Ms. AMISHA ANAND ANGLE IV YEAR BPT SCHOOL OF ...amishapro.com/wp-content/uploads/2016/11/4TH-YEAR-AMISH...2016/11/04  · 2 CERTIFICATE This is certify that Miss Amisha Anand Angle

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COMMON MUSCULOSKELETAL PROBLEMS IN UNDER GRADUATE PHYSIOTHERAPHY STUDENTS EVALUATED BY

USING NORDIC MUSCULOSKELETAL QUESTIONNAIRE

Ms. AMISHA ANAND ANGLE

IV YEAR BPT

SCHOOL OF PHYSIOTHERAPHY

D. Y. PATIL UNIVERSITY, NERUL, NAVI MUMBAI

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CERTIFICATE

This is certify that Miss Amisha Anand Angle has satisfactorily carried out 4th year project as prescribed by the School of Physiotherapy, D.Y.Patil University, Nerul Navi Mumbai, During the academic year 2016-2017.

Dr. Shweta Phadke Dr. Unnati Pandit,

Associate professor Professor & Director,

and guide, School of Physiotherapy

School of Physiotherapy, D.Y. Patil University.

D.Y.Patil University.

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ACKNOWLEDGEMENT

I take this opportunity to express my sincere gratitude to those people without whose support and concern, this project would not have been a great success.

I am extremely thankful to Dr.Unnati Pandit, Head of Department of Physiotherapy of D.Y.Patil University, who has bestowed upon me her valuable advice and given me the permission to initiate the project in this institution.

I am also extremely thankful to my guide, Dr. Shweta Phadke, Associate Professor of D.Y.Patil University.

And last but not the least, the colleagues of our batch who deserve a word of thanks for their co-operation and all the teaching and non-teaching staff for their support and also my subjects who deserve a word of thanks for their co-operation.

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INDEX

SR.NO. TOPIC PAGE NOS.

1 INTRODUCTION 5 2 AIM AND OBJECTIVES 6 3 MATERIAL AND METHODOLOGY 7 4 DATA REPRESENTATION AND ANALYSIS 8-23 5 DISCUSSION 24-33 6 CONCLUSION 34 7 RECOMMENDATIONS 35-41 8 REFERENCES 42 9 CONSENT FORM AND QUESTIONNAIRE 43-47

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Musculoskeletal disorders (MSDs) consist of minor physical disabilities. This term is used to describe a variety of conditions that affect the muscles, bones and joints. The severity of the musculoskeletal disorders can vary. Pain and discomfort may interfere with everyday activities. Musculoskeletal disorders are extremely common and risk increases with age. Early diagnosis is the key to ease pain while potentially decreasing further bodily damage.(1)

Introduction

Work-related musculoskeletal disorders (WMSDs) are a group of painful disorders of muscles, tendons and nerves. Injuries resulting from overuse and those that develop over time. Work activities which are frequent and repetitive or activities with awkward postures cause these disorders which may be painful during work or at rest. Almost all work requires the use of the arms and hands. Therefore, most work-related musculoskeletal disorders affect the hands, wrists, elbows, neck and shoulders. Work using the legs can lead to work-related musculoskeletal disorders of legs, hips, ankles and feet. Some back problems also result from repetitive activities.

The Nordic Musculoskeletal Questionnaire (NMQ) was developed from a project funded by the Nordic Council of Ministers. Aim was to develop and test a standardized questionnaire methodology allowing comparison of low back, neck, shoulder and general complaints for use in epidemiological studies. The tool was not developed for clinical diagnosis. The Nordic Musculoskeletal Questionnaire can be used as a questionnaire or as a structured interview. However, significantly higher frequencies of musculoskeletal problems were reported when questionnaire was administered as part of a focused study on musculoskeletal issues and work factors than when administered as part of a periodic general health examination.(2)we are investigating musculoskeletal problems in Bachelor of Physiotherapy students using NMQ questionnaire.

The students have burden of carrying books, improper posture while studying. Improper posture while taking history or treating patients can cause musculoskeletal problems. Tiredness of whole day working in hospital. . When slouching or sleeping there may be improper posture and musculoskeletal problems. At any point of time physiotherapist should have good healthy muscles which ultimately leads to strengthen the ligaments which is attached to bones. Because they have to take care of everybody’s health and to treat them. Because they tend to ignore their own problem. And they are more prone for musculoskeletal problem as they are in awkward position while treating patients. Same field interest, passion, profession. My survey will help other physiotherapists in their prevention.

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AIMS AND OBJECTIVES

To screen work related musculoskeletal pain in students of Physiotherapy .

AIM:-

To screen for body part with Chronic Pain in Physiotherapy students.

OBJECTIVES:-

To screen for body part with Acute Pain in Physiotherapy students. To screen for body part with cause of Activity Loss in Physiotherapy students . To recommend preventive strategies for pain and activity loss in Physiotherapy students .

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MATERIAL AND METHODOLOGY

Research Approach: Cross sectional survey study. Study Design: The data for this study was collected by direct interview method with help

of questionnaire. Study Setting:Undergraduate Student of physiotherapy, D Y Patil University. Sample Size: 112. Inclusion Criteria: 18-21 years of age apparently healthy Bachelor of physiotherapy

students from Student of physiotherapy, Dr. D Y Patil University. Exclusion: history of medical, surgical and trauma.

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DATA REPRESENTATION AND ANALYSIS

Graph 1. – Prevalence of chronic pain in 1st YEAR BPT students.

1ST YEAR YES LOWER BACK 15 NECK 13

UPPER BACK 12 SHOULDER 3

WRIST/HAND 3 ELBOW 1

ANKLE/FOOT 1 HIP/THIGH 0

KNEE 0 48

INFERENCE- Lower back is most affected area for chronic pain in 1st year students.

0 2 4 6 8

10 12 14 16

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Graph 2. – Prevalence of acute pain in 1st YEAR BPT students.

1ST YEAR YES LOWER BACK 6

UPPER BACK 6 NECK 5

SHOULDER 3 ELBOW 1

WRIST/HAND 1 HIP/THIGH 0

KNEE 0 ANKLE/FOOT 0

INFERENCE- Lower back and Upper back is most affected area for acute pain in 1st year students.

0 1 2 3 4 5 6

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Graph 3. – Prevalence of loss of activity pain in 1st YEAR BPT students.

1ST YEAR YES LOWER BACK 7 NECK 4

UPPER BACK 4 SHOULDER 1

ELBOW 1 WRIST/HAND 1

HIP/THIGH 1 KNEE 1

ANKLE/FOOT 1

INFERENCE- Lower back is most affected area for loss of activity pain in 1st year students.

0 1 2 3 4 5 6 7

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Graph 4. – Prevalence of chronic pain in 2nd YEAR BPT students.

2ND YEAR YES LOWER BACK 12 NECK 11 SHOULDER 10 UPPER BACK 7 ANKLE/FOOT 6 HIP/THIGH 4 KNEE 4 WRIST/HAND 3 ELBOW 1

INFERENCE- Lower back is most affected area for chronic pain in 2nd year students.

0 2 4 6 8

10 12

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Graph 5. – Prevalence of acute pain in 2nd YEAR BPT students.

2ND YEAR YES NECK 7 LOWER BACK 5 UPPER BACK 5 SHOULDER 4 KNEE 2 HIP/THIGH 1 ANKLE/FOOT 1 ELBOW 0 WRIST/HAND 0

INFERENCE - Neck is most affected area for acute pain in 2nd year students.

0 1 2 3 4 5 6 7

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Graph 6. – Prevalence of loss of activity pain in 2nd YEAR BPT students.

2ND YEAR YES LOWER BACK 5 NECK 4 KNEE 4 UPPER BACK 3 HIP/THIGH 3 ANKLE/FOOT 3 SHOULDER 2 ELBOW 1 WRIST/HAND 1

INFERENCE- Lower back is most affected area for loss of activity pain in 2nd year students.

0

1

2

3

4

5

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Graph 7. – Prevalence of chronic pain in 3rd YEAR BPT students.

3RD YEAR YES LOWER BACK 14 NECK 9 UPPER BACK 5 SHOULDER 4 KNEE 4 WRIST/HAND 2 HIP/THIGH 2 ELBOW 1 ANKLE/FOOT 1

INFERENCE- Lower back is most affected area for chronic pain in 3rd year students.

0 2 4 6 8

10 12 14

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Graph 8. – Prevalence of acute pain in 3rd YEAR BPT students.

3RD YEAR YES LOWER BACK 7 NECK 2 SHOULDER 2 UPPER BACK 2 KNEE 2 ELBOW 1 WRIST/HAND 1 ANKLE/FOOT 1 HIP/THIGH 0

INFERENCE- Lower back is most affected area for acute pain in 3rd year students.

0 1 2 3 4 5 6 7

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Graph 9. – Prevalence of loss of activity pain in 3rd YEAR BPT students.

3RD YEAR YES LOWER BACK 4 WRIST/HAND 2 KNEE 2 NECK 1 SHOULDER 1 ELBOW 0 UPPER BACK 0 HIP/THIGH 0 ANKLE/FOOT 0

INFERENCE- Lower back is most affected area for loss of activity pain in 3rd year students.

0 0.5

1 1.5

2 2.5

3 3.5

4

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Graph 10. – Prevalence of chronic pain in 4th YEAR BPT students.

4TH YEAR YES NECK 17 LOWER BACK 15 UPPER BACK 15 SHOULDER 11 ANKLE/FOOT 9 KNEE 8 HIP/THIGH 3 WRIST/HAND 1 ELBOW 0

INFERENCE- Neck is most affected area for chronic pain in 4th year students.

0

5

10

15

20

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Graph 11. – Prevalence of acute pain in 4th YEAR BPT students.

4TH YEAR YES LOWER BACK 8 NECK 6 SHOULDER 3 UPPER BACK 3 KNEE 3 ANKLE/FOOT 3 WRIST/HAND 2 ELBOW 1 HIP/THIGH 1

INFERENCE- Lower back is most affected area for acute pain in 4th year students .

0

1

2

3

4

5

6

7

8

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Graph 12. – Prevalence of loss of activity pain in 4th YEAR BPT students.

4TH YEAR YES LOWER BACK 6 NECK 3 UPPER BACK 3 SHOULDER 2 KNEE 2 HIP/THIGH 1 ANKLE/FOOT 1 ELBOW 0 WRIST/HAND 0

INFERENCE- Lower back is most affected area for loss of activity pain in 4th year students .

0 1 2 3 4 5 6

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Graph 13. - Pain prevalence in physiotherapy students.

CRONIC LOSS OF

ACTIVITY ACUTE 1ST YEAR 18% 8% 8% 2nd YEAR 22.20% 9.90% 9.50% 3rd YEAR 18% 4% 8% 4th YEAR 30.20% 6.80% 11.40%

INFERENCE- 4th year students are more prevalent for chronic pain and acute pain than any other year.

0%

5%

10%

15%

20%

25%

30%

35%

1ST YEAR 2nd YEAR 3rd YEAR 4th YEAR

CRONIC

LOSS OF ACTIVITY

ACUTE

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Graph 14.-Chronic pain in all students.

CHRONIC

LOWER BACK 56 NECK 50

SHOULDER 28 UPPER BACK 24

ANKLE/FOOT 17 KNEE 16

WRIST/HIP 9 HIP/THIGH 9

ELBOW 3

INFERENCE- lower back pain is most prevalent in all student in chronic pain.

56

50 28

24

17

16 9 9 3

CHRONIC

LOWER BACK

NECK

SHOULDER

UPPER BACK

ANKLE/FOOT

KNEE

WRIST/HIP

HIP/THIGH

ELBOW

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Graph 15. -Loss of activity in all students.

LOSS OF

ACTIVITY LOWER BACK 22 NECK 12

UPPER BACK 10 KNEE 9

SHOULDER 6 HIP/THIGH 5

ANKLE/FOOT 5 WRIST/HAND 4

ELBOW 2

INFERENCE- lower back pain is most prevalent in all student for loss of activity.

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12 10

9

6

5

5 4 2

LOSS OF ACTIVITY

LOWER BACK

NECK

UPPER BACK

KNEE

SHOULDER

HIP/THIGH

ANKLE/FOOT

WRIST/HAND

ELBOW

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Graph 16.- Acute pain in all students.

ACUTE LOWER BACK 26 NECK 20 UPPER BACK 16

SHOULDER 12 KNEE 7

ANKLE/FOOT 5 WRIST/HAND 4

ELBOW 3 HIP/THIGH 2

INFERENCE- lower back pain is most prevalent in all students for acute pain.

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20 16

12

7

5 4 3 2

ACUTE

LOWER BACK

NECK

UPPER BACK

SHOULDER

KNEE

ANKLE/FOOT

WRIST/HAND

ELBOW

HIP/THIGH

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Discussion

In our study we have chosen Under Graduate students of Physiotherapy from D Y Patil University of Nerul (E), for screening common musculoskeletal problems by universally accepted Nordic musculoskeletal questionnaire. Our total sample size was 112. It’s a cross sectional survey study. Data was collected by direct interview method with consent. Age group from 18-21 year old students with no h/o medical, surgical and trauma in a group of people. Let’s start with analysis. From Graph 1:- Lower back is most affected area for chronic pain in 1st year students. From Graph 2:- Lower back and Upper back is most affected area for acute pain in 1st year students. From Graph 3:- Lower back is most affected area for loss of activity pain in 1st year students. From Graph 4:- Lower back is most affected area for chronic pain in 2nd year students. From Graph 5:- Neck is most affected area for acute pain in 2nd year students. From Graph 6:-Lower back is most affected area for loss of activity pain in 2nd year students. From Graph 7:- Lower back is most affected area for chronic pain in 3rd year students. From Graph 8:-Lower back is most affected area for acute pain in 3rd year students. From Graph 9:- Lower back is most affected area for loss of activity pain in 3rd year students. From Graph 10:-Neck is most affected area for chronic pain in 4th year students. From Graph 11:- Lower back is most affected area for acute pain in 4th year students. From Graph 12:- Lower back is most affected area for loss of activity in 4th year students. From Graph 13:- 4th year students are more prevalent for acute pain and chronic pain than any other year. From Graph 14:-Lower back pain is most prevalent in all student in chronic pain. From Graph 15:- Lower back pain is most prevalent in all student for loss of activity. From Graph 16:- Lower back is most prevalent in all student for acute pain. From Graph 13:- The highest chronic pain in percentage is in 4th year by 30.20% and highest loss of activity is in 2nd year by 9.90% and highest acute pain is in 4th year by 11.40%. And then as we can intere lower back as most affected area in acute and chronic pain.The following reasons can be given- Low back pain is a universal human experience- almost everyone has it at some point. The lower back, which starts below the ribcage is called the lumbar region. Pain here can be intense and is one of the top causes of missed work. Fortunately, low back pain often gets better on its own. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. Pain that lasts more than 3 months is considered chronic. Low back pain main culprit is as follows- Sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or

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you tend to slouch. Overloading. The students bag: Although you may wear your purse, backpack or briefcase over your shoulder, it is the lower back that supports the upper body- including any additional weight you carry. So an overstuffed bag can strain the lower back,

especially if you carry it day after day. Being overweight. Inactive lifestyle. Require heavy lifting.(3) Backpack and back pain. Using a backpack allows a child to carry a number of schoolbooks and items in a practical way, distributing the heavy load across the strong back and shoulder muscles. The risk, however, is overload, which can strain the back, neck or shoulders. A heavy weight carried in backpacks can: Distort the natural curves in the middle and lower backs, causing muscle strain and irritation to the spinal joints and ribcage. Lead to rounding of the shoulders. Cause a person to lean forward, reducing balance and making it easier to fall. Limiting the backpack weight to 10-15% of child’s body weight is reasonable. Habitually carrying backpacks over one shoulder will make muscles strain to compensate for the uneven weight. The spine leans to opposite side, stressing the middle back, ribs and lower back more on one side than the other. This type of muscle imbalance can cause muscle strain, muscle spasm and back pain in the short term and speed the development of back problems later in life if not corrected. A heavy backpack can pull on the neck muscles, contributing to headache, shoulder pain, lower back pain, and/or neck and arm pain.(4)

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Postural-structural-biomechanical factors contributing to low back pain. Trunk asymmetry, thoracic kyphosis and lumbar lordosis in teenagers and developing low back pain in adulthood. Low muscle strength, low muscle endurance, or reduced spinal mobility and erector spinea pairs imbalances during extension. Variations in lumbar lordosis and thoracic kyphosis. Increased lumbar lordosis and sagittal pelvic tilt on back pain during pregnancy. Differences in regional lumbar spine angles or range of motion. Disc degeneration, spina bifida, transitional lumbar vertebra, spondylolysis and spondylolisthesis. Pelvic obliquity and the lateral sacral base angle pelvic asymmetry. Hamstrings and psoas tightness. Inflexibility of the lower extremities or leg length discrepancy. Correcting foot mechanics has no effect on preventing back pain.(5) KINEMATICS:- Movements available-flexion, extension, lateral flexion and rotation. Gliding- anterior to posterior, medial to lateral and torsional. Tilt- anterior to posterior, lateral directions. Distraction and

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compression. Lumbar range of motion- flexion:50ᶿ, extension:15ᶿ, axial rotation:5ᶿ, lateral flexion:20ᶿ. Lumbar flexion: More limited than extension. Maximum motion at lumbosacral joint. Anterior tilting and gliding of superior vertebra occurs. Increases diameter of intervertebral foramina. Flexion generates compression forces on anterior side of disc tending to migrate nucleus pulposus posteriorly. Limited by tension in posterior annulus fibrosus and posterior ligament system.

Lumbar extension: Increase in lumbar lordosis. Posterior tilting, gliding of superior vertebra. Lumbar extension reduces the diameter of intervertebral foramina. Fewer ligaments checks extension. During lumbar extension nucleus pulposus displaces anteriorly.

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Lateral flexion: Superior vertebra laterally tilts, rotates and translates over vertebra below. Annulus fibrosus is compressed on convex side. Nucleus pulposus migrate slightly towards convex side of bend. Spinal rotation: Rotation causes movement of vertebral arch in opposite direction. Ipsilateral facet joints go for gapping and contralateral facet joints for impaction. Axial rotation to for right, between L1 and L2 for instance, occurs as left inferior articular facet of L1 approximates or compresses against left superior articular facet of L2. Limited due to shape of zygapophyseal joints. Also restricted by tension created in stretched capsule of apophyseal joints and stretched fibres within annulus fibrosus. Amount of rotation available at each vertebral level is affected by position of lumbar spine. When flexed, range of motion in rotaton is less than when in neutral position. The posterior annulus fibrosus and PLL limit axial rotation when spine is flexed. The largest lateral flexion range of motion and axial rotation occurs between L2 and L3.

SPINAL COUPLING: Kinematic phenomenon in which movement of the spine in one plane is associated with an automatic movement in another plane. Most consistent pattern involves an association between axial rotation and lateral flexion. With lateral flexion, pronounced flexion

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and slight ipsilateral rotation occurs. With axial rotation, however, substantial lateral flexion in a contralateral direction occurs. Lumbo-pelvic rhythm: The kinematic relationship between lumbar spine and hip joints during sagittal plane movements. Bending forward-lumbar flexion(40ᶿ) followed by anterior tilting of pelvis at hip joint(70ᶿ). Return to erect-posterior tilting of pelvis at hips followed by extension of lumbar spine. Integration of motion of pelvis about hip joints with motion of vertebral column. Increases range of motion available to total column. Reduces amount of flexibility required for lumbar region. Hip motion: Eliminates need for full lumbar flexion. Protecting annulus fibrosus and posterior ligaments from being fully lengthened.

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KINETICS: Compression- Lumbar region provides support for weight of upper part of body in static as well as in dynamic situations. Lumbar region must also withstand tremendous compressive loads produced by muscle contraction. Lumbosacral loads in erect standing posture in range of 0.82 to 1.18 times body weight. During level walking in range of 1.41 to 2.07 times body weight. Changes in position of body will change location of LOG and thus change forces acting on lumbar spine. Lumbar interbody joints share 80% of load, zygapophyseal facet joints in axial compression share 20% of total load. This % can change with altered mechanics: with increased extension or lordosis, zygapophyseal joints will assume more of the compressive load. Also with degeneration of intervertebral disk, zygapophyseal joints will assume increased compressive load. Shear- In upright standing position, lumbar segments are subjected to anterior shear forces caused by: lordot ic position, body weight, ground reaction forces. Resisted by direct impaction of inferior zygapophyseal facets of the superior vertebra against superior zygapophyseal facets of adjacent vertebra below. PLL is most heavily innervated while anterior, sacroiliac and interspinous ligaments receives nociceptive nerve endings. The lumbar intervertebral discs are innervated posteriorly by sinuvertebral nerves. Laterally by branches of ventral rami and grey rami communicate. PATHOMECHANICS: Exaggerated lordosis- Abnormal exaggeration of lumbar curve. Weakened abdominal muscles. Tight hip flexors, TFL, and deep lumbar extensors. Increase compressive stress on posterior elements. Predisposing to low back pain.

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Sway back- Increased lordot ic curve and kyphosis. Weak: lower abdominals, lower thoracic extensors and hip flexors. Tight:Hip extensors, lower back extensors and upper abdominals. Flat back posture- Relative decrease in lumbar lordosis (20ᶿ). COG shifts anterior to lumbar spine and hips. Lumbar contusions, strains and sprains, fractures and dislocations- 75 to 80% of population experiences low back pain stemming from mechanical injury to muscles, ligaments or connective tissue.(6) EFFECTS OF LOW BACK PAIN ON ACTIVITY LOSS: Restriction of movement, specifically on the movement of affected area of the back. Problems with leg movements are also frequently experienced. Affects a wide range of activities but its direct effects may vary from person to person. In some people, back pain disrupts physical

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activities such as walking, climbing up the stairs, bending and twisting, lifting heavy objects, prolonged sitting and standing. Aside from posture and movement, the pain can also affect one’s concentration and this may cause difficulty in carrying out tasks that demand a lot of attention. The discomfort that occur with back problems may also impact the quality of your sleep. You may find it difficult to get sleep at night because of the pain. In some cases, the pain gets worse in middle of night and because of this, your body fails to rejuvenate. You may feel tired at day time, and this can make it even more difficult to tolerate the pain. Chronic back pain has significant occupational and financial implications. It has been estimated that around 10% of all days lost from work through illnesses are due to back pain. (7) Causes of acute low back pain: The exact source of acute low back pain is often difficult to identify. In fact, there are numerous possible pain producers including muscles, soft connective tissue, ligaments, joint capsules and cartilage, and blood vessels. These tissues may be pulled, strained, stretched or sprained. Additionally, annular tears (small tears that occur in the outer layer of the intervertebral disc) can initiate severe pain. Even if the actual tissue damage is minor, and likely to repair quickly, the pain experienced may be quite severe. No matter which tissue is initially irritated, a cascade of events occurs which contributes to the pain experience. Numerous chemical substances are released in response to tissue irritation. These substances “stimulate” the surrounding pain sensitive nerve fibers, resulting in the sensation of pain. Some of these chemicals trigger the process of inflammation, or swelling, which also contributes to pain. The chemicals associated with this inflammatory process feed back more signals which perpetuate the process of swelling. The inflammation attributable to this cycle of events may persist for days to weeks. Muscular tension (spasm) in the surrounding tissues may occur resulting in a “ trunk shift” (the body tilts to one side more than the other) due to muscular imbalance. Additionally, a relative inhibition or lack of the usual blood supply to the affected area may occur so that nutrients and oxygen are not optimally delivered and removal of irritating byproducts of inflammation is impaired.(8) Causes of chronic low back pain: Chronic low back pain may be the result by many different conditions. It may start from diseases, injuries or stresses to a number of different anatomic structures including bones, muscles, ligaments, joints, nerves or the spinal cord. The affected structure sends a signal through nerve endings, up the spinal cord and into the brain where it registers as pain. A number of different theories have developed to try to explain chronic pain but the exact mechanism is not completely understood. In general, it is believed that the nerve pathways that carry the pain signals from the nerve endings through the spinal cord and to the brain may become sensitised. Sensitisation of these pathways may increase the frequency or intensity with which pain is perceived. A stimulus that is usually not painful, such as light touch, can be amplified or changed by these sensitised pathways and experienced as pain. Sometimes, even after the original injury or disease process has healed, sensitised pathways continue to send signals to the brain. These signals feel just as real and sometimes worse than the pain caused by the original injury or disease process.

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Imagine an old television set or computer screen in which the same image is projected continuously. This image is eventually “burned” into the screen. Even when the screen is turned off, the image can still be seen on the screen. In the same manner, after the original source of pain is healed or no longer present, chronic pain patients may continue to feel pain. Although this is an oversimplification of what may happen in chronic pain, it helps to illustrate the current understanding of this condition. (9) Thus from this we can inferred that low back is most vulnerable area for physiotherapy students.

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CONCLUSION

From 1st-4th year BPT students the most affected area is low back.

1. The highest chronic pain in percentage is in 4th year by 30.20%

2. highest loss of activity is in 2nd year by 9.90%

3. highest acute pain is in 4th year by 11.40%.

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RECOMMENDATION

•

EXERCISES FOR LOWER BACK:-

BACK AND CORE STRENGTH

CAT AND CAMEL EXCERISES

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LUMBAR ROTATION (LOWER TRUNK ROTATION)

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EXERCISES FOR NECK

NECK MUSCLES STRETCH

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ISOMETRICS FOR NECK

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•

EXERCISES FOR SHOULDER

MOBILITY EXERCISES FOR SHOULDER WITH WEIGHT CUFFS

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•

EXERCISES FOR BOTH SHOULDER AND NECK

FOR TIGHTNESS IN NECK AND SHOULDER MUSCLES

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REFERENCES

1. http://www.healthline.com/health/musculoskeletal-disorders#Overview1,Written by Kristeen Cherney,Medically Reviewed by William Morrison, MD on 18 October 2016 2. Work-related Musculoskeletal Disorders (WMSDs) Work-related Musculoskeletal Disorders (WMSDs) _ OSH Answers.html last updated on January 8, 2014 3. http://www.webmd.com/back-pain/ss/slideshow-low-back-pain-overview Reviewed by Arefa Cassoobhoy, MD, MPH on December 15, 2015 Date on which assessed is 6 october 2016 4. http://www.spine-health.com/wellness/ergonomics/tips-prevent-back-pain-kids-backpacks Backpacks and Back Pain in Children-webmd, By John J. Triano, DC, PhD, Updated-08/10/2012 Published-09/19/2000, Date on which assessed is 6 october 2016 5. The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain,CPDO Online Journal (2010), March, p1-14. www.cpdo.net https://www.scribd.com/document/68018311/Lederman-the-Fall-of-the-Postural-structural- biomechanical-Model,Eyal Lederman*,CPDO Ltd., 15 Harberton Road,London N19 3JS,UK,Date on which assessed is 6 october 2016 6. http://www.slideshare.net/venus88/biomechanics-of-lumbar-spine Venus Pagare, Assit. Professor at Padmashree Dr. D.Y. Patil College of Physiotherapy, Pimpri, Pune,Published on Apr 7, 2014,Date on which assessed is 6 october 2016 7. http://www.foundhealth.com/back-pain/effects-of-back-pain,Written by maria_rn.,Date on which assessed is 6 october 2016 8.http://www.knowyourback.org/Pages/SpinalConditions/LowBackPain/Acute.aspx,Date on which assessed is 6 october 2016 9.http://www.knowyourback.org/Pages/SpinalConditions/LowBackPain/Chronic.aspx, Date on which assessed is 6 october 2016

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CONSENT FORM

I hereby give my consent for research survey Common Musculoskeletal Problems In Undergraduate Student Evaluated By Using Nordic Musculoskeletal Questionnaire.

The physiotherapist has informed me the accepted benefits of survey. I confirm that I read and fully understand the consent form. I agree for participation in research. Signature Name

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QUESTIONNAIRE

Demographic Questionnaire

NAME- AGE- GENDER- ADDRESS-

1. Posture you use for studying? Ans-

2. How many hours do you spend in lectures? Ans-

3. How many hours do you spend at home in studies? Ans-

4. In what position do you rest? Ans-

5. Do you take break in-between studies How many breaks and duration of breaks? Ans-

6. Do you change positions while sitting or standing? How offen? Ans-

7. How tired are you at the end of routine day physically / mentally ? Ans- Not at all tired

Less tired Tired Very tired Severely tired

8. Do you regularly exercise?

⃝ Yes ⃝No

9. How much time you exercise? Ans- /day , /week

10. What kind of exercise do you do? Ans-

11. How is your posture while doing daily activities? ⃝Standing ⃝Sitting ⃝Bending ⃝Stooping ⃝Squatting

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12. Do you suffer from pain?

⃝Yes ⃝No

13. How long does the pain persists? Ans- 14. Aggravating factor- 15. Relieving factor- 16. Do you stop work because of pain? ⃝Yes ⃝No 17. Do you suffer from any other muscular skeletal problems? Stiffness/Restricted joint movements- Weakness of muscles- Swelling- 18. Have you taken any treatment for muscular skeletal problem? ⃝Yes ⃝No If yes, ⃝Physiotherapy ⃝Home Remedy ⃝General Physician/ medicine 19. Do you have any breathing problems? Ans- 20. What is the nature of pain? ⃝Stabbing ⃝Radiating ⃝Stretching ⃝Dull Aching 21. Is there any day which is free of pain? Ans- 22. What kind of bag do you use while going to college? ⃝Handbag ⃝Shoulder Bag ⃝Back Pack 23. How is the onset of pain? ⃝Early in the morning ⃝on-off ⃝End of day ⃝Continuously throughout the day 24. How much load do you carry everyday approximately? ⃝2kg ⃝3kg ⃝4kg ⃝more than 4kg ⃝less than 2kg 25. Does your pain affect your studies? ⃝Yes ⃝No

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26. Is your sleep getting disturbed because of pain? Ans- 27. What provokes pain? ⃝Long Standing ⃝Long Sitting ⃝Kneeling ⃝Squatting ⃝Bending ⃝Others 28. Do you have any addictions? ⃝Smoking ⃝Alcohol ⃝Tobacco ⃝Others 29. If yes, then specify doses? ⃝Daily ⃝2-3 days/week ⃝Once a week ⃝Rarely 30. What method do you use to alleviate your discomfort ⃝Ice ⃝Stretching ⃝Changing Positions ⃝Heat ⃝More Breaks ⃝Physiotherapy ⃝Any other please specify ⃝None

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