Cyriax Friction Massage Approach Health And Social Care Essay

INTRODUCTION

Shoulder girdle can be a complex group of articulations that is imperative to many activities of everyday living. This condition can impact on working lifestyle, leisure and general standard of living .A global reduction in shoulder function is called Periarthritis, referring to the actual adherence of the shoulder capsule to the humeral mind.

Periarthritis (frozen shoulder) is an insidious painful condition with gradual restriction of most planes of movement in the shoulder. The causes of frozen shoulder are not fully understood. It really is because of idiopathic or post-traumatic triggers .Factors connected with adhesive capsulitis include female gender , age over the age of 40 years , trauma , immobilization , diabetes ,thyroid disease , stroke , myocardial infarction , the presence of autoimmune ailments , cervical spine disorders , reflex sympathetic dystrophy syndrome. Idiopathic (key) adhesive capsulitis is seen as a fibrosis of the capsule resulting with progressive, unpleasant loss of productive and passive shoulder movement.

In Periarthritis shoulder, adhesions (abnormal bands of tissue) grow between the joint surfaces, restricting movement. There is also a lack of synovial fluid, which normally lubricates the gap between the bone and socket to help the shoulder joint approach. The loss of movement is biggest for lateral rotation than for abduction and medial rotation (Cyriax’s capsular pattern, Cyriax 1978

The natural course of a frozen shoulder is normally self-limiting. It is a disease that improves over an 18 to 24 month period. Multiple studies have demonstrated a noticable difference with various kinds of treatment. Dominant arm involvement possesses been shown to have a good prognosis; associated

Intrinsic pathology or insulin – dependent diabetes greater than 10 years are poor prognostic indicators.

STAGES OF PERIARTHRITIS SHOULDER

Reeve’s has defined three stages of the disease:

STAGE 1(PAINFUL STAGE)

This stage is mainly characterized by pain usually lasting 2-9months.

Generalized ache that is difficult to pinpoint.

Muscle spasms in the trapezius likewise commonly occur during this phase.

Increasing pain during the night and at rest.

The condition progresses to one of severe pain accompanied by stiffness and decreased flexibility.

STAGE 2(FROZEN Level)

Pain steadily subsides or less discomfort.

Stiffness is marked long lasting 4-12 months.

Restriction of movement.

Decreasing pain at night and at rest.

Discomfort felt at intense ranges of movement.

STAGE 3(RECOVERY STAGE)

Decreased pain

Marked restriction with sluggish, gradual increase of range of motion.

Recovery is spontaneous but frequently incomplete.

Frozen shoulder occurs much more commonly in people with diabetes, impacting 10% to 20% of these individuals. Other medical concerns associated with increased risk of frozen shoulder consist of Hypothyroidism, Hyperthyroidism, Parkinson’s disease, cardiac disease or surgery. Frozen shoulder can develop after a shoulder is certainly wounded or immobilized for a time frame. Attempts to prevent frozen shoulder include early on movement of the shoulder after it’s been injured

Pain due to frozen shoulder is often dull or aching. It usually is worsened with attempted action. The pain is usually located over the outer shoulder area and quite often the higher arm. The predominant feature of this disorder is restricted action or stiffness in the shoulder. Patients experiencing this condition cannot approach the shoulder normally .Motion can be limited when another person attempts to go the shoulder for the patient.

PATHOLOGY

Synovial hypertrophy.

Reduced volume with a good capsule.

Neo vascular proliferation.

Hyper vascular synovitis.

Capsular contraction and thickening.

No synovitis is seen and decrease in the thickness of the capsule.

Decreased level of the gleno humeral joint with limited ROM.

Although the glenohumeral joint synovial capsule is normally involved, much of the disease process involves structures outside the shoulder joint, including the coracohumeral ligament, rotator interval, subscapularis musculotendinous unit, and the subacromial burse.

Although recovery is generally spontaneous, treatment with Intra-articular corticosteroids and delicate but persistent physical remedy may provide a better outcome, leading to little functional compromise. Physiotherapy solutions used for severe adhesive capsulitis include native temperature, SWD, TENS, Ultrasound, Mobilizations and exercises.

NEED FOR THE STUDY

Periarthritis shoulder or frozen shoulder is among the prevalent afflictions of shoulder joint, affecting as much as 2% of general population .Pain is the most disturbing element and it brings about functional impairments, include difficulty in dressing.

There was a need to study about the consequences of cyriax manipulation and shortwave diathermy on unpleasant stage of the periarthritis shoulder

STATEMENT OF THE PROBLEM

To analysis the: ” Efficacy of cyriax friction massage strategy and conventional therapy in patients with unpleasant level of unilateral periarthritis shoulder”

OBJECTIVE OF THE STUDY

The objective of the study was to evaluate the effectiveness of Cyriax friction massage technique and conventional therapy in patients with painful level of unilateral periarthritis shoulder”

HYPOTHESIS

Null Hypothesis:

The study was carried out on the basis of the null hypothesis that could be explained as “There is absolutely no significant improvement in pain and functional actions between cyriax friction therapeutic massage technique and typical physical remedy in patients with painful level of unilateral periarthritis shoulder “

Alternate Hypothesis:

The alternate hypothesis states have “There exists a significant improvement in soreness and functional activities between cyriax friction massage technique and regular physical remedy in patients with painful stage of unilateral periarthritis shoulder”

REVIEW OF LITERATURE

Leah Steele, Hannah Lade, Stephanie McKenzie, and Trevor G. RussellInt J Telemed Appl. 2012; Physiotherapists sometimes assess and treat consumers with shoulder pain, and there is considerable evidence of effective physiotherapy treatments for most shoulder disorders, with conservative physiotherapy administration shown to provide up to an 88% improvement in shoulder function in the long run.

Jing-lan Yang, Shiau-yee Chen, Ching-Lin Hsieh, BMC Musculoskeletal Disorder. 2012; 13: 46. Clinical methods like mobilization, stretching, and/or massage may reduce shoulder tightness and increase symptoms in subjects with stiff shoulders.

Nicola Crichton, D. Gould et al.2012. Visual Analogue Scale (VAS) is a measurement instrument that tries to assess a feature or attitude that’s believed to range across a continuum of ideals and cannot conveniently be directly measured.

Jose Orlando Ruiz .J Man Manip Ther. 2009; 17(1): 58-63. Various treatment approaches have been explained for limited shoulder passive range of motion (ROM)5. These techniques include different forms of manual therapy, electrotherapy, energetic exercise, and several kinds of passive stretching5. The usage of passive stretching of the shoulder capsule and soft tissues by means of mobilization techniques has been recommended.

Jenna Godfry, Richard Humman(2009) the simple shoulder test

demonstrated overall acceptable functionality of shoulder.

U.-D. Reips and F. Funke (2008) there is facts showing that visual analogue scales have superior metrical characteristics than discrete scales, so a wider range of statistical methods could be put on the pain measurements.

James P. Tasto, MD and David W. Elias, MD (Sports activities Med Arthrosc Rev 2007; 15:216-221). The word ‘frozen shoulder” is defined as a clinical condition with restricted energetic and passive range of motion (ROM) in

all directions, including flexion, abduction, and rotation

Pajareyak, et al, 2004, concluded that physical therapy is effective for individuals with adhesive capsulitis.

Fusun Guler – Uysal, Erhankozanagils, Swiss medical weekly 2004 : 134 : 353 – 358 , indicates daily mobilizations exercises provides quicker and better response in the early stage of treatment in periarthritis shoulder.

Gules-Ursal F , Kozanoglu E , Swiss Med WKY.2004 Jun 12;134(23-24);353A randomized , comparative study on the early response of two methods of rehabilitation (cyriax methodology Vs conventional physiotherapy) in adhesive capsulitis figured the cyriax ways of rehabilitation provides as more rapidly and better response than conventional physical therapy methods in the early phase of treatment in adhesive capsulitis.

Joshua Cleland , Christoper J Durall, and physical therapy for adhesive capsulitis , physiotherapy Aug 2002 : 88 : 8 : 450 -457 example of a rhetorical analysis essay , proposes that six months of physical therapy , Codman’s exercises ,and strengthening exercises shows significant improvements in active flexibility in people with adhesive capsulitis.

Levy O, Rath E, A tar D 2001, figured when soreness and limitation of passive flexibility persist, gentle manipulation dramatically shortens the debilitating process.

Griggs SM, Ab n A, Green A good, 2000, proved that patients with idiopathic Periarthritis shoulder can be successfully treated with a specific four direction stretching workout program.

MATERIALS & METHODOLOGY

Materials:

Mobilization bed and towel

Simple shoulder test

Visual Analogue Scale

Shoulder assessment form

Shortwave Diathermy unit

SELECTION CRITERIA

Inclusion criteria:

Age group between 40-60 years.

Shoulder pain of minimum amount 2 months duration with no major shoulder trauma.

Marked loss of effective and passive shoulder action.

Pain with action and a minimum visual

analogue scale (VAS) score of 3 cm.

Normal results on anteroposterior and axillary lateral radiographs of the glenohumeral joint.

Willingness to take part in study.

Exclusion criteria:

Adhesive capsulitis secondary to rotator cuff tear.

Patient with OA and RA shoulder.

Dislocation and fracture in and around shoulder joint.

Chronic circumstance of adhesive capsulitis.

Patients with background of intra articular steroid injectionas.

Poly arthritis or neurological disease or cervical neuropathy.

Medical conditions such as for example cardiac disease, attacks, coagulations disorders.

Tumors around shoulder area.

Cervical rib.

Cervical Brachialgia

Cervical Spondylosis.

Parameters

Visual analog scale

Simple shoulder test

METHODOLOGY

STUDY DESIGN:

A pre-test and post-test experimental review design.

SAMPLE SIZE:

Thirty patients with adhesive capsulitis (Level 1) who comes under inclusion conditions were taken for the study.

Group 1 (Experimental Group): Sufferers cured with cyriax friction therapeutic massage technique.

Group2: (Control Group): Individuals cured with shortwave diathermy.

Both groups concluded their procedures with daily home exercise program.

SAMPLING:

The subjects for this study were picked through a easy sampling technique.

STUDY SETTING:

The study was conducted in Division of Physiotherapy, Sri Ramakrishna Medical center, Coimbatore. All the individuals were interviewed and examined to make sure that the selection criteria had been fulfilled. Such eligible topics were selected and they took part in the analysis after obtaining informed consent.

Study duration:

The study was carried out for 6 months.

Treatment duration:

Both groupings received treatment, for four weeks.

Experimental Group: Once in alternative days/week.

Control Group: Everyday once except weekends.

Demographic info of Experimental group:

Age group

Males

Females

Total

40-50

50-60

60-70

70-80

Total

Side Involved

Number

Right

Left

Total

Demographic data of Control Group:

Age group

Males

Females

Total

40-50

50-60

60-70

70-80

Total

Side Involved

Number

Right

Left

Total

STATISTICAL TOOLS

Independent t evaluation was used showing the effectiveness of treatment between Group1 and Group2.

Independent “T” test =

Where,

S = Combined standard deviation

= difference of mean of experimental group

= difference of mean of control group

= number of subjects in experimental group

= number of topics in control group

INTERVENTION TECHNIQUE

CYRIAX MANIPULATION

Principle

Cyriax introduces transverse deep friction massage therapy for soft tissue damage and lesions.

Effects of cyriax friction massage

Traumatic hyperaemia which help evaluate pain triggering metabolites. Activity of the affected composition which prevents or damage the adhesion and helps to optimize the quality of scar tissue formation. Stimulation of the mechano receptor that produces an excellent of afferent impulse that activate the temporary analgesia and also help the patient in movement exercises.

Technique

Patient position ought to be in supine or great sitting.

Therapist stands treatment part of the patient and holds the individual arm with one hands .Applying the friction push to the treatment area by using the Middle and Index finger of the therapist. Before and during the friction massage therapist should provide a mild traction by pulling the sufferers arm. No motion should occur between skin area and finger.

SHORT WAVE DIATHERMY

Definition

Diathermy is the application of high -regularity electromagnetic energy that is primarily used to create heat in body cells.

Dosage

SWD with 220 V/50 Hz power supply and 27.12 MHz oscillation frequency was applied to the remedy region.

Position of the patient

Patient’s position should be in supine and pad electrode should place antero-posteriorly in contra planar method .

In the 15 minute treatment duration , we ought to ask to the patient about heat and their comfy oftenly.

FREE EXERCISES

Definition:

Free exercises are those that will be performed by the patient’s own muscular initiatives without the assistance or resistance of external force, besides that of gravity.

Objective exercises – in which patient aims to attain particular goal (Wall structure climbing exercises /finger ladder workout ) :

Face a wall about three quarters of an arm size away from it. Using only your fingers (not really your shoulder muscles), increase your arm up to shoulder level. Perform models of 10 to 20 exercises at each session

Over head pulleys:

Instruct the patient to carry one end of the rope by usual hand and additional end by the afflicted hand, with the normal hand pull the rope and lift the engaged extremity forward (flexion), out to the side (abduction). The patient should not shrug the shoulder or lean the trunk. The individual position may be sitting, position, or supine.

Patient by using a wand for self assisted shoulder rotation:

T-Bar Abduction

Loosely grasp end of T-bar with involved side and hold much longer end with uninvolved palm .Use uninvolved palm to lift included arm outward to area of body so far as tolerable, hold, then slowly and gradually return to start. Repeat 30 times.

T-Bar Extension

Loosely grasp end of T-bar with involved side and hold much longer end with uninvolved hands. Use uninvolved hand to lift included arm backward behind physique so far as tolerable, hold, then slowly and gradually go back to start. Repeat 30 instances.

T-Bar Flexion

Loosely grasp end of T-bar or broom stick to involved palm and hold longer end with uninvolved hands. Use uninvolved hands to lift involved arm upward in front of body as great as conceivable, hold, and gradually lower. Involved arm may assists soreness allows .Repeat 30 instances.

Codman’s exercises ( Pendular exercises ) :

For mild distraction, no weight can be used. The subject standing with the trunk flexed at the hip about 90 degree. The arm, hangs loosely downward ready between 60 level and 90 degree flexion .A pendulum or swinging action of the arm is initiated by getting the patient approach the trunk slightly backwards and forwards. Motions of flexion, expansion, and horizontal abduction, adduction and circumduction can be achieved .Raise the arc of action as tolerated.

Mariners wheel exercises:

This height – adjustable, wall structure -mounted wheel was created to exercise the complete arm: the shoulder, the forearm, and the wrist. An individual grasps the wheel’s horizontal cope with and their arm goes through 360° of rotation with the wheel. This device has a resistance control so as the user’s strength and range of motion improves the difficulty of the exercise could be increased for progressive rehabilitation. The exercise likewise encourages lateral movement in the arm.

Towel stretch:

Take a 3 ft . long towel, grasp it with both of your hands, and hold it in the horizontal position. Use the upper, great arm, to pull the affected arm toward the lower back. This can be repeated with the towel at a 45° position. Perform sets of 10 to 20 stretches at each session.

Shoulder bracing exercises

Shoulder 90° of abduction, elbow 90° flexion request the patient to

Protract and retract the shoulder, total arm should move front and back.

SIMPLE SHOULDER TEST FOR GROUP i

S.No

Pre test

Post test

Difference

SIMPLE SHOULDER Evaluation FOR GROUP ii

s.no

Pre test

Post test

Difference

VISUAL ANALOGUE Level FOR GROUP 1

S.NO

Pre test

Post test

Difference

VISUAL ANALOGUE SCALE FOR GROUP 2

S.NO

Pre test

Post test

Difference

Data Analysis and Interpretation

ANALYSIS OF PRE Evaluation VALUES OF Straightforward SHOULDER TEST

TEST

Cyriax friction massage Vs Short wave diathermy with free of charge exercise

Pre test

Mean value

Group 1

Group 2

30.4

30.13

Independent t test

0.18

P value and its

significance

P valueËƒ0.05 is insignificance

The calculated pre test’t’ worth between group1 and group2 was 0.18 and the critical worth was 1.701, which declares that there is a no significant difference between two groups.

ANALYSIS OF PRE Test out VALUES OF SIMPLE SHOULDER TEST

ANALYSIS OF POST Test out VALUES OF SIMPLE SHOULDER TEST

TEST

Cyriax friction massage therapy Vs Short wave diathermy with free exercise

post test

Mean value

Group 1

Group 2

76.93

55.66

Independent t test

2.083

P value and its

significance

P valueËƒ0.05 is insignificance

The calculated post evaluation ‘t’ benefit between group1 and group2 was 2.083 and the critical benefit was 1.701which claims that there exists a factor between two groups.

ANALYSIS OF POST TEST VALUES OF SIMPLE SHOULDER TEST

ANALYSIS OF Basic SHOULDER Check WITH CYRIAX AND FREE EXERCISE

TEST

Group1

Cyriax friction therapeutic massage with free exercise

Pre test mean value

Post test mean value

30.4

76.93

Independent t test

18.44

P value and its

significance

P worthËƒ0.05 is insignificance

The student’t’ test benefit for group1 (Cyriax friction massage with free exercise) was 43.09 and the critical value was 1.761 which states that there is significant difference the pre test and post test value group1.

ANALYSIS OF SIMPLE SHOULDER TEST WITH CYRIAX AND No cost EXERCISE

ANALYSIS OF Straightforward SHOULDER TEST WITH SHORT WAVE DIATHERMY AND FREE EXERCISE

TEST

Group2

Short wave diathermy with free of charge exercise

Pre test mean value

Post test mean value

30.13

55.66

Independent t test

14.67

P value and its

significance

P worthËƒ0.05 is insignificance

The student’t’ test benefit for group1 (brief wave diathermy with no cost workout) was 25.66 and the critical value was 1.761 which states that there exists significant difference between your pre test benefit and post test worth group2.

ANALYSIS OF Basic SHOULDER TEST WITH Brief WAVE DIATHERMY AND No cost EXERCISE

ANALYSIS OF VISUAL ANALOGUE SCALE OF PRE Evaluation OF TWO GROUP

TEST

Cyriax friction therapeutic massage Vs Brief wave diathermy with no cost exercise

Pre test

Mean value

Group 1

Group 2

7.46

7.73

Independent t test

0.77

P value and its

significance

P worthËƒ0.05 is insignificance

The calculated pre test’t’ value between group1 and grou2 was 0.77and the critical value was 1.701, which declares that there surely is no significant

difference between two groupings.

ANALYSIS OF VISUAL ANALOGUE Level OF PRE Test out OF TWO GROUP

ANALYSIS OF VISUAL ANALOGUE SCALE OF POST Check OF TWO GROUP

TEST

Cyriax friction massage therapy Vs Short wave diathermy with no cost exercise

Post test

Mean value

Group 1

Group 2

3.46

5.46

Independent t test

5.68

P value and its

significance

P worthËƒ0.05 is insignificance

The calculated content test’t’ worth between group1 and grop2 was 5.68 and the critical value was 1.701 which declares that there exists a significant difference between two groups.

ANALYSIS OF VISUAL ANALOGUE SCALE OF POST Test out OF TWO GROUP

ANALYSIS OF VISUAL ANALOGUE Level OF GROUP 1

TEST

Group 1

Cyriax friction massage therapy with free exercise

Pre test mean value

Post test mean values

7.46

3.46

Independent t test

24.18

P value and its

significance

P benefitËƒ0.05 is insignificance

The student’t’ test value for group2(Cyriax friction massage therapy with free training ) was 24.18 and the critical value was 1.761, which states that there exists significant difference between your pre test and post test worth of group.

ANALYSIS OF VISUAL ANALOGUE SCALE OF GROUP 1

ANALYSIS OF VISUAL ANALOGUE SCALE OF GROUP 2

TEST

Group 2

Short wave diathermy with no cost exercise

Pre test mean value

Post test mean value

7.73

5.46

Independent t test

14.83

P value and its

significance

P worthËƒ0.05 is insignificance

The student’t’ test worth for group1 (Short wave diathermy with no cost work out ) was 14.83 and the critical value was1.761, which states that there is significant difference between your pre ensure that you post test value of group 2.

ANALYSIS OF VISUAL ANALOGUE SCALE OF GROUP 2

RESULTS

Effectiveness of Group1(Cyriax friction massage with free of charge exercise ) is elicited by comparing the pre ensure that you post test value Group2(shoulder function) using paired ‘t’ check , the calculated worth is 18.44 , where in fact the critical value is 1.761.Because the calculated value is higher than the critical value , there exists a significant difference between the pre ensure that you post test worth ofGroup2

Effectiveness of Group2( Short wave diathermy with no cost workout )is elicited by evaluating the pre test and post evaluation of Group1(shoulder function) using paired ‘t’ test; the calculated worth is 14.67,where the critical value is 1.761.Since the calculated value is greater than the critical value , there is a significant difference between your pre test and post test benefit of Group2

While comparing the post test worth of Group1 and Group2 employing independent’t’ , the calculated value is ,2.083 where the critical value is 1.761 , which ultimately shows that there exists a significant difference between the pre test and post test benefit of two groups

When evaluating the mean value of both post test, mean benefit of Group1, 76.93 is normally greater than the post test out mean worth of Group2, 55.66 which confirms that Group1 displays a significant improvement than Group 2

Effectiveness of Group1 (Cyriax friction massage with free work out) is elicited by evaluating the pre ensure that you post test worth Group2(visual analogue scale) using paired ‘t’ test out , the calculated value is 24.18 , where in fact the critical value is 1.761.Since the calculated value is higher than the critical value , there exists a significant difference between the pre ensure that you post test value ofGroup1

Effectiveness of Group2 (Short wave diathermy with no cost work out) is elicited by comparing the pre ensure that you post evaluation of Group2(visual analogue scale) using paired ‘t’ test out; the calculated benefit is 14.83,where the critical value is 1.761.Because the calculated value is higher than the critical value , there exists a significant difference between the pre test and post test value of Group2

While comparing the post test value of Group1 and Group2 using independent’t’ , the calculated value is ,5.68 where the critical value is 1.761 , which ultimately shows that there exists a significant difference between your pre ensure that you post test benefit of two groups

When comparing the mean benefit of both post test, mean value of Group1, 3.46 is significantly less than the post test out mean value of Group2, 5.46 which confirms that Group1 displays a substantial improvement than Group 2

This review is fiend out the potency of cyriax friction massage strategy and free work out is improving the treatment and functional activities as evidenced by visual analogue scale and straightforward shoulder test in painful stage of unilateral periarthritis shoulder”

DISCUSSION

This study compares the effectiveness of Cyriax technique and brief wave diathermy in topics with painful level of unilateral periarthritis shoulder”

Both groupings were aimed reducing pain and increasing examples of research paper functional actions of shoulder joint. This review involves the pre test and post test with 15 patients. The variables taken in this study includes ,

VAS

SIMPLE SHOULDER TEST

This study was carried out on the basis of null hypothesis that could be stated as there is no significant difference in soreness and function activities between Cyriax friction massage and short wave diathermy in clients with painful level of periarthritis of shoulder joint.

Group 1 clients were treated with Cyriax strategy and Group 2 individuals were treated with Short wave diathermy. And both group also receive the free exercise. Pre ensure that you post test ideals of VAS and Straight forward SHOULDER Evaluation were assessed.

The intra group evaluation displayed that calculated ‘t’ value of group1 is higher than group2. Hence we can accept the choice hypothesis.

All statistical research showed that “there was significant improvement in group 1 who were cared for with Cyriax friction therapeutic massage technique and free work out than in group 2 who were treated with brief wave diathermy and free of charge exercise.

CONCLUSION

The statistical evaluation done to compare the effectiveness of Cyriax friction massage Technique and Brief wave diathermy, in case of painful level of periarthritis Shoulder.

Independent’t’ value was found in this study to check the importance of pre and post treatment ideals of the patients.

Based on the statistical evaluation, it was found that there is a significant result in decrease in pain, and increase in functional actions of shoulder at the conclusion of the procedure with Cyriax friction massage therapy technique than with Brief wave diathermy.

So, the null hypothesis is rejected and alternate hypothesis is certainly accepted stating that “there is significant difference in Cyriax friction therapeutic massage technique with free training in improving functional convenience of individuals with unilateral Periarthritis shoulder.

From this review, we conclude that, “Cyriax friction massage technique free exercise is most effective than Short wave diathermy with free of charge exercise in treating people with painful level of periarthritis.

LIMITATIONS

The limitation to your study may be that we do not have the long- term follow up info for our treatment groups.

Based on the literature info reflecting no differences between any treatments in the long term, the study was planned to search for the speed of recovery of two strategies in the early phase.

In this study, straightforward shoulder test scale is used for assessing the shoulder function. Separated flexibility is not completed.

This study was carried out to compare the result of Cyriax friction massage technique alone .Other approaches of manipulations was not used to account.

SUGGESTIONS

Randomized controlled studies of large study populations are needed to clearly define a standardized treatment algorithm in patients with different levels of periarthritis shoulder.

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