Objective: To determine and compare the effects of Deep Transverse Friction (DTF) Massage and Mill’s manipulation (Cyriax) with Mobilization with movement (MWM) and Taping (Mulligan) in lateral epicondylitis patients. Material & Methods: A Randomized Control Trial (NCT03848117) was conducted in Physiotherapy Department of DHQ Hospital Bahawalnagar after the approval from the competent authority. Non-probability convenient sampling technique was used to collect sample. The n=30 sample size was randomly allocated in two groups as Group A i.e. the Cyriax group (DTF Massage & Mill’s Manipulation) and Group B i.e. the Mulligan group (Taping & MWM), with 15 participants in each group having sub acute lateral epicondylitis. Data was collected in terms of age, gender, BMI and occupation. Patient related tennis elbow evaluation (PRTEE) questionnaire was used to determine the level of pain, functional disability and hand grip strength. Mann Whitney U statistics test was used for between the group analysis and Friedman with Wilcoxon signed ranks test was used for within the group analysis. The significance level was set at p<0.05. Results: The mean±SD age of subjects in Cyriax group was 33.60±6.864 years and in Mulligan group was 36.93±7.741 years. MWM with taping and Mill’s manipulation with DTF massage both showed significant improvement (p<0.001) in pain, function ability and handgrip strength throughout the treatment duration. When comparing the both group regarding pain, Cyriax approach showed significant improvement after 2nd week while mulligan’s approach showed more improvement than Cyriax approach (p<0.001) in functional ability from 2ndto 3rd week. Hand grip strength in both groups did not show any significant difference (p≥0.05). Conclusion: Mobilization with movement& taping (Mulligan) and mill’s manipulation with DTF massage (Cyriax), both are effective in improving pain, functional ability and handgrip strength in lateral epicondylitis. Cyriax approach is more effective in relieving pain in lateral epicondylitis as compare to Mulligan’s approach. On the other hand, functional ability, more improve with Mulligan’s approach. But both treatments are equally effective in improving hand grip strength in lateral epicondylitis. Keywords: Tennis elbow, mobilization with movement, hand grip strength, patient rated tennis elbow evaluation (PRTEE), Deep Transverse friction massage.

Background: Osteoarthritis (OA) is a persistent joint disorder, which normally affects the weight bearing joints especially knee joint. Lateral wedge insole is one such approach suggested by professionals to manage the knee osteoarthritis. Objective: To determine the effectiveness of lateral wedge insoles on knee osteoarthritis outcomes in Pakistani population Design: A single-blinded, pretest-posttest comparison. Setting: District Headquarter (DHQ) Hospital, Bahawalnagar and National Institute of Rehabilitation Medicine (NIRM), for a time period of one month. Population: Patients with the age criteria of 40-70 years, and who had knee OA were included in the study. Methods: Participants were randomly divided in two groups; lateral wedge insoles (LWI) group (n=20), and conventional physical therapy (CPT) group (n=20). Pain, stiffness, activities of daily living, sports and recreational activities, and quality of life was assessed on Urdu version of Knee Injury and Osteoarthritis Outcome Score scale (KOOS) on every week till 4th week of intervention. Mixed ANOVA was used for interaction effect of between-subject factor (group) and within-subject factor (time) with-in group analysis and one way ANOVA for between group comparisons with their effect size (ɳp2). Results: Significant improvement with large effect size was observed in Symptoms and stiffness (p<0.001, ɳp2=.329} , pain (p<0.001, ɳp2=.559), functional activities (p<0.001, ɳp2=.394), recreational activities (p<0.001, ɳp2=.369) and quality of life (p<0.001, ɳp2=.280). The CPT group showed more significant improvement (p<0.001) in all domains of KOOS as compared to LWI group. Conclusion: Lateral wedge insoles (LWI) and conventional physical therapy (CPT) both have positive impact on knee osteoarthritis outcomes. But conventional physical therapy was more effective in improving functional independence. Clinical rehabilitation impact: This study provides the evidence on the use of LWI and CPT as alternative strategies to improving Knee OA outcome measures. Keywords: Knee osteoarthritis, functional independence, geriatric population, musculoskeletal physiotherapy, orthotics, quality of life, rehabilitation

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Background: Cerebral palsy (CP) is a set of permanent movement disorders which are caused by non-progressive lesions of the developing brain. Other disorders concerning (CP) are disturbances of sensation, cognition, and/or seizure disorder. The current study intended to compare the frequency of factors associated with risk in cerebral palsy and their link with the type of cerebral palsy.Methods: Case-control study was conducted to collect the data through a structured questionnaire. Data was collected from the mother of the CP child and from the mother of healthy individuals at the National Institute of Rehabilitation and Medicine Islamabad. Sample of 400 individuals selected through purposive sampling technique and divided in two groups. 100 were in the case group and 300 were in the control group. For statistical significance, SPSS 20 was used. Results: An aggregate of 400 patients selected in this study among which 100 were assigned as a case group and 300  as a control group. male and female children were equally distributed with N=150 in the control group, similarly equal gender distribution (N=50 for male and female each) was adopted for the case group. Among the risk factors leading to CP development, the most prevalent was maternal infection (56%) followed by poor socioeconomic status (45%), delayed crying(48%) after birth, and high-grade fever with fits leading to spastic CP(44%) and was significantly higher in case group as compared to control(p‹0.05). A higher frequency of CP children with a p-value of 0.00 was found in mothers having pregnancy in the age group 35-40 years. Conclusions: Our study concludes that among the risk factors associated with CP, the most frequent is maternal infection followed by delayed crying, low socioeconomic status and high-grade fever with fits and mother age of pregnancy above 35 years.

Background: Plantar fasciitis is regarded as the supreme reason of inferior heel pain. The pain and discomfort that comes with this condition have an intense impact on physical mobility and function. This study was conducted to evaluate the effectiveness of Myofascial release with conventional physical therapy in patients with chronic plantar fasciitis. Methods: Subjects were clinically diagnosed with chronic plantar fasciitis and then screened after assessing their suitability according to the inclusion and exclusion criteria. Subjects participating in the study were instructed about the nature of the study and the interventions and an informed written consent was taken. Data was collected from the patients visiting the outpatient department of Pakistan Institute of Medical Sciences (PIMS) Islamabad and Mega Medical Complex Hospital Rawalpindi. n=30 patients were divided into two groups using random allocation with n= 15 in each group, Group 1 received MFR with conventional physical therapy (ultrasound and exercise therapy) whereas Group 2 received conventional physical therapy alone. The treatment was given on alternative days for 2 weeks. Results: Within group analysis was done with repetitive measure ANOVA, mean percentage of visual analog scale for both groups were same at the baseline but for experimental group significantly decrease from baseline (8.00) to midline (4.73) and at the end of session (1.40). While, mean percentage of FFI in experimental group significantly decreased from baseline to midline and till the end of the sessions. Between the group analysis was performed with independent t-test and results of VAS and FFI were statistically significant in both groups (p<0.01) but mean values showed that experimental group showed more reduction in pain and improved functional level as compared to control group. Conclusion: Myofascial release technique with conventional physical therapy showed efficacy in reducing the pain intensity and increasing the foot function in chronic plantar fasciitis patients. This study will benefit the patients of plantar fasciitis for better management of their condition and thus overall quality of life of such patients will improve in future.