بسم هللا الرحمن الرحيم و قل اعملوا فسيري هللا عملكم و رسوله و المؤمنون )التوبة اآلية ١٠٥(

Transcription

1 بسم هللا الرحمن الرحيم و قل اعملوا فسيري هللا عملكم و رسوله و المؤمنون )التوبة اآلية ١٠٥(

2 Balance Assessment Following Proximal Versus Distal Lower Limb Muscles Cooling in Healthy Females By Samar Osama Ahmed Hassounah Demonstrator in the Department of Biomechanics Faculty of Physical Therapy Cairo University

3 Acknowledgements Prof. Dr. Ghada El Hafez Prof. Dr. Nagui Sobhi Dr. Ayman Goda Prof. Dr. Salam El Hafez Prof. Dr. Mohammed Fouad Ibrahim Khalil Dr. Abeer Farag Dr. Hossam El Din Fawaz International Dry Ice Company (DIFCO2) My Family

4 Cryotherapy Is one of the most common and inexpensive forms of treatment for both acute and chronic athletic injuries.

5 Ice has been used to limit the damage caused by the injury. Reduces tissue temperatures. Reduces metabolic demands. Vasoconstriction. Alleviates pain, and promotes analgesia.

6 Negative effects of cryotherapy Decline in all the sensations. Reduction of proprioception. Reduction the Nerve Conduction Velocity (NCV).

7 Proprioception and Balance Possible affection of the athlete s postural stability. Possible affection of the athlete s performance. Possible increase in future risk of injury.

8 There is a deficiency in research concerning the impact of cooling lower limb muscles on balance in healthy females.

9 Most common injuries Hip adductor muscles. Ankle evertors muscles. Females

10 Purpose of the study This study aimed at examining the effect of cryotherapy application on: The Overall postural stability index (OSI), Medio- Lateral postural stability index (MLSI), and the Antero-Posterior postural stability index (APSI) in healthy females. To compare between the effect of cryotherapy application on the proximal (hip adductors) versus distal ( ankle evertors) lower limb muscles on postural stability indexes in healthy females.

11 Methodology

12 1- Patient Selection 33 female participants. Age: ranged from years. Weight: ranged from Kg. Height: ranged from m. All participants had unrestricted ankle and hip joints range of motion. All participants had ankle and hip muscles strength grade four to five.

13 2- Instrumentation Biodex Balance System (BBS) 3 Measures High Score Varying Stability Ice packs Height and weight scale

14 3- Procedure This study involved a within-subject experimental design One sample of participants Before Cryotherapy After Cryotherapy (Muscle 1) After Cryotherapy (Muscle 2)

15 1- Preparatory Phase A- Pre-experimental instructions

16 B-Balance system and Subject preparation

17 A B E 10 0

18 2- Experimental Phase A- Balance Testing Practice Trial

19 A high score is indicative of poor balance

20 B- Cryotherapy Session Cryotherapy application on the ankle evertors. Balance Re-test

21 The same whole procedure was repeated again 30 minutes later Application of cryotherapy on muscle 2 Cryotherapy application on the hip adductors. Balance Re-test

22 Statistical Analysis In the current study, two independent variables and three dependent variables were tested. Data were initially screened for normality assumption as a prerequisite for parametric analysis. Normality Tests Skewness and Kurtosis Extreme scores

23 Once data were found not to violate the normality assumption Two-way repeated measure MANOVA. Multiple pairwise comparison tests. P<0.05

24 Results

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31 Interaction OSI APSI MLSI

32 Discussion

33 The non significant reduction in postural stability indexes following cryotherapy application in both conditions may be attributed to Cooling might not have reached the deep tissues. Differential response of primary and secondary spindle. Using peripheral information from Other mechanoreceptors Make up for the lack of proprioceptive information coming from the muscle Maintain adequate joint proprioception and adjust their motor response

34 Direct relationship between the decrease in nerve temperature, and the subsequent decrease in NCV Myelinated and small fibers. Pain-transmitting fibers Greatly Affected Not equal in nerve fibers with different diameters Unmyelinated and large fibers. proprioceptive afferent fibers from muscle spindles to the CNS Mildly Affected

35 cooling increase in muscle activity and a greater force production 1- Increase joint and musculotendinous stiffness. 2- Inhibit the golgi tendon organ ability to perform reflexive protection. increase in muscular performance around a joint as a secondary protective mechanism.

36 Postural stability has been said to be a combination of three systems Visual, Vestibular, Proprioceptive When one system is impaired Increased contribution from the two other systems is noted to maintain equivalent postural control.

37 Conclusion The immediate effects of cryotherapy are not detrimental to lower extremity balance, and can be safely used without fear of re-injury due to decreased proprioception.

38 Limitations A relatively young participant cohort was studied. Participants were not active. The current study was also limited to the immediate effects of crushed ice packs on the dominant leg.

39 Recommendations for future studies Study the long term effects of icing muscles. Developing modes, durations, and frequencies of ice application. Assess how much reduction in temperature is required before the decline in postural stability becomes apparent. Study other components (strength and flexibility), which might be affected after ice therapy and in upper extremity dominant sports.

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41 Balance Assessment Following Proximal Versus Distal Lower Limb Muscles Cooling in Healthy Females By Samar Osama Ahmed Hassounah Demonstrator in the Department of Biomechanics Faculty of Physical Therapy Cairo University