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Abstract Background Nonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual’s poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion. Methods It is a single-blinded randomized clinical trial with 60 patients aged 18–40 years, with moderate intensity NSNP for > 3 weeks and 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement. Conclusion Between NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP. Trial Registration Registered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

Abstract Background The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back. Methods A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober’s test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman’s correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal–Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant. Results The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p 0.05). Conclusions The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.

Background: Overactive bladder (OAB) is characterized by urinary urgency, frequency, and nocturia, often accompanied by urinary incontinence. OAB significantly impacts the quality of life of affected individuals. Transcutaneous Tibial Nerve Stimulation (TTNS) is a non-invasive treatment option used to manage overactive bladder (OAB) symptoms. Objective: to determine the effects of Transcutaneous Tibial Nerve Stimulation on overactive bladder symptoms in adults. Methods: A randomized controlled trial was held at the Sindh Institute of Physical Medicine and Rehabilitation with a non-probability purposive sampling technique. After screening for inclusion criteria 60 patients were randomly allocated into two Group A received Transcutaneous tibial nerve stimulation (TTNS) combined with traditional physiotherapy, while Group B just received traditional physiotherapy. Both interventions were given for six weeks. The overactive Bladder Symptom Score was used as an outcome measure tool. Results: Group A improved in all OAB parameters, including daytime frequency (p=0.008), nocturia (p=0.006), urinary urgency (p=0.002), and urge urinary incontinence (p=0.008) with a significant improvement p

Background: The patients with low back pain have the frequency to seek physiotherapy. There are various outcome measures for low back pain with proven reliability and validity. Objective: To investigate the practice level of physiotherapists working in clinical settings about the usage of outcome measures for low back pain and its barriers. Study type,settings& duration:A cross-sectional study was conducted at different public and private hospital/ clinical setting or health care setting of Karachi, Pakistan from August to December 2019. Methodology:A questionnaire was used to conduct study among 335 physiotherapists. Frequencies and percentages were reported of all descriptive variables. Mean and standard deviation was used to report continuous data. Results:Among 335 physiotherapists, 118 (35.2%) were males, and 217 (64.8%) were females with a mean age of 29.88±5.92 and clinical experience of 5±5.9 years. About 244(72.8%) physiotherapists use outcome measures. Mostly, physiotherapists use a pain visual analogue scale. Approximately 88 (26.2%), 83 (24.7), and 61 (18.2%) physiotherapists identify lack of access to information, lack of time and knowledge as barriers to use outcome measures, respectively. Conclusion:The outcome measures in low back pain being used in physiotherapy practices like other health care professions. However, the lack of access to the information is the most perceived barrier to use outcome measures. The study suggests improving physiotherapists' access to outcome measures and their relevant information can enhance its usage.

Abstract Background Knee osteoarthritis (KOA) considered as one of the most common degenerative diseases of synovial joint. KOA is mostly managed by physical therapy, focused on pain management, the range of motion and muscle strengthening but muscle flexibility is usually neglected. A study was conducted to evaluate the effectiveness of dynamic soft tissue mobilization (DSTM) in comparison with the proprioceptive neuromuscular facilitation (PNF) stretching in the management of hamstring tightness, reduction of pain intensity and improvement of physical functionality in KOA. Methods Forty eight patients with KOA were randomly allocated to group A receiving DTSM and group B receiving PNF stretching. The cryotherapy and isometric strengthening exercises were also given to both groups. Total treatment duration consisted of 4 weeks, 3 sessions per week and total 12 sessions per patient. Each treatment session comprised of 30 min. At baseline and post treatment, Active knee extension test(AKET), Visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess hamstring flexibility, pain intensity level and physical functional capability respectively. The continuous variables were shown as mean and standard deviations. For the comparison of outcome within and between groups, paired sample and independent t-test was applied. Considerable p value was less than 0.05. Results The between group analysis of VAS, right AKE test, and left AKE test showed non-significant (p > 0.05) mean difference as 0.2 (95% CI= -0.29, 0.70), 1.79 (95% CI= -1.84, 4.59), 1.78 (95% CI= -1.6, 5.19) respectively. KOOS domains of symptom, pain, ADLs, sports and recreational, and quality of life had also non-significant (p > 0.05) mean difference as 1.12 (95% CI= -4.05, 6.3), -5.12 (95% CI= -12.71, 2.46), -2.55 (95% CI= -7.47, 2.38), -2.7 (95% CI= -9.72, 4.3), and − 0.68 (95% CI= -7.69, 6.36) respectively. Significant (p

Objective: To determine the frequency of hamstring tightness and its impact among patients with chronic neck and low-back pain. Method: The analytical, cross-sectional study was conducted at the outpatient department of the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, from September 10, 2021, to January 31, 2022, and comprised patients of either gender aged 18-40 years with non-specific cervical and lumbar pain for more than 3 months. The participants were divided into 2 groups. Group A included those with chronic neck pain and group B included participants with chronic low-back pain. Clinical assessment was done to measure hamstring tightness and pain by using the active knee extension test and the visual analogue scale, respectively. Data was analysed using SPSS 24. Results: Out of 104 participants, there were 52(50%) males and as many females. The overall mean age was 28.155.10years. There were 52(50%) subjects in each of the two groups. Hamstring tightness was found in 73(70.2%) subjects. Patients with chronic low-back pain reported more tightness of hamstring muscle 38(73.1%) than those with chronic neck pain 35(67.3%) (p>0.05). Conclusion: Hamstring tightness was frequent among patients with chronic neck pain and low-back pain though not significantly. Key Words: Lumbar, Muscle, Neck pain, Pain intensity.

Abstract Background Neck pain is a common musculoskeletal issue that has been seen as high in terms of disability. Muscle Energy Techniques (MET) are advanced soft tissue techniques to treat Mechanical Neck Pain (MNP). This study compares the Autogenic inhibition (AI) technique with the Reciprocal Inhibition (RI) technique providing conventional treatment to improve functional outcomes. Methods A randomized control trial was conducted at Sindh Institute of Physical Medicine & Rehabilitation, Karachi, Pakistan from August 28, 2021, to December 31, 2021 among 20–50 years old patients with Moderate intensity MNP for more than 4 weeks and with limited Neck ROMs. The sample were divided randomly and allocated into two groups (groups 1 and 2). Group 1 and 2 received 12 sessions of AI and RI with Conventional therapy respectively. The randomization sheet was generated online from randomization.com for a sample size of 80 and two groups of study ‘AI’ and ‘RI’ with a ratio of 1:1 by an independent statistician. Pain (primary outcome), range of motion, and functional disability (secondary outcomes) were assessed through visual analog scale (VAS), Goniometer, and Neck disability index (NDI) at baseline, 1st, and last session respectively. Mean and standard deviation, frequency, and percentages were calculated. Chi-square test and independent t-test compare baseline characteristics. The Repeated Measure Two-Way ANOVA compared mean VAS, NDI, and ROM. The significant P-value was less than 0.05. Results The mean duration of neck pain was 8 weeks. There was a more significant (p

Neck pain is the 4th highest reason for disability among adults. The adult population showed a prevalence of 5.9% to 38.9%. Females are more frequently affected than males.1 Mostly, the patients with neck pain seek consultations in health care settings for their neck pain associated issues and the health care provider avails the best available evidence to make decision regarding treatment. The decision making for assessment and treatment of neck pain in clinical settings can be complex for health care providers when it is accompanied by hamstring tightness. This feature can put the health care provider at risk of avoiding connection of neck pain and hamstring tightness. Hamstring tightness influences the posture of the pelvic region which contributes to the symptoms like inappropriate lumber pelvic region movements and low back pain. This distortion in the lumber pelvic region can also cause limitation in a variety of cervical movements and can cause neck pain.2 The fact is because one neural system connects the hamstrings and those muscles around the neck. That neural system passes through the dura and is known as the superficial back line (SBL).2The Superficial Back Line (SBL) connects and protects from the base of the lower limbs to the top of the head on the posterior surface of the human body. The function of the SBL is to support the body in the upright position and to prevent forward bending.3 The fascia consists of myofascial chains that encompassed the SBL from the plantar fascia to neck muscles along with the erector spinea, sacrotuberous ligament, hamstrings, gastrocnemius, and achilles tendon.3 The Figure-1 shows the concept of SBL with direction in red line connecting the back of human body between the neck and the base of heel. The flexion of upper limb increases movement of same side erector spinea, gluteal region till hamstring and muscles of foot. The SBL eases effective force transmission between the extremities and trunk due to its anatomical integration.4 Furthermore, it allows movements of upper limbs in combination with the trunk and the lower limbs during different functional activities like walking, sit to stand etc.3 The amount of force created by the cells of SBL is quite sufficient to influence the movement of musculoskeletal structures throughout the human body. Although the presence of myofibroblasts signifies a believable explanation for stiffness changes in tissues, it most likely is not the single cause. A systematic review suggests good evidence for the presence of myofascial chains which consists of plantar fascia, gastrocnemius, hamstrings, erector spinae muscles throughout the spine. Therefore, evidence of superficial backline association with hamstring tightness can be presented with neck pain.5 A clinical example regarding SBL is when treatment of the plantar fascia results in increased hamstring flexibility and hip range of motion. The Figure-2 shows the composite movement of floor touch, hamstring flexibility allowing touching the floor. This fact elaborates the implication of SBL that makes an impact on the flexibility of muscles.6 Meanwhile, it has been stated that the application of intervention on neck muscles can improve the flexibility of hamstring muscle with improved neck symptoms.3 Effectiveness of suboccipital muscle (muscle around the neck) inhibition technique, and self-myofascial release technique on hamstring flexibility has been recognized. The application of both techniques acknowledged, being effective with the direction of that when the tensed suboccipital muscles relax, the tone of the hamstrings muscle also decreases. This is because of the myofascial relaxation, where it revealed an association between a symptom of neck and hamstring.1 The implication of SBL is also supported by the evidence found in a randomized clinical trial that the application of static stretching and remote myofascial release on plantar fascia and muscles around the neck has been seen to be beneficial to improve the flexibility of hamstring muscle. However, it was further found that combined effects of both have additional effects.6 In another randomized control trial, the suboccipital muscle inhibition technique and craniocervical flexion exercises have been shown to improve the hamstring flexibility along with the increased popliteal angle, craniovertebral angle, and cervical range of motion. This evidence enlightens the implication of SBL as connection of suboccipital area with hamstring activity.4 A randomized clinical trial conducted to found remote effects of the instrument-assisted soft tissue mobilization of hamstring. It was found that the instrument-assisted soft tissue mobilization on the upper and lower part of the SBL can improve hamstring flexibility significantly leading to improved composite functions.3 These all facts suggest the validity of hamstring association in neck symptoms and enlightens the clinical application of SBL. Hence, the recent clinical trials showed significant results in their mean indicating the important association of hamstring tightness and neck pain. It is important to acknowledge this relation in neck-related symptoms during examination and treatment of a patient’s neck pain that would decrease the frequency of clinical consultancy. There is a need for further research for an implication of its clinical practice among patients with neck pain.

Abstract Background Non-specific neck pain is the most prevailing musculoskeletal disorder which has a large socioeconomic burden worldwide. It is associated with poor posture and neck strain which may lead to pain and restricted mobility. Physical therapists treat such patients through several means. Post isometric relaxation and Myofascial release therapy are used in clinical practice with little evidence to be firmed appropriately. So, this study was conducted to explore the effect of Post-isometric relaxation in comparison to Myofascial release therapy for patients having non-specific neck pain. Methodology Sixty patients were randomly allocated to Post isometric group and the Myofascial group. The treatment period was of 2 weeks. All the patients were evaluated using the Visual analogue scale (VAS), Neck disability index (NDI), Universal Goniometer, and WHO BREF Quality of life-100 in the 1st and 6th sessions. Recorded data was entered on SPSS 21. Data were examined using two-way repeated ANOVA to measure the variance of analysis (group x time). Results Analysis of the baseline characteristics revealed that both groups were homogenous in terms of age and gender i.e. a total of 60 participants were included in this research study 30 in each group. Out of 60 patients, there were 20(33.3%) males and 40(66.7%) females with a mean age of 32.4(5.0) years. Participants in the Post Isometric group demonstrated significant improvements (p

Objective: To determine the effects of hip joint mobilisations and strengthening exercises on pain, physical function and dynamic balance in patients with knee osteoarthritis. Method: The single-blind three-arm parallel randomised controlled trial was conducted at Sindh Institute of Physical Medicine and Rehabilitation, the outpatient department of Dow University of Health Sciences’ Ojha Campus, Rabia Moon Memorial Welfare Trust and the Civil Hospital, Karachi, from January to July 2021. The sample comprised patients aged at least 50 years having knee osteoarthritis grade 1-3. The patients were randomised into 3 equal groups, with group A receiving hip mobilisations along with strengthening exercises of hip and conventional knee exercises, group B receiving strengthening exercises of hip along with conventional knee interventional exercises, and group C receiving conventional knee exercises only. Pain, physical function and dynamic balance were assessed using visual analogue scale, knee injury osteoarthritis outcome score and four-step square test, respectively, at baseline and after 18th session. Data was analysed using SPSS 21. Results: Of the 74 subjects assessed, 66(89.2%) were included; 22(33.3%) in each of the three groups. The sample had 19(28.8%) male subjects and 47(71.2%) female. The mean age in groups A, B and C were 55.64±3.56 years, 53.64±4.65 years and 54.91±4.30 years, respectively. There was significant difference among groups post-treatment (p

Objective: To determine the relationship between gross motor function of children with cerebral palsy and quality of life of their primary caregivers. Method: The cross-sectional analytical study was conducted from December 2020 to August 2021 at the Sindh Institute of Physical Medicine and Rehabilitation and the Rabia Moon Trust, Karachi, and comprised children with cerebral palsy and their caregivers. The children were assessed on the basis of Gross Motor Function Measure-66 and Gross Motor Functional Classification System, while the caregivers were asked to complete the self-administered World Health Organisation Quality of Life-BREF questionnaire. All the categorical variables were presented through frequencies and percentages. Spearman’s Correlation was applied to evaluate the correlation. Data was analysed using SPSS 16. Results: Of the 43 children, 26(60.5%) were male and 17(39.5%) were females. The overall mean age was 5.70±1.820 years. Among the caregivers, 40(93%) were females and 3(7%) were males. The mean age of the caregivers was 27.70±4.77 years. None of domains of quality of life showed significant correlation with total score of Gross Motor Function Measure-66 (p>0.05). Conclusion: The disease severity among children with cerebral palsy was not a factor associated with quality of life of the caregivers. The physical health was relatively lower among the caregivers, but it was not associated with motor disabilities. Key Words: Caregiver burden, Child development disorders, Correlation, Developmental, Disabilities, Family caregivers.

Background: Now, a days myofascial trigger points are tremendously occurring and become a stressful part of nearly any person at any time in a lifetime. This study compares the effects of ischemic compression pressure with spray and stretch technique to treat active myofascial trigger points of the trapezius muscle in patients with neck pain. Methodology: A comparative interventional study was conducted at Dow University of Health Sciences from December 2016 and May 2017. Seventy patients (35 in each group) with active myofascial trigger points of trapezius were randomly assigned to group A (ischemic compression pressure) and group B (vapocoolant spray and stretch technique). Baseline and last session assessment of pain intensity, pain pressure tolerance, cervical range of motion and functional disability were measured through numerical pain-rating scale, algometer, goniometer and neck disability index, respectively. Results: Both groups showed significant improvement in all dependent variables of study which were neck pain, cervical range of motion and pain pressure tolerance (p-value

Objective: To determine median nerve tightness in smartphone users, and to compare the upper limb functions between those with and without median nerve tightness. Method: The cross-sectional, observational study was conducted at the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from March 2020 to January 2021, and comprised subjects of either gender aged 20-40 years who had been using smartphone for >1 year. Body mass index was calculated. The participants were evaluated using upper extremity functional index-15. A hand-held dynamometer was used to assess handgrip strength, and a pinch meter assessed the pinch strength. Manual upper limb tension test 1 was used for median nerve tightness. Frequencies and percentages were drawn for all categorical variables. Data was analysed using SPSS 22. Results: Of the 277 subjects, 198(71.5%) were females. The largest group 176(63.5%) was aged 21-25 years. The mean upper limb functional index was 84.24±15.09. Also, 113(40.8%) subjects were positive for left-side median nerve tightness and 122(44%) were positive on the right side. There was no significant association between median nerve tightness and upper extremity function (p>0.05). The association, however, was significant with the duration of mobile usage in years (p

Objective: To evaluate physiotherapy practices in the rehabilitation of patients undergoing coronary artery bypass grafting. Methods: The cross-sectional study was conducted from October 2016 to January 2017 in cardiac care units of two private and two government hospitals in Karachi, and comprised physiotherapists dealing with patients undergoing coronary artery bypass grafting. Data was collected using a modified and validated version of ‘tucker q’ questionnaire. Data was analysed using SPSS 21. Results: Of the 101 physiotherapists, 60(59.4%) were females and 41(40.6%) were males. The overall work experience was 4.89+2.08 years. Of the total, 60(59.4%) physiotherapists used air suctioning in preoperative physiotherapy practices. Relaxation techniques were used by 86(85.10%) professionals and postural drainage by 85(84.20%), while breathing exercises were used by 65(64.4%) subjects in postoperative physiotherapy practices. Conclusion: Physiotherapists were found to be more or less keeping abreast with advances made regarding managing patients undergoing cardiac artery bypass grafting. Key Words: Coronary artery surgery, Heart surgery, Cardiac rehabilitation, Physical therapy, Breathing exercises, Postoperative care. Continuous...

Background & Objective: Low back pain (LBP) is the foremost cause to hamper an individual's functional activities in Pakistan. Its impact on the quality of life and work routine makes it a major reason for therapeutic consultations. About 90% of the cases with LBP are non-specific. Various options are available for the treatment of LBP. Posterior-anterior vertebral mobilization, a manual therapy technique; and thermotherapy are used in clinical practice, however evidence to gauge their relative efficacy is yet to be synthesised. This study aimed to compare the effectiveness of posterior-anterior vertebral mobilization versus thermotherapy in the management of non-specific low back pain along with general stretching exercises., Methods: A randomised controlled trial with two-group pretest-posttest design was conducted at IPM&R, Dow University of Health Sciences (DUHS). A total of 60 Non-specific low back pain (NSLBP) patients with ages from 18 to 35 years were inducted through non-probability and purposive sampling technique. Baseline screening was done using an assessment form (Appendix-I). Subjects were allocated into two groups through systematic random sampling. Group-A (experimental group) received posterior-anterior vertebral mobilization with general stretching exercises while group B (control group) received thermotherapy with general stretching exercises. Pain and functional disability were assessed using NPRS and RMDQ respectively. Pre & post treatment scores were documented. A maximum drop-out rate of 20% was assumed. Recorded data were entered into SPSS V-19. Frequency and percentages were calculated for categorical variables. Intragroup and intergroup analyses were done using Wilcoxon signed ranked test and Mann-Whitney Test respectively. A P-value of 0.05 was considered statistically significant., Results: Pre and post treatment analysis revealed that P-values for both pain and disability were less than 0.05, suggesting significant difference in NPRS and RMDQ scores. Whereas, median scores for both pain and disability were decreased by 75% in experimental group and 50% in control group. For inter group analysis p-values for both pain and disability were found to be less than 0.05., Conclusion: Both physiotherapeutic interventions, the PAVMs and thermotherapy, have significant effects on NSLBP in terms of relieving pain and improving functional disability. However PAVMs appeared to be more effective than thermotherapy.