Effectiveness of Structured Myofacial Chain Exercises After Distal Radius Fracture

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Being between the ages of 18-70
* Being able to establish written and verbal communication in Turkish
* Post-Op rehabilitation after primary DRF surgery, at 4 weeks, post op at 6 weeks at the l latest
* Fixation using volar plating and nailing method
* Post-op, if instruments were left temporarily, these instruments should be removed before the study
* No previous history of surgery involving the upper extremity
* To have sufficient technological device usage skills and fast internet infrastructure to use video communication technologies without any problems
* Having a device that provides the necessary equipment for video calling
* Having a table and 6 m2 of space to allow exercise in the living area

Exclusion Criteria:

* Occurrence of one of the complex regional pain syndrome subtypes after fracture
* History of any chronic systemic, rheumatological, neurological, vascular disease
* History of traumatic injury to intact extremities and trunk in the last 6 months
* Presence of pain complaints including spine and shoulder pain over 3 according to the Visual Analogue Scale
* Those who use anti-inflammatory drugs
* Presence of cognitive or psychological illness that will prevent cooperation