RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE II
REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the Candidateand Address / THOUDAM BANDANAPATI DEVI
GARDEN CITY COLLEGE OF PHYSIOTHERAPY
16th KM, OLD MADRAS ROAD
VIRGONAGAR POST
BANGALORE-560049
2. / Name of the Institution / GARDEN CITY COLLEGE OF PHYSIOTHERAPY
3. / Course of study and subject / Master Of Physiotherapy (MPT)
Musculoskeletal Disorders and Sports Physiotherapy
4. / Date of admission to Course / 15-07-2013.
5. / Title of the Topic
A STUDY TO FIND THE EFFECT OF RUDDY’S RAPID RESISTIVE DUCTION TECHNIQUE (PULSED MET) ON HAMSTRING FLEXIBILITY IN COLLEGE STUDENTS.
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Brief resume of the intended work:
6.1 Need for the study:Hamstring tightness is one of the most common problems faced by people of all ages in the
general population.1 Muscle tissue length is thought to play an important role in efficiency and effectiveness of human movement.2,3 Muscle tightness is caused by a decrease in the ability of the muscle to deform, resulting in a decrease in the range of motion at the joint on which it acts. Muscle tightness usually results from inadequate or improper rehabilitation following sustained muscle injury or low levels of physical activities in individual. It could make the musculotendinous unit more susceptible to injury, increase resistance to various anatomical structures. It could also lead to some pathological conditions at the joint on which the muscle acts, especially on a muscle like the hamstrings which passes over two joints. Decreased hamstring flexibility is a risk factor for development of patella tendinopathy, patellofemoral pain and hamstrings strain injury.4 The visco-elastic characteristics of the hamstring muscle can be altered by various therapeutic modalities and methods including stretching, muscle energy technique, ice and heat therapy.3
Flexibility has been defined as the ability of a muscle to lengthen and allows one joint or more than one joint to move through a range of motion.5 Flexibility is a physical fitness attribute and is often evaluated from the joint range of motion (ROM)4, an essential element of normal biomechanical functioning in sports.
Static stretching is a common technique used to increase muscle length. Static stretching is a method in which the muscle is slowly elongated to tolerance and the position held with the muscle in this greatest tolerated length for a period of time. This type of stretching takes the muscle to its end range. Static stretching has been shown to be very effective at increasing hamstring length.6
Muscle energy technique (MET) is a soft tissue osteopathic manipulation method that incorporates precisely directed and controlled, patient initiated, isometric or isotonic contractions, designed to improve musculoskeletal function and reduce pain. Isometric and isotonic techniques of MET are used to strengthen or tone weak muscles, release
hypertonicity, stretch tight muscles and fascia, improve musculoskeletal function, mobilise joints in which movement is restricted and improve local circulation.7,8
Ruddy’s rapid resistive duction technique (pulsed MET) includes rapid rhythmic (pulsed) isometric alternative to sustained contractions consisting of a series of rapid, low-amplitude muscle contractions (2 per sec) towards the barrier. This approach can be applied in all areas where isometric contractions are suitable.8,9
The effects of Ruddy’s rapid resistive duction technique (i.e. pulsed isometric contractions) include improved local oxygenation, enhanced venous and lymphatic circulation, as well as an improved static and kinetic posture, due to the effects on proprioceptive and interoceptive afferent pathways. These variations, along with their particular influences, appear to produce identical benefits in terms of increased ROM and extensibility of soft tissues.8
Therefore the need of this study is to find if Ruddy’s rapid resistive duction technique (pulsed MET) is effective in reducing hamstring muscle tightness and improving flexibility in college students.
6.2 REVIEW OF LITERATURE:
· Reurink G et al (2013) determined intertester reliability of the AKET (active knee extension test) and the PKET (passive knee extension test) in patients with acutehamstringinjuries and they concluded that both tests can be reliably used to assessflexibilityin injured hamstrings, despite pain and discomfort during testing.10
· Ayala F et al (2012) examined the test-retest reproducibility and criterion-related validity of the sit and reach test (SRT) and the toe touch test (TT) for estimatinghamstringflexibilitymeasured through the passive straight leg raise test (PSLR) and they found that reproducibility of SRT, TT test and PSLR is acceptable and the criterion-related validity of SRT and TT test is moderate.11
· Meroni R et al (2010) compared a passive and an active stretching technique to determine which one would produce and maintain the greatest gain in hamstring flexibility and also to determine whether a passive or an active stretching technique results in a greater increase in hamstring flexibility and compared whether the gains are maintained and they concluded that active stretching produced the greater gain in the AKER (active knee extension ROM) test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group.12
· Smith M,Fryer GA (2008) compared twomuscleenergytechniquesfor increasing flexibility of the hamstringmusclegroup and they concluded that both techniquesappeared to be equally effective in increasing hamstring extensibility, and there appeared to be sustained improvement for 1 week following the initial treatment.13
· Fiona Ballantyne et al (2003) studied the effectiveness of muscle energy technique on hamstring extensibility and concluded that muscle energy technique produced an immediate increase in passive knee extension.7
· H. Fredriksen et al (1997) conducted a study to find out the reliability of passive knee extension test to measure hamstring muscle tightness and they found that the passive knee extension test is a simple and reliable method, and the associated pelvic motion is minimal.14
· Gajdosik RL (1991) examined the effects of static stretching on the maximal length and resistance to passive stretch of short hamstring muscles using slow, static stretch for 15 seconds and reported that holding the stretch for 15 seconds caused increase in ROM of the hamstring muscles, as measured by straight leg raising.15
· Richard L Gajdosik et al (1987) reviewed the related literature on the reliability and validity of goniometric measurements of the extremities and they concluded that clinicians should adopt standardized methods of testing and should interpret and report goniometric results as ROM measurements only.16
6.3 OBJECTIVE OF THE STUDY:
To study the effect of Ruddy’s rapid resistive duction technique (Pulsed MET) on hamstring flexibility in college students.
6.4 HYPOTHESIS
Alternate Hypothesis: Ruddy’s rapid resistive duction technique (Pulsed MET) will be significantly effective on hamstring flexibility in college students.
Null Hypothesis: Ruddy’s rapid resistive duction technique (Pulsed MET) will not be significantly effective on hamstring flexibility in college students.
MATERIAL AND METHODS
7.1 SOURCE OF DATA
Study will be conducted among the Garden city college students, Bangalore.
7.2 METHOD OF SAMPLING
50 subjects will be selected using convenient sampling.
7.2.1 RESEARCH DESIGN
Experimental research design.
7.2.2 DURATION OF STUDY
6 months.
7.2.3 STATISTICAL TOOL
The data will be analyzed by using paired t-test.
7.2.4 SAMPLE SIZE
Sample size is 50.
INCLUSION CRITERIA
· 18-26 years.1
· Both genders.
· SLR equal to or less than 70 degree.15
EXCLUSION CRITERIA
· History of lower extremity injury.
· Subjects on muscle relaxant.
· Prior surgeries on the knee joint.
· Quadriceps weakness.
· Knee joint stiffness conditions.
· Neurological problem.
· Subjects having referred pain in lower limb due to case of back pain.
· Individuals who had participated in stretching or exercise programmes which differed from their normal routine.
INSTRUMENTATION
1. Wooden couch
2. Goniometer
3. Yardstick
4. Inch tape
7.3 METHOD OF COLLECTION OF DATA
50 healthy subjects who fulfilled the inclusion criteria will be selected and randomly assigned into two groups, group A and group B, each consists of 25 subjects. Informed consent will be obtained prior to the treatment.
The tests given below are common for both the groups.
1. Passive knee extension test
Ø It will be done by using a goniometer.16
Ø The subject will be measured for knee extension ROM on both lower extremities by using goniometer. Measurement of knee extension ROM will be made with the subject lying supine with the opposite lower extremity extended and the lower extremity being measured positioned at 90 degrees of hip flexion. The greater trochanter and the lateral epicondyle of the femur and lateral malleolus will be palpated and served as landmarks during measurement. Hip flexion will be at 90 degrees while the assistant moves the tibia into the terminal position of knee extension, which will be defined as the point at which the subject reported feeling discomfort. The goniometric value will then be recorded.17
Ø This will be measured at baseline, at 2 weeks and at 4 weeks.
2. Sit and reach test11
Ø The subject will be made to sit on the mat with the yardstick between the legs, the 36-inch end facing out. A strip of tape will put across the stick at the 15-inch mark. The subject will be asked to keep the leg straight, heels on the tape at that 15-inch mark, with feet about 12 inches apart. The subject will again be made to sit up straight, one hand will place on top of the other, exhale, and slowly reach forward as far along the yardstick as the subject can, lowering the head between the arms. The subject will be asked not to bounce and sit up in a relaxed position and ask to repeat the same procedure twice more, the farthest inch that the subject reach will be marked.
DESCRIPTION OF TREATMENT:
Subjects will be divided into two groups- control group and experimental group.
Control group: Self stretching exercises will be taught to the subjects.
Ø Subject will be asked to stand in front of a wooden couch straight with the feet shoulder width apart and feet pointing straight ahead. The therapist will ask to place either right or left leg onto the wooden couch and then will be asked to reach down and touch the ankle and hold each stretch for 15 sec.18
Ø The same procedure will be repeated for 6 sessions, 5 days per week for 4 weeks.19
Experimental group: Ruddy’s rapid resistive duction technique (Pulsed MET) will be given to the subjects.
Ø The subject will be in supine position with hip and knee of the leg to be treated, flexed. The therapist will stand on the side of the leg to be treated. The therapist will ask the patient to extend the flexed knee to its first barrier of resistance. Then the subject will be asked to perform muscle contraction of the leg towards the barrier against the resistance of the therapist. A series of 20 mini-contractions will be commenced from the barrier. Contractions will be short, rapid and rhythmic. Following the contractions, the slack will be taken out of the tissues, and another series of contractions will be commenced from the new barrier. The amplitude of the contractions will be increased over time and the degree of resistance will be increased gradually. The effort itself will never exceed the barest initiation of an isometric contraction.8,9
Ø The same procedure will be repeated for 3 times after 3 seconds of relaxation, 5 days per week for 4 weeks.20,21
7.4 ETHICAL CLEARANCE
Ethical clearance for the study has been obtained from the ethical committee of our institution.
LIST OF REFERENCES
1. Gajdosik Richard, Lusin Gary. Hamstring muscle tightness: Reliability of an active knee extension test. Physical Therapy. 1983;63(7):1085-1088.
2. Weijer CD, Gorniak PT. The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. Journal of Orthopedic Sports Physical Therapy. 2003 Dec;33(12):727-33.
3. Murphy DF, Connolly DAJ, Beynnon BD. Risk factors for lower extremity injury: a review of the literature. British Journal of Sports Medicine. 2003; 37:13-29.
4. Hopper D,Deacon S Das, Jain A, Riddell D,Hall T,Briffa K. Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects. Journal of Sports Medicine. 2005;39:594-8.
5. Sharon S, Susan L, Ray G, Janine E. Lower extremity muscular flexibility in long
Distance runners. Journal of Orthopedic Sports Physical Therapy. 1993 Feb; 17(2):102-7.
6. Scott D Davis, Paul E Ashby, Kristi L Mccale, Jerry A Mcquain, and Jaime M Wine. The Effectiveness of 3 Stretching Techniques on Hamstring Flexibility Using Consistent Stretching Parameters. Journal of Strength and Conditioning Research. 2005;19(1):27–32.
7. Ballantyne F, Fryer G, Mclaughlin P. The effect of muscle energy technique on hamstring extensibility: the mechanism of altered flexibility. Journal of Osteopathic Medicine. 2003 Oct;6(2):59-63.
8. Leon Chaitow. Muscle energy technique, 3rd edition. Churchill Livingstone Elsevier; 2006.
9. Ruddy T. Osteopathic rhythmic resistive duction therapy. Yearbook of Academy of Applied Osteopathy. Indianapolis; 1961. P. 58.
10. Reurink G,Goudswaard GJ,Oomen HG,Moen MH,Tol JL,Verhaar JA,Weir A. Reliability of the active and passive knee extension test in acutehamstringinjuries. American Journal of Sports Medicine. 2013 Aug;41(8):1757-61.
11. Ayala F,Sainz de Baranda P,De Ste Croix M,Santonja F. Reproducibility and criterion-related validity of the sit and reach test and toe touch test for estimatinghamstring flexibilityin recreationally active young adults. Physical Therapy and Sport. 2012 Nov;13(4):219-26.
12. Meroni R,Cerri CG,Lanzarini C,Barindelli G,Morte GD,Gessaga V,Cesana GC,De Vito G. Comparison of active stretching technique and static stretching technique on hamstring flexibility. Journal of Sports Medicine. 2010 Jan;20(1):8-14.
13. Smith M, Fryer G. A comparison of two muscle energy techniques for increasing flexibility of the hamstring muscle groups. Journal of bodywork and movement therapy. 2008 Oct;12(4):321-317.
14. Fredriksen H, Dagfinrud H, Jacobsen V,Maehlum S. Passive knee extension test to measure hamstring muscle tightness. Journal of Medicine & Science in Sports. 1997 Oct;7(5):279-282.
15. Gajdosik RL. Effects of static stretching on the maximal length and resistance to passive stretch of short hamstring muscles. Journal of Orthopedic Sports Physical Therapy.1991;14(6):250-5.
16. Richard L Gajdosik, Richard W Bohannon. Clinical Measurement of Range of Motion. Review of Goniometry Emphasizing Reliability and Validity Physical Therapy. 1987 Dec;67(17):1867-1872.
17. Brent J Feland,William J Myrer,Shane S Schulthies,Gill W Fellinghamand,Gary W Measom. The Effect of Duration of Stretching of the Hamstring Muscle Group for Increasing Range of Motion in People Aged 65 Years or Older. Journal of American Physical Therapy Association. 2001 May;81(5):1110-1117.
18. Birgit Schuback, JulieHooper, LisaSalisbury. A comparison of a self-stretch incorporating proprioceptive neuromuscular facilitation components and a therapist-applied PNF-technique on hamstring flexibility. Physiotherapy journal. 2004 Sept;90(3):151-157.
19. Bandy WD,Irion JM,Briggler M. The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles. J Orthop Sports Phys Ther. 1998;27(4):295-300.
20. Emad T Ahmed, Safa S Abdelkarim. Efficacy of Muscle Energy Technique versus Static Stretching Technique in Increasing Hamstring Flexibility Post Burn Contracture. International Journal of Health and Rehabilitation Sciences. 2013 Jan; 2(1):22-27.
21. Shadmehr A, Hadian MR, Naeimi SS, Jalaie S, Mokhtari A. The effect of Muscle Energy Techniques on Flexibility of the Short Hamstring Muscles. Modern Rehabilitation. 2007;1(2):60-65.
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