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Dec 1, 2014 - the calf muscles in a shortened position and ... previous injury, disorder, surgery or trauma of the .... ultrasound and stretching showed most.

December 2014

ORIGINAL RESEARCH International Journal of Health and Rehabilitation Sciences

Volume 3

Issue 4

Effect Of Concomitant Use Of PNF Stretching With Thermotherapy And Massage On Plantar Flexors Flexibility In Young Females Sandeep Singh

Sandeep Singh, Ambika Mehta

Assistant Professor Department of Physiotherapy, Punjabi University, Patiala, Punjab -147002, India Ambika Mehta Post-Graduate Student (MPT-Neurology) Department of Physiotherapy, Punjabi University, Patiala, Punjab -147002, India Corresponding Author: Sandeep Singh E-mail: [email protected], Mobile. No. =9417802490

Abstract Background: Adequate flexibility is an important characteristic of physical fitness but there continues to be debate regarding the optimal technique for flexibility training. Heat with stretching have benefits but combined effects of massage and stretching can even prove to be more beneficial. Purpose: Present study intends to investigate and compare the efficacy of thermotherapy plus PNF (contract-relax) stretching over massage (petrissage) plus PNF stretching on plantar flexor flexibility in young women.

Materials and Methods: 30 females aged between 20-30 years having plantar flexors tightness were included in study and allocated equally into two groups, Group A and B, respectively. Group A was given moist heat pack for 15 minutes plus PNF stretches to plantar flexors muscle and Group B was given petrissage(wringing) technique of massage for 5 minutes plus PNF stretches. Both the groups received interventions for 3 weeks, 5 days per week. Goniometeric Active and Passive Dorsiflexion Range of Motion (ADROM / PDROM) was performed before and after the 3 weeks protocol.

Results: Within the group comparison demonstrated that the ADROM / PDROM was significantly increased from baseline values on 15th day, in both groups. Between groups comparison, however, demonstrated that non-significant differences existed in values of ADROM / PDROM on 15th day suggesting that both interventional programs were equally effective in improving ankle dorsiflexion range of motion

Conclusion: Addition of both moist heat pack and petrissage massage to PNF is found to be equally effective in improving plantar flexors flexibility in healthy young females. Keywords: Proprioceptive neuromuscular facilitation, Moist heat pack, Petrissage massage, Plantar flexors flexibility.

www.ijhrs.com .

84

June 2015

International Journal of Health and Rehabilitation Sciences

Volume 4

Issue 2

Use of Heat and Massage with PNF Stretches to improve ankle ROM

Introduction

Physiotherapists devote considerable time and

Plantar flexors are important group of muscles

energy to improve or maintain the flexibility but

that play a vital role in postural control and gait

an optimal method influencing flexibility is yet to

cycle1. Lack of their extensibility cause decrease

be identified

in ankle dorsiflexion which has been associated

evidences convincingly report Proprioceptive

with increased knee valgus 2 and greater ground

Neuromuscular Facilitation (PNF) stretching

reaction

3

forces

alterations

.

These

forces

biomechanical

individuals

to

adopt

17

. However, numerous emerging

techniques to be most efficacious methods than traditional static stretching exercises for range of 18, 19, 20

compensatory gait patterns such as genu

motion or flexibility enhancement

recurvatum, early heel lift and excessive subtalar

Nonetheless, there are some reports that

4,5,6

joint pronation

which then predispose

.

stretching does not provide significant benefits21,

individuals to develop various pathologies such

22

as metatarsalgia, ankle sprain , medial tibial

form of warm-up exercises (passive/active)

traction periositis, Achilles tendinopathy, plantar

should be combined with stretching to augment

7,8,9,10,11

fasciopathy

. So there remains need to

. Hence, many authors are of view that some

its efficacy on flexibility 23, 24.

counteract plantar flexion tightness to mitigate its

It is believed that concurrent use of some passive

ill effects.

warm-up exercises (superficial heating, massage)

Plantar flexor tightness, nowadays, is common

would

occurrence in urban young females, owing to

augmenting flexibility. Use of moist heat

much use of high heel footwear 12. It is estimated

followed by stretching has shown better results

that about 69% of women wear high-heel shoes

on flexibility 25, 26. However, we could not locate

on daily basis

13

complement

PNF

stretching

in

and hence have preponderance

the studies in literature that have investigated

for the plantar flexor tightness. High heels place

combined effect of hot pack and PNF stretching

the calf muscles in a shortened position and

on muscle flexibility.

continuous use of high heels induces structural

Despite lacking supporting evidence, it is widely

and functional changes in highly malleable

believed that massage is effective modality for

muscles and tendons thus causing reduction in

increasing flexibility

ankle range of motion that

high

heel

dorsiflexion

of

14, 15

. Kim et al., reported

wearers about

have 17

decreased

degrees

and

27

. Studies on effects of

massage in flexibility are limited.

Though

researchers have attempted to study and compare the effects of massage with static stretching but

recommended such females to routinely perform

findings have varied

some kind of flexibility exercises16.

numerous

effects

28

such

. Massage induces as

biomechanical,

physiological, reflexive and psychological 29 and 85

June 2015

International Journal of Health and Rehabilitation Sciences

Volume 4

Issue 2

Use of Heat and Massage with PNF Stretches to improve ankle ROM

it gives patient confidence, encouragement and

and passive Ankle Dorsiflexion Range of Motion

psychological stimulation to use the part 30. It is

(PDROM) was recorded in supine position with

hypothesised that concomitant application of

knee extended and foot in 00 of inversion and

massage and PNF stretching could come up as

eversion for participants of both groups. Centre

promising

flexibility

of fulcrum of goniometer was placed over the

augmentation. Hence present study intended to

lateral aspect of the lateral malleolus, proximal

investigate

of

arm was aligned with the lateral midline of the

(contract-relax)

fibula, using head of the fibula for reference and

stretching over massage (petrissage) plus PNF

distal arm was kept parallel to the lateral aspect

stretching in plantar flexor flexibility in young

of 5th metatarsal

women.

to pull his feet towards himself as much as

intervention

and

thermotherapy

for

compare plus

PNF

the

efficacy

32

(Fig1). Participant was asked

possible and for ankle PDROM measurement feet

MATERIALS AND METHODS:

was moved passively to maximum ankle

Subjects

dorsiflexion (Fig 2). Intra-rater reliability and

Thirty females, aged between 20 -30 years,

intra-class correlation coefficients (ICCs) are

having plantar flexors tightness were recruited in

typically greater than 0.9 regardless of the

present study by convenient sampling method.

technique 33.

Informed written consent was obtained from all

Group A was given moist heat pack for 15

the participants. Females having mild to

minutes plus PNF stretches to plantar flexors

moderate plantar flexors tightness as evident by

muscle

having active ankle dorsiflexion range less than

petrissage(wringing) technique of massage for 5

90 measured with knee in full extension 31 (Fig1)

minutes plus PNF stretches. Both the groups

were included and individuals with history of

received interventions for 3 weeks, 5 days per

previous injury, disorder, surgery or trauma of the

week.

lower back, lower extremity, ankle joint and calf

Dorsiflexion Range of Motion (ADROM /

muscle were excluded. Approval was obtained

PDROM), respectively, was performed again

from Institution Ethics Committee (IEC) of

after the 3 weeks protocol on 15th day.

and

Group

Goniometric

B

Active

was

and

given

Passive

Punjabi University, Patiala. Procedure

Intervention

Participants were allocated equally into two

Moist Heat Pack (MHP) and

groups, Group A (n=15) and Group B (n=15).

relax) stretching

PNF(contract-

Baseline goniometric measurements of ankle Active Dorsiflexion Range of Motion (ADROM) 86

June 2015

International Journal of Health and Rehabilitation Sciences

Volume 4

Issue 2

Use of Heat and Massage with PNF Stretches to improve ankle ROM

Participants of Group A received Moist Heat Pack (MHP) and PNF(contract-relax) stretching

DATA ANALYSIS

to plantar flexors.

Statistical analysis was done using Microsoft

MHP heated to about 800 C in hot water bath and

excel 2010 version software for windows.

wrapped in towel was applied to calf muscle for

Unpaired t-test was used to compare age,

15 minutes

34

subsequently contract-relax-PNF

physical characteristics, baseline measurements

stretches were applied by taking ankle passively

of ankle ADROM / PDROM of both groups and

to maximum achievable passive dorsiflexion

also for between the groups comparison. Paired

range and then asking participant to contract

t-test was applied for within the group

plantar flexors against resistance provided by

comparison.

therapist for 10 seconds and relax for 5 seconds,

significance.

thereafter ankle was taken to new gained ankle

p