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ABSTRACT
PURPOSE OF THE STUDY
To compare the effectiveness of Muscle Energy Technique and Maitland mobilization
coupled with Ultrasound in patients with periarthritis%%quotesdetected%% of shoulder
joint.
MATERIALS AND METHODS
20 subjects with periarthritis were randomly allocated. The subjects were treated Ultrasound
coupled with Muscle Energy Technique (Group I) and Maitland Mobilization (Group II).The
treatment was given for 45 minutes a day up to 2 months. The outcome was measured in
terms of shoulder pain and disability index (SPADI).
RESULTS
Independent t- test was used to compare the pre test and post test values between each
groups. On comparing the mean values of SPADI of two groups, the study shows there is a
significant increase in the post test values of ultrasound coupled with muscle energy
technique than Ultrasound coupled with Maitland Mobilization. %%quotesdetected%%
CONCLUSION
Ultrasound coupled with muscle energy technique is more effective than Maitland
mobilization in reducing pain and disability, enhancing shoulder function among periarthritis
subjects.
KEY WORDS
Maitland mobilization, Ultrasound, Muscle Energy Technique, Neer’stest, shoulder joint,
periarthritis. %%quotesdetected%%

INTRODUCTION
The shoulder joint (glenohumeral joint) is a ball and socket joint between the scapula and
humerus. It is the major joint connecting the upper limb to the trunk. It is one of the most
mobile joints in the human body, at the cost of joint stability. The shoulder joint is formed by
the articulation of the head of the%%quotesdetected%% humerus with the glenoid cavity of
the scapula. This gives rise to the alternate name for the shoulder joint. Like most synovial
joints, the articulating surfaces are covered with hyaline cartilage. The head of the
humerus%%quotesdetected%% is much larger than the glenoid fossa, giving the joint a wide
range of movement at the cost of inherent instability. To reduce the disproportion in
surfaces, the glenoid fossa is deepened by a fibrocartilage rim, called the
glenoid%%quotesdetected%% labrum. As a ball and socket synovial joint, there is a wide
range of movement permitted: Flexion, Extension, Abduction, Adduction, Internal rotation,
External rotation.
Shoulder joint is one of the most rewarding and functional joints involved in daily routines
including performances, occupational and recreational activities. Operation of this joint
facilitates stability and mobility which often mutually co-exist between the upper and lower
limb movements during skilled and powerful activities of the hands. The joints in human
body get affected by different disabilities, of which arthritis represents a major one. Arthritis
of the shoulder joint is reported since 1872, described as ‘Humero Scapular Periarthritis’. The
ailment was renamed as ‘Frozen Shoulder’ in 1934 by Codman and later described as
‘Adhesive Capsulitis’, by
Neviarer in 1945, who reported the occurrence of this ailment amongst 7%-21% of the
population. %%quotesdetected%% The condition is characterized by painful stiff shoulder.
Shoulder pain is a commonly encountered problem, with prevalence studies indicating a
frequency of 7–20% among the adult general population. Frozen shoulder, also called
adhesive capsulitis, %%quotesdetected%% is one of the diseases that cause shoulder pain.
The incidence of this condition in the general population is between 2% and 5%. It is more
common among women aged 40–60 years. The disease is characterized by pain, loss of
function, and loss of joint range of motion (ROM). Its etiology is incompletely elucidated. The
pathologic anatomy of frozen shoulder includes synovial inflammation, joint capsule
hypertrophy, and a resulting development of fibrous structures. The condition occurs
bilaterally in 20–30% of cases. Awareness of the disease generally starts with a sensation of
strain while performing critical movements and joint pain when moving in any direction.
One of the main complaints in patients with shoulder pain is functional disability. Treatment
of shoulder pain is usually aimed at pain reduction and improvement of functional
disabilities. Consequently, outcome measurements should include an instrument (e.g.,
questionnaire) for the evaluation of functional disabilities. There are several self-
administered shoulder pain and disability questionnaires. Patients ranked the Shoulder
Disability Questionnaire (SDQ) and the Shoulder Pain and Disability Index (SPADI) as the
most relevant questionnaires. The SPADI was the least time- consuming, both the SDQ and
the SPADI appear to be convenient and easy to complete. The SPADI was originally
developed in English. It has been translated and validated in several languages and showed
excellent reliability and responsiveness.
The cases of chronic adhesive capsulitis are%%quotesdetected%% reported to be
responding well to therapeutic massage with muscle energy technique (MET), leading to
decreases in pain and increase in functional quality. MET is generally classified as a direct
technique against other methods,
because the muscular effort%%quotesdetected%% is in the form of controlled position at
specific direction against its counterforce. However, the key exercise of this method is to
normalize the joint range, rather than
improving joint flexibility. These techniques have been recommended for all joints with
restricted
Range of Motion (ROM) identified during the passive assessment.

The correlation between the tightness in a joint capsule and pattern of motion restriction ina
joint was revealed by Hannafin %%quotesdetected%% et al. Agonizing shoulder, freezing
stage with chronic pain, frozen stage with significant limitation of ROM and thawing phase
with progressive improvement in ROM have been identified as the major phases of frozen
shoulder. End range mobilization of the shoulder joint and intensive mobilization techniques
[MT] have been identified as useful approaches for reducing the risk of stiffness or joint
contracture progression in patient with adhesive capsulitis%%quotesdetected%%. However,
MET has been reported to be facilitating release of muscles and promoting body healing
mechanisms and improving shoulder ROM.
Three phases of clinical presentationPainful freezing phase%%quotesdetected%%
Duration 10-36 weeks, Pain and stiffness around the Shoulder with no history of injury. A
nagging constant Pain is worse at night, with little response to Non-steroidal anti-
inflammatory drugs
Adhesive phase

Occurs at 4-12 months. %%quotesdetected%% The pain gradually subsides but stiffness
remains. Pain is apparent only at the extremes of movement. Gross reduction of
glenohumeral movements, with near total obliteration of external rotation
Resolution phase
Takes 12-42 months. Follows the adhesive phase with spontaneous improvement in the
range of movement. %%quotesdetected%% Mean duration from onset of frozen shoulder to
the greatest resolution is over 30 months
MET is a unique technique in which the patient provides the corrective force rather than the

care provider. MET is defined as the procedure that provides voluntary con- traction of the
muscle
at varying levels of intensity, in a very controlled direction, against a force applied by the
care provider. The potential applications of MET includes lengthening and strengthening of
muscles, increasing fluid flow and decreasing local edema.
Application of ultrasound as a therapeutic modality has been in practice since the 1940’s.
Potential heating effect, promotion of tissue relaxation, easing local blood flow, and
breaking down of the scar tissue achieved through ultra- sound therapy makes it a highly
useful treatment mode in physiotherapy. This therapy is used in the treatment of frozen
shoulder as well. Availability of the portable ultrasound device makes it a convenient mode,
followed at homes also. Visual Analog Scale (VAS) and Shoulder Pain and Disability Index
(SPADI) are standard measurement tools in clinical practices comparing the pain and physical
functional scores in a linear scale from mild to severe pain pre and post treatments.
Although, MET coupled with ultrasound therapy and joint mobilization technique coupled
with ultra sound technique are effective in treating periarthritic%%quotesdetected%%
shoulder, it would be interesting to determine the technique which is more effective in
treating periarthritic shoulder. The present study intends to compare the effectiveness of
MET coupled with ultrasound therapy and joint mobilization coupled with ultrasound
therapy in patients with periarthritic%%quotesdetected%% shoulder%%quotesdetected%%.
The term “Muscle Energy’’ suggests that effort and energy of person or patient performing
movements provide the primary force involved in process. It is used to help mobilize
restricted joints by stretching hypertonic muscles, capsules, ligaments, and fascia. This leads
to improved postural alignment and the restoration of proper joint biomechanics and
functional movement.
1.1 AIM OF THE STUDY
The Aim of the study is to compare the effectiveness of Muscle energy technique and
Maitland Mobilization coupled with Ultrasound in improving shoulder function on patients
among periarthritic%%quotesdetected%% shoulder subjects.
1.2 OBJECTIVES OF THE STUDY

To evaluate the effectiveness of Ultrasound coupled with Muscle energy technique to

improve the shoulder function on patients among %%quotesdetected%% periarthritic
shoulder subjects.
To evaluate the effectiveness of Ultrasound coupled with Maitland Mobilization to improve
the shoulder function on patients among periarthritic%%quotesdetected%% shoulder
subjects.
To compare the effectiveness of Muscle energy technique and Maitland Mobilization to
improve the shoulder function on patients among periarthritic shoulder subjects.
To compare the effectiveness of Muscle energy technique and Maitland Mobilization
coupled with Ultrasound to improve the shoulder function on patients among periarthritic
shoulder subjects.

1.3 NEED OF THE STUDY

Frozen shoulder can be a primary or idiopathic problem or it may be associated with another
systemic illness. By far the most common association of a secondary frozen shoulder is
diabetes mellitus. The incidence of frozen shoulder in diabetes patients is reported to be
10%- 36%.
The prevalence of shoulder pain throughout the whole lifetime is estimated to be
approximately %%quotesdetected%% 35% (Guerra de Hoyos et al, 2004). Shoulder problems
were believed to be connected with abnormal scapular dyskinesia and shoulder muscle
tension, spasms, and inflammation in the shoulder region like the rotator cuff syndrome as
well as associated joints such as glenohumeral, scapulothoracic, sternoclavicular and
acromioclavicular (Ratcliffe et al, 2014).
A variety of shoulder functional enhancement including Muscle Energy Technique and
Maitland Mobilization coupled with Ultrasound are used, to provide clinical evidence in the
management of individuals with shoulder pain to improve shoulder function.
2. HYPOTHESIS
Null hypothesis (HO) %%quotesdetected%%
There is no significant improvement in shoulder function following Ultrasound coupled with
Muscle energy technique among periarthritic shoulder subjects.
There is no significant improvement in shoulder function following Ultrasound coupled with
Maitland Mobilization among periarthritic%%quotesdetected%% shoulder subjects.
There is no significant improvement in shoulder function following Ultrasound coupled with
Muscle Energy Technique and Maitland Mobilization among
periarthritic%%quotesdetected%% shoulder subjects.
Alternate hypothesis (AO)
There is significant improvement in shoulder function following Ultrasound coupled with
Muscle energy technique among periarthritic shoulder subjects.
There is significant improvement in shoulder function following Ultrasound coupled with
Maitland Mobilization among periarthritic%%quotesdetected%% shoulder subjects.
There is significant improvement in shoulder function following Ultrasound coupled with
Muscle Energy Technique and Maitland Mobilization among periarthritic shoulder subjects.

3. OPERATIONAL DEFINITIONS:
PERIARTHRITIS:

Adhesive capsulitis and frozen shoulder syndrome (FSS) are two terms that have been used
to describe a painful and stiff shoulder. The current consensus definition of a frozen
shoulder by the American Shoulder and Elbow Surgeons is "a condition of uncertain etiology
characterized by significant restriction of both active and passive shoulder motion that
occurs in the absence of a known intrinsic shoulder disorder."
MAITLAND MOBILIZATION:
“The Maitland Concept of Manipulative Physiotherapy *as it became to be known+,
emphasizes a specific way of thinking, continuous evaluation and assessment and the art of
manipulative physiotherapy (“know when, how and which techniques to perform, and adapt
these to the individual Patient”) and a total commitment to the patient.”
The application of the Maitland concept can be on the peripheral or spinal joints, both
require technical explanation and differ in technical terms and effects, however the main
theoretical approach is similar to both.
ULTRASOUND:
Therapeutic ultrasound is a treatment modality commonly used in physical therapy. It is
used to provide deep heating to soft tissues in the body. These tissues include muscles,
tendons, joints, and ligaments.
MUSCLE ENERGY TECHNIQUE:

Muscle Energy Technique (MET) %%quotesdetected%% is a form of a manual therapy which

uses a muscle’s own energy in the form of gentle isometric contractions to relax the muscles
via autogenic or reciprocal inhibition, and lengthen the muscle. As compared to static
stretching which is a passive technique in which therapist does all the work, MET is an active
technique in which patient is also an active participant. MET is based on the concepts of
Autogenic Inhibition and Reciprocal Inhibition. If a sub-maximal contraction of the muscle is
followed by stretching of the same muscle it is known as Autogenic Inhibition
MET, and if a sub-maximal contraction of a muscle is followed by stretching of the opposite
muscle than this is known as Reciprocal Inhibition MET.
GLENOHUMERAL JOINT MOBILISATION:
%%quotesdetected%% Skilled passive movement of the articular in shoulder joint performed
by a physical therapist to decrease pain or increase joint mobility.
SCAPULAR STABILISATION EXERCISE:

Scapula stabilization exercises to strengthen the trapezius and serratus anterior muscle,
which are responsible for stabilizing the scapula. They also restore the position and
movement of the scapula to prevent any secondary damage to theshoulder joint, and help to
restore the range of motion in shoulder.
SHOULDER FUNCTION:

Shoulder function is a compromise between mobility and stability. Its large mobility is based
on the structure of the%%quotesdetected%% glenohumeral joint and simultaneous motion
of all segments of the shoulder girdle. This requires fine-tuned shoulder muscle
coordination. Given the joint's mobility, stability is mainly based on active muscle control
with only a minor role for the %%quotesdetected%% glenohumeral%%quotesdetected%%
capsule, labrum and ligaments.

PAIN INTENSITY:

Pain intensity was measured using a numeric rating scale (NRS). The NRS is a clinically
standard instrument used to assess in patients with chronic pain. The NRS involved asking
the patients to rate their pain from 0 (best) to 10 (worst), with 0 representing one end of the
pain intensity.

RANGE OF MOTION (ROM):

The ROM was actively measured using a standard goniometer during shoulder flexion and
abduction in sitting positions. The ROM test was performed three times consecutively
without pain and the average of the tests was calculated. This device has a reliability of
.95and a validity of .85 (Kolber and Hanney, 2012).

REVIEW OF LITERATURE
The review of literature is instrument to get clear idea and supports the findings with regard
to the problem under study. An essential aspect of research project is the review of related
literature. Survey of the literature is a crucial aspect of the planning of the study and the
time spend in such a survey is wise. The study of the relevant literature is an essential step to
get a full picture of what has been done and said with regard to the problem under study.
such a review brings about deep inside and clear perspective of the overall field.

Janda (2010); %%quotesdetected%% suggests that before any attempt is made to

strengthen weak muscles, any hypertonicity in their antagonists should be addressed by
appropriate treatment which relaxes (and if appropriate lengthens) them.
Greenman (1989) depicts that Muscle Energy Technique helps to regain the mobility of the
hypomobile joints by restoring normal length tension relationships which are shortened and
by strengthening the weakened muscles and reduce edema by pumping action for lymphatic
system.
Handel et al quoted that MET procedures and post isometric procedures such as
Proprioceptive Neuromuscular Facilitation (PNF), %%quotesdetected%% have concluded to
be more effective than static stretching for improving extensibility of shortened muscle.
There is very little strain on the therapists as long as proper body mechanics are used.
Individuals who suffer from headache or chronic shoulder, neck or back pain may find relief
through MET.An experimental study concluded that MET produced a change in ROM was
possibly due to an increased tolerance to stretch, as there was no evidence of viscoelastic
change.
Baena de Leon E, et. al,(2002): The interplay of 4 articulations of the shoulder complex,
results in an coordinated movement pattern of the arm elevation. The involved movements
at each joint are continuous, although occurring at various rates and at different phases of
arm elevation. The movement of the scapula can be described by rotations in relation to the
thorax. The scapula moves around a dorso-ventral axis, resulting in a rotation in the frontal
plane. The %%quotesdetected%% glenoid cavity is turned In this movement
cavity is turned cranially (upward rotation) or caudally (downward rotation). In the sagittal
plane, around a latero-lateral axis the scapula rotates posteriorly (posterior tilting) or
anteriorly (anterior tilting). External and internal rotation occurs around a cephalo-caudal
(longitudinal) axis. The external rotation brings the glenoid cavity more into the frontal
plane, whereas the internal rotation turns the glenoid cavity.
Hess SA, Richardson C, Darnell R, et. al,(2005): When we perform abduction, the GH- joint
contributes 90-120°. The combination of scapular and humeral movement result in a
maximum range of elevation of 150-180°. Also by abduction Inman et al. reported an
inconsistent amount and type of scapular motion in relation to GH- motion this time during
the initial 30°. In this early phase, motion occurs primarily at the GH joint, although stressing
the arm may increase the scapular contribution.
Park SI, Choi YK, Lee JH, et. al,(2009): The Disabilities of the Arm, Shoulder, and Hand (DASH)
questionnaire, the Shoulder Pain and Disability Index (SPADI) and the American Shoulder and
Elbow Surgeons (ASES) score. These questionnaires have been shown acceptable for clinical
use. These questionnaires are specific for scapulohumeral rhythm disorders.
Ratcliffe E, Pickering S, McLean S, et. al,(2010): The Shoulder Pain and Disability Index
(SPADI) was developed to measure current shoulder pain and disability in an outpatient
setting. The SPADI contains 13 items that assess two domains; a 5-item subscale that
measures pain and an 8-item subscale that measures disability. There are two versions of the
SPADI; the original version has each item scored on a visual analogue scale (VAS) and a
second version has items scored on a numerical rating scale (NRS). The latter version was
developed to make the tool easier to administer and score.
JS, Moffet H, Hebert LJ, et. al,(2011): The original version the patient was instructed to place
a mark on the VAS for each item that best represented their experience of their shoulder
problem. Each subscale is summed and transformed to a score out of
100. A mean is taken of the two subscales to give a total score out of 100, higher score
indicating greater impairment or disability. In the NRS version the VAS is replaced by a 0-10
scale and the patient is asked to circle the number that best
describes the pain or disability.

Kolber and Hanney, et.al,(2011): The SPADI demonstrates good construct validity, correlating
well with other region-specific shoulder questionnaires .
(Hawker et al, 2011).: It has been shown to be responsive to change over time, in a variety of
patient populations and is able to discriminate adequately between patients with improving
and deteriorating conditions.

%%quotesdetected%% Tucci HT, Martins J, Sposito Gde C, et. al,(2010): When the SPADI is
used more than once on the same subject, eg, at initial consultation and then at discharge,
the minimal detectible change is noticed.
Walther M, Werner A, %%quotesdetected%% Stahlschmidt T, et. al,(2011): The Shoulder
Pain and Disability Index (SPADI) is a self-administered questionnaire that consists of two
dimensions, one for pain and the other for functional activities. The pain dimension consists
of five questions regarding the severity of an individual's pain. Functional activities are
assessed with eight questions designed to measure the degree of difficulty an individual has
with various activities of daily living that require upper- extremity use. The SPADI is the
reliable and valid region-specific measure for the shoulder.

METHODOLOGY
STUDY DESIGN:
Experimental study comparative in nature.
STUDY SETTING:
OPD of Career College of Physiotherapy.
SUBJECTS:
20 subjects were included in the study.
PROJECT DURATION:
2 months
STUDY DURATION:
45 days.
TREATMENT DURATION:

45 minutes
SAMPLING METHOD:
Convenient sampling method.

INCLUSION CRITERIA
Age between 35-50 years.
Only male were included.
Subjects with Chronic periarthritic%%quotesdetected%% shoulder
EXCLUSION CRITERIA
Malignancy in area of treatment
Infectious Arthritis
Metabolic Bone Disease
Neoplastic Disease
Fusion or Ankylosis%%quotesdetected%%
Osteomyelitis
Fracture or Ligament Rupture
Arthroplasty
Hypermobility
MATERIALS AND MEASUREMENT TOOL:
Informed consent
Patient information sheet
Shoulder pain and disability index chart
Couch with bed
Ultrasound

VARIABLES:
Independent variables:
Maitland Mobilization
Muscle Energy Technique
Ultrasound

Dependent variables:
Shoulder joint pain and Function

PROCEDURES
The subjects were screened based on the inclusion and exclusion criteria. The subjects were
explained about the Ultrasound coupled with Muscle Energy Technique and Maitland
Mobilization. The purpose of study was explained to them and informed consent was
obtained. The subjects were randomly assigned into Group I and Group II. The subjects in
Group I were treated with Ultrasound coupled with Muscle Energy Technique, the subjects
in group II were treated with ultrasound coupled with maitland %%quotesdetected%%
mobilization
The treatment was given for the total time period of 45 minutes.

MUSCLE ENERGY TECHNIQUE COUPLED WITH ULTRASOUND

The subjects of Group A received Muscle energy technique coupled with ultrasound therapy
(called as METU here- after) for Glenohumeral joint restricted flexion, joint restricted
abduction, and joint restricted external rotation.
For flexion, the therapist placed one hand at the subject’s superior part of the scapula and
glenohumeral joint to examine for motion. The other hand of the therapist supported the
subject’s flexed elbow and stretched the humerus bone at the
glenohumeral%%quotesdetected%% joint in the sagittal plane to the initial point of
resistance. The subject was subsequently instructed to extend his elbow against the
therapist’s counterforce. The force was maintained for 5 s and let to relax for 2 s.
For abduction, the therapist placed hand to cup %%quotesdetected%% the glenohumeral
joint to examine for motion. The subject was directed to press his elbow towards the body.
MAITLAND MOBILIZATION COUPLED WITH ULTRASOUND:
The subject is advised to rest in one end of the couch in supine position, Joint mobility is
tested according to ordinal scale (joint mobility), subjects satisfying grade 2 of ordinal scale
were selected for mobilisation.
Applying translatory glide thrust mobilization grade V to the affected shoulder joint (concave
surface: glenoid fossa %%quotesdetected%% and convex surface: humerus head).

Grade I – small amplitude movement at the beginning of the available ROM

 Grade II – large amplitude movement at within the available ROM Grade III – large
amplitude movement that reaches the end ROM Grade IV – small amplitude movement at
the very end range of motionGrade V%%quotesdetected%% – high velocity thrust of small
amplitude at the end of the
available %%quotesdetected%% range and within its anatomical range (manipulation)

The Group B patients received Mobilization technique (general) coupled with ultrasound
therapy (called as MTU hereafter) for glenohumeral%%quotesdetected%% joint abduction,
joint external rotation, joint forward flexion.
For flexion, the subject was allowed to lie in a supine position and the affected arm was
made to rest on the edge of the resting table and the upper limb was brought forward to
flexion. The arm of the subject was supported against the therapist’s trunk; the distal
humerus %%quotesdetected%% of the subject was grasped by the therapist’s lateral hand.
The lateral border of the therapist’s top hand was placed ina distal position to the anterior
margin of the joint, with the fingers positioned in a superior position. Caudal glide was per-
formed to improve rotation and range beyond 90 degrees.
For abduction, the subject was made to lie in a supine position with the arm in resting
position. The forearm of the subject was supported between the therapist’s trunk and
elbow. The therapist stood on the affect side of the subject facing toward the cephalic end.
The therapist subsequentlyplaced one hand on the subject’s axilla thereby providing grade 1
distraction. %%quotesdetected%% The web space of the therapist’s other hand was placed
distally to the acromion and subsequently caudal glides were provided.
DISCUSSION

Shoulder pain and disability are the major common cause for shoulder dysfunction in
shoulder complex abnormalities. Scapula plays a major role in shoulder kinematics. Scapular
dysfunction may occur due to muscle weakness or injury to the shoulder complex.
In this study the effect of scapular stabilization exercise in enhancing shoulder function is
measured through shoulder pain and disability scale. After
45 days of experimentation, the results show that there is significant improvement
inshoulder%%quotesdetected%% function.
This study provides evidence that Ultrasound coupled with Muscle Energy Techniquewas
effective in improving shoulder function through SPADI scores from 63 to
28.8 with%%quotesdetected%% the mean difference of 34.4. And the Ultrasound coupled
with Maitland Mobilization gleno were from 65.6 to 35.4 with the mean difference of 30.2.
Hence Ultrasound coupled with Muscle Energy Technique improved in SPADI than
Ultrasound coupled with Maitland Mobilization. There was a significant difference between
the US coupled with MET and MM.

CONCLUSION
The study aims at exploring the effectiveness of Ultrasound coupled with Muscle Energy
Technique in the treatment of periarthritis %%quotesdetected%% shoulder to enhance
shoulder function by reducing shoulder pain and disability.
In this study we used Ultrasound coupled with Muscle Energy Technique and Maitland
Mobilization, the aim of the study is to find effectiveness of Ultrasound with Muscle Energy
Technique to enhance shoulder function among periarthritic%%quotesdetected%%
shoulder
This study concluded that the Ultrasound with Muscle Energy Technique in periarthritic
shoulder is more effective than Ultrasound with Maitland Mobilization in Periarthritic
%%quotesdetected%% shoulder condition.
LIMITATIONS AND FUTURE RECOMMENDATIONS

LIMITATIONS
This study was limited to small sample size of 20 subjects

Study researches concentrated only in improving shoulder function.

Short duration of study

The long term retention of training was not studied

Only one measurement tool (SPADI) was used for shoulder pain anddisability.
%%quotesdetected%%
FUTURE RECOMMENDATIONS

Sample size can be increased

Studies can be done with various duration%%quotesdetected%%
Studies can be done with larger samples
Further studies can include other measuring tools

It is recommended to do the studies with specific age and gender

DATA ANALYSIS

4.1 TECHNIQUE OF DATA ANALYSIS

The improvement in the reduction of pain and disability was calculated using the pre-test
and post-test taken before and after treatment.
The data obtained are analyzed using paired “t” test.
1. MEAN
2. STANDARD DEVIATION S

PAIRED
. “t” TEST
Where,
= calculated mean difference pre-test and post- testn%%quotesdetected%% = sample size
S.D=standard deviation

d =difference between pre and post-test

UNPAIRED “t” TEST

The unpaired “t” test was used to compare the statistical significant difference between
Group A and Group B.

FORMULA

%%quotesdetected%% Total number of subjects in Group I

=Total number of subjects in Group II

Difference between pre test and post test values of Group I Difference between pre-test
and post-test values of Group II

= Mean difference between pre test and post test values of Group I

=Mean difference between pre-test and post-test values of Group II.

Table 1, shows the comparative mean value, mean difference, standard deviation & SEM
between pre and post-test of Group I.

Table 1%%quotesdetected%%:

Above values shows that there is significant improvement in shoulder function among pre
&post-test values
Table -2, shows the comparative mean value, mean difference, standard deviation & SEM
between pre and post-test in Group II.
Table: 2

Above values shows that there is significant improvement in shoulder function among pre
and post-test value
Table-3, shows the comparative mean value, mean difference, standard deviation & paired’
value between pre and post-test of shoulder function in Group I and Group II.

In paired’ test the calculated’ value is 1.9908. Above values shows that there is significant
difference in improving shoulder function among Group I and Group II.
GRAPH-1
COMPARISION BETWEEN PRE-TEST AND POST-TEST MEANS INGROUP I:

Bar diagram shows pre-test and post-test Mean values of Group

Pre-test and post-test values are 63 and 28.6 respectively. This shows %%quotesdetected%%
thatthere is improvement of Mean value of pre and post-test of Group I
GRAPH-2
COMPARISION BETWEEN PRE-TEST AND POST-TEST MEANS INGROUP II:
Bar diagram shows pre-test and post-test Mean values of Group
Pre-test and post-test values are 65.6 and 35.4 respectively. This shows
thatthere%%quotesdetected%% is improvement of Mean value of pre and post-test of
Group II.
GRAPH-3
COMPARISION OF TWO GROUP I & II
RESULTS
The%%quotesdetected%% umber%%quotesdetected%% of subjects for the study was 20
(n=10).The subjects were divided into two groups (group I & group II).For group I Ultrasound
coupled Muscle Energy Technique was given. The group II received Ultrasound coupled with
Maitland Mobilization.
%%quotesdetected%% Readings of pre and post-test values of shoulder pain and disability of
Group I and II given in table 1 & 2 respectively. The result showed that for Ultrasound
coupled with Muscle Energy Technique , group I the mean values of pre-test and post- test
values were 63 and
28.6 respectively, %%quotesdetected%% and the mean difference is 34.4, standard
deviation is 5.6316 with SEM 1.7074.
The result showed that for Ultrasound coupled with Maitland Mobilization, group II the
mean values of pre- test and post-test values were 65.6 and 35.4 respectively, and the mean
difference is 30.2, standard deviation is 3.569 with SEM 1.0934.The paired ‘t’ value for
comparative analysis is 1.9639 at 0.005 levels, and p value is 0.0811. Thereby the null
hypothesis is rejected and alternative hypothesis is accepted.
Hence this study concludes that group I shows difference in significant improvement of
shoulder function than group II. We concluded that group I received Ultrasound coupled
with Muscle Energy Technique will be more effective than group II which received
Ultrasound coupled with Maitland Mobilization.
REFERENCE
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