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IJPR.2017.183

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Type of Article:  Original Research

Volume 5; Issue 4 (August 2017)

Page No.: 2259-2264

DOI: https://dx.doi.org/10.16965/ijpr.2017.183

IMMEDIATE EFFECT ON EXTERNAL ROTATION AND OVERHEAD REACH IN PATIENTS WITH SHOULDER PATHOLOGY USING PROPRIOCEPTIVE NEUROMUSCULAR FASCILITATION AND SOFT TISSUE MOBILIZATION

Gadpal  Pratiksha *1, Bhave  Shobha 2, Deshpande N.K 3.

*1 Intern , Physiotherapy school and centre, Government medical college, Nagpur.

2 Professor, Physiotherapy school and centre, Government medical college, Nagpur.

3 Head of department, Physiotherapy school and centre, Government medical College, Nagpur.

Address for correspondence: Dr.  Pratiksha Gadpal  [P.T.], Intern, Physiotherapy school and centre, Government medical college, Nagpur, Maharashtra, India. E-Mail: drpratikshag@yahoo.com

ABSRTACT

Background: It is postulated that restriction in glenohumeral external rotation when measured at 45 degree of abduction represent subscapularis muscle  flexibility deficits as compared to when it is measured at 90 degrees of abduction which indicates capsular restriction. Adequate glenohumeral external rotation is believed to be essential for the ability to reach overhead . Patients coming to physiotherapy department with shoulder pathology often have to attend various sessions of therapy to get free range of motion of the joint. Thus the aim of this study was to find out whether a single session of soft tissue mobilization and proprioceptive neuromuscular fascilitation improves the range of shoulder abduction and thus the ability to reach overhead.

Materials and Methods: Present study conducted with 20 subjects between the age group of 40 and 60 as per the inclusion and exclusion criterion and study designed as a Randomized control trail. All those individuals who exhibited limitation in glenohumeral external rotation at 45 degrees of abduction in supine were supposed to have shoulder internal  rotator (subscapularis) inflexibility and those who had restriction in overhead reach were included  in the study. All included subjects were given soft tissue mobilization  to the restricted mobility area for 5 minutes followed by 5 repetitions of contract relax to shoulder internal rotators and 5 repetitions of proprioceptive neuromuscular fascilitation  pattern of flexion abduction external rotation. External rotation and overhead reach was measured pre and Immediately post intervention .

Result: SPSS v 16.0 was used for analysis. Descriptive & inferential statistics was calculated.  Paired t test was used to compare External Rotation & Overhead Reach before & after treatment. Statistical significance was kept at p value less than 0.05. The results obtained in the study, showed  ‘p value’< 0.05 , indicating that there was statistically significant improvement in external rotation and overhead reach following the single intervention session.

Conclusion: A single session of soft tissue mobilization with proprioceptive neuromuscular fascilitation showed immediate improvement in glenohumeral external rotation and overhead reach.

KEY WORDS: Proprioceptive neuromuscular fascilitation, Soft tissue mobilization, Subscapularis.

REFERENCES

  1. Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis .1998 Nov ;57(11): 649-55.
  2. Cleeman E, Brunelli M, Gothelf T, et al. Releases of subscapularis contracture: an anatomic and clinical study. J Shoulder Elbow Surg. 2003;12:231‐6.
  3. Warwick R, Williams P, Gray H. Gray’s Anatomy (35 ed). Philadelphia: Saunders Company; 1973;532‐540.
  4. Ward S, Hentzen E, Smallwood L, et al. Rotator cuff muscle architecture: implications for glenohumeral stability. Clin Orthop Relat Res. 2006 jul ;448:157‐163.
  5. D. Chaurasia’S human anatomy..Regional and applied dissection and clinical. vollume 1. upper limb and thorax. 4th edition, 2004; 76.
  6. Turkel S, Panio M, Marshall J, Girgis F. Stabilizing Mechanisms Preventing Anterior Dislocation of the Glenohumeral Joint. J Bone Joint Surg Am. 1981 Oct;63(8):1208-17.
  7. Hawkins RJ, Hobieka PE. Impingement syndrome in the athletic shoulder. Clin Sports Med. 1983 Jul;2(2):391-405.
  8. Simons D. G., Travell J. G., . Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. Volume 1. The upper body. 2nd ed, 1999;596–612.
  9. Greenfield BH, Tovin BJ. Evaluation and treatment of the Shoulder. An integration of the guide to physical therapist practice. Philadelphia F.A.Davis ;2001.
  10. Pichon F, Carlioz H . Disinsertion of the subscapularis muscle in the treatment of obstetric paralysis of the upper limb. Chir Pediatr. 1979;20[2]:135-41.
  11. Carlioz H, Brahimi L . Place of internal disinsertion of the subscapularis muscle in the treatment of obstetric paralysis of the upper limb in children. Ann chir infant.1971 mar-apr;12[2] :159-67.
  12. Pearl ML . Arthroscopic release of shoulder contracture secondary to birth palsy: an early report on findings and surgical technique. arthroscopy 2003 Jul-Aug;19(6):577-82.
  13. MacDonald PB, Hawkins RJ, Fowler PJ, Miniaci A. Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder. J Bone Joint Surg Am. 1992 Jun;74(5):734-7.
  14. Godges JJ., Mattson-Bell M ., Thorpe D. , Shah D. The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33(12):713-8.
  15. Travell J, Simons D. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1983:410‐424.
  16. Turkel S, Panio M, Marshall J, Girgis F. Stabilizing Mechanisms Preventing Anterior Dislocation of the Glenohumeral Joint. J Bone Joint Surg Am. 1981 oct;63(8):1208-17.
  17. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8:468–475.
  18. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil. 1998;79:863–872.
  19. Chang CW, Chen YR, Chang KF. Evidence of neuroaxonal degeneration in myofascial pain syndrome: a study of neuromuscular jitter by axonal microstimulation. Eur J Pain. 2008;12:1026–1030.
  20. Carel BrHYPERLINK “https://www.ncbi.nlm.nih.gov/pubmed/?term=Bron C[Author]&cauthor=true&cauthor_uid=17983467″on, Michel Wensing, Jo LM Franssen,  Rob AB Oostendorp. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial .BMC Musculoskelet Disord .2007; 8: 107.
  21. Funk D, Swank AM, Adams KJ, et al.  Efficacy of moist heat pack application over static stretching on hamstring flexibility. J Strength Cond Res, 2001; 15: 123–126.
  22. Sharman MJ., Cresswell AG., Riek S. Proprioceptive neuromuscular facilitation stretching : mechanisms and clinical implications. Sports Med.2006;36(11), 929-39.
  23. Bron C., Wensing M., Franssen JL., Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial.BMC Musculoskeletal Disord,2007;107-26.
  24. Ji SK, Lee MH, Kim MK, et al. The effects of CI technique in PNF on the muscle activity, fatigue, and balance in hemiplegic patients. J Korean Soc Phys Ther, 2009;21:17–24.
  25. Decicco PV, Fisher MM. The effects of proprioceptive neuromuscular facilitation stretching on shoulder range of motion in overhand athletes. J Sports Med Phys Fitness. 2005; 45: 183–187.
  26. Weon-Sik L, Hyung-Soo S, In-Sup K, et al. The effects of scapular pattern and hold-relax technique of PNF on the ROM and VAS in frozen shoulder patients.  J Kor Soc Phys Ther. 2002;14(1):15-26.
  27. Sharman M, Cresswell A, Riek S. Proprioceptive Neuromuscular Facilitation Stretching: Mechanisms and Clinical Implications. Sport Med. 2006;36(11):929–939.
  28. Simons DG, Travell JG, Simons LS, Travell JG. Travell & Simons’ myofascial pain and dysfunction The trigger point manual. Volume 1, 2ndupper half of body 1999;668-694.
  29. Chuen-Ru Hou, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical Medicine and Rehabilitation. Volume 83, Issue 10, October 2002; 1406–1414.
  30. Hanten WP, Olson SL, Butts NL, Nowicki AL. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000 oct;80(10):997–1003.
  31. Hong, C.Z., Chen, Y.C., Pon, C.H., Yu, J. Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point. Journal of Musculoskeletal Pain. 1993; volume 1 ,issue 2: 37–53.
  32. Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on cervical myofasical pain and trigger point sensitivity. Arch Phys Med Rehabil. 2002;83:1406–14.

Cite this article: Gadpal Pratiksha, Bhave Shobha, Deshpande N.K. IMMEDIATE EFFECT ON EXTERNAL ROTATION AND OVERHEAD REACH IN PATIENTS WITH SHOULDER PATHOLOGY USING PROPRIOCEPTIVE NEUROMUSCULAR FASCILITATION AND SOFT TISSUE MOBILIZATION. Int J Physiother Res 2017;5(4):2259-2264. DOI: 10.16965/ijpr.2017.183
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