Effect of manual therapy & kinesiotaping on pain, ankle range of motio

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 369 IJAMSCR |Volume 6 | Issue 2 | Apr - Jun - 2018 www.ijamscr.com Research article Medical research Effect of manual therapy kinesiotaping on pain ankle range of motion ROM function in plantar fasciitis: a comparative study Padmavati A. Degaonkar 1 Dr. Archana Bodhale 2 Dr. Snehal Ghodey 3 1 Student BPTh Intern MAEERS’ Physiotherapy College Talegaon-Dabhade India. 2 Lecturer MAEERS’ Physiotherapy College Talegaon- Dabhade India. 3 Principal MAEERS’ Physiotherapy College Talegaon- Dabhade India. Corresponding Author: Padmavati A. Degaonkar Email id: arcbodgmail.com ABSTRACT Background Purpose It has been estimated that plantar fasciitis affects as much as 10 of the general population over the course of a lifetime. This study will help to explain the comparison between effect of kinesiotaping effect of manual therapy. The aim is to find out which technique shows early effect. Method Total 48 patients were screened from which 30 patients were in inclusion criteria. The patients were randomly divided into two groups Group A B. Group A was treated with kinesiotaping Group B was treated with manual therapy Maitland mobilization. The conventional treatment includes ice pack intrinsic muscle strengthening stretching of gastrocnemius soleus tendoachilles plantar fascia was given to both the groups. Results Wilcoxon signed rank test was used to examine changes within same group which shows p value for pain group A p 0.0001 group B p 0.0001 for function group A p 0.0001 group B p0.0010 i.e. statistically significant. Mann-Whitney U test was used to examine changes between two groups which shows p value for pain function p 0.0865 p 0.7398 respectively i.e. statistically not significant. Paired t-test was used to examine the changes within same group which shows p value for ROM group A p 0.0001 group B p 0.0001 i.e. statistically significant unpaired t-test was used for the changes between two groups p value for ROM p 0.8990 i.e. statistically not significant. Which shows both the techniques were equally effective. Conclusion The study concluded that manual therapy kinesiotaping are equally effective on pain ROM function in plantar fasciitis. Keywords: Plantar fascia Mobilization Kinesiotape ISSN:2347-6567 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 370 INTRODUCTION Plantar fascitiis is a non-inflammatory degenerative syndrome of plantar fascia resulting from repeated trauma at its origin on the calcaneus. 1 Plantar fascia is an important static support for the longitudinal arch of foot. Strain on the longitudinal arch exerts its maximal pull on the plantar fascia. The plantar fascia elongates with increase in loads to act as shock absorber but its ability to elongate is limited. 2 Patient typically reported an insidious pain which is usually burning stabbing dull aching or sharp in nature localized under plantar surface of heel. It is commonly experienced upon weight bearing after a period of rest. 3 This pain is most noticeable in morning with the first few step and is often described as ‘first-step pain’. 4 Plantar fasciitis is considered as a self limiting condition. Therapeutic treatment include systemic medications local ultrasound cryotherapy deep friction massage plantar fascia stretching strengthening of intrinsic muscles of foot heel cushion etc. 5 Kinesiotape KT is thin porous latex free 100 acrylic adhesive heat activated cotton fibers which allows for evaporation quicker drying. This makes KT waterproof. 6 Kinesiotape has roughly the same thickness as the epidermis it can be stretched within 30 to 40 of its resting length. 6 Kase et al have proposed several benefits of kinesiotaping which are 7  Provides positional stimulus through the skin  Proper alignment of fascial tissue  Provide sensory stimulation to assist or limit the motion  Reduces oedema by directing exudates towards the lymph duct Mobilization is passive skilled manual technique applied to joints related soft tissues at varying speeds amplitudes using physiological or accessory motions for therapeutic purposes. 8 Joint mobilization also known as manipulation refers to manual therapy techniques that are used to modulate pain treat joint impairments that limits range of motion ROM by specifically addressing the altered mechanics of the joint. The varying speeds and amplitudes could range from a small-amplitude force applied at high velocity to a large-amplitude force applied at slow velocity. 8 The indications of joint mobilization are pain muscle guarding spasm joint hypomobility positional faults progressive limitations functional immobility etc. Passive joint mobilization reduces pain by modulation of nervous tissue. 8 As both the techniques are effective in plantar fasciitis the aim is to find out which technique shows early effect. This study will help to explain the comparison between effect of kinesiotaping effect of manual therapy. MATERIALS METHODOLOGY Total 48 patients were screened initial assessment was done from which 18 patients were in exclusion criteria 30 were in inclusion criteria. The patients were randomly divided into two groups Group A Group B by chit method. Group A was treated with kinesiotaping Group B was treated with manual therapy Maitland mobilization. The conventional treatment was given to both the groups. Inclusion criteria 1. Age group 22– 55 yrs 9 2. Both male female 3. NPRS score of 5-8 Exclusion criteria 1. Ankle sprain 2. Red flags to manual therapy i.e. tumor fracture osteoporosis 3. Prior surgery to distal tibia fibula ankle joint or near foot region 4. Any tape allergy 5. Any skin infection 6. Impaired circulation to distal extremities Outcome Measures  ROM was assessed by goniometer  Pain was assessed by Numerical Pain Rating Scale NPRS  Functional ability was assessed by Plantar Fasciitis Pain/Disability Scale PFPS Group A Kinesiotaping Subjects were treated with kinesiotaping-I:T striped taping for one week. 10

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 371 Group B Manual therapy Subjects treated with Maitland mobilization: Ankle-foot complex-Talocrural joint posterior glide  Subtalar joint lateral glide  Subtalar joint distraction Conventional treatment was given to both the groups which includes ice pack intrinsic muscle strengthening stretching of gastrocnemius soleus tendoachilles plantar fascia. RESULTS Table 1 – Comparing mean values of pain between both groups PAIN Group A Kinesio taping Group B Manual therapy Pre mean ±SD 6.47 ± 1.125 6.93 ± 1.22 Postmean ± SD 1.33 ± 0.82 2.60 ± 1.84 Graph 1: Showing pre post R x mean values The above graph shows that there is an improvement in ROM in both the groups. Table 2 – Comparing the mean value of ROM between both groups ROM Group A Kinesio taping Group B Manual therapy Pre mean ± SD 16.27 ± 3.92 14.20 ± 3.34 Post mean ± SD 20.87 ± 3.83 18.87 ± 3.02 Graph 2 – Showing pre post R x mean values The above graph shows that the pain get reduced in both the goups. 0 10 20 30 MOBILIZATION TAPING ROM Pre Post 0 5 10 MOBILIZATION TAPING Pain Pre Post

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 372 Table 3 – Comparing the mean value of function between both groups FUNCTION Group A Kinesio taping Group B Manual therapy Pre mean ± SD 34.793 ± 3.472 37.500 ± 3.579 Post mean ± SD 30.347 ± 2.493 31.193 ± 6.771 Graph 3 – Showing pre post R X mean values The above graph shows that there ia an improvement in function in both the groups. Table 4 – Comparing the mean values of the measured outcomes for both groups Pain ROM Function Group AKinesio taping -5.13 ± 0.92 4.60 ± 1.595 -4.447 ± 2.914 Group B Manual therapy -4.33 ± 1.35 4.667 ± 1.234 -6.307 ± 6.241 Graph 4 – Comparison between both groups The above graph shows that both groups are effective in pain ROM function in plantar fasciitis. The dependent variables were NPRS PFPS ankle ROM. Pre-treatment scores for pain ROM function were recorded on the first day. Then treatment was given to both the groups and their post- treatment scores were recorded on the last day. Non-parametric tests were used for the analysis of the scores of pain function. Wilcoxon signed rank test was used to examine changes within same group Mann-Whitney U test was used to examine changes between two groups. Parametric tests were used for the analysis of ROM. Paired t-test was used to examine the 0 20 40 MOBILIZATION TAPING Function Pre Post 0 4 8 NRS ROM FUNCTION COMPARISON BETWEEN MOBILIZATION TAPING MOBILIZATION TAPING

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 373 changes within same group unpaired t-test was used to examine the changes between two groups. DISCUSSION This study was conducted to check which technique shows early effect in plantar fasciitis. 30 patients with plantar fasciitis were randomly allocated into group A kiesio taping group B manual therapy. Conventional treatment was given to both the groups which includes ice pack stretching of plantar fascia stretching of tendoachilles stretching of gastrocnemius stretching of soleus strengthening of intrinsic foot muscles. The outcome measues were goniometer Numerical pain rating scale NRS Plantar fasciitis pain/disability scale PFPS. In this study as shown in garph 2 the pre post changes obsereved in ROM were significant in both the groups group A p 0.0001 group B p 0.0001 . Kinesiotaping can control the pulling force to a certain tendon or ligament in order to avoid further injury so that tissue repair can be facilitated. By applying kinesiotaping on the plantar fascia the pulling force of the plantar flexors plantar fascia the tension get reduced which helps in improving ankle ROM. 10 Kinesio tape will help in correcting muscle function by strengthening weakened muscles relieving abnormal muscle tension helping to return the function of fascia and muscle to normal which can improve ankle ROM. 11 Due to the pain immobilization of particular joint may occur. With immobilization there is fibrofatty proliferation which causes intra- articular adhesions as well as biomechanical changes in tendon ligament joint capsule tissue. Mobilization will help in breaking down of adhesions helps in maintaining biomechanics of joint. 8 Due to joint motion afferent nerve impulses from joint receptors transmit information to central nervous system which provides awareness of position motion. 8 As shown in graph 3 the pre – post changes observed in pain were significant in both the groups group A p 0.0001 group B p 0.0001 As discussed above kinesiotaping can control pulling force of the plantar flexors plantar fascia can be reduced which help in reducing pain. Kinesio tape exerts its physiological effect on skin circulatory and lymphatic system fascia muscles and joints which will help in reducing pain. The skin towards with the tape forms wave like convolutions on returning to the resting state when the skin of affected area is stretched prior to the application of kinsio tape. Due to lifting of the skin the space between skin subcutaneous tissue increases which will drain the lymph inflammatory substance reduces pressure on pain receptors. As the tissue is constantly lifted lowered lymphatic drainage blood circulation are stimulated in same way to a pump action. 12 Kinesio tape decreases pain through neurological suppression. The possible improvement in the local circulation due to application of kinesiotape may facilitate the resolution of pain. Passive movements or mobilization eliminates movement related irritating cause reduces pain. Mobilization techniques appear to exert a predominant influence on mechanical nociception via dorsal periaqueductal grey modulation rather than thermal nociception. 13 Small amplitude oscillatory distraction movement stimulate the mechanoreceptors which may inhibit the transmission of nociceptive stimuli at the spinal cord or brain stem level. 8 These movements are used to cause synovial fluid motion which brings nutrients to the articular cartilage. Gentle joint motion helps to maintain nutrient exchange thus prevent painful degenerating effects of stasis when joint is painful swollen cannot move through the ROM. 8 Graph 4 shows significant changes in pre – post scores of function in both the groups i.e. group A p 0.0001 group B p0.0010. When patient cannot functionally move joint at its full ROM the mobilization will maintain available joint play which will help in performing daily activities. 8 As the pain get reduced ROM is improved the function will improve automatically. As shown in graph 5 the analysis between group A group B for ROMpain function was not significant p 0.8990 p 0.0865 p 0.7398 respectively.

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 374 Conventional treatment includes ice pack stretching of tendoachilles gastrocnemius soleus strengthening of intrinsic muscles As per Lewis Hunting reaction alternative vasoconstriction vasodilation will take place when ice is applied. Vasodilation will lead to increased blood flow which will help in reducing pain. Cold slows the conduction velocity of peripheral nerves which decreases nociceptive information transmission through primary afferents centrally to the spinal cord which results in a decrease in behavioural signs a decrease in neural activity in dorsal horn neurons. 13 Stretching exercises helps in restoring increasing the extensibility of the muscle tendon unit thus regain or achieve the flexibility ROM required for necessary or desired functional activities. 8 Stretching of tight muscles around the foot is considered an effective treatment of plantar fasciitis. 14 According to studies by Wolgin et al. 1994 and Davies Severund and Baxter 1994 stretching of the Achilles tendon was found to be the most effective form of treatment. 15 Strengthening program correct functional risk factors such as weakness of the intrinsic foot muscles. 16 CONCLUSION The study concluded that manual therapy kinesiotaping are equally effective on pain ROM function in plantar fasciitis. ABBREVIATON  ROM- Range Of Motion  NRS- Numerical Pain Rating Scale  PFPS- Plantar Fasciitis Pain/Disability Scale ACKNOWLEDGEMENT The authors would like to thank MAEERS’ Physiotherapy College for the use of their facilities and all the participants of the study. REFERENCES 1. Shashwat Prakash Anand Misra. Effect of manual therapy versus conventional therapy in patients with plantar fasciitis- A comparative study. Int J Physiother Res 21 2014 378-382 2. Clinical Orthopaedic Rehabilitation Second Edition Brent Brotzman Kelvin E. Wilk 393-403 3. Alvarez Nemegyei JCanoso JJ. Heel pain: diagnosis and treatment step by step. Cleve Clin J Med.73 2006 465-71 4. Barrett SJ O’Malley R. Plantar fasciitis and other causes of heel pain. Am Fam Physician.59 1999 2200-06. 5. Mohammad Ali Tahririan Mehdi Motififard Mohammad Naghi Tahmasebi et al. Plantar fasciitis. Journal of Clinical Epidemiology. 44 1991 561-570. 6. Thelen MD Dauber JA Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized doubleblinded clinical trial. J Orthop Sports Phys Ther 387 2008 389–95 7. Halseth T McChesney JW De Beliso M et al. The effects of Kinesio taping on proprioception at the ankle. J Sports Sci Med 31 2004 1–7 8. Kisner C Colby L: Therapeutic Exercise: Foundations and Techniques. 5th edition. Philadelphia: F.A. Davis Company 2007. 9. Hyland MR Webber-Gaffney A Cohen L et al. Randomized controlled trial of calcaneal taping sham taping and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther 36 2006 366. 10. C.T. Tsai W.D. Chang J.P. Lee Effects of short-term treatment with kinesiotaping for plantar fasciitis J Muscoskel Pain 18 2010 71-80 11. Justin L. Petzer An investigation into the effectiveness of two different taping techniques in the treatment of plantar fasciitis – 196 2015 21 61 18 12. Birgit Kumbrink. K Taping: An illustrated guide. Springer – Verlag Berlin Heidelberg New York 2012 13. Wright A Sluka KA. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain 17 2001 33–46. 14. Toomey E.P. Plantar heel pain. Foot and Ankle Clinics 142 2009 229-245.

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Padmavati A. D et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-62 2018 369-375 375 15. Wolgin M Cook C Graham C et al Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. 15 1994 97-102. 16. Young CC Rutherford DS Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician. 63 2001 467- 475. How to cite this article: Padmavati A. Degaonkar Dr. Archana Bodhale Dr. Snehal Ghodey. Effect of manual therapy kinesiotaping on pain ankle range of motion ROM function in plantar fasciitis: a comparative study. Int J of Allied Med Sci and Clin Res 2018 62: 369-375. Source of Support: Nil. Conflict of Interest: None declared.

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