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Effectiveness of Myofascial Release on Spasticity and Lower Extremity

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Effectiveness of Myofascial Release on Spasticity and Lower Extremity hysical M f P ed l o ic a in n r e u & o R J International Journal of Kumar and Vaidya, Int J Phys Med Rehabil 2014, 3:1 l e a h n a DOI: 10.4172/2329-9096.1000253 o b i t i l a ISSN: 2329-9096i t a n r t i e o t n n I Physical Medicine & Rehabilitation Research Article Open Access Effectiveness of Myofascial Release on Spasticity and Lower Extremity Function in Diplegic Cerebral Palsy: Randomized Controlled Trial Chandan Kumar1* and Snehashri N Vaidya2 1Associate Professor, Smt Kashibai Navale College of Physiotherapy, Narhe, Pune, Maharashtra, India 2MGM’S School of Physiotherapy, Aurangabad, India Abstract Purpose: To find out the effectiveness of Myofascial Release in combination with conventional physiotherapy on spasticity of calf, hamstring and adductors of hip and on lower extremity function in spastic diplegic subjects. Methodology: 30 spastic diplegic subjects of age group 2-8 years were taken by random sampling method from MGM College and other private clinics in Aurangabad. 15 subjects were assigned in each group. Group A: Myofascial release and conventional PT treatment. Group B: conventional PT treatment. Both the groups received training for 4 weeks. Baseline and Post treatment measures of Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS) and Gross Motor Function Test (GMFM-88) were evaluated. Results: Mean difference of MAS and R2 value of MTS in group A was more than group B, for calf, hamstring and adductors, whereas GMFM showed nearly equal improvement in both groups. Conclusion: Overall, it can be concluded from our study that the MFR along with conventional treatment reduces spasticity in calf, hamstring and adductors of hip in spastic diplegic subjects. Keywords: Spastic diplegic cerebral palsy; Myofascial release; MAS; patella alta, and patellar fragmentation are the most commonly seen MTS; GMFM abnormalities. Progressive equinovalgus and equinovarus of the foot and ankle are associated with rocker-bottom deformity and subluxation Introduction of the talonavicular joint. Early recognition of progressive deformity in “Cerebral Palsy (CP) described as a group of permanent disorders subjects with cerebral palsy allows timely treatment and prevention of of the development of the movement and posture, causing activity irreversible change [8]. limitation that is attributed to non- disturbances that occurs in One of the survey describing problems in adult CP reported that developing fetal or infant brain. The motor disorders of cerebral palsy 77% of CP children were having problems with spasticity, 80% had are often accompanied by disturbances of sensation, perception, contractures and 18% had pain every day [9]. cognition, communication, behavior, by epilepsy and by secondary musculoskeletal problems [1]. This term is commonly used name The increase in muscle tone is responsible for relative failure for a group of conditions characterized motor dysfunction due of muscle growth and may produce functional problems. Spastic to non-progressive brain damage early in life. It is stated as static deformities of the lower limbs affect ambulation, bed positioning, encephalopathy in which even though the primary lesion, anomaly sitting, chair level activities, transfers, and standing up [6]. or injury is static, the clinical pattern of presentation may change with There are three potential aims of treating the spasticity - to improve time due to growth and developmental plasticity and maturation of function, to reduce the risk of unnecessary complication and to alleviate Central Nervous System (CNS) [2]. pain [10-13]. The current all over worldwide prevalence in children ages 3 to 10 There are various ways to tackle the spasticity which include the years is 2.4 per 1000 children [3] with incidence being 2 to 3 per 1000 medical, surgical and physiotherapy management. The common live births [4]. The male female ratio is 2.42: 1, with males being more physiotherapy approaches to reduce spasticity are stretching, severely disabled [2]. strengthening of the antagonistic muscles, positioning, inhibitive CP can be classified according to the severity of motor deficits as casting and bracing, and weight bearing exercises [13]. mild, moderate, or severe. Several other classification systems exist based on the pathophysiology, etiology, and distribution of motor Some manual techniques such as massage, myofascial release deficits [5]. (MFR), and acupressure are also used along with other physiotherapy techniques [13]. In CP the lesion in the central nervous system frequently results in spasticity of various muscle groups.6 approximately 75% of children with CP have spasticity, a state of increased muscle tone and heightened *Corresponding author: Chandan Kumar, Associate Professor, Smt Kashibai deep tendon reflexes [6,7]. Navale College of Physiotherapy, Narhe, Pune, Maharashtra, India, Tel: 8087518006; E-mail: [email protected] Spasticity is defined as a velocity-dependent resistance to stretch. Spastic CP is caused by damage to the pyramidal parts of the brain4. Received October 31, 2014; Accepted December 16, 2014; Published December Bone and joint changes in cerebral palsy result from muscle spasticity 20, 2014 and contracture. The spine and the joints of the lower extremity are Citation: Kumar C, Vaidya SN (2014) Effectiveness of Myofascial Release on most commonly affected. Scoliosis may progress rapidly and may Spasticity and Lower Extremity Function in Diplegic Cerebral Palsy: Randomized Controlled Trial. Int J Phys Med Rehabil 3: 253. doi:10.4172/2329-9096.1000253 continue after skeletal maturity. Progressive hip flexion and adduction lead to windswept deformity, increased femoral anteversion, apparent Copyright: © 2014 Kumar C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted coxa valga, subluxation, deformity of the femoral head, hip dislocation, use, distribution, and reproduction in any medium, provided the original author and and formation of a pseudoacetabulum. In the knee, flexion contracture, source are credited. Int J Phys Med Rehabil Volume 3 • Issue 1 • 1000253 ISSN: 2329-9096 JPMR, an open access journal Citation: Kumar C, Vaidya SN (2014) Effectiveness of Myofascial Release on Spasticity and Lower Extremity Function in Diplegic Cerebral Palsy: Randomized Controlled Trial. Int J Phys Med Rehabil 3: 253. doi:10.4172/2329-9096.1000253 Page 2 of 9 Myofascial therapy can be defined as “the facilitation of mechanical, Outcome Measures neural and psycho physiological adaptive potential as interfaced by the myofascial system” [14]. The purpose of deep myofascial release is to Modified ashworth scale (MAS) release restrictions (barriers) within the deeper layers of fascia. This The Modified Ashworth Scale is considered the primary clinical is accomplished by a stretching of the muscular elastic components of measure of muscle spasticity in subjects with neurological conditions. the fascia, along with the crosslinks, and changing the viscosity of the The Modified Ashworth Scale can be applied to muscles of both the ground substance of fascia [15]. upper or lower body. The Modified Ashworth Scale shows conflicting Myofascial Release (MFR) techniques are utilized in a wide range results regarding its reliability and validity [17-19]. of settings and diagnoses; pain, movement restriction, spasm, spasticity, Modified tardieu scale (MTS) neurological dysfunction, i.e., cerebral palsy, head and birth injury, Cardiovascular Accidents (CVA), scoliosis [16]. Tardieu is a scale for measuring spasticity that takes into account resistance to passive movement at both slow and fast speed. The quality Myofascial release and Static stretching are expected to have an of the muscle reaction at specified velocities and the angle at which effect on the spastic/tight muscles, efficacies of these methods need to the muscle reaction occurs are incorporated into the measurement of be established in clinical practice. Moreover, there are few studies done spasticity using the Modified Tardieu Scale (Morris, 2002). Modified on Myofascial release to reduce spasticity which showed immediate & Tardieu describes R1 and R2; R1 is the angle of muscle reaction, R2 short term effect. there are insufficient published evidences available is the full PROM. The angle of full ROM (R2) is taken at a very slow for effect of MFR technique on spasticity, so present study is focus speed (V1). The angle of muscle reaction (R1) is defined as the angle in on to find out the effectiveness of Myofascial Release on calf muscle, which a catch or clonus is found during a quick stretch (V3). R1 is then hamstring muscle and adductor muscles of hip spasticity in spastic subtracted from R2 and this represents the dynamic tone component of diplegic subjects. the muscle. The Tardieu Scale differentiates spasticity from contracture, Methodology and having had good reliability and validity [20-22]. • Type of Study: Experimental study Gross motor function test (GMFM-88) • Study Design: Randomized controlled trial. The GMFM is a measure designed to assess change in gross motor • Study Setting: Neuroscience department of Physiotherapy function for children aged 5 months to 16 years with Cerebral Palsy OPD, MGM Hospital Aurangabad, other hospitals and private (CP). The 88-item GMFM is a performance based measure with 5 clinics of Aurangabad, Maharashtra, India. dimensions: lying and rolling; crawling and kneeling; sitting; standing; and walking, running and jumping. The
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