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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