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IRCT20230606058395N1 IRCT 2023-06-26 The University of Faisalabad Comparative Effects of PIR Technique and Mulligan TSLR Technique alng with Retrowalking in Knee OA Comparative Effects of Post Isometric Relaxation Technique and Mulligan Traction Straight Leg Raise Technique Along with Retro walking on Hamstring Flexibility in Knee Osteoarthritis 2023-06-09 anticipated 48 Complete https://irct.ir/trial/70539 interventional Randomization: Randomized, Blinding: Double blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: Randomization will be done by double lottery method while allocating individuals in Group A and Group B equally divide, Blinding description: Double Blinding As participant do not know about treatment or in which treatment Group, he/she was allocated. The care provider also do not know the individual group. Investigator and outcome assessor will only collect outcome of the individuals instead of knowing the group and treatment allocation. N/A Knee Osteoarthritis. Intervention 1: Baseline treatment was given to both groups A and B. Where moist heat applied for 10 minutes to the hamstrings muscles in supine position. Quadriceps isometrics by foam roller 10 rep with 5-7 hold, then Group A was treated by (Post isometric relaxation technique). In Group A, the participants received a treatment known as the baseline treatment and Post-Isometric Relaxation (PIR) Technique. Patient Positioning: During this technique, the patient was positioned in a supine lying position, and the therapist stood on the side affected by the condition. Procedure: The involved leg's knee was gently extended, while the involved leg’s hip was flexed. Then therapist placed the patient's calf on their shoulder and positioned their hands across the upper leg, just above the knee joint. Next, the therapist passively flexed the hip of the affected leg until they encountered resistance. Isometric contraction: The patient was instructed to gently push down on the therapist's shoulder with their leg, exerting resistance against the therapist's effort to extend the hip while inhaling air by normal breathing. This created an isometric contraction, which was held for approximately 5-8 seconds, with appropriate breathing instructions provided to the patient. After the contraction, the patient was instructed to relax and do exhalation, then therapist gently flexed the whole leg at hip joint until the next point of resistance was reached. Repetition: This cycle was repeated 3 to 4 times per day, with three sessions per week on alternate days. After technique application, 2 minutes interval and then retro walking was advised to both group individuals to do at flat surface at their maximum pace for 5-10 minutes. Intervention 2: Baseline treatment was given to both groups A and B. Where moist heat applied for 10 minutes to the hamstrings muscles in supine position. Quadriceps isometrics by foam roller 10 rep with 5-7 hold, then Group B will be treated with baseline treatment and TSLR technique involves sustained traction applied to the limb. Patient actively does the SLR and both the therapist and the patient note the range. Therapist now grasp patient lower leg proximal to the ankle joint and raise it off the bed to a position just short of the painful range. Therapist flexes his knees and holds the clasped leg to his chest. When the therapist extends his knees this will effectively apply a longitudinal traction to the leg provided the bed is low enough and the therapist is tall enough. Sustain this traction and undertake a straight leg raise as far as it will go provided there is no pain. Then pain free SLR with traction is given for 3 times, three sessions per week. After technique application, 2 minutes interval and then retro walking was advised to both group individuals to do at flat surface at their maximum pace for 5-10 minutes. Undecided - It is not yet known if there will be a plan to make this available Justification or reason for indecision in sharing IPD is Ethical
public Rubina Zulfiqar
Sargodha road near Kia motors Faisalabad
Faisalabad Pakistan 38000 +92 41 9392994 rubinazulfqar@gmail.com The University of Faisalabad scientific Nimra Iftikhar
House 42 Daewoo road Faisalabad
Faisalabad Pakistan 38002 +92 41 2698888 nimraiftikhar@gmail.com The University of Faisalabad Pakistan Pakistan Knee pain with crepitus sound for 6 months or more Both genders having age 40-60 Morning stiffness lasting <30 minutes Bony tenderness with no palpable warmth Tight Hamstrings muscles Numeric Pain Rate Scale (NPRS) score of 5 or greater than 5 Radiographic finding Grade II-III according to Kellgren Lawrence Scale Bilateral or Unilateral Involvement 40 years 60 years Both Any history of trauma to the knee ligament or any neurological impairment Any other pathology (e.g. fractures, bursitis, backache, radiating pain to the leg) History of recent steroid injection since 3 months Severe valgus or varus deformity History of recent lower limb or spinal surgeries Signs of active infection or inflammation to the knee joint Participants who are unwilling to participate in study Rehabilitation Rehabilitation Baseline treatment was given to both groups A and B. Where moist heat applied for 10 minutes to the hamstrings muscles in supine position. Quadriceps isometrics by foam roller 10 rep with 5-7 hold, then Group A was treated by (Post isometric relaxation technique). In Group A, the participants received a treatment known as the baseline treatment and Post-Isometric Relaxation (PIR) Technique. Patient Positioning: During this technique, the patient was positioned in a supine lying position, and the therapist stood on the side affected by the condition. Procedure: The involved leg's knee was gently extended, while the involved leg’s hip was flexed. Then therapist placed the patient's calf on their shoulder and positioned their hands across the upper leg, just above the knee joint. Next, the therapist passively flexed the hip of the affected leg until they encountered resistance. Isometric contraction: The patient was instructed to gently push down on the therapist's shoulder with their leg, exerting resistance against the therapist's effort to extend the hip while inhaling air by normal breathing. This created an isometric contraction, which was held for approximately 5-8 seconds, with appropriate breathing instructions provided to the patient. After the contraction, the patient was instructed to relax and do exhalation, then therapist gently flexed the whole leg at hip joint until the next point of resistance was reached. Repetition: This cycle was repeated 3 to 4 times per day, with three sessions per week on alternate days. After technique application, 2 minutes interval and then retro walking was advised to both group individuals to do at flat surface at their maximum pace for 5-10 minutes. Baseline treatment was given to both groups A and B. Where moist heat applied for 10 minutes to the hamstrings muscles in supine position. Quadriceps isometrics by foam roller 10 rep with 5-7 hold, then Group B will be treated with baseline treatment and TSLR technique involves sustained traction applied to the limb. Patient actively does the SLR and both the therapist and the patient note the range. Therapist now grasp patient lower leg proximal to the ankle joint and raise it off the bed to a position just short of the painful range. Therapist flexes his knees and holds the clasped leg to his chest. When the therapist extends his knees this will effectively apply a longitudinal traction to the leg provided the bed is low enough and the therapist is tall enough. Sustain this traction and undertake a straight leg raise as far as it will go provided there is no pain. Then pain free SLR with traction is given for 3 times, three sessions per week. After technique application, 2 minutes interval and then retro walking was advised to both group individuals to do at flat surface at their maximum pace for 5-10 minutes. Knee Pain. Timepoint: Before intervention and 4 weeks after intervention. Method of measurement: Numeric Pain Rate Scale. Range of motion. Timepoint: Before intervention and 4 weeks after intervention. Method of measurement: Universal Goniometer. Functional Ability. Timepoint: Before intervention and 4 weeks after intervention. Method of measurement: WOMAC Questionnare. Cadence. Timepoint: Before intervention and 4 weeks after intervention. Method of measurement: Pedometer. The University of Faisalabad Approved 2023-05-25 The University of Faisalabad Street 5, Madan pura Faisalabad Faisalabad Punjab Pakistan