Journal Riphah College of Rehabilitation Sciences

Role of Dry Needling in Management of Cervicogenic Headache: A Systematic Review

2025-10-16T05:33:35+00:00

Background: Cervicogenic headache is one of the most common types of headache. It is caused due to musculoskeletal dysfunction in the cervical muscles. The underlying mechanisms involve myofascial trigger points. Dry needling is a technique that targets these myofascial trigger points. This technique is considered as an effective non-pharmacological method for treating cervicogenic headaches.

Objective: The purpose of this review is to evaluate the clinical significance and therapeutic effectiveness of dry needling. It focuses on its effects on pain reduction, cervical function, and patient-reported outcomes.

Methodology: Peer-reviewed articles from databases like PubMed, ScienceDirect, and Google Scholar are included. The study designs are meta-analyses, systematic reviews, and randomized controlled trials. Patients who have symptoms like cervical pain, range of motion, and functional activities are included.

Results: According to the reviewed literature, dry needling is considered an effective treatment option. It improved cervical range of motion, lowered the frequency and severity of headaches, and improved the quality of life. It has better outcomes when combined with traditional physical therapy. More research is needed to determine its long-term effects.

Conclusion: Dry needling seems to be a clinically significant intervention for the treatment of cervicogenic headaches. Current evidence supports its short-term effectiveness. More high-quality research is required to determine long-term outcomes and establish standardized protocols.

Keywords: Dry Needling, Cervicogenic Headache, Myofascial Trigger Points, Cervical Spine, Neck Pain

Digital Health: Pakistan’s Missing Link to Equitable Rehabilitation Access

2026-02-16T07:59:41+00:00

Effectiveness of McKenzie Neck Exercise Combined with Conventional Physical Therapy versus Conventional Physical Therapy Alone in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial

2025-10-08T11:00:13+00:00

Background: Neck pain is a common problem, commonly associated with poor posture, mechanical stress or trauma. It is often nonspecific, i.e. no underlying disease is detected. Neck pain may interfere with the normal life and result in a chronic ache. The goal of the effective treatments, the physical therapy and exercises, including McKenzie technique, is to relieve pain and restore mobility.

Objective: To identify the superior outcome between McKenzie exercises versus conventional physiotherapy versus conventional physical therapy on its own in reducing pain and enhancing functionality and cervical range of motion in patients with persistent nonspecific neck pain.

Methodology: The present study was designed as a randomized controlled trial (RCT) conducted in the Hayatabad Medical Complex, Peshawar. A total of 26 participants were included, with sample size calculated using G*Power software (effect size = 1.0, power = 80%, α = 0.05). Participants were randomly allocated into control and experimental groups using a lottery. The Control group participants were given conventional physiotherapy only, whereas the experimental group received conventional physiotherapy with the addition of the McKenzie exercise. The numerical pain rating scale was used for pain. The Neck Functional Disability Scale was used for functional disability, and cervical ranges were measured through a goniometer

Results: The mean age of the participants was 43.35 ± 10.19 years. Male participants were 16 (61.5 %) and female participants were 10 (38.5 %). There were statistically significant differences in the NPRS score (p = 0.047), CNFDS score (p = 0.042), cervical flexion range (p = 0.046), cervical extension range (p = 0.035), cervical left rotation range (p = 0.025), cervical right rotation range (p = 0.051), cervical left lateral flexion range (p = 0.040) and cervical right lateral flexion range (p = 0.031) between control and experimental groups.

Conclusion: This study revealed that McKenzie exercises, along with conventional physiotherapy, are more effective at decreasing neck pain, and improving functionality, and cervical ROM than conventional physiotherapy alone in the context of chronic nonspecific neck pain. This advantage can be explained by the fact that the McKenzie method focuses on recurrent end-range movements and postural correction that assist in decreasing mechanical stress, centralizing pain, and increasing spinal mobility via active patient interaction.

Keywords: Chronic Non-specific neck pain, Copenhagen neck functional disability scale,

McKenzie Exercise, NPRS.

Effect of Lumber Sustained Natural Apophyseal Glides on Lower Cross Syndrome: A Randomized Controlled Trial

2025-10-16T05:17:38+00:00

Background: Lower cross syndrome, also referred to as pelvic crossed syndrome, develops when insufficient muscle strength causes an imbalance in the lower extremities. It is marked by a pattern of weakness and tightness between opposing muscle groups on the front and back of the body. Lumbar sustained natural apophyseal glides (SNAGs) are a mobilization technique used to reduce pain, correct hypomobility and biomechanical faults such as anterior pelvic tilt and hyperlordosis, and improve posture and function.

Objective: To determine the effect of lumbar SNAGs on pain and hypomobility in individuals with Lower Cross Syndrome.

Methodology: A randomized controlled trial was conducted at Gulam Abbas Orthopedic Hospital, kotli, Azad Kashmir and the District Headquarter Hospital, kotli Azad Kashmir, with a sample size of 36 participants determined by G*Power (effect size 0.25, α = 0.05, power = 0.95). Participants were allocated into two group using non-probability purposive sampling technique Group A (lumbar SNAGs plus moist heat, stretching tight erector spinae, hip flexors and strengthening of weak abdominals and gluteal muscles) and Group B (moist heat with stretching tight erector spinae, hip flexors and strengthening of weak abdominals and gluteal muscles only, with 5-7 reps of 1 set of each exercise, delivered three times a week for three weeks. Pain was assessed using the Numeric Pain Rating Scale and lumbar range of motion using goniometer. (Clinical Trial Registry Number: (NCT06707805)

Results: Between-group analysis demonstrated statistically significant effects of lumbar SNAGs combined with conventional therapy, showing a reduction in pain intensity (p < 0.05) and an improvement in lumbar range of motion (p ≤ 0.05).

Conclusion: This study concludes that the addition of lumbar SNAGs to conventional therapy produces clinically meaningful improvements in pain reduction and lumbar mobility compared with conventional therapy alone, in the management of patients with lower-crossed syndrome.

Keywords: Conventional therapy, Lumbar SNAGs, Lower cross syndrome, NPRS, ROM

Relationship of Kinesophobia with Pain Intensity, Disability, and Sleep Quality in Patients with Chronic Low Back Pain: A Cross-Sectional Study

2025-12-29T12:48:32+00:00

Background: Chronic low back pain is one of the major health care concerns. It impacts the activities of daily living and mental well-being. Kinesiophobia is often associated with chronic pain that may lead to a cascade of further movement dysfunctions.

Objective: To explore the relationship of kinesiophobia with pain intensity, disability, and sleep quality in patients with chronic low back pain.

Methodology: The study was conducted at the University of Lahore, and data were collected from the medical and outpatient physiotherapy departments of the University Teaching Hospital, Lahore. A sample of 97 participants was recruited using a convenience sampling technique. The participants of both genders, aged between 18 and 60 years, presenting with chronic low back pain for the last three months, were included. Kinesiophobia. Pain intensity, functional disability, and sleep quality were outcome measures. Spearman’s correlation was used to find the strength and direction of the relationship between variables.

Results: The mean age of participants was 37.38 ±7.045. There were 50 (51.5%) females, and the mean BMI was 22.17 ±1.73 kg/m2. The mean of pain intensity was 6.60±1.04, functional disability was35.84±4.85, sleep quality was 9.52±2.22, and kinesiophobia was 41.20±4.38. The analysis showed a significant positive correlation of kinesiophobia with pain intensity (r=0.294, p=0.003), functional disability (r=0.293, p=0.004), and sleep quality (r=0.426, p=0.001).

Conclusion: Kinesiophobia has a positive relationship with pain intensity, functional disability, and quality of sleep. The higher the level of kinesiophobia, the higher the severity of pain, functional disability, and the poorer the sleep quality.

Keywords: Chronic Low Back Pain, Kinesiophobia, Pain Intensity, Functional Disability, Sleep Quality

Functional Independence in Traumatic Spinal Cord Injury Patients with Neuropathic Pain: A Cross-Sectional Study

2025-11-26T04:54:01+00:00

Background: Traumatic spinal cord injury is a severe neurological condition that cause the life-long disability. Impairments are associated with motor and sensory dysfunctions. Central neuropathic pain is a complication after spinal cord injury.

Objective: To find out the functional independence in traumatic spinal cord patients with neuropathic pain.

Methodology: This is descriptive cross-sectional study, which included the sample size of 65 by using WHO sample size calculator as a non-probability purposive sampling technique. The study included paraplegia patients with neuropathic pain after six month of traumatic spinal cord injury with age 25-50 years which included both male and female gender. Other neurological condition that causing the neuropathic pain were excluded from the study. Data analysis was done by using Statistical Package for Social Science.

Results: Out of 65 patients,70.8%(n=46) were male and 29.2%(n=19) were females. The mean age of subject was 36.62 ± 11.819 years. Descriptive analysis of total score of Spinal Cord Independence Measure III showed with mean 47.77 ±15.161 and the total score of Self Administrative Lead Assessment of Neuropathic Sign and Symptoms showed with mean 14.88 ± 5.045 years confirming the moderate functional dependence of patients.

Conclusion: The moderate functional independence was found in traumatic spinal cord injury patients with neuropathic pain.

Keywords: Functional Independence, Neuropathic pain, Traumatic spinal cord injury

Frequency of Scapular Dyskinesis and its Association with Shoulder Pain in Gym-Going Females in Hayatabad: A Cross-Sectional Survey

2025-10-16T05:31:03+00:00

Background: Scapular dyskinesis is a common issue among individuals who engage in regular gym activities. As the scapula provides a stable base for movement, alterations in its positioning or motion can impair shoulder function. To address performance limitations, it is essential to identify the frequency of scapular dyskinesis, particularly in at-risk populations such as female gym-goers.

Objectives: The primary objectives of this study were to determine the frequency of scapular dyskinesis in gym-going females and to examine its association with shoulder pain.

Methods: For this cross-sectional study, 114 participants were surveyed through convenience sampling at Rehman Medical Complex gym, Hayatabad Sports Complex, and Iqra University gym in Peshawar. Participants were selected based on predefined inclusion and exclusion criteria. Eligible participants were females aged 18–40 years who voluntarily participated and had been performing upper-body workouts for at least one month. Those with a history of shoulder pathology, diabetes mellitus, pregnancy, recent upper-limb fractures within past two months, or neurological disorders were excluded. The data were collected over a three-month period from May 2022 to July 2022, followed by an additional three months for data analysis and manuscript preparation, which were completed by October 2022. Participants received two diagnostic tests to identify scapular dyskinesis. By using SPSS version 26, frequencies were calculated for categorical variables, and the chi-square test was applied to examine the association between scapular dyskinesis and shoulder pain.

Results: The study revealed an overall frequency of scapular dyskinesis of 70.3%. A statistically significant association exists between scapular dyskinesis and shoulder pain (p = 0.006).

Conclusion: Scapular dyskinesis was found to be highly frequent among gym-going females and demonstrated a significant association with shoulder pain. These findings underscore the importance of appropriate training techniques and targeted scapular muscle conditioning to prevent dysfunction and optimise upper-limb performance in female gym populations. Clinically, the results support the incorporation of structured scapular muscle strengthening exercises into routine gym-based training programmes as a preventive strategy to reduce the risk and severity of shoulder pain among gym-going individuals.

Keywords: Gym-goer, lateral scapular slide test, scapular dyskinesis, shoulder pain.

Occurrence of Musculoskeletal Symptoms, Among Teachers of Special Education Institutes in Rawalpindi and Islamabad: A Cross-Sectional Study

2026-01-22T06:45:25+00:00

Background: Teaching students with mental, physical, and learning disabilities is a highly demanding nature of work, which often leads to varying degrees of musculoskeletal disorders worldwide. Nevertheless, there is a limitation of the studies focusing on the occurrence of musculoskeletal symptoms in this group. Therefore, the purpose of this research was to investigate the occurrence of musculoskeletal symptoms among special education teachers in Rawalpindi and Islamabad. Pakistan.

Objective: To determine the prevalence of musculoskeletal disorders among teachers of special education institutes.

Methodology: This cross-sectional study was conducted between September 2023 and June 2024. Two tools were used: the primary tool was the Nordic Musculoskeletal Questionnaire (NMQ), and the second tool was a socio-demographic questionnaire developed by the research team. With the use of Rao-soft, a sample size of 109 was obtained; however, data were collected from 150 special education teachers aged 24 to 50.

Results: The average age of the participants was 36 years (SD = 8.66). In total, musculoskeletal issues were reported by 66.3% of special education instructors. The most often impacted body parts within the previous 12 months were the shoulders (32%), lower back (35.3%), and neck (36.7%). On the other hand, lower back pain was the most common complaint reported during the previous seven days (19.3%).

Conclusion: Musculoskeletal problems were shown to be quite prevalent among special education teachers in this study, affecting 66.3% of participants. Most frequently, the neck was affected, then the shoulders and lower back. These results emphasise how crucial it is to improve workplace design, implement ergonomic interventions, and embrace preventive measures in order to reduce the likelihood that special education instructors in Pakistan would experience musculoskeletal complaints.

Keywords: Special education teachers, Musculoskeletal disorders, Musculoskeletal symptoms, work-related musculoskeletal disorders

Association of Depression with Balance and Mobility in Patients Suffering from Parkinson’s Disease: A Cross-Sectional Study

2025-11-26T04:26:14+00:00

Background: Parkinson’s disease (PD) represents a gradual neurodegenerative process that involves motor and non-motor functions including the emotional state and the ability to move. One of the main non-motor symptoms of PD is depression and it might seriously affect both the physical performance and the patient's life quality.

Objective: To determine the correlation between depression and mobility problems in the patient population with PD.

Methodology: The study was performed in Lahore, Pakistan, over a course of six months (Jan 2025-Jun2025) at four different tertiary care hospitals. Non-probability convenience sampling was the method used by the researchers which led to the selection of a total of seventy-three (73) individuals with Parkinson's disease who were between the ages of 45-65, had a confirmed diagnosis and were scoring 24 or more on MMSE. The depression levels were assessed using the Beck Depression Inventory (BDI), while mobility was evaluated by the Timed Up and Go (TUG) test. A TUG time of over 13.5 seconds was considered to indicate an increased risk of falling. The connection between depression and mobility was explored using Chi-square analysis.

Results: The research highlighted a clinically meaningful link between the level of depression and the mobility test scores (χ² = 11.989, p = 0.017). Those patients with moderate to borderline depression diagnosis were slower in the TUG test performing and their longer time was indicating that they were at a higher risk of falling. The Cramér's V value was 0.405, which corresponded to a medium degree of connection.

Conclusion: Patients with PD who have more depressive symptoms show less mobility. The mental health screening and intervention that is no longer part of PD care can result in better mobility outcomes and decreased fall risk. Longitudinal studies are suggested to determine causality and assess the combined treatment methods.

Keywords: Beck Depression Inventory, Fall Risk, Mental Health, Parkinson's disease, Timed Up and Go Test

Exploring Satisfaction and Perceived Learning in Physical Therapy Students during Online Learning: A Cross-Sectional Survey

2025-12-29T11:00:30+00:00

Background: The coronavirus outbreak which occurred in 2019 brought an unprecedented transformation in the education sector, accelerating the shift from traditional face-to-face learning to online platforms. While virtual learning existed before, it was largely considered a supplementary tool rather than a primary mode of instruction. Because of the corona outbreak, all the educational institutes either deferred regular class sessions or extracurricular events. Students were experiencing major disturbances in learning and assessment in their subject areas.

Objective: To determine outcomes of online learning on student’s satisfaction and Perceived learning level.

Methodology: This was a cross- sectional survey conducted from various institutes in Rawalpindi and Islamabad. After taking ethical approval from ethical committee of foundation university Islamabad data was collected from students following inclusion criteria. Sampling technique used was non-probability convenient sampling and Sample Size was calculated using Rao soft. Data collection tool was SLE-OLE (Student Learning and Satisfaction in Online Learning Environment) questionnaire. Study duration was of six months.

Results: Statistical analysis was done using SPSS 21 version. Normality tests were applied which data was statistically significant. Total of 507 were included in study. Out of which 449 were males and 56 were females. The mean age was 21.4±1.65. Overall, 148(28.00%) students were somewhat satisfied with the overall experience of the course. 165(31.20%) were somewhat pleased with what they have learnt during the course. 138(26.10%) agreed that learning tasks enhance the understanding of the content. 152(28.70%) somewhat agreed on learning less than anticipated. 126(23.80%) slightly agreed with the skills that will help in the future.

Conclusion: Results of this study revealed that majority of students were agreed with all the constructs of satisfaction and the process of learning in an online environment of learning instrument. Findings of the study will help to identify all the factors that need to be improved in the online education system to enhance overall learning and satisfaction of Physical therapy students.

Keywords: Online learning, Perceived learning, Student Satisfaction