RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.NAME OF THE CANDIDATE AND ADDRESS

SHAH BRIJESHKUMAR PANKAJKUMARPLOT NO:- 1127/2,SECTOR NO:-2/D,NR, SWAMINARAYAN TEMPLE,GANDHINAGAR, GUJARAT-382007

2.NAME OF THE INSTITUTION KRUPANIDHI COLLEGE OF

PHYSIOTHERAPY, BANGALORE

3.COURSE OF THE STUDY AND SUBJECT

MASTER OF PHYSIOTHERAPY IN MUSCULOSKELETAL DISORDERS AND SPORTS PHYSIOTHERAPY

4.DATE OF ADMISSION TO THE COURSE

13-JUNE-2013

5.TITLE OF THE TOPIC: EFFECT OF YOGIC NECK EXERCISE ON FUNCTION & DISABILITY OVER CONVENTIONAL PHYSIOTHERAPY IN PATIENTs WITH CERVICAL SPONDYLOSIS

6 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage

and bones of the neck (cervical vertebrae) and it caused by chronic wear on the

cervical spine. This includes the disks (cushions) between the neck vertebrae and

the joints between the bones of the cervical spine.  People who are very active at

work or in sports may be more likely to have them. The major risk factor is aging

but other factors that can make a person more likely to develop spondylosis are,

Having a job that requires a lot of bending and twisting, Small fractures to the spine

from osteoporosis, Past neck injury (often several years before), Ruptured or

slipped disk, Severe arthritis. The symptoms is like pain over the neck & over the

shoulder blade or it may spread to the upper arm, forearm, or fingers (rarely).[1]

The major risk factor is aging. By age 60, most women and men show signs of

cervical spondylosis. People who are very active at work or in sports may be more

likely to have them. Being overweight and not exercising, having a job that requires

heavy lifting or a lot of bending and twisting, Small fractures to the spine from

osteoporosis, past neck injury (often several years before), Ruptured or slipped

disk.[2]

In cervical spondylosis very commonly seen pain over the neck & shoulder blade &

it may spread to the upper arm & forearm. When the pain gets worse it leads to

affecting in standing & sitting, at night due to disturb sleep. Whenever sneeze or

cough gets pain. Neck stiffness, abnormal sensations & headaches. This all leads to

functional disability for living daily routine life.[1]

Cervical spondylosis concern of physical therapists and rehabilitation specialists,

claim have been made to control the pain, to live normal routine life with the help

of the treatment. Decrease of care towards this leed to get the worsion the condition

and causes neck stiffness, numbness & abnormal sensation in the shoulder, arms &

headache.[1]

Physiotherapy treatment is needed to decrease the pain, improve the ROM,

improved flexibility, improved muscle performance, injury prevention, promotion

of healing. In physiotherapy threatment we offenly used Interferential currents

(IFT), Moist Heat & Isometrics exercises. The Interferential currents (IFT) is work

on the Pain Gait theory and tha medium frequency current convertded in to Low

frequency current in the 90 vector & it effect at the trigger point & reduce the pain.

The Moist Heat is work on the thermal effect, it produce the vosodilation and

increase the blood flow to reduce the spasm, impove the healing process. Isometric

execise is help to improve the muscles strength of peraspinal muscles & maintain

ROM. This treatment is help to reduce the pain.[3] Apart from the this the tradisanal

Yogic neck exrcises also prescribed in reducing the musculo skeletal pain. This

study intended to analysis the yogic intervention in fuctional recovery in the

treatment of cervical spondlosis.

6.1 NEED FOR THE STUDY

There are various methods available for management of cervical Spodyolysis to

regain the Normal Life. But limited research compares the effectiveness of Yoga

Neck Exercise in cervical Spodylosis. Hence, the research is aimed to conduct the

study to provide scientific evidence for the same.

6.2 OBJECTIVES OF THE STUDY

(A) OBJECTIVE:

1. To assess the effect of Yogic Neck Exercice on fuctional outcome in

cervical spondylosis.

2. To compare with the Yogic exercise over & above conventional

physiotherapy treatment.

(B) HYPOTHESIS

NULL HYPOTHESIS:

The Yogic Neck Execise has no significant difference over convectional routine

physiotherapy Execise on neck disability in cervical spondylosis.

ALTERNATIVE HYPOTHESIS:

The Yogic Neck Execise has significant difference over convectional routine

physiotherapy Execise on neck disability in cervical spondylosis.

6.3 REVIEW OF LITERATURE

1. Pubmed health library stated that Cervical spondylosis is a disorder in

which there is abnormal wear on the cartilage and bones of the neck

(cervical vertebrae). It is a common cause of chronic neck pain. Given the

information that it also seen herniated disc & spinal Stenosis.[1]

2. Zhong-ren Sun stated that cervical spondylosis (CS) is an age-related

chronic disc degeneration, which is caused by unspecified degenerative

changes of the muscles, tendons, joints, and bones of the neck and shoulder. [4]

3. Darren R. Lebl, & Alex Hughes stated that the Age-related changes in the

spinal column result in a degenerative cascade with resultant disc

desiccation, facet joint hypertrophy, ligamentum flavum infolding, and

kyphotic collapse. Genetic, environmental, and occupational influences may

play a role in this degenerative process. These spondylotic changes may

result in direct compressive and ischemic dysfunction of the spinal cord.

Both static and dynamic factors play a role in the pathogenesis and should

be considered when considering treatment options.[5]

4. G. C. Goats, stated that the therapeutic effects of interferential currents

Control of pain, Control of circulation and reducing oedema, Effects upon

cell metabolism and the healing process, & neurological impairment.[6,7,8,9,10,11]

5. Scott F. Nadle stated that the chronic pain use of manipulation and

Mobilization, exercise, and psychological intervention along with Isometric

exercises, Superficial heat (Moist Heat), Traction, Transcutaneous

Electrical Nerve Stimulation(TENS).[12,13,14,15,16]

6. BRUCE M. McCORMACK, stated that the Neck pain from cervical

spondylosis will usually respond to simple remedies, including activity

modification, neck immobilization long with the isometric exercises.[17]

7. Kieran Michael Hirpara stated that the therapy regime requires 15–20

sessions of between 30- and 45- minute duration over a 3-month period.

The treatment should be tailored to individual patients but includes

supervised isometric exercises, Thermal therapy provides symptomatic

relief only.[3,18,19,20]

8. Emily R. Howell stated that the Neck pain related disability and function need to be measured in order to assess pre and post treatment patient outcomes, as well as provide valuable information. NDI is a reliable, responsive and internally consistent clinical tool to measure self-reported disability as it relates to patients with neck pain. The Neck Disability Index (NDI) is a 10-item questionnaire that measures a patient’s self-reported neck pain related disability. It has been shown to have high “test-retest” reliability.(sensitivity of 0.78 and a specificity of 0.80)[21]

9. Victoria Misailidou & Paraskevi Malliou stated that for the measure pain

they used Pain scales, Simple descriptive scale, Numeric rating scale along

with them The VAS is the most frequently used pain measure because it is

simple to use and has good psychometric properties. ( reliability values

varied from 0.60 to 0.77 & scores from 0.76 to 0.84)[22,23]

7.MATERIALS AND METHOD

7.1 SOURCE OF DATA

(A) POPULATION:

Subject who are diagnosed as Cervicla Spondloysis by physician in an & around

Banglore.

(B) SAMPLE SIZE:

30 subjects will be taken from the total population based on selection criteria.

MATERIALS USED FOR THE STUDY:

1. Visual Analysis Scale

2. Neck Disability Scale

3. Attendance sheet

7.2 METHOD OF COLLECTION OF DATA:

(A) SAMPLING TECHNIQUES:

Block randomization Technique.

[B] TOOLS

1. Yoga Met

2. Moist Heat pad

3. Interferntional Treatment(IFT) Machine

4. Chair

5. Splinth

6. Pillow

(C) METHODOLOGY:

(I) STUDY DESIGN:

It is a Randomized Control study.

(II) INCLUSION CRITERIA:

1. Pain in the neck is defined as cervical Spondylosis

2. Subjects taken will be volunteers who will sign an institutionally approved

informed consent statement.

3. Pain in the cervical spine or shoulder region over the past 6 months.

(III) EXCLUSION CRITERIA:

1. Histories of neck movement problems, such as episodes of pain in Neck,

fractures and surgery in the past 1 year.

2. Subjects with cervical joint movement contracture by checking movements.

3. Any musculoskeletal disorders in the trunk eg. scoliosis etc.

4. Subjects confirmed pregnant.

5. Noncompliance with the program.

6. Any discomfort that is more than normal sensation during the yogic

exercises.

(IV) PROCEDURE:

The subjects who after the preliminary screening by the testing physical therapist

will be eligible according to the selection criteria; are asked to sign in the

“informed consent form”.

The total of samples will be divided into 2 groups equally by Block

Randomization Method.

Pretest data will collected with Neck Disability Index (NDI) & Visual

Analogue Scale for cervical spondlyosis for the intervention.

After randomization, subjects alloted to GROUP-I will be performing

Conventional physiotherapy treatment and GROUP-II Subjects will be performing

Yogic neck exercises along with Conventional physiotherapy treatments.

INTERVENTION:-

[A] GROUP- I (C ONVlTIONAL PHYSIOTHERAPY TREATMENT)

Group I will be receiving Conventional physiotherapy treatment with

interferential currents (IFT), Moist Heat, Isometric Exercise, to be performed 5

times per week & this treatment is given for the 2 weeks.

Following:-

1] INTERFERENTIAL CURRENT (IFT) [6]

Position of the patient:- Patient lie on Prone position.

Application:-

1. Method - Quadripolar technique.

2. Frequency:- 100 Hz[7,9]

3. Intencity:- as per patient tolerance.

4. Duration:- 10 minutes.

5. Procedure:- Place 2 elecrods at the lateral side of the upper Neck &

2 elecrods at the lateral side of the lower neck (C6-C7) & slowely

increase the intencity as per the patient tolerance.

2] MOIST HEAT[3,12]:-

Position of the patient:- Patient lie on Prone Postion.

Application:- Hot pack is placed on the painful area, The packs are stored

in very hot (158 to 167 degree F) water. When the moist heat packs are

prepared for use, they are placed in towels and/or special wraps. This help

to prevent burns.

1. Duration:- Hot Pack place there while patient relax for about 10 to

15 minutes.

3] ISOMETRIC EXERCISES[3, 12,17]:-

(a) Neck Exercise 1 st Kind :- Stand straight/Sitting. Place your right hand on

your right cheek. Now try to move the neck toward right side and resist the neck

from moving by your right palm. Both the pressure will be equal and hence the

neck should not move. Hold the position and count 10. Do the same thing with left

side.

(b) Neck Exercise 2 nd Kind :- Stand straight/ Sitting. Place two palms below

your chin. Now push the palms with your chin and resist it with your palms. Both

the pressure will be equal prohibiting any movement. Hold the position and count

10.

(c) Neck Exercise 3 rd Kind :- Stand straight/ Sitting. Place your right

palm above the ear and resist the head to move at right side. Both the pressure will

be equal and hence the neck should not move. Hold the position and count 10. Do

the same thing with left side.

(d) Neck Exercise 4 th Kind :- Stand straight / Sitting. Place your

interlocked palms on the forehead. Now push your forehead with interlocked hands

and resist your hands with your forehead. The pressure will be equalize so that the

head cannot move forward. Hold the position and count 10

(e) Neck Exercise 5 th Kind:- Stand straight/ Sitting. Interlock the palms

of both hands and place at the backside of head. Now push your head with

interlocked hands and resist your hands with your head. Both the pressure of the

hands and head should be equal to keep the neck straight. Hold the position and

count 10.

[B] Group II:- (Yogic Exrcises) [24]:-

Group II will be receving Conventional physiotherapy treatment along with

Yogic neck Exercises for to be performed 5 times per week. Each session in a day

consists of 10 repetitions. A rest period of 15 seconds is to be given between the

repetition & this treatment is given for the 2 weeks.

Exercise I :- (Side to Side)

Stand straight. Turn your head toward right side. Then move your head back in

normal posture. Then turn your head toward left and then come back to normal

position. Do this for 10 times, and take rest.

Exercise II :- (Back to Front)

Stand straight. Turn your head toward up and bend backward then come back in

normal posture. Do this for 10 times and take rest.

Exercise III :- (Streching of shoulder blader)

Stand straight. Interlock your fingers of both hands at the back side of your head.

Now bring the elbows together in front. Do this for 10 times.

Exercise IV :- (Shoulder Rolling)

Stand straight with hands aside. Roll your shoulders in clockwise manner for 10

times and then in anticlockwise manner for 10 times.

Exercise V :- (Hand Streching aginst the Wall)

Stand straight with one hand distance from wall. Raise your hand till shoulder level

and move towards the wall by crawling your fingers. Stretch your body and try to

raise your hand upward till the level you can. Hold the position & count 5. Then

return to the start position.

Exercise VI :- (Abhyasana)

Sit in padmasana and raise your right hand sidewise till shoulder level. Left hand

will rest on left knee in gyan mudra. Turn your head toward left side. Hold this

position and count 10. Repeat by changing the hand. Again repeat the whole

process by changing your legs in padmasana.

Exercise VII :- (Pranayam)

Sit in sukhasana posture. Palms will be on respective knees in gyan mudra. Close

your eyes. Now slowly exhale and inhale. Concentrate on your breathing. Do this

for 10 times and then take rest.

Exercise VIII :- (Bhamori)

Sit in sukhasana. Keep your index finger of both hands inside your respective ears.

Close your eyes inhale and utter the word ‘AUM’. Give stress on the letter ‘M’.

While uttering the word, exhale. Do this for 10 times.

Exercise IX :- (Saral Hasta Bhujangasana)

Lying in prone position. Bring both the hands near the chest and place the palms on

the ground with the fingers together pointing forward and thumbs pointed towards

the body. The elbows should be raised towards the ceiling close to the body. Place

the forehead on the ground. While inhaling slowly raise the forehead, bend the neck

backwards and then slowly raising the shoulders, chest and abdomen from the

ground until the arms are straight, very slowly, vertebrae by vertebrae, stretching

backwards. Continue to maintain the asana, breathing normally. Inhale and while

exhaling slower lower the abdomen, chest and finally the forehead on the ground

using the support of the arms.Place the chin on the floor and return the arms back to

the prone position.

Exercise X :- (Low Cobra)

Lie prone on the floor. Stretch your legs back, tops of the feet on the floor. Spread

your hands on the floor under your shoulders. Hug the elbows back into your body.

Press the tops of the feet and thighs and the pubis firmly into the floor. On an

inhalation, begin to straighten the arms to lift the chest off the floor, going only to

the height at which you can maintain a connection through your pubis to your legs.

Press the tailbone toward the pubis and lift the pubis toward the navel. Firm but

don't harden the buttocks. Firm the shoulder blades against the back, puffing the

side ribs forward. Lift through the top of the sternum but avoid pushing the front

ribs forward, which only hardens the lower back. Hold the pose anywhere from 15

to 30 seconds, breathing easily. Release back to the floor with an exhalation.

Exercise XI :- (Setu Bhandhasana)

Lie in supine Position. Fold your knees and keep your feet hip distance apart on the

floor, 10-12 inches from your pelvis, with knees and ankles in a straight line. Keep

your arms beside your body, palms facing down. Inhaling, slowly lift your lower

back, middle back and upper back off the floor; gently roll in the shoulders; touch

the chest to the chin without bringing the chin down, supporting your weight with

your shoulders, arms and feet. Feel your bottom firm up in this pose. Both the

thighs are parallel to each other and to the floor. Keep breathing easily. Hold the

posture for a minute or two and exhale as you gently release the pose.

Attendance sheet is to be maintained to ensure compliance of the subjects. If a

subject misses a exrcise session, he/she would have to undergo exrcise session later

or the next day.Any subject who missed 2 exrcise sessions would be excluded.

After 2 weeks of exrcise, post study measurements would be taken in the same

manner as the pre-studying measurements. The 2 investigators will be present; one

to measure and other to read the measurement, thereby limiting bias in taking the

new measurement.

Subjects would wear comfortable cloth and instructed to position themselves so

they can perform exrcises easly.

(VII) STATISTICAL ANALYSIS

T test will be used.

7.3 Does the study require any investigation or intervention to be conducted

on patients or other humans or animals? If so please describe.

Yes, the study will be done on human’s and informed consent will be taken.

7.4 Has ethical clearance been obtained from the subject and the institution?

Yes, ethical clearance has been obtained from the institution.

8. LIST OF REFERENCES:

1) Pubmed health library, Available from http://www.ncbi.nlm.nih.gov /pubmedhealth/PMH0001472/

2) Medlineplus health library, Available from http://www.nlm.nih.gov/medlineplus/ ency/article/000436.htm

3) KieranMichael Hirpara & Joseph S. Butler, “NonoperativeModalities to Treat Symptomatic Cervical Spondylosis”, Hindawi Publishing Corporation Advances in Orthopedics. 2012:294857. doi: 10.1155/2012/294857:1-5.

4) Liang Z, Zhu X, Yang X, Fu W, Lu A: Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomized controlled study. Complement Ther Med. 2011; 9: S26–S32.

5) Darren R. Lebl, & Alex Hughes, Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment, HSSJ. 2011; 7: 170–178

6) G. C. Goats, Interferential current therapy, Br. J. Sp. Med; 1990; 24, 2.

7) De Domenico, G. New Dimensions in Interferential Therapy: A Theoretical and Clinical Guide. 1st Edn Reid Medical Books, 1987, Lindfield, NSW, Australia

8) Melzack, R. and Wall, P.D. Pain mechanisms: a new theory Science 1965; 150: 971-979

9) De Domenico, G. Pain relief with interferential therapy Aust I Physiother 1982; 28: 14-18

10) Watson, J. Pain mechanisms: a review. 3. Endogenous pain mechanisms Aust I Physiother 1982; 28: 38-45

11) De Domenico, G. Basic Guidelines for Interferential Therapy. Theramed Books, 1981. Ryde, NSW, Australia

12) Scott F. Nadler, Nonpharmacologic Management of Pain. 2004; 104: S6- S10.

13) Jette DU, Jette AM. Physical therapy and health outcomes in patients with spinal impairments. PhysTher. 1996; 76: 930-944.

14) Nadler SF, Steiner DJ, Erasala GN, Hengehold DA. Continuous low level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute

low back pain & Spine. 2002; 27:1012-1014.

15) Highland TR. Dreisinger TE, Vie LL, Russell GS. Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation. Spine. 1992;17 :77-82.

16) Jordan A, Bendix T, Nielsen H, Hansen FR, Host D, Winkel A. Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded randomized clinical trial. Spine. 1998;23:311-318.

17) bruce m. Mc Cormack, Conferences and Reviews, Cervical Spondylosis An Update. 1996; 165: 43-51

18) L. C. G. Persson, C. A. Carlsson, and J. Y. Carlsson, “Longlasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar: a prospective, randomized study,” Spine. 1997; 22; 751–758.

19) L. C. G. Persson, U. Moritz, L. Brandt, and C. A. Carlsson, “Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar: a prospective, controlled study,” European Spine Journal. 1997; 6: 256–266.

20) P. G.Matz, “Does nonoperative management play a role in the treatment of cervical spondylotic myelopathy?” Spine Journal, 2006; 6: S175–S181.

21) Emily R. Howell, “The association between neck pain, the Neck Disability Index and cervical ranges of motion: a narrative review”. 2011; 55 :211–221.

22) Victoria Misailidou & Paraskevi Malliou, “Assessment of patients with neck pain: a review of definitions, selection criteria, and measurement tools” Journal of Chiropractic Medicine. 2010; 9: 49–59

23) Echternach JL. Management of the individual with pain, parts 1and 2. PT Magazine article on the Internet). 1996.Available from http://iweb.apta.org/ Purchase / ProductDetail .aspx? Product_code=LMS-16.

24) Yogic exercise available from http://www.woyoso.org/Cervical-Spondylosis.html

9 SIGNATURE OF CANDITATE

(SHAH BRIJESHKUMAR PANKAJKUMAR)

10 REMARKS OF GUIDEPRESENTED TO THE RESEARCHCOMMITTEE AND APPROVED

11.1 NAME AND DESIGNATION RAMESH KUMAR. J.

PROFESSOR.

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)N/A

11.4 SIGNATUREN/A

11.5 HEAD OF THE DEPARTMENT MR.MASIH MUHAMMAD KHAN

MPT (MUSKULOSKELETALDISORDERS AND SPORTSPHYSIOTHERAPY)

11.6 SIGNATURE

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.1 SIGNATURE