RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA BANGALORE

ANNEXURE II

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|Name of the Candidate And |BIBIN VISWAM |

|Address |SREEE DEVI COLLEGE OF PHYSIOTHERAPY, |

|(in block letters): |MANGALORE |

|Name of the Institute : |SHREE DEVI COLLEGE OF PHYSIOTHERAPY, BALLALBAGH, MANGALORE-575 003 |

|Course of study and subject : |MASTERS OF PHYSIOTHERAPY (MPT) |

| |2 YEARS DEGREE COURSE |

| |PHYSIOTHERAPYIN MUSCULOSKELETAL |

| |DISORDERS AND SPORTS PHYSIOTHERAPY. |

|Date of Admission to Course : | 31st OCTOBER 2011 |

|Title of the topic: |“A COMPARATIVE STUDY ON THE EFFECTIVENESS OF INTERMITTENT CERVICAL TRACTION AND MASSAGE |

| |Vs INTERMITTENT CERVICAL TRACTION AND EXERCISES IN RELIEVING PAIN AND IMPROVING THE LEVEL|

| |OF FUNCTION OF CERVICAL SPONDYLOSIS PATIENTS”. |

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|6 . |BRIEF RESUME OF THE INTENTED WORK : |

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| |6.1 Need for the study : |

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| |Neck pain is almost common and a universal condition. Degenerative affliction of cervical spine are expected to affect all of us |

| |in various degrees at some point in our lives. The spectrum of presentations and disease entities is wide, which varies from |

| |cervical spondylosis, cervical radiculopathy is caused by disc herniation or lateral recess stenosis and cervical myelopathy or |

| |mixed radiculopathy. For many patients with pain in cervical region results from ageing and wear and tear.1 A discussion of |

| |mechanism of neck, suboccipital pain, chemical and mechanical factors responsible for neurological symptoms are warranted. The |

| |natural history of these conditions suggests that for the most part of patients with radiculopathy will continued to be disabled |

| |by their pain.2 |

| |The following treatment procedures are used to reduce the pain and the other symptoms and improve the function. Intermittent and |

| |continuous cervical traction, IFT, Low Level Laser Therapy, superficial and deep heating modalities including pulsed SWD, |

| |Ultrasound and soft tissue mobilization including stretching, myofacial release, deep massage, stain counterstrain craniosacral |

| |therapy, joint mobilization including oscillation, muscle energy techniques, functional techniques and therapeutic exercises |

| |includes isometric and endurance activities. |

| |Though the intermittent cervical traction (ICT) alone is less significant in reliving the symptoms, the separation of vertebra |

| |affect both articular and non-articular structures, reliving the symptoms like pain and stiffness and helps in relaxation of |

| |muscles of neck region in cervical spondylosis. |

| |Massage is commonly accepted for pain relief in practice of cervical spondylosis. Dynamic neck exercises has proven its effect in |

| |reducing pain, increasing strength and endurance and producing long term improvements in functions of patients with cervical |

| |spondylosis. |

| |Though all modalities have its own effect in reducing pain, weakness and increasing endurance, strength, ADL to some extent, the |

| |combined application of selective modalities are effective in earlier recovery in patients with cervical spondylosis. Here the |

| |study focused to compare the effectiveness of ICT and massage versus ICT and exercises in reducing pain and improving the level |

| |of function. |

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| |The objective examination consist of: |

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| |Detailed history. |

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| |Examination of posture. |

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| |Evaluation of pain characteristics. |

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| |Palpation. |

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| |Neurological examination |

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| |Diagnostic test |

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| |Evaluation of functional status. |

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| |6.2 RESEARCH QUESTION: |

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| |Is there significant difference in the reduction of pain and improvement of functional level between ICT and massage versus ICT |

| |and exercises in patients with cervical spondylosis. |

| |Null hypothesis: |

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| |There is no significant difference in the reduction of pain and improvement of functional level between ICT and massage versus ICT|

| |and exercises in patients with cervical spondylosis. |

| |Alternate Hypothesis: |

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| |It is assumed that there is significant difference in the reduction of pain and improvement of functional level between ICT and |

| |massage versus ICT and exercises in patients with cervical spondylosis. |

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| |6.3 REVIEW OF THE LITERATURE: |

| |In International classification cervical diseases have been classified in to three categories – cervical spondylosis, cervical |

| |disorders and other disorders of the cervical region.3 Cervical spondylosis is the result of wear and tear of the weight bearing |

| |structures of the cervical spine.4 Degeneration process is generally considered to occur first in the articular cartilage but it |

| |is not limited to the cartilage. Dentist, meat cutters, heavy workers have high prevalence for cervical spondylosis.5 |

| |Mechanical intermittent cervical traction separates the vertebrae of the cervical spine affecting both articular and periarticular|

| |structures. Relief of symptoms during the treatment in a good prognostic sign that the traction will be of cervicaeneficial for |

| |the patient with cervical spondylosis. ICT produces twice as much separation as sustained traction. If separation of the vertebral|

| |bodies is desired, high traction force for short period time will achieve goal.7,8 |

| |ICT is effective in reliving pain, increasing the frequency of myoelectric signals and improving the blood flow in the affected |

| |muscles.9 |

| |It was assumed that soft tissue massage (STM) has effect on fibroblast. This was proved by Davidson CJ who stated, after massage |

| |there is fibroblastic proliferation and rearrangement of collagen fibers.10 |

| |The recent studies about STM reported a significant improvement in pain, ROM and function. The ROM is used as a parameter to |

| |check the effectiveness of STM.11 Gentle stroking, effleurage, STM over lumbosacral area showed improvement in pain,|

| |SLR, extension strength and ADL inpatients with low back pain.12 |

| |Neck massage received for 10 sessions decreased neck pain, tension head ache and also showed significant ENMG changes on frontalis|

| |and trapezius muscle.13 |

| |Dynamic muscle training of neck and shoulder muscles showed greater reduction of pain and headache incidences, also increases |

| |maximal isometric muscle strength of cervical extension and lateral flexion, grip strength and endurance when treatment involves |

| |heat, massage, stretching in patients with occupational cervicobrachial disorders14. |

| |Rehabilitation with spine exercises showed better outcome of pain neck disability index scale and increased patient satisfaction |

| |when combined with cervical spine manipulation in patients with chronic neck pain.15 |

| |Combined intermittent pelvic traction and massage showed significant improvement in low back pain patients immediately after three|

| |months of treatment16. |

| |Cervicospondylosis patients treated with cervical traction and exercises showed more beneficial effects than analgesics17. |

| |Combined application of cervical traction, electrotherapy and exercises produced immediate improvements in cervical |

| |radiculopathy18 |

| |6.4 OBJECTIVES OF STUDY: |

| |1. To evaluate the effectiveness of ICT and massage in patients with cevical spondylosis |

| |2. To evaluate the effectiveness of ICT and exercises in patients with cevical spondylosis |

| |3.To compare the effectiveness among the two group of people which were given the above mention treatment |

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| |MATERIALS AND METHODS: |

|7. |7.1 Source of data: |

| |Wenlock Government hospital |

| |Sreedevi College out patient department |

| |SCS Hospital Mangalore |

| |7.2 Method of collection of data: |

| |40 patients will be chosen based on inclusion and exclusion criteria. Both female and male patient between 30 to 50yrs will be |

| |taken. |

| |Study design: Comparative study. |

| |Sample size: 40 Subject [20 in each] |

| |Sample method: Random sampling technique |

| |Inclusion Criteria: |

| |1. Age group 30 -50 years of both sexes |

| |2. Vas >5 |

| |3. Cervical pain with radiation |

| |4. Special test like Cervical compression and distraction test can use for investigation. |

| |Exclusion criteria |

| |1 . Patients with cervical IVDP, carcinoma, deformities, recent fractures and surgery, infection, hypersensitivity, skin diseases,|

| |sensory disorders, UMN lesion. |

| |2. Patients with chronic unstable cardiopulmonary disorders. |

| |3. Un co-operative and Psychiatric problems. |

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| |Statistical test: |

| |Two sample T test |

| |Outcome measure: |

| |1.Visual analogue scale(VAS) |

| |2. Neck Disability Index |

| |Methodology |

| |Patient informed consent form will be taken assessed. |

| |The patients who are fulfill inclusion and exclusion criteria will be included in the study. |

| |Explain about the treatment protocol. |

| |Assessment of pain: |

| |The visual analogue scale and neck disability index is designed to present to the respondent to know the pain and functional |

| |ability. |

| |Patients screened for cervical sponylosis will be randomly assigned in to two groups, each group consists of 20 patients. |

| |Group ‘A’: Will be treated with ICT and massage. |

| |Group ‘B’: Will be treated with ICT and exercises. |

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| |The aims of this study were firstly to investigate the effectiveness of manual and mechanical therapy intervention in patients |

| |experiencing pain in patients with cervical spondylosis. |

| |Group A will be receiving ICT and massage |

| |ICT and massage will be given to cervical region for reliving pain and improving the functional mobility. The subjects will be |

| |made to lie in supine for ICT after checking the weight. Traction will be applied with 1/8 of the total body weightof the patient.|

| |the duration of cervical traction is 20 min. |

| |For massage patient will be in sitting position. Head will be resting on a soft pillow in forwarded position. This technique will|

| |be applied using stroking, effleurage and deep friction for 20 min. |

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| |Group B will be receiving ICT and exercises |

| |Patient in sitting position. Exercises including isometric neck exercises, deep flexor strengthening and dynamic exercises. 3 sets|

| |of 10 repetitions. |

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| |Tools used: |

| |Couch and chair |

| |Pillow |

| |VAS scale |

| |Traction table |

| |Weighing machine |

| |Talcum powder |

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| |7.3 Does the study require any investigations or interventions to be conducted on patient or other humans or animals? |

| |If so, please describe briefly. |

| |Yes. |

| |Study requires physiotherapy treatment. ICT, Massage, Exercises. |

| |X ray to rule out degenerative changes |

| |Physical examination to confirm disc and neural involvement. |

| |7.4 has ethical clearance been obtained from your institution in case of 7.3? |

| |Yes |

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| |List of references: |

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| |Dougloss AB, Bope ET. Am Board Farm Pract. 2004 Nov-Dec;17:13-22. |

| |Gregory S, McDowell and Frank P, Clinical Orthopaedics, Phyladelphia. 1999;330-340. |

| |Roa R Neck pain, Cervical radiculopathy and Cervical myelopathy; pathophysiology, natural history and clinical evaluation. Instr |

| |Course Lect.2003;52:479-88. |

| |WHO: International classification of diseases. Manual of international classification of diseases, injuries and cause of death. |

| |Geneva,1997:vol 1. |

| |Steven A Stratton, G M Brayan. Dysfunctions, evaluation and treatment of cervical spondylosis and thoracic inlet. |

| |Orthophysiotherapy. II Edn. Churchill Livinston Newyork, 1994. |

| |Hagberg M, Wegman DH. Prevalence rate and odd ratios of shoulder neck diseases in different occupational groups. Br J Ind Med. |

| |1987;44:602-610. |

| |Valtonan E J, Molter K, et al. Comparative radiographic study of the effect of intermittent cervical traction and continuous |

| |traction on elongation of cervical spine. Ann Med Int Fenn. 1968;57:143. |

| |Voltonan E J, Kiuru E. Cervical traction as a therapeutic school- a clinical analysis based on 212 patients. Scand J Rehabil |

| |Med.1970;2:29. |

| |Nanno M. Effects of intermittent cervical traction on muscle pain. Flow metric and electromyographic studies of the cervical para|

| |spinal muscles. 1991; Apr:61(2):137-47. |

| |Davidson CJ, Ganion LR, Genslen GM, et al. Rat tendon morphologic and functional changes resulting from soft tissue mobilization. |

| |Med Sci Sports Exerc.1997;29(3):313-319. |

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| |Paul A Vanden Dolder and David L Roberts. A trail in to effectiveness of soft tissue massage in treatment of shoulder pain. Aus J |

| |of Phys Ther.2003;49:183-188. |

| |Ernst E. Massage therapy for low back pain. A systematic review. Journal of pain and symptoms. 1999 May;17(1):65-69. |

| |Pussjarvi K, Airakshinen O, Pontinen PJ. Effects of massage with chronic tension headache. Accupunture and electrotherapeutic |

| |research. 1990;15(2):159-62. |

| |Levoska S, Kenanen-Kiukaannieemi S. active or passive physiotherapy for occupational cervicobrachial disorder? A comparision of |

| |two treatment methods with a one year follow-up. Arch Phys Med Rehabil, 1993 April,74(4):425-30. |

| |Bronfort G, Evans R, Nelson B, Aker PD, Goldsmith CH, Vernon. H. A randomized clinical trail of exercise and spinal manipulation |

| |for patients with chronic neck pain. Spine.2001 Apr;26(7):788-97. |

| |Werners R, Pynsent PB, Bulstrode CJ. Randomized trail comparing interferntial therapy with motorized lumbar traction and massage |

| |in the management of low back pain in primary care sitting. Spine 1999 Aug;24(15):1579-84. |

| |Shakoor MA, et al. Effects of cervical traction and exercise therapy in cervical spondylosis. Bangladesh Med Res Counc Bull. 2002 |

| |Aug;28(2):61-69. |

| |Joghataei MT, Arat AM, Khaksar H. The effects of cervical traction combined with conventional therapy on grip strength on patients|

| |with cervical radiculopathy. Clinical rehabilitation. 2004 Dec; 18(8):879-87. |

| |Lisa Gridly and paul A Vanden Dolder. The percentage improvement in pain scale as a measure of physiotherapy treatment effects. |

| |Aus J of Physiotherapy.2001.vol :47. |

| |Vernon H and S Mior. The neck disability index- A study of validity and rehability Manip Physio Ther. 1991:14;411. |

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|8. | |

| |Signature of the Candidate | |

|8 | | |

|9 |Remarks of the guide | |

|10 |10.1 Name and designation of guide: in block letters : |Mr. MURALEEDHARAN A |

| | |ASSOCIATE PROFESSOR |

| |10.2 Signature : | |

| |10.3 Co-guide (if any) : | |

| |10.4 Signature: | |

| |10.5 Head of the Department: |VIJAY P |

| | |PRINCIPAL, SHREEDEVI COLLEGE |

| | |OF PHYSIOTHERAPY |

| | |MANGALORE |

| |10.6 Signature: | |

| |10.7Head of the Department: | |

|11. |Remarks of the Chairman & Principal : | |

|12 |Signature: | |

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