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Effect of Sit To Sit And Activity On Forward Bending Test


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Effect of Sit To Sit And Activity On Forward Bending Test

  1. 1. “Effect of Sit-to-Stand activity on flexibility of lower back, hamstring and tendoachilles muscle groups” Project Guide: Dr. Rashmi Bhoyar. Date: 10.10.12 Presented by: 1.Miss. Aparna Shirbavikar . 2.Miss. Apeksha Besekar.
  2. 2. INTRODUCTION  Flexibility is defined as “the absolute range of movement in a joint or series of joints that is influenced by muscles, tendons, ligaments, bone and bony structures.”  Hypo mobility caused by adaptive shortening of soft tissues can occur as a result of many disorders or situations.  Factors include: 1. Prolonged immobilization of a body segment, 2. Sedentary lifestyle, 3. Postural malallignment and muscle imbalances, 4. Impaired muscle performance(weakness) associated with an array of musculoskeletal or neuromuscular disorders, 5. Tissue trauma resulting in inflammation and pain, 6. Congenital or acquired deformities.
  3. 3.  Stretching, is a general term used to describe any therapeutic maneuver designed to increase the extensibility of soft tissues, thereby improving flexibility by elongating structures that have adaptively shortened and have become hypomobile overtime.  It is used as an integral part of physical fitness and rehabilitation programme because it positively influences performance.
  4. 4. AIM  To determine the effectiveness of sit-to-stand activity as a pre stretching tool on the flexibility of the lower back, hamstring and tendoachilles muscles.
  5. 5. NEED FOR STUDY  With a view to prevent injury to the muscles during stretching an adequate rise in temperature and blood circulation is a pre requisite.  This can be achieved by proper muscle contraction preceding the stretching exercises.  Satoh et al (2000) has used quadriceps muscle contraction as a pre stretching activity prior to hamstring muscle stretching exercises.  Sit-to-stand is a frequently performed dynamic activity which recruits large group of lower limb muscles.  Hence this study was undertaken to obtain a long term clinical implication showing effectiveness of sit-to-stand activity on flexibility of lower back and lower limb muscles.
  6. 6. REVIEW OF LITERATURE  Dipti B. Geete and Amita Mehta (2003) in their prospective study studied the “Effect of sit-to-stand exercise on forward bending test.” The results showed significant improvement in flexibility of back, hamstring and tendoachilles muscles.  Kazunori Morozumi et al (2002) tested the “Effect of previous standing-up exercise on forward bending test in the long sitting position in elderly subjects.” The results indicated forward bending distance significantly decreased after the standing-up exercise.  In a study on similar grounds again by Kazunori Morozumi et al (2003) reported “Effect of single-leg half squat exercise on forward bending test in normal adults.” The results suggested forward bending distance in long sitting was decreased significantly in squat group when compared with controlled group.”
  7. 7.  J.S. Munton et al (1984) studied the leg muscle activity by using electromyography in patients with arthritis and in normal subjects during rising from the chair.  Miroslav Janura et al (1980) reported the “evaluation of stability of sit-to-stand” and showed how stable is sit-to-stand performance in repeated trials and are there any differences in the sit-to-stand movement on the right and left side of the body.
  8. 8. METHODOLOGY  Study design: Experimental.  Sample size: 50 females ageing between 17-25 years.  Study setting: V.S.P.M’s College of Physiotherapy OPD setup.  Duration: 3 months.
  9. 9. Inclusion criterion  Females at present not undergoing any stretching programme between ages of 17 to 25years were selected. Exclusion criterion  Acute neuromuscular or musculoskeletal pathology. For e.g. Prolapsed Intervertebral Disc, Ankle sprain, Hamstring Strain.  Subjects having any limb length discrepancy due to structural deformity in the lower limb.  Males.
  10. 10. MATERIAL Chair without arm support Half circle metal goniometer
  11. 11. Measuring tape Velcro-strap
  12. 12. Stop-watch
  13. 13. PROCEDURE  Subjects were distributed in two groups: Group A: Sit-to-stand activity-10 repetitions. (25 subjects) Group B: Sit-to-stand activity-20 repetitions. (25 subjects)  The flexibility of lower back, hamstrings and tendoachilles muscles was measured before and after performing sit-to- stand activity by using: a) Forward bending test in long sitting position, b) Hamstring muscle tightness and c) Tendoachilles muscle tightness.
  14. 14. Measurement of forward bending in sit and reach test  Each subject was seated in long sitting position with ankle joints fixed in neutral position and the knee joints in extended position. The subject bent her trunk with arms extending straight ahead. The sole of foot was calibrated ‘0’ position and the distance from the ‘0’position to the tip of the third finger at which each subject could hold 3 seconds and was measured 3 times to score the maximal value.
  15. 15. Assessment of hamstring muscle tightness  It was done in supine position with the help of goniometer.  The lower extremity was fixed at hip at 90 degrees. Tightness was measured as the angle between vertical and that obtained by passively extending the knee at a point at which the therapist perceived resistance to passive extension. Lack of knee extension was considered the criterion for measurement of hamstring muscle tightness.
  16. 16. Assessment of tendoachilles muscle tightness  It was done in supine lying with the help of goniometer.  Alignment of ankle joint was maintained in neutral position and with passive dorsiflexion angle was measured.
  17. 17. Sit-to-stand activity  It was given on a chair without arm support. The chair height was such that the subject could stand up from sitting position with knee joint at the angle of 90 degrees. The load was adjusted by timing the stand up exercise (Once per 4 seconds) with the help of stopwatch.
  18. 18. Sit-to-stand activity
  19. 19. OBSERVATION  As seen in graph there is statistically significant difference observed in pre and post forward bending distance in both the groups, which indicates increase in flexibility of lower back muscles. Graph 1
  20. 20. Graph 2  As seen in graph there is statistically significant difference observed in pre and post Hamstring muscle tightness in both the groups, which indicates there was increase in flexibility of hamstring muscle.
  21. 21. Graph 3  As seen in graph there is statistically significant difference observed in pre and post tendoachilles muscle tightness in both the groups, which indicates there was increase in flexibility of tendoachilles muscle.
  22. 22. DATA ANALYSIS  The collected data was analyzed for statistical significance using paired & unpaired t test. For within the group comparison, paired t test was used to compare the effect of sit- to-stand activity on pre and post forward bending test, hamstring and tendoachilles muscle tightness.  For between the groups comparison unpaired t test was used to compare the effect of 10 repetitions with 20 repetitions of sit- to-stand activity.
  23. 23. RESULTS PARAMETER PRE POST DIFFERENCE SIGNIFICANCE Forward bending dist. 13.88+6.52 7.28+6.06 6.6+4.23 t=8.10,p<0.001 Hamstring 14.72+6.94 7.2+6.14 7.52+3.93 t=9.92,p<0.001 Tendoachilles 3.92+1.44 1.76+1.2 2.16+1.31 t=8.55,p<0.001 TABLE 1: Significance of 10 repetitions. PARAMETER PRE POST DIFFERENCE SIGNIFICANCE Forward bending dist. 16.78+6.76 8.68+6.18 8.1+3.59 t=11.65,p<0.001 Hamstring 15.4+7.11 6.8+5.38 8.6+4.62 t=9.63,p<0.001 Tendoachilles 4.96+1.62 2.6+1.44 2.36+1.18 t=10.31,p<0.001 TABLE 2: Significance of 20 repetitions. As seen in tables 1 & 2, there was a significant difference observed in pre and post forward bending distance in both the groups, which indicate increase in flexibility of lower back, hamstring and tendoachilles muscles.
  24. 24. TABLE 3: Significance OF 10-Repetitions vs. 20-Repetitions  In table 3, on comparison between the two groups no statistically significant difference was seen (p>0.05) which means that both the techniques were equally effective. PARAMETER DIFFERENCE SIGNIFICANCE 10-REPETITIONS 20-REPETITIONS Forward bending dist. 6.6+4.23 8.1+3.59 t=1.35,p=0.18 Hamstring 7.52+3.93 8.6+4.62 t=0.37,p=0.88 Tendoachilles 2.16+1.31 2.36+1.18 t=0.57,p=0.56
  25. 25. Graph 4 Graph 5 Graph 5
  26. 26. Graph 6
  27. 27. DISCUSSION  In this study Sit-to-Stand activity was given as a pre stretching tool to increase the effectiveness of stretching exercise.  50 females were selected and were randomly divided into two groups of 25 each for the comparative study between 10 and 20 repetitions of sit to stand activity.  There was highly significant decrease in forward bending distance and significant increase in hamstring, tendoachillies muscle flexibility after 10 and 20 repetitions of sit-to-stand activity as the p value obtained is less than 0.001. The statistical results of the two groups when compared with each other showed no significant difference between the effectiveness of a particular exercise regime as the p value was more than 0.05.
  28. 28. Analysis of sit-to-stand activity As per Munton J S et al in “use of EMG to study leg muscle activity” (1984).
  29. 29.  Kazunori Morozumi et al, Munton J S et al and William E et al in their respective studies have shown that increase in flexibility observed after sit-to-stand activity can be hypothesized due to reciprocal inhibition, autogenic inhibition and warm-up. RECIPROCAL INHIBITION:  EMG study done by Capaday & Laveo et al (1990) on reciprocal inhibition shows reciprocal inhibition of soleus muscle with tibialis anterior muscle stimulation in various motor tasks. Applying this principle to our study as discussed in biomechanics of sit-to-stand activity i.e. erector spinae, rectus abdominis , gluteus maximus, quadriceps muscle, tibialis anterior that causes reflex relaxation of opposite group of muscles. These relaxed muscles give less resistance to consequent stretching and hence show improvement in flexibility.
  30. 30. AUTOGENIC INHIBITION:  William E et al (2001) suggested the second neurophysiologic basis of increased flexibility is the principle of autogenic inhibition, which is reflex muscular relaxation that occurs in the same muscle when Golgi tendon organ is stimulated.  In our study, the muscles that would have undergone this effect are gluteus maximus, hamstring muscle and gastrocnemius. WARM-UP:  According to Aoki j, Satoh Y, Muraoka I (2001), the sit-to- stand activity acted as warm up for further stretching. Muscle contractions increase the muscle and body temperature and improve physiological functions and are closely related to muscle performance.
  31. 31. CONCLUSION  There was statistically highly significant (p<0.01) difference observed in the flexibility after 10 repetition &20 repetition of sit-to-stand activity.  No statistically significant difference (p>0.05) difference was seen on comparison between 10 repetition and 20 repetition of sit-to -stand activity indicating that 10 repetition is as effective as 20 repetition to improve flexibility.
  32. 32. RECOMMENDATIONS  The findings of the study enables a therapist to use the activity of sit-to-stand as a simple and safe pre-stretching tool so that consequent stretching becomes more effective.  In geriatric age groups, sit-to-stand activity can be use effectively and safely, to stretch the bi articular muscles without any musculoskeletal injury.  Sit-to-stand activity can promote reduction in joint stiffness which could be useful in consequent exercise session. This benefit is more applicable in geriatric age group where joint stiffness is more common due to inactivity.