Background: Spasticity is the common problem encountered in the treatment of hemiplegic patients. Various treatment techniques have been developed to reduce spasticity, neuromuscular electrical stimulation is one of them. Several studies have proved that stimulation of either spastic muscle or stimulation of antagonist muscle to spastic muscle results in a reduction of spasticity. However, there is no literature available on a comparative study to suggest which method is more effective in spasticity reduction. Hence this study was undertaken to find out the efficacy of each technique and to compare the two techniques of Neuromuscular electrical stimulation to determine the most effective technique. Methods:In this study with pre and post-experimental design 30 post-stroke patients were selected and they were randomly assigned into two groups. Group A received anatagonist (triceps) muscle Neuromuscular electrical stimulation and Group B received agonist (biceps brachii) muscle Neuromuscular electrical stimulation for 2 weeks, one session per day for a duration of 30 minutes. Outcome measures were recorded using modified Ashworth scale and deep tendon reflex grading scale.Results: Statistical analysis was carried out by using Wilcoxon signed rank sum test and Mann-Whitney U test at 0.05 level of significance. There was a significant recovery after the treatment based on the Modified Ashworth Scale and deep tendon reflex grading scale scores before and after the intervention within the groups and between the groups with p-value< 0.001. The group receiving the antagonist muscle neuromuscular electrical stimulation showed better recovery with a mean difference of 1.8 and 1.2 on Modified Ashworth Scale and reflex grading scale respectively. Conclusion:The study concluded that both the techniques resulted in reduction of spasticity and on comparison it was found that antagonist muscle (triceps) Neuromuscular electrical stimulation reduced spasticity more effectively than the agonist muscleNeuromuscular electrical stimulation

Background: Piriformis syndrome is a commonly overlooked specific cause of low back pain. Apart from mimicking the sciatica-like symptoms, unilateral piriformis tightness can cause rotational dysfunction and pain in the lumbar region. This could lead to low back pain which is a common musculo skeletal problem and a major reason for activity limitation. Stretching the piriformis tightened muscle is a preferred choice of treatment against surgical intervention to release the muscle. Mulligan's mobilization is based on movement with mobilization which is proven to be effective in many musculo skeletal dysfunctions including the lumbar spine. The purpose of this study is to explore and compare the two treatment methods in relieving the low back pain in clinical conditions with piriformis syndrome. Method:In this experimental study, 40 patients with piriformis syndrome were selected and divided into two groups. One group was given only piriformis stretching for the tightened muscle and the other group given Mulligan mobilization for lumbo sacral joints. VAS and lower limb functional index were taken to compare before and after the treatment regime of 4 weeks. Results:There was no significant difference between the two groups in both pain scale and lower limb mobility and function. But there was significant improvement in pain relief and LLFI after the treatment regime in both groups compared to the pre-treatment status. Conclusion:Even as the piriformis syndrome is caused by the tightness of the muscle, the consequence in the lower back and lumbar spine mobility can be improved by a Mulligan mobilization as a single mode of intervention .

Gerhardt-Mitchell's disease which is also named as Erythromelalgia is an unusual neurovascular pain syndrome which features with group of three characteristics i.e., raise in temperature, red color pigmentation of skin and pain with a quality of burning. All three characteristics are most importantly seen in the extremities. Erythromelalgia may occur either as a primary or secondary disorder. Clinical presentation of primary erythromelalgia is linked with severe burning pain, pronounced erythemaof the skin, swelling and increased skin temperature, specifically of the feet. We present the case of a patient, 12 years old girl with primary erythromelalgia who came to our physiotherapy department with features of repeated redness, burning pain, increased warmness of the skin on anterior aspect of right foot. Computer Assisted Capillary Microscopy demonstrated reduced capillary density and capillary perfusion. Another observatory test was done by elevating patient's right leg noting the reversal in skin color from red to pale.Her detailed evaluation was carried out and physiotherapy treatment was started.

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