Publications by authors named "V Prem"

17 Publications

Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis.

J Bodyw Mov Ther 2021 Jul 4;27:328-338. Epub 2021 Mar 4.

Department of Physiotherapy, Manipal College of Health Professions, MAHE, Bangalore, India. Electronic address:

Background: Dry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.

Methods: Databases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.

Results: Out of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.

Conclusion: Good quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.
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http://dx.doi.org/10.1016/j.jbmt.2021.02.015DOI Listing
July 2021

Comparison of Glutues Maximus Activation to Flexion Bias Exercises Along with MET Technique in Subjects with Anterior Rotated Sacroiliac Joint Dysfunction-a Randomised Controlled Trial.

Int J Ther Massage Bodywork 2021 Mar 1;14(1):30-38. Epub 2021 Mar 1.

Department of Physiotherapy, Manipal Academy Of Higher Education, School of Allied Health Sciences, Bangalore, India.

Background: Sacroiliac joint dysfunction (SIJD) is the primary source of low-back pain. Main muscles forming the force closure of sacroiliac joint are the biceps femoris and gluteus maximus which increase the stability through massive attachments via sacrotuberous ligament. However, there is a dearth of literature of the importance of activation of gluteus maximus in SIJD.

Purpose: To study the effect of gluteus maximus activation on Oswestry Disability Index (ODI), visual analog scale (VAS), and pelvic tilt angle in subjects with anterior rotated sacrolilac joint dysfunction.

Settings: The study was conducted in outpatient Physiotherapy Department, Manipal Hospital, Bangalore, India.

Participants: Anterior rotated SIJD subjects were recruited in the study. They were divided into two groups (experimental and control groups) by block randomisation.

Research Design: This is a randomised control trial.

Controlled Treatment: Treatment order was determined by block randomisation. The subjects of both experimental and control group received Muscle Energy Technique (MET) technique on 1 session to correct the anterior rotated SIJD. The experimental group received gluteus maximus activation protocol, whereas the control group received flexion bias exercises. The groups received the treatment of 20 mins per session. There were two supervised sessions per week for four weeks.

Main Outcome Measures: The primary outcome measure in the study is Oswestry Disability Index (ODI). The secondary outcome measures included visual analog scale (VAS) and Palpation Meter (PALM).

Results: 48 subjects (26 females, 22 males) were randomised into experimental and control groups having anterior rotation SIJD, and average age in groups was 38.83 ± 11.4 years and 34.96 ± 9.5 years, respectively. The within-group analysis showed significant improvements in only ODI outcome of both the groups ( = .001). The between-group analysis in both groups did not show any statistical significant difference in ODI, VAS, or PALM.

Conclusion: The flexion bias exercise and the gluteus maximus activation exercises used in this study were equally effective in improving physical function and reduction in pain, and maintaining the normal pelvic angle in subjects with anterior rotated SIJD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892328PMC
March 2021

Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed?

Orthop Traumatol Surg Res 2021 02 9;107(1):102766. Epub 2021 Jan 9.

University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore.

Purpose: This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder.

Materials And Methods: The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months.

Results: Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01).

Conclusion: This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques.

Level Of Study: II; Meta-analysis and systematic review.
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http://dx.doi.org/10.1016/j.otsr.2020.102766DOI Listing
February 2021

Effect of neuromuscular training on functional throwing performance and speed in asymptomatic cricket players.

J Bodyw Mov Ther 2019 Jul 17;23(3):502-507. Epub 2018 Feb 17.

Dept. of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Bangalore, Karnataka, India. Electronic address:

Objective: To determine the effect of neuromuscular training on functional throwing performance and speed among asymptomatic cricket players.

Design: Single-subject A-B-A design.

Method: Forty-three male asymptomatic sub-elite cricket players were recruited from Karnataka Institute of Cricket, Bangalore, India, with a mean age of 20.4 ± 2.03 years. Throwing accuracy and throwing speed were measured using Functional Throwing Performance Index (FTPI) and radar gun respectively, at zero, 12, 24 and 30 weeks in accordance with the A-B-A single-subject design. The neuromuscular training of the throwing arm was performed for 12 weeks, two days a week of supervised training including rhythmic stabilization drills were performed. A non-supervised training session including shoulder strengthening programme was conducted three days a week.

Result: Participants demonstrated significant improvement in throwing accuracy (p < 0.001) and speed (p < 0.001) after 12 weeks of neuromuscular training. Six weeks post-withdrawal of the neuromuscular training on throwing accuracy was not significant (p = 0.117), However, speed was sustained (p = 0.013).

Conclusion: Neuromuscular training showed an improved efficiency in throwing performance following 12 weeks of training in sub-elite cricket players. The sustained effect was not observed following 6 weeks of withdrawal of training.
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http://dx.doi.org/10.1016/j.jbmt.2018.02.014DOI Listing
July 2019

Effects of movement impairment based treatment in the management of mechanical neck pain.

J Bodyw Mov Ther 2018 Apr 24;22(2):534-539. Epub 2017 Jul 24.

Dept. of Physiotherapy, School of Allied Health Sciences, Manipal University, Bangalore, India. Electronic address:

Background: Neck pain is a common musculoskeletal complaint in computer users due to prolonged static or awkward work postures. It has been shown that pathogenesis of neck pain is associated with scapular movement impairment syndromes. However, there is a dearth of literature in treatment based on these syndromes.

Aim: To identify the effects of movement impairment-based treatment in the management of mechanical neck pain, in computer users.

Methods: In the present study, twenty-seven subjects were recruited. Based on the identified scapular impairment syndrome, they were trained with scapular movement impairment-based exercises for four weeks. Pain, disability and cervical range of motion were measured with numeric pain rating scale, neck disability index and inclinometer, respectively, at baseline and at four weeks.

Results: Twenty-one subjects completed the study. After four weeks, a significant difference of 4.81 points for numeric pain rating scale and 24.47% for neck disability index at 95% CI were found. The cervical range of motion showed a significant change (p < 0.05) of 10.09° for flexion, 24.47° for extension, 7.42° for right lateral flexion, 6.23° for left lateral flexion, 15.52° for right rotation and 14.95° for left rotation at 95% CI.

Conclusions: Exercises based on scapular impairment syndromes were given for four weeks. It was found to be effective in relieving pain and reducing dysfunction in computer users with mechanical neck pain.
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http://dx.doi.org/10.1016/j.jbmt.2017.07.007DOI Listing
April 2018
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