Effectiveness of Structured Myofacial Chain Exercises After Distal Radius Fracture
Condition: Distal Radius Fractures
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      When determining the treatment method to be applied in distal radius fracture (DRF), in
      addition to clinical and radiological evaluation, the patient's age, physical activity level,
      cognitive status, severity of trauma, mechanism of injury and type of fracture are important
      factors in the treatment plan. Clinical studies show that physiotherapy is useful in
      improving the limitation of movement and pain in DRF. It shows that the active movement level
      is increased by decreasing the level. Rehabilitation after surgery proceeds similarly to
      conservative treatment. When exercise approaches in the literature are examined, it is seen
      that specific exercises for the wrist and forearm are recommended for treatment, but it has
      been reported that there are not enough studies to constitute evidence value. For decades,
      the skeletal muscles of the human body have been characterized as independent structures.
      However, recent research supports the "single muscle theory", contrary to this classical
      view. According to this theory, the fascia tissue that covers the entire body connects the
      muscles to each other in the form of chains, and the muscles in the chain work together in
      performing functional movements. These chains are called myofascial chains. Fascia tissue
      that creates all these connections; It consists of tightly arranged connective tissue and is
      structurally similar to tendons and ligaments. It surrounds organs, muscles, vessels and
      nerves, connects tissues and allows them to slide and move over each other. Past histological
      studies have reported that there are also contractile cells in the fascia structure. Although
      there are problems in rehabilitation after DRF that go beyond a single segment and affect the
      whole body; There is no study in the literature that uses the myofascial chain exercises
      approach in the treatment of these problems. In the light of all this information, the thesis
      study aims to ensure the active participation of the upper body muscles in the rehabilitation
      process with the DRUK program planned with myofascial chain exercises and in this way to
      improve the functional level obtained as a result of rehabilitation.
    

Detailed description: 
      Clinical studies show that physiotherapy is useful in improving the limitation of movement in
      distal radius fractures and increases the level of active movement by reducing the level of
      pain. Providing functional restoration with physiotherapy not only increases the quality of
      life but also reduces the number of days patients cannot go to work. Rehabilitation after
      surgery proceeds similarly to conservative treatment. When exercise approaches in the
      literature are examined, it is seen that specific exercises for the wrist and forearm are
      recommended for treatment, but it has been reported that there are not enough studies to
      constitute evidence value. Due to the increased risk of prolonged immobilization and damaged
      tissues after surgery compared to closed reduction; If problems such as disuse atrophy, loss
      of proprioception and joint range of motion are taken into consideration, all upper extremity
      disorders may occur after surgery, including the elbow and shoulder joints, which are
      positioned together with the wrist and whose use is restricted. The following have been
      reported as early and late complications after surgical treatments: i)Complex regional pain
      syndrome, reflex sympathetic dystrophy, algodystrophy, compartment syndrome; ii) Tendon
      adhesion or rupture; iii)Nerve compression; iv) Post traumatic arthritis; v)Dupuytren's
      contracture. Although some of these complications are related to surgery, other complications
      are affected by processes involving the fascial system. For decades, the skeletal muscles of
      the human body have been characterized as independent structures. However, recent research
      supports the "single muscle theory", contrary to this classical view. According to this
      theory, the fascia tissue that covers the entire body connects the muscles to each other in
      the form of chains, and the muscles in the chain work together in performing functional
      movements. These chains are called myofascial chains. In cadaveric studies, mechanical force
      transfer along these connections has been demonstrated, and this connection has been tried to
      be explained with biotensegrite models. Due to this load transfer, all structures on the
      chain are affected by the forces or disorders that any structure in the myofascial chain is
      exposed to, and this is explained by the biotensivity theory. Fascia tissue that creates all
      these connections; It consists of tightly arranged connective tissue and is structurally
      similar to tendons and ligaments. It surrounds organs, muscles, vessels and nerves, connects
      tissues and allows them to slide and move over each other. Past histological studies have
      reported that there are also contractile cells in the fascia structure. Although there are
      problems in rehabilitation after distal radius fracture that go beyond a single segment and
      affect the whole body; There is no study in the literature that uses the myofascial chain
      exercises approach in the treatment of these problems. In the light of all this information,
      the thesis study aims to ensure the active participation of the upper body muscles in the
      rehabilitation process with the distal radius fracture program planned with myofascial chain
      exercises and in this way to improve the functional level obtained as a result of
      rehabilitation.
    

Intervention name(s): Therapeutic Exercises
Intervention type(s): Other
Intervention description(s): Participants who have inclusion criterias after DRF reconstrontion pos-op 4. week will included this study. Certified Physiotherapist who have master of science degree and doctorate student will assessed them before and after treatment with face to face. Also exercise education will give face to face with same therapist. After that first sessions patients will progress their standardize or structered exercises pragram with telerehabilition during 4 weeks and 16 sessions. All sessions will be supervised with physiotherapist. End of study assessments will perform again with same therapist.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Prospective Randomized Control Single-Blind Study
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Tele-Health; Exercise; Physical Therapy And Rehabilitation; Distal Radius Fractures