Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome

Background: "Text neck" is a term coined to describe the posture created by leaning forward for lengthy periods of time, such as when reading and texting on a cellphone which has been linked to stress injuries. Neck pain, upper back discomfort, shoulder pain, frequent headaches, and greater curvature of the spine are all dangerous indications of text neck. According to a survey, 35% of smartphone users suffer from text neck syndrome. People between the ages of 15 and 18 are more likely to have neck pain. This protocol has been created that describes the design of comparative study to evaluate effectiveness of progressive resisted exercise along with conventional exercise and conventional exercise program alone in text neck syndrome. Methods: The participants (n=80) will be recruited in the study suffering from text neck syndrome and meeting the inclusion criteria. Two groups will be formed such that patients in group A will be treated with conventional therapy and group B will be treated with progressive resisted exercise (PRE) along with conventional therapy. The protocol will cover 4 weeks of treatment. In the rehabilitation period, we will evaluate the pain intensity, strength of neck muscles and functional activity. Our outcome measures will be- Numerical pain rating scale (NPRS) and Neck disability index (NDI). Discussion: Efficacy of the intervention will be evaluated by analyzing the pain intensity by using Numerical pain rating scale (NPRS) and level of functional disability by using Neck disability index (NDI). The result of the study will significantly provide affirmation on either using combination therapy of PRE with conventional exercise or conventional exercise alone.

Efficacy of Instrument Assisted Soft-Tissue Mobilization in Patients with Heel Pain: An Experimental Study

Aim: The purpose of this study was to evaluate and compare the effects of Instrument-Assisted Soft-Tissue Mobilisation (IASTM) and Therapeutic Ultrasound in patients with heel pain in terms of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. This was undertaken as even though Ultrasound is regularly used, heel pain still remains resistant to treatment in some patients. Hence, the need to compare a relatively newer technique with it. Study Design : Experimental study Place and Duration: Department of Musculoskeletal Physiotherapy Sciences, Ravi Nair Physiotherapy College, Sawangi (Meghe) , Wardha , duration of 12 months. Methods: Seventy people (n=70) with heel discomfort (lasting 6 weeks to 1 year) were chosen at random and placed into two groups, each getting eight therapy sessions. IASTM and Home Exercise Program was given to Group A, whereas Therapeutic Ultrasound and Home Exercise Program was given to Group Calf muscle stretches and Plantar fascia stretches were incorporated in the Home Exercise Programme. Outcome measures were recorded both at the beginning of treatment and after final treatment. The patients were assessed for Numerical Pain Rating Scale with first step in morning and at the beginning of first session and after end of last session and for Foot and Ankle Ability Measure scale at the beginning of first session and after end of last session. A follow up period of 90 days (after last session) was taken, the measurements of Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale were taken again to see the long-term effects. Results: Group A which received IASTM + Home exercises showed great improvements than Ultrasound and Home exercise group, from baseline to week 4 after the pain intensity and foot function were assessed using Numerical Pain Rating Scale and Foot and Ankle Ability Measure scale. Statistically significant differences were found in both the groups. i.e. P=0.0001. But 7 people in Ultrasound group complained of pain and functional ability at follow-up session. Conclusion: In this study, it can be concluded that combining both the IASTM and Home Exercise Program have got beneficial effects in decreasing the pain intensity thus improving the foot and ankle function in patients with heel pain.

Coolsense® versus EMLA® for peripheral venous cannulation in adult volunteers: A randomised crossover trial

Peripheral venous cannulation (PVC) is a commonly performed invasive medical procedure. Topical treatments such as the eutectic mixture of local anaesthetics (EMLA®, Aspen Pharmacare Australia Pty Ltd, St Leonards, NSW) attenuate the associated pain, but are limited by requiring up to one hour of application before becoming effective. The Coolsense® (Coolsense Medical Ltd., Tel Aviv, Israel) pain numbing applicator is a new device using a cryoanalgesic means to anaesthetise skin within seconds. Coolsense is being increasingly used for cannulation, but comparative studies are lacking. We recruited 64 healthy adult volunteers to this open-label two sequence, two period randomised crossover trial. Participants had two 20 gauge venous cannulae inserted, one on the dorsum of each hand. Each cannulation attempt was preceded by treatment with Coolsense or an EMLA patch containing 2.5% lidocaine and 2.5% prilocaine. The primary outcome was participant pain using the 0–10 numerical pain rating scale. Secondary outcomes were participant satisfaction scores on a 0–10 scale, treatment preference, and failed cannulation attempts. Participants were randomly assigned to either the Coolsense EMLA ( n = 32) or EMLA Coolsense ( n = 32) sequence. All participants completed the trial. The pooled mean paired difference of the numerical pain rating scale was –1.84 (95% confidence intervals –1.28 to –2.41; P < 0.001) in favour of EMLA. The pooled mean paired difference for satisfaction score was 2.26 (95% confidence intervals 1.46 to 3.07; P < 0.001) higher with EMLA. Most participants preferred EMLA over Coolsense ( P < 0.001). There was no significant difference regarding failed cannulation between the two treatments ( P = 0.14). Among healthy individuals undergoing elective PVC, EMLA was associated with reduced pain, increased satisfaction, and was the preferred treatment compared to Coolsense.

Effect of Cervical Mobilization, Transcutaneous Electrical Stimulation and Suboccipital Release in Cervicogenic Headache: A Case Report

Background: Cervicogenic headaches are one of the common musculoskeletal disorders that originates in the neck and are radiates from neck to head. Cervicogenic headache is usually treated with a comprehensive strategy that includes pharmacologic, nonpharmacologic, manipulative, anesthetic, surgical procedures and physiotherapy. Physiotherapy includes spinal manipulation, mobilization, myofascial release, exercises and electrotherapeutic modalities. Purpose: This case report aims to evaluate the effects of combination of cervical spine mobilization, TENS, Suboccipital release on cervicogenic headache in maintaining long-term benefits. Methods: This a case report of 31-year-old male having cervicogenic headache from 4-5 years. He reported symptoms like pain in right side neck which radiates into head till forehead and stiffness in neck. Physiotherapy treatment like cervical spine mobilization, TENS and Suboccipital release was given for 5 sessions (alternate days) for 10 days. Outcome Measures: Numerical pain rating scale, Neck disability Index and Cervical range of motion was used as outcome measures. Results: There was marked decrease in pain intensity from 8 on NPRS to 1 on NPRS. Also there was increase in cervical range of motion specially flexion, lateral flexion and rotation and decrease in neck disability index from 28 to 10. Conclusion: Physical therapy with TENS, Cervical spine mobilization & sub occipital release can be used as an effective intervention protocol for reducing pain and stiffness and increasing range of motion in patients with Cervicogenic Headache. Key words: Transcutaneous electrical nerve stimulation, Cervical Spine mobilization, Suboccipital release, Cervicogenic Headache, Numerical Pain Rating Scale, Neck Disability Index.

Analgesic Efficacy of Ultrasound Guided Transversus Abdominis Plane Block after Cesarean Delivery

Introduction Transversus abdominis plane (TAP) block is a simple and effective technique of providing analgesia for lower abdominal surgeries with easily identifiable landmarks. This study investigated the postoperative analgesic efficacy of bilateral ultrasound-guided transversus abdominis plane blocks, in patients undergoing caesarean delivery at Paropakar Maternity and Women's Hospital, Kathmandu, Nepal. Methods Seventy-four patients undergoing caesarean section under spinal anesthesia were randomized to receive TAP block with bupivacaine (n =37) versus no TAP group (n =37), in addition to analgesia with intravenous paracetamol 1gram 6 hourly. At the end of the surgery, an ultrasound-guided TAP block was given bilaterally using 0.25% bupivacaine or no TAP block. Each patient was assessed postoperatively at regular intervals up to 24 hours for numerical pain rating scale and requirement of pethidine. SPSS version 20.0 software was used. Demographic data were analyzed using Student’s t-test and Mann–Whitney U-test. Results The TAP block with bupivacaine compared with no TAP group reduced the postoperative numerical pain rating scale. The time to first analgesic demand time was shorter in the control group (79.05±26.99) minutes compared to the bupivacaine group (416.75±87.29) minutes (P <0.05) which was statically significant. The 24 hours pethidine requirement was less in the bupivacaine group (P<0.05). There were no complications attributable to the TAP block. Conclusions Bilateral ultrasound-guided TAP block significantly reduced postoperative pethidine consumption in 24 hours after cesarean delivery.

Randomized Control Trial of Short Infusion of Low Dose Ketamine Vs Intravenous Morphine as Adjunct Analgesia for Acute Long Bone Fracture Pain in Emergency Department

BackgroundKetamine is known as an alternative for pain control, but reports of emergency reactions limits its widespread use. We assessed the efficacy of short infusion of low dose ketamine (LDK) compared with intravenous morphine (MOR) as adjunct analgesia for acute long bone fracture pain.MethodsPatients aged 18-60 years old, with acute long bone fracture and with numerical pain rating scale (NPRS) of 6 or more after 3mg intravenous morphine were eligible for enrolment. Subjects were consented and randomized to either short infusion LDK (0.3mg/kg) over 15 minutes or intravenous morphine (MOR) (0.1mg/kg) over 5 minutes. Evaluations of NPRS score and vital signs occurred at 15, 30, 60, 90 and 120 minutes. The primary outcome from this study was the mean reduction of numerical pain rating scale (NPRS) score from baseline and the mean time to achieve ³ 3 score reductions in NPRS. The secondary outcomes were the incidence of adverse events and mean consumption of rescue analgesia.ResultsFifty-eight subjects were enrolled (MOR 27, LDK 31). Demographic variables and baseline NPRS scores MOR (8.33) vs LDK (8.84) were similar. The mean reduction of NPRS were significantly different between LDK (Mean= 3.1, SD=2.03) and MOR (Mean =1.8, SD 1.59), p= 0.009 at 30 minutes. Incidence of dizziness was reported higher in Ketamine group 19.4% (p=0.026).ConclusionWhen used as an adjunct, short infusion low-dose ketamine at 0.3mg/kg over 15minutes provides greater analgesic effect in comparison to intravenous morphine alone for acute long bone fracture pain but has higher incidence of dizziness.Trial RegistrationNational Medical Research Register: https://www.nmrr.gov.my/ Registered 24 November 2017 ID:NMRR-17-3184-38970

TO STUDY THE IMMEDIATE EFFECTS OF DYNAMIC STRETCHING V/S DYNAMIC STRETCHING AND KINESIO TAPING IN MARATHON RUNNERS WITH SHIN SPLINTS: A COMPARATIVE STUDY

Background: The number of people is now becoming extremely health conscious hence taking up activities like marathons, sprinting and other forms of exercises to full recreational and tness needs. With an increasing number of sprinters chances of developing shin splints become higher. Warm ups, stretching and kinesio taping are great preventive measures and treatment protocols. Methodology: Group A received dynamic stretching and group B received dynamic stretching and kinesio taping. Outcome measures were time taken in seconds and pain intensity using Numerical Pain Rating Scale (NRS). Conclusion: Dynamic stretching along with Kinesio taping resulted in greater improvement in the 30-meter running time as compared to just dynamic stretching.

The visual time analog scale: simple, novel measurement approach to assess pain in patients with chronic pain

Aim: We conducted a preliminary evaluation of a newly developed, time-based visual time analog (VITA) scale for measuring pain in chronic pain patients. Materials & methods: 40 patients with chronic back pain rated their pain over four visits using numerical (pain) rating scale (NRS) and VITA assessing pain intensity by distributing the amount of time spent on ‘not aware of pain’ (blue), ‘aware of nothing but pain’ (red) and time in between (yellow). Results: The NRS scores were correlated with the VITA Red but not with VITA Blue. The psychometric analyses revealed that VITA achieved greater reliability and sensitivity than did NRS. Conclusion: The results provide preliminary support for VITA scale for assessing pain intensity in patients with chronic pain.

Hand rehabilitation with sonification techniques in the subacute stage of stroke

After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.

Effectiveness of transcutaneous electrical nerve stimulation as an adjunct to selected physical therapy exercise program on male patients with pudendal neuralgia: A randomized controlled trial

Objective: To assess the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) combined with selected physical therapy exercise program on male patients with pudendal neuralgia. Design: A double-blinded randomized controlled study. Setting: Out-patient setting. Participants: Fifty-two male participants with pudendal neuralgia (30–50 years) were allocated randomly into two groups; study and control. The same physical therapy exercises were applied to all participants, plus the same prescribed analgesic medication (Etodolac). Participants in the study group received additional TENS and sham TENS were given to those in control group. Intervention: Intervention lasted for 12 weeks, three sessions per week (60 minutes/session). Outcome measures: Numerical pain rating scale and daily Etodolac intake dose were measured before and after intervention. Results: Statistically significant differences were detected in numerical pain rating scale and daily Etodolac intake in favor of the study group ( P < 0.05). After 12 weeks of intervention, the mean ± SD for numerical pain rating scale and daily Etodolac intake were 4.25 ± 1.9 and 259.25 ± 84.4 mg, in the study group, and 6.22 ± 2.22 and 355.55 ± 93.36 mg in the control group, respectively. The mean difference (95% CI) for numerical pain rating scale and daily Etodolac intake was −1.97 (−3.09: −0.83) and −96.3 (−144.9: −47.69), between groups post treatment, respectively. Conclusion: Adding TENS to physical therapy exercise program is more effective than physical therapy program alone in improving pain in male patients with pudendal neuralgia as measured by numerical pain rating scale and daily analgesic intake dose.