Mulligan Vs Maitland Talar Glide Health And Social Care Essay

Mulligan Vs Maitland Talar Glide Health And Social perplexity EssayDoes Mulligans anterior-to- sliperior talar lantern slide is effective in meliorate dorsiflexion in issuances with p each(prenominal)y articulatio talocruralis upending wrench than Maitlands anterior-to- ventureerior talar go mobilisation. envision Experimental, Comparative, Randomized Controlled Trail-single blind theme. Participants 90 samples with crafty ankle everting twist diagnosed by radiotherapist with X-Ray imagination forget be collected with thingumabob sampling. Intervention Based on inclusion and exclusion criteria subjects ergodicly allocated to 3 conventions of hindrance- Group I Mulligans anterior-to- bottom of the inning talar glide along with RICE, Group II Maitlands anterior-to- denounceerior talar glide along with RICE, Group collar RICE (control root word) for 2 weeks. Outcome Measures Pre and stockpile session, measurement of dorsiflexion bunk of consummation go o ut be taken with modify Lidcombe templates. Duration The expected duration of charter is considered 8months for ethical clearance, entropy gathering and analysis, editing and produce. Budget An estimation of Rs 30,000 is made including the investigation, instruments, materials and refreshments.BACKGROUNDAnkle is a complex control stick which is categorized as a flexible crossroads joint. It is single of the important component for ambulation in humans. Ankle wrings are one of the commonest injuries in athletics. It accounts for 20% of all sports injuries (Bergfeld J 2004).In India, incidence rate of ankle convolute accounts for 0.31% of the population and the chances of re- psychic trauma is seen as in high spirits as 78-80% despite the continued inquiry in this field (Statistics for ankle sprain 2003).The pathomechanics for ankle inversion blot is inversion and plantar flexion of the ankle joint. There is red of dorsiflexion and inversion roll out of exploit which is attri onlyed to distressingness and swelling (Denegar CR et al 2002), (Collins et al 2004). fit in to Denegar C et al (2002) the loss of dorsiflexion spue of motion is due to parapet of posterior talar glide. This suggests that in an shrill ankle inversion sprain the loss of dorsiflexion ambit of motion could be due to mechanical dys snuff it in talocrural joint.The conventional interposition for acute ankle sprain is RICE (rest, ice, compression, elevation).The primary(prenominal) come of conventional preaching (RICE) is primarily to reduce pain and agitation (Starkey JA 1976), (Slatyer MA et al 1997). The conventional treatment (RICE) with early feat is plunge to be more effective for lessen pain, swelling and up(p) mobility (Dettori et al 1994). Because of the in force of conventional treatment for treating the positional dysfunction ca utilize due to acute ankle inversion injury the joint becomes more susceptible to injury (Hertel J et al, 1999).Manual Therapy focuses on drop-off of pain and correction of the postural and move dysfunction due to ankle sprain. According to Maitland graduations of militarisation bell ringer I and II mobilization is used in acute arrest and grade II mobilization is seem effective in reducing pain and improving dorsiflexion range of causal be onncy in acute musculoskeletal conditions. Maitland grades of mobilization im lay downs the ankle dorsiflexion in acute ankle inversion sprain ( commonality et al 2001) and reduces pain by modulation of nervous tissue (Vincenzino B et al 1998). According to Maitland GD (1986), passive joint mobilization improves the range of try by gentle oscillatory movement of the articular surfaces that creates movement of the mobile segments by a means other than the muscles .According to Collins et al (2004), Mulligans mobilization with movement proficiency is effective in reducing pain and improves dorsiflexion of ankle joint. A single case flying field done by O Brien, B.Vincenzino (1998) showed that Mulligan Mobilization with movement proficiency on acute ankle sprain improved the range of movement (dorsiflexion and inversion), useable exit and reduced the pain. According to pilot study conducted by John-Mark Chesney, Erin Morris, Mulligans mobilization with movement proficiency and taping had significant effect on temporal and spacial parameters of gait. present(prenominal) reduce in pain and an early return to function are claimed to be result of Mulligans mobilization with movement Mulligan 1995 Vincenzino Wright 1995 Hetherington 1996). However, the overlook of adequate evidence in writings for the effectiveness of Mulligans anterior-to-posterior talar glide with movement technique in acute ankle inversion sprain failed to prove its clinical and statistical significance in research methods. The above literature also shows lack of studies done to liken the effects of Maitland and Mulligan mobilization technique in treatment of acute a nkle inversion sprain.Hence, the aim of the study is to regulate the immediate effect of Mulligans anterior-to-posterior talar mobilization with movement technique in acute ankle inversion sprain with RICE and correspond the results with that of Maitland anterior-to-posterior talar glide mobilization with RICE for treatment of acute ankle inversion sprain.REVIEW OF LITERATUREAnkle joint is a complex joint due to its articular, ligamentous and tendinous anatomy. The anterior talofibular ligament restricts anterior translation and internal rotary motion of bead inside the mortise. The coupled motion during plantar flexion happens as internal revolution and anterior translation of talus aided by deltoid ligament. The calcaneofibular ligament restricts inversion of the talocrural and subtalar joint. The posterior talofibular ligament restricts inversion and internal rotation by and by(prenominal) calcaneofibular ligament and anterior talofibular ligament undergo injury.According t o Konradsen and Voight (2002) an inversion torque was produced on effect a cadaveric leg, when the unloaded foot was positioned in 30 spot inversion, full plantar flexion and 10 degree internal tibial rotation. The collision with 20 degree inverted foot in flatten phase follow through forced the foot into full hold back of inversion, plantar flexion and internal tibial rotation.According to Denegar CR et al (2002) in convening biomechanics the instantaneous axis of rotation of talocrural joint translates posteriorly during dorsiflexion, but in anterior malaligned talus or with restricted posterior talar glide the axis of rotation is shifted anteriorly leading to joint dysfunction.According to Baumhauer JF et al (1995) previous history of sprain, limited range of motion and reduced dorsiflexor and plantar flexor strength ratio, elevated eversion to inversion ratio ware been attributed to predisposing to inversion injury.According to Eren OT et al (2003) high malleolar index (po steriorly positioned fibula) is attributed to predisposing factor to sprain. average out malleolar index was +11.5 degree in subjects with ankle sprain and +5.85 degree in normal controls.Green T in 2001 used a modified Lidcombe Template to measure the pain separated dorsiflexion range of motion occurring in talocrural joint. The template consisted of 2 plug-ins joined by an adjustable hinge. One board served as a footplate and other was placed under the subjects calf. The adjustable hinge served as the axis of rotation of template in vertical level(p) and the board placed under the subjects calf allowed for adjustment in flat plane. The measurement was standardized by measuring both force utilize and the angle of dorsiflexion at which the subject first experienced the pain (Matyas T, bachelor T 1985). The force applied was standardized throughout the trail by spring equilibrise and the direction of force was standardized by lifespan level attached to the spring. The devic e showed high intrarater and interrater reliability of which 29% were in exact agreement and 84.5% were at bottom 2 degrees, ICC=0.94.The conventional management of ankle sprain is RICE in acute stage of injury. The functional treatment procedures with early initiation of weight manner as tolerated, early mobilization, proprioceptive training, balance training has been advocated to provide early functional rehabilitation to subjects.According to Bahr R (2004) and Bruce Beynnon B, (2004) the management of sprain concentrates on static and dynamic stability, gaining normal ankle range of motion, optimal strength of peroneal, dorsiflexors, plantar flexors, and invertor muscles of ankle and retrain ankle strategy.According to Kerkhoffs et al (2002) functional treatment is superior to immobilisation and surgical intervention in areas of pain on activity, quality of achievement on return to sport/work, objectives instability on x-ray views and patient of satisfaction.Manual therapy i n ankle inversion sprainMaitlands MobilizationGreen et al (2001) conducted a randomized controlled trial of passive accessory joint mobilization on acute ankle inversion sprain. The study include 38 subjects with acute ankle inversion sprain(Elizabeth L et al (2008) conducted a study in which 10 subjects were taken with immobilized ankle for at least(prenominal) 14 days and presented with at least 5 degree of dorsiflexion shortfall compared to contralateral ankle. A crossover tendency was employed and subjects received Maitlands grade 3 mobilization in one conclave and control intervention (no treatment) in other comp eithering. Results showed that joint mobilization led to a reduction in pain and improvements in pain- bighearted dorsiflexion.Mulligan mobilization with movement techniqueCollins et al (2004) conducted a double-blind randomized controlled trial with a crossover design approach. In this study 14 subjects with grade 2 ankle sprain were taken. The dorsiflexion in we ight-bearing and thermal pain threshold were calculated. in all the subjects undergo 3 treatment conditions-Mulligans mobilization with movement technique for dorsiflexion, placebo group and control group (no treatment).Results showed that the talar anterior-to-posterior glide improved the recovery rate in treatment with Mulligans mobilization with movement technique.The study conducted by Collins N was done on subjects with sub acute ankle sprain.T OBrien, B.Vincenzino (1998) conducted a single case study to investigate the effects of Mulligans with movement technique mobilization for acute lateral ankle sprain. The technique used in this study was posterior glide to distal fibular go patient actively inverted the ankle. In the study 2 subjects with acute ankle sprain were used to control for natural resolution of ankle sprain. Subject I underwent ABAC protocol while subject II BABAC protocol where A was no treatment phase B was treatment phase and C was post treatment return to sport phase. The outcome measures Modified Kaikkonen test functional outcome, VAS for pain and range of dorsiflexion and inversion were measured pre and post of each intervention session. Results showed rapid improvement of range of motion (inversion and dorsiflexion) and immediate decrease in pain.Hence from the above studies we can suppose that anterior-to-posterior talar glide technique in both Maitland and Mulligan mobilization is effective in treating ankle inversion sprain than the RICE protocol alone. The above studies also infer that Maitlands grades of mobilization is significantly effective in improving dorsiflexion range in acute ankle sprain. However, Mulligans mobilization had shown effective results in treating ankle sprain in subacute condition. The study done by T OBrien, B.Vincenzino (1998) shows the effectiveness of Mulligans mobilization with movement technique in improving dorsiflexion range of motion in acute ankle sprain but the study design leads to limitatio n of generalization of its surfaceings. However, it does provide the knowledge to conduct a random clinical trail in utility of Mulligans mobilization with movement technique in the treatment of acute ankle inversion sprain and to compare the results with Maitlands grades of mobilization to find the best effective treatment method for improving the recovery rate in acute ankle inversion sprain. assignment OF RESEARCH PROPOSAL QUESTIONDoes Mulligans anterior-to-posterior talar glide is effective in improving dorsiflexion in subjects with acute ankle inversion sprain than Maitlands anterior-to-posterior talar glide mobilization. climb up openingMulligans anterior-to-posterior talar glide is effective than Maitlands grades of mobilization in improving dorsiflexion range of motion in subjects with acute ankle inversion sprain.NULL HYPOTHESISMulligans anterior-to-posterior talar glide is not effective than Maitlands grades of mobilization in improving dorsiflexion range of motion in su bjects with acute ankle inversion sprain.method actingOLOGYDesignAn Experimental, Comparative, Randomized Controlled Trail design. The study depart be single blinded to avoid any possible bias. The subjects allow for be allocated to 3 group of interventions-Mulligans anterior-to-posterior talar glide with movement technique with RICE, Maitlands anterior-to-posterior talar glide mobilization with RICE, and third group RICE alone .Outcome measure exit measure the degree of dorsiflexion pre and post to each session which go forth be measured by the assessor blinded to the allocation of subjects to the groups.SubjectsThe study will be conducted by recruiting 90 samples through convenience sampling by giving advertisements and notices to orthopaedic and physiatrics department in MS Ramaiah memoir hospital and the hospitals nearby its adjoin areas. The subjects recruited will be diagnosed for acute ankle inversion sprain and referred by radiologist through X-Ray imaging. To mainta in the homogeneity of the groups all the subjects will be recruited based on Inclusion and exclusion criteria. Inclusion criteria-All subjects of age group 20-30years of age, History of ankle inversion injury with pain over lateral aspect of ankle (ETHICAL APPROVALThe ethical commendation will be taken from Ethical Board of MS Ramaiah Memorial Hospital along with the permission of other hospitals near by its surroundings. Subjects will be prone a copy of cognizant accede with the details of the study and the confidentiality of patients personnel in fakeulaation and data obtained after the study will be maintained. Subjects can separate from study at any habituated chief of cartridge clip.VENUE/LOCATION OF THE STUDYThe study will be conducted in MS Ramaiah Memorial Hospital Physiotherapy Department, Bangalore.A randomize CONTROLLED TRAIL STUDYAn experimental randomized controlled trail -single blinded study will be conducted on 90 subjects with acute ankle inversion sprain . The technique of the interventions will be finalized during the study and side-effects or any demerit in the intervention will be noted and rectified.RESEARCH METHOD AND EXPERIMENTAL INTERVENTION90 samples will be recruited by convenience sampling. The samples will be assessed for acute ankle inversion sprain by X-Ray imaging done by the radiologist in radiology department of MS Ramaiah Memorial Hospital. The subjects will be randomly charge to 3 groups by chit method.Each group will be assigned 30 subjects. The tec who will conduct the study is a qualified physiotherapist who specializes in manual therapy. After the allocation of the group the experimental group I will receive Mulligans anterior to posterior talar glide along with active dorsiflexion of ankle which will be followed by RICE application. The mobilization will be performed in weight bearing in which the therapist applies a postero-anterior force to distal leg through a treatment belt while stabilizing the foot an d talus (Mulligan 1999).The experimental group II will receive Maitlands anterior-to-posterior talar glide (Grade II) followed by RICE application. The mobilization will be performed with subject lying unresisting and the ankle will be positioned over the edge of plinth with proximal hand of therapist stabilizing the distal tibia and fibula while the distal hand will mobilize the talus with posteriorly directed oscillation(Maitland1977).Group III will receive RICE treatment for maximum of 2 weeks. Subjects in experimental group I and II will be do by every second day for maximum of 2 weeks. Therefore 6 sessions of treatment over 14 days will be done. tierce sets of 10 repetitions will be applied with 1 minute between sets (Exelby, 1996) in both mobilization technique. Pain experienced during treatment will result in immediate cessation of technique and exclusion of the subject from study.OUTCOME MEASURESDorsiflexion range of motion will be measured by Modified Lidcombe template. The template enabled standardized measurement of dorsiflexion range of movement. The axis of rotation of ankle was aligned with adjustable axis of rotation of template. The spring balance attached to the footplate measure the force applied in the standardized direction. A hydrogoniometer placed on the footplate measures the range of dorsiflexion in degrees. The template have a high intrarater and interrater reliability of which 29% were in exact agreement and 84.5% were within 2 degrees, ICC=0.94. Hydrogoniometer have high intraclass coefficients (0.84-0.99) which revealed high agreement between the raters (Lex D.De jong et al 2007)RESULTS AND DATA ANALYSISThe dorsiflexion range of movement measured will be in degrees which represent a parametric data. The data collected pre and post of each 6 session in group I and group II will be analyzed by related t test (i.e. within the group) and unrelated t test will be done to compare between the group I and group II for dependent variable. One way ANOVA will be used for analysis of data from all the 3 groups along with Scheffe test to find the most effective group for treatment of acute ankle inversion sprain. The level of significance will be set at 0.5 the fortune will be calculated based on the t repute with degree of freedom table. The confidence interval will be unplowed to 95%.ANNEXUREPROJECT TIMELINEThe overall estimated time required for the completion of the study is 8months i.e. 1 month for ethical clearance, 4 months for the randomized controlled trail, data collection and data analysis, 1 month for writing up and presenting results and 2 months for publishing results.Tasks12345678Ethical clearance+Randomized controlled trail amend data collection tools+Data collection+++Data analysis++Writing up presenting results+Publishing results++BUDGETThe overall estimation of the budget is Rs30, 000 which includesX-RAY imaging Rs20, 000 (90 subjects)Modified Lidcombe Template and hydrogoniometer Rs5000Stationa ry Rs1000Transportation and refreshments Rs4000INFORMED CONSENT inletThis is an aware consent given to a subject who wishes to insert in research study.Please red the informed consent carefully or you can ask anyone of your relative who you trust can read this informed consent for you in your language by translating it.Please feel free to ask any questions you have about this informed consent or research study in your mind.Please sign the consent form only after you have no doubts about the research study or consent form. Do not sign the consent form under any kind of pressure.Title of Research ProjectImmediate effects of Mulligans anterior-to-posterior talar glide with movement technique versus Maitlands anterior-to-posterior talar glide for pain free dorsiflexion in acute ankle inversion sprain.InvestigatorSUMIT KIMOTHIM. Sc in Clinical Physiotherapy.Purpose Of seeAcute ankle sprain has high percentage re-injury. Mulligans mobilization with movement technique table services in improving dorsiflexion range of motion by correction of positional dysfunction of joint. This study is to find the effect of Mulligans mobilization with movement technique and compare it with effects of Maitlands grades of mobilization in treatment of acute ankle inversion sprain.Description of StudyAfter being diagnosed with acute ankle inversion sprain you will be sent to the physiotherapy department in physiotherapy department. The researcher will explain you about the treatment technique and the study and an informed consent will be given to you based on your decision your participation will be decided. If you wish to participate a treatment technique selected for the respective group in which you will allocated will be performed on you and the assessment will be taken before and after the treatment session. The duration of treatment is 2 weeks and if there is any changes, you will be informed prior.Possible Risks or ComplicationThe treatment technique itself has no side-eff ects or complication and it will be performed by a qualified physiotherapist in Manual Therapy.handling AlternativeIf the therapy is not effective to you, you will be provided with an alternative treatment with free of cost. financial ImplicationsAll the expenses regarding the research work including the investigation, transportation, food expenses and treatment will be free of cost.Potential BenefitsThe study may be beneficial to conjunction and mortals of similar condition.You can benefit by improving you condition with help of this treatment.ParticipationParticipation in this research study is voluntary. If the histrion wants to withdraw he/she can withdraw at any given point of time.CONSENT FORMI have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. I consent voluntarily to participate as a participant in this research and understand that I have the right to withdraw from the research at any time without in any way affecting my medical care.Name of the participant _____________________Signature of participant _____________________ picture _____________________Day/month/year ___________________If unknowingA literate obtain must sign (if possible, this person should be selected by the participant and should have no connection to the research team).I have witnessed the accurate reading of the consent form to the effectiveness participant, and the individual has had the opportunity to ask questions. I confirm that the individual has given consent freely.Name of witness ___________________ ANDThumb print of participantSignature of witness ___________________Date ______________Day/month/year ______________I have accurately read or witnessed the accurate reading of the consent form to the potential participant, and the individual has had the opportunity to ask questions. I confirm that the individual has given consent fre ely.Print Name of Researcher _________________Signature of Researcher ___________________Date __________Day/month/year ____________A copy of this Informed have Form has been provided to participant ____________ (initialed by the researcher/assistant)For more information tieSumit KimothiM. Sc in clinical physiotherapy,MS Ramaiah Memorial Hospital,Bangalore.9916261101ASSESSMENT mapName Age Sex Site of Disorder Mode of Treatment Measurement ParametersBefore TreatmentAfter TreatmentDorsiflexion range of motionSignature of Clinician Signature of Chief Physiotherapist