Rajiv Gandhi University of Health Sciences
Rajiv Gandhi University of Health Sciences
Bangalore
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
| | | |
| | |ANUBHA VERMA |
|1. |NAME OF THE CANDIDATE AND ADDRESS |GARDEN CITY COLLEGE OF PHYSIOTHERAPY, 16th KM, OLD MADRAS ROAD, |
| | |VIRGONAGAR POST, |
| | |BANGALORE-49. |
| | | |
|2. |NAME OF THE INSTITIUTION |GARDEN CITY COLLEGE OF PHYSIOTHERAPY |
| | | |
|3. |COURSE OF STUDY AND SUBJECT |MASTERS OF PHYSIOTHERAPY |
| | |(MUSCULOSKELETAL AND SPORTS ) |
| | | |
| | | |
|4. |DATE OF ADMISSION TO COURSE |26/09/2011 |
| | |
|5. |TITLE OF THE TOPIC: |
| |“ A STUDY TO COMPARE THE EFFECTIVENESS OF CRYOKINETICS AND |
| |MULLIGAN’S MOBILIZATION WITH MOVEMENT (MWM) TECHNIQUE IN |
| |ACUTE ANKLE INVERSION SPRAIN. “ |
| | |
| | |
| |BRIEF RESUME OF THE INTENDED WORK: |
| | |
| |6.1 NEED FOR THE STUDY |
| | |
| |Ankle sprain, typically ankle inversion injuries, are common orthopaedic conditions |
| |frequently evaluated and treated by health care providers. The ankle is one of the most |
| |common sites for acute musculoskeletal injuries and sprains accounts for 75 percent of ankle |
| |injuries. Acute ankle trauma is responsible for 10 to 30 percent of sports-related injuries in |
| |young athletes.1 |
| | |
| |Lateral ankle sprains are thought to be suffered by men and women at approximately the |
| |same rates. However, one recent report suggests that female interscholastic and |
| |intercollegiate basketball players have a 25% greater risk of incurring grade I ankle sprains |
| |than their male counterparts. More than 23,000 ankle sprains have been estimated to occur |
| |per day in the United States, which equates to one sprain per 10,000 people daily.2 |
| | |
| |Lateral ankle sprains most commonly occur due to excessive supination of the rearfoot about |
| |an externally rotated lower leg soon after initial contact of the rearfoot during gait or landing |
| |from a jump.2,3 Excessive inversion and internal rotation of the rearfoot, coupled with |
| |external rotation of the lower leg, results in strain to the lateral ankle ligaments. If the strain |
| |in any of the ligaments exceeds the tensile strength of the tissues, ligamentous damage |
| |occurs. Increased plantar flexion at initial contact appears to increase the likelihood of |
| |suffering a lateral ankle sprain.2 |
| | |
| |In addition to the immediate onset of pain, swelling and loss of joint motion, it has been |
| |reported that in 15 – 73% of cases, chronic ankle instability (CAI) with recurrent sprains and |
| |residual sensations of giving way may occur following lateral ankle sprain.4 |
| | |
| |Ankle sprains are classified from grades I to III (mild, moderate or severe). Grade I and II |
| |injuries recover quickly with nonoperative management. There are lots of nonoperative |
| |functional treatment programmes used. One of the conventional protocol includes use of |
| |RICE (rest, ice, compression, elevation), a short period of immobilization and protection with |
| |a tape or bandage. Interventions including early range of motion exercises, weight-bearing |
| |and neuromuscular training exercises and Proprioceptive training exercises on a tilt board |
| |after helps improve balance and neuromuscular control of the ankle.5 |
| | |
| |Cryokinetics is a combination of cold application and active exercises.6 The cold applications |
| |decrease injury pain so that active exercise within a normal range of motion can begin |
| |quickly after the initial injury, and rehabilitation is completed more quickly.7 Recent |
| |evidence has suggested that the addition of exercise to ice application is more effective than |
| |ice application alone after various soft tissue injuries, including acute ankle sprain.4,8 |
| | |
| |Mobilization with movement (MWM) is a class of manual therapy techniques that is widely |
| |used in the management of musculoskeletal pain. It involves the manual application of a |
| |sustained force to a joint while a concurrent movement of the joint is actively performed by |
| |the patient (Mulligan, 1999). The success of the technique is contingent upon an immediate |
| |relief of symptoms during its application.9,10 |
| | |
| |Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders. It has been |
| |used in the treatment of musculoskeletal conditions for many years. Based on these |
| |experimental findings, ultrasound is used in physical therapy to relieve pain, reduce |
| |swelling, and improve joint mobility in a wide variety of musculoskeletal disorders |
| |including ankle sprains.11 |
| | |
| | |
| | |
| |Even though recent advances has suggested that cryokinetics is an effective treatment of |
| |acute ankle sprain and clinical benefits such as immediate decrease in pain and an earlier |
| |return to function are claimed to be the result from Mulligan’s mobilization with movement |
| |(MWM) treatment approach but there is little substantial evidences to their effect. Inadequate |
| |treatment of ankle sprains can lead to chronic problems such as decreased range of motion, |
| |pain, and joint instability. The intent of this study is to find the suitable technique to |
| |accelerate the improvement of the functional activity of the subjects with Acute Ankle |
| |Sprain. |
| | |
| |Hence, this study is an effort to find out the effectiveness of cryokinetics and Mulligan’s |
| |mobilization with movement (MWM) in subjects with acute ankle sprain in improving their |
| |functional abilities. And the significant difference in the effectiveness of the same. |
| | |
| |REVIEW OF LITERATURE |
| | |
| |Joshua C. Dubin DC. et al (2010) have discussed normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral|
| |ankle sprain or syndesmotic “high ankle” sprain, assessment and diagnostic procedures, and presents a treatment algorithm based on normal |
| |ligament healing principles.12 |
| | |
| |Chris M Bleakley. et al (2010) have conducted a randomised controlled study of 120 subjects with an acute grade I or grade II ankle sprain. |
| |The Subjects were randomised under strict double-blind conditions to either a standard cryotherapy (intermittent ice applications with |
| |compression) or cryokinetic treatment group (intermittent ice applications with compression and therapeutic exercise). Primarily function was,|
| |assessed using the Lower Extremity Functional Scale (LEFS), additional outcomes included pain (10 cm Visual Analogue Scale), swelling |
| |(modified figure-of-eight method) and activity levels (activPAL™ physical activity monitor, PAL Technologies, Glasgow, UK). After baseline |
| |assessment subjects were followed up at 1, 2, 3 & 4 weeks post injury. They found that an accelerated exercise protocol during the first week |
| |after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving |
| |standard care.4,8 |
| | |
| |Natalie Collins. et al (2004) have conducted a double-blind randomized controlled trial that |
| |measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold. The subacute ankle |
| |sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle. Significant improvements |
| |in dorsiflexion occurred initially post-MWM (Fð2;26Þ ¼ 7:82; P ¼ 0:002), but no significant changes in pressure or thermal pain threshold were|
| |observed after the treatment condition. Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than |
| |hypoalgesic effect in subacute ankle sprains.19 |
| | |
| |4. Carl G. Mattacola. et al (2002) conducted a study on Rehabilitation of the Ankle after |
| |Acute Sprain or Chronic Instability to outline rehabilitation concepts that are applicable to |
| |acute and chronic injury of the ankle, to provide evidence for current techniques used in the |
| |rehabilitation of the ankle, and to describe a functional rehabilitation program that |
| |progresses from basic to advanced, while taking into consideration empirical data from the |
| |literature and clinical practice. He recommended early functional rehabilitation of the ankle |
| |should include range-of-motion exercises and isometric and isotonic strength-training |
| |exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training |
| |exercises should be incorporated. Although it is important to individualize each |
| |rehabilitation program, this well-structured template for ankle rehabilitation can be adapted |
| |as needed.13 |
| | |
| |Auvo Kaikkonen. et al (2002) did a study to introduce and evaluate a standardized test protocol and scoring scale i.e. Kaikonnen Functional |
| |Scale (KFS) for evaluation of ankle injuries. After evaluation of 11 different functional ankle tests, questionnaire answers, and |
| |results of clinical ankle examination, the final test protocol. The final total test score correlated significantly with the isokinetic |
| |strength results of the ankle, subjective opinion about the recovery, and subjective-functional assessment. The scale presented is recommended|
| |for studies evaluating functional recovery after ankle injury.14 |
| | |
| |Toni Green. et al (2001) have conducted a study to investigate the effect of a specific joint |
| |mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and |
| |3 gait variables: stride speed (gait speed), step length, and single support time. Subjects. |
| |Forty-one subjects with acute ankle inversion sprains ( ................
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