 repetitions


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3. Simple supine obliques

Patient supine with hips/knees slightly flexed (20) and arms by the

side. Patient performs a drawing-in maneuver and holds it as he/shesimultaneously reaches for the right ankle with the right hand and

rotates the trunk to the right, bringing his/her left shoulder off the

mat until the inferior angle of the left scapula clears the mat. Holds for

a count of 1 and returns to starting position. Repeat on opposite side.

Cervical spine may not flex and shoulders may not protract. Performeduntil patients technique deteriorates.

4. Standing latissimus dorsi pull-down

The patient stands facing the high pulley and grasps the wide bar with

hands slightly wider than shoulder width apart. The patient performs

the drawing-in maneuver and an isometric gluteus maximus squeeze

prior to beginning each set of exercise. The bar is pulled down to a

point on the patients chest between the sternal notch and the nipple

line. The patient is not allowed to extend the back during the concentric

phaseor be pulled forward during the eccentric phase


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STATISTICAL ANALYSIS USED IN THE STUDY

A 2-tailed t test

REFERENCE

1. University of Michigan Guidelines for Health System Low Back PainGuideline Team

2. Journal of Orthopedics & Sports Physical Therapy (JOSPT)M

uscle Energy Technique in Patients With Acute Low Back Pain: A PilotClinical TrialCapt. Eric Wilson, PT, DSc, OCS, SCS, CSCS1 Otto Payton,PT, PhD, FAPTA2 Lisa Donegan-Shoaf, PT, PhD3 Katherine Dec, MD4.

3. Greenman P. Principles of Manual Therapy. 2nd ed Baltimore, MD: Williams& Wilkins; 1996.

4. ObjectiveAssessment with Establishment of Normal Values for Lumbar Spinal Range ofmotion

G. KELLEY FITZGERALD, KEVIN J. WYNVEEN, WENDY RHEAULT, and BRUCEROTHSCHILD


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5. Fairbank JCT & Pynsent, PB (2000)The Oswestry Disability Index. Spine,

25(22):2940-2953.DavidsonM & Keating J (2001) A comparison of five low back

disability questionnaires: reliability and responsiveness. Physical Therapy

2002;82:8-24.

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