Instrument Assisted Soft Tissue Mobilization Versus Dynamic Oscillatory Stretch Technique in Females Wearing High Heels

Study Overview
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Brief Summary
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Rationale of this research is to compare the effect of instrument assisted soft tissue mobilization and dynamic oscillatory stretch technique on gastro soleus muscles flexibility with shortened calf muscle-tendon unit (MTU),thicker and stiffer Achilles tendon in individual wearing high heel. This study will observe effect in all range of motion of ankle joint. In Pakistan no previous research is conducted, that compare the effect of IASTM and DOST in females wearing high heel.

Detailed Description
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Regular wearing of high heels would lead to shortening of the fascicles of the gastrocnemius muscle together with changes in the mechanical properties of the Achilles' Tendon, by the continuous ankle plantar flexion cause by the heel lift resulting in functional alteration. The purpose of the study is to identify the optimal technique for alleviating the symptoms in patients with high heel syndrome. It is a randomized controlled trial.Sample size is total 54 participants which would be divided into two groups, 27 each.Non-probability Convenience Sampling will be used and participants are randomly assigned into GROUP A(IASTM) and GROUP B (DOST) through sealed envelope methods after baseline assessment. All participants in both groups were evaluated on two occasions: (i) baseline (ii) at 12th session.

Official Title
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Comparison of Instrument Assisted Soft Tissue Mobilization Versus Dynamic Oscillatory Stretch Technique in Females Wearing High Heels

Conditions
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Behavior, Social

Intervention / Treatment
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* Other: Instrument Assisted Soft Tissue Mobilization
* Other: Dynamic oscillatory stretch technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 20-40 years Duration of wearing heels: minimum 1 year Wearing heels for minimum 3 times a week and 5 hours a day. Heel height: 2 and above Ankle Dorsiflexion ROM: decreased dorsiflexion (about 17 degrees) Pain scale showing more than 3. Exclusion Criteria: DVT Musculoskeletal injury or surgery of lower limb. Acute Cardio-Respiratory or Neurological condition. Medical or surgical co-morbidities

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Instrument Assisted Soft Tissue Mobilization<br>Graston tool on gastrocnemius and soleus muscle. Conventional treatment will include Hot pack for 10-15 min (calf muscles) Stretching exercises of gastro-soleus (10reps x 2Sets). Post session : Cold pack for 5 minutes (calf muscles) | Other: Instrument Assisted Soft Tissue Mobilization<br>* give gentle strokes from proximal to distal to check for trigger point or taut band. After knowing the exact location, give gentle strokes with minimal pressure in all directions by keeping the instrument in 30 to 60 degree angle. Application time will be between 40- 120 seconds. Conventional treatment will include Hot pack for 10-15 min (calf muscles) Stretching exercises of gastro-soleus (10reps x 2Sets). Post session : Cold pack for 5 minutes (calf muscles)<br>|
| Active Comparator: Dynamic oscillatory stretch technique<br>Dynamic oscillatory stretch technique on gastrocnemius and soleus muscle10reps x2 second hold oscillation x 3 sets. Conventional treatment will include Hot pack for 10-15 min (calf muscles) Stretching exercises of gastro-soleus (10reps x 2 Sets). Post session : Cold pack for 5 minutes (calf Muscles | Other: Dynamic oscillatory stretch technique<br>* Passively dorsiflexe the ankle to a point of the first stretch sensation. The next component to DOS, 2- second, passive stretch with slow oscillations at end range was applied. This procedure is repeated 10 times in each set with total of 3 sets .Therefore,10reps x2 second hold oscillation x 3 sets are given.Conventional treatment will include Hot pack for 10-15 min (calf muscles) Stretching exercises of gastro-soleus (10reps x 2Sets). Post session : Cold pack for 5 minutes (calf muscles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ankle Range of Motion | Goniometer is used to measure ankle dorsiflexion, Plantarflexion, inversion, eversion ROM and it is use to assess and monitor patient's mobility to track progress during rehabilitation. | 4th week | 
| Lower Extremity Functional Scale (LEFS) | The Lower Extremity Functional Scale (LEFS) is a commonly used tool in physical therapy and rehabilitation to assess the functional abilities of patients with lower extremity impairments. It is a self-reported questionnaire that consists of 20 items, each with five response options ranging from 0 (unable to perform) to 4 (able to perform without difficulty). The scores on the LEFS range from 0 to 80, with higher scores indicating better function. | 4th week | 
| NUMERIC PAIN RATING SCALE | The numeric pain rating scale is used to measure pain intensity. It typically ranges from 0 to 10, with 0 indicating no pain and 10 indicating the worst possible pain. Patients are asked to rate their pain on this scale, with the healthcare provider using the rating to help guide treatment decisions. It is a simple and effective way to communicate pain intensity, and can be useful in tracking changes in pain over time. | 4th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ROM ankle dorsi flexion | changes from baseline to final session | 4th week | 
| ROM ankle plantar flexion | changes from baseline to final session | 4th week | 
| ROM ankle inversion | changes from baseline to final session | 4th week | 
| ROM ankle eversion | changes from baseline to final session | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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instrument assisted soft tissue mobilization, dynamic oscillatory stretch technique, high heel users