Journal Riphah College of Rehabilitation Sciences

Biomechanical Divergence: Why Male Coaching Models Fail Female Fast Bowlers

Saqib Hussain Junejo — 2026-06-29

The growth of women cricket in Pakistan is gaining momentum; nonetheless, coaching, training, and rehabilitation patterns are still based to a large extent on male based biomechanical models. The clinical implications of such a mismatch have become clinically relevant and have become more common in musculoskeletal practice.

Traditional models of fast bowling are based on the focus on the velocity of the approach, lengthy run-ups and high flexion of the trunk forward. Sex-specific biomechanical studies, however, suggest an alternative leading way of power production in elite female fast bowlers. In elite pace bowlers, Feros et al. found the ball-release velocity to be more correlated with the thoraco-pelvic lateral flexion at the front-foot contact and pelvic orientation at the back-foot contact than with the linear approach velocity.¹ These findings suggest that elite female pace bowlers preferentially generate ball velocity through rotational and angular momentum mechanisms rather than linear approach speed. Increased emphasis on run-up speed or overemphasized forward trunk positioning may jeopardize the lumbo-pelvic stability which is central to the effectual transmission of force.

There are anatomical and neuromuscular differences that on average differ between female and male athletes including morphology of the pelvis, Q-angle fixation and trunk mobility profiles.² These differences affect rotational leverage and spinal stabilization measures. Instead of being manifested as technical faults, enhanced pelvic rotation and lateral flexion in women bowlers could be the adaptive strategies to deal with a decrease in linear momentum.^2,3 It has been proposed that motion-analysis studies indicate that female bowlers more often use front-on bowling, and they create power with late-lateral-phase pelvic-trunk rotation.³ This might increase the rotational potential but lack of neuromuscular control could increase lumbar loading especially when bowling in large volumes.

Mechanisms in the lower limbs can also increase the risk of injury. Bowling patterns that favor rotation and fatigue and lack of control over hip position could be more predisposing to anterior cruciate ligament injury particularly when training surfaces are not even and qualified strength and conditioning support is unavailable.⁴ Specifically in cricket, Lyons et al. reported that kinematic demands in female pace bowlers differ markedly from male counterparts, with implications for lower-limb loading and injury susceptibility.²

These reflections show that coaching and rehabilitation systems of female fast bowlers may need to differ substantially from those designed for male athletes. Anti-rotation control measures and progressive thoraco-pelvic dissociation training should be followed by rotational power development. Specific neuromuscular training of the hip-pelvis complex, especially gluteus medius and deep pelvic stabilizers should be given first priority. Moreover, the patterns of workload-monitoring models constructed in male athletes might not be the accurate predictors of load patterns and injury risk among females.⁵

With the sustained investment in female Pakistani cricket, it is now time to change biomechanics, coaching, and rehabilitation practices and align them to new evidence of females. Female fast bowlers may experience different loading patterns and injury risks and the risk of injury, and these distinctions must be clearly implemented into the system of training and medical care.

References

1. Feros SA, Gerhardy MH, Fyfe JJ, Dwyer DB. The kinematic relationships of ball release speed in elite female cricket pace bowlers. J Sports Sci. 2024;42(6):521-530.

2. Lyons C, Felton PJ, McCabe C. Female cricket pace bowling: kinematic and anthropometric relationships with ball release speed. S Afr J Sports Med. 2023;35(1):a15080.

3. Jacobs J, Olivier B, Brandt C, Boulle N. Anthropometric and biomechanical factors in elite male and female fast bowlers. J Biomech. 2024; 170:112157.

4. Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: mechanisms and risk factors. Am J Sports Med. 2006;34(2):299-311.

5. Hulin BT, Gabbett TJ, Lawson DW, Caputi P, Sampson JA. The acute:chronic workload ratio and injury risk in elite sport. Br J Sports Med. 2016;50(4):231-236.

Frequency of Tarsal Tunnel Syndrome in Salesperson of Rawalpindi and Islamabad: A Cross-Sectional Study

Isbah Kainaat — 2026-06-29

Background: Tarsal Tunnel Syndrome (TTS) is a condition that occurs as a result of compression on a nerve in the foot, which leads to symptoms like pain, tingling, and numbness. People who spend long hours standing, like salespersons, may be more likely to develop this problem.

Objective: To determine frequency and severity of TTS in salesperson

Methodology: This descriptive cross-sectional study was conducted from June 2024 to July 2025 in shopping malls and retail stores of Rawalpindi and Islamabad. A total of 377 salespersons aged 18–45 years, who had at least one year of job experience and stood for 8 or more hours daily, were selected through non-probability convenience sampling. Screening for TTS was done using Tinel’s Sign. Participants with a positive result were further assessed using the TTS Severity Rating Scale. Data were analyzed using SPSS version 21, and results were presented in terms of percentages, frequencies, and means.

Results: Statistical analysis was done through SPSS version 21.0. Total of 377 Salesperson were included. The mean age was 26.97+- 6.89 years. 10.9% of participants were tested positive for TTS. The remaining 89.1% did not exhibit symptoms consistent with the condition.

Conclusion: This study concluded that Tarsal Tunnel Syndrome is fairly common among salespersons, especially those who stand for long hours daily. As most of the symptoms were mild, the findings showed that early detection, better footwear, and workplace changes will help reduce the occurrence of this condition.

Keywords: Foot, Pain, Standing position, Tarsal tunnel syndrome, Tibial nerve

Comparison of Mulligan’s Spinal Mobilization with Proprioceptive Neuromuscular Facilitation Technique on Pain, Disability and Range of Motion in Patients with Cervical Radiculopathy: A Randomized Clinical Trial

Muhammad Azeem Tajdin — 2026-06-29

Background: Cervical radiculopathy involves response, motion and sensational changes e.g. radiating pain, paresthesia, numbness that can be raised by bad positions and motions of neck.

Objective: To determine spinal mobilization and proprioceptive neuro-muscular facilitation comparison on the pain, level of disability and movements ranges in cervical radiculopathy individuals.

Methodology: The 38 subjects (determined by G*Power 3.1.9.7) divided in 2 groups by lottery method. Control group got Mulligan’s spinal mobilization with arm movements (6 glides three sets) and experimental group received Proprioceptive neuro-muscular facilitation contract relax technique, passive stretching (3 bunches of 10 times repeat) and isometric exercises (2 clusters of 10 times repeat). Numeric pain rating scale for the pain, neck disability index for the level of disability and goniometer for the range of motion outcome measures included. Data analysis was achieved by SPSS (statistical package for social sciences) version 26. (Clinical Trial Registry Number: NCT06866821)

Results: There were 15 males (39.5%), 23 females (60.5%) with right side involved in 24 (63.2%) and left side involved in 14 (36.8%) individuals. The mean, standard deviation of age was 33.95±7.935 years and of duration symptoms were 8.08±1.402 months. There was statistically significant enhancement in NPRS, NDI and cervical ROM pre & post mean values more in experimental group as compared to control group with P value <0.001.

Conclusion: The individuals managed by proprioceptive neuromuscular facilitation contract relax technique, passive stretching and isometric strengthening exercises had significantly better relief in the pain, level of disability and change in cervical ranges of movements than control group.

Keywords: Cervical Radiculopathy, Pain, Range of motion, Distraction and Proprioceptive neuromuscular facilitation.

Effects of Scapular Proprioceptive Neuromuscular Facilitation on Pain and Range of Motion in Patients with Adhesive Capsulitis: A Randomized Controlled Trial

Maryum Fatima — 2026-06-29

Background: Adhesive capsulitis is a common musculoskeletal condition exhibiting pain and a gradual loss of range of motion in the glenohumeral joint. This affects the activities of daily life and most commonly results in functional limitations.

Objective: To assess the effects of proprioceptive neuromuscular facilitation (PNF) technique on scapula along with conventional physical therapy on pain reduction and improvement in the range of motion of shoulder joints in patients with adhesive capsulitis.

Methodology: At the department of Physical medicine and rehabilitation of Fauji Foundation Hospital, Rawalpindi and District Head Quarter Hospital, Jhelum a single-blind randomized controlled trial was carried out, dated from October 2022 to September 2023. A total of 32 patients with diabetes, aged 40 years and above, both males and females who were diagnosed with pain in one shoulder and whose range of motion was limited were included in this study. Patients with prior shoulder surgery, manipulation under anesthesia, corticosteroid injections within the last three months, or any musculoskeletal, neurological, or cardiovascular disorders were not included in this study. Conventional physiotherapy was given to the control group, and scapular proprioceptive neuromuscular facilitation with conventional treatment was given to the experimental group for two weeks. Pain (visual analogue scale), shoulder ROM (goniometer), and scapular dyskinesia (LSST), were the outcome measures which were assessed at baseline and after two weeks as well. (Clinical Trial Registry Number: NCT05889065)

Results: A total of 32 participants were randomized (n=16 per group). VAS differences between groups were non-significant at baseline (p=0.052) and at 2 weeks (p=0.277), although both groups improved significantly over time (p<0.001). Significant between-group effects were observed for shoulder flexion (168.12 ± 11.08 vs. 146.80 ± 18.51; p=0.001) and abduction (165.62 ± 10.93 vs. 142.80 ± 22.94; p=0.001), but not external rotation (p=0.145). LSST values were comparable at neutral and 45°, with a significant difference at 90° (p=0.031). Within-group improvements were significant at 45° and 90° positions in both groups (p<0.05). The experimental group demonstrated clinically greater improvement across most outcomes.

Conclusion: Scapular PNF combined with conventional physiotherapy produced greater improvements in pain, shoulder range of motion, and selected measures of scapular stability than conventional therapy alone. These findings support the added benefit of incorporating scapular PNF techniques in the rehabilitation of patients with diabetic shoulder dysfunction.

Keywords: Adhesive Capsulitis, Pain, Physical Therapy Modalities, Proprioceptive Neuromuscular Facilitation, Range of Motion, Articular.

Frequency of hallux valgus deformity among university students: A Cross-Sectional Study

Hafsah Arshad — 2026-06-29

Background: Hallux valgus is common forefoot deformity which involves lateral deviation of the big toe and medial deviation of the first metatarsal. HV results in altered foot biomechanics causing pain and functional limitations. It may develop due to prolong weight bearing, fashion foot wear choices, improper shoes or genetic predisposition in young people.

Objective: The aim of this study was to find out the frequency of hallux valgus deformity and examine its association with different factors among university students.

Methodology: The descriptive cross-sectional study was conducted from February 2022 to July 2022. The study included 340 volunteer university students of 18-26 years’ age. The sample size was raised using non-probability convenient sampling technique. Data was collected by using a semi-structured questionnaire which includes self-reported Manchester scale for Hallux valgus, Numeric pain rating scale (NPRS) and questions related to family history and footwear. Those who were having any congenital foot deformity, previous injury e.g., foot fracture, surgery and co morbidities like diabetes, rheumatoid arthritis, and gout were excluded from study. Informed consent was taken from each participant. Data was analyzed by SPSS version 26.

Results: The mean age of participants was 22.04±1.65 years. The overall frequency of Hallux valgus was 30.3% (n=103). Bilateral HV was noted in 61.0% (n=63) of participants. Among male participants 25.3% (n=42) had mild and 5.4% (n=9) had moderate HV while in females 16.0% (n=28) had mild and 2.3% (n=4) had moderate HV. HV was more prevalent in male participants with significant association of male footwear (p=0.002). There was a significant association of big toe pain (p=0.003) with HV.

Conclusion: The frequency of hallux valgus was 30.3% among university students. It was more frequent in male students. Special attention should be given to footwear and big toe pain among such cases for early prevention of HV.

Keywords: Hallux valgus, bunion, foot, deformities, university students

Assessment of Kinesiophobia in Postoperative Cardiac Patients: A Cross-Sectional Study

Naeem ud Din — 2026-06-29

Background: Cardiac surgeries are commonly and successfully performed to treat various cardiovascular disorders. Postoperative cardiac rehabilitation is essential to minimize the negative effects of surgery. Despite this, cardiac rehabilitation is not routinely practiced in many developing countries. Subsequently, patients often avoid physical activity and exercise due to fear or lack of guidance.

Objective: To evaluate the level of fear of movement and exercise in patients attending cardiac rehabilitation.

Methodology: This was a cross-sectional study conducted on post-operative cardiac patients visiting cardiac rehabilitation department at Peshawar Institute of Cardiology. A total of 277 patients (mean age 50.9±15 years) were recruited in the study through convenience sampling technique. Both male (n= 126) and female (n=91) were included in the study. All the patients were assessed for fear of movement by using Tampa scale for kinesiophobia. Data was analyzed through Statistical Package for the Social Sciences (SPSS).

Results: The results of this study reported that fear of movement was significantly higher in male; majority reporting severe to debilitating kinesiophobia (49.44%). Overall (62.6%) patients reported severe form of fear to movement, (16.4%) reported debilitating kinesiophobia while 38% reported mild fear post-operatively in all phases of outpatient cardiac rehabilitation.

Conclusion: It was established that severe debilitating fear of movement is prevalent across all age groups and phases of cardiac rehabilitation, though these factors did not show a statistically significant association with fear levels. The only statistically significant association observed was between gender and fear; males reporting higher levels of kinesiophobia compared to females.

Keywords: Cardiac rehabilitation, Fear of movement, Kinesiophobia

Physical activity during the follicular phase versus the luteal phase of the menstrual cycle among eumenorrheic females: A Cross-Sectional Study

Arooj Fatima — 2026-06-29

Background: Fluctuations of hormones in the luteal and follicular phases of eumenorrheic women affect their physical activities in various aspects. Studies on these effects in eumenorrheic females, who experience regular menstrual cycles, remain limited. This study evaluates physical activity across these phases, contributing to personalized exercise recommendations and improved health outcomes.

Objective: To measure physical activity during the follicular phase vs the luteal phase of the menstrual cycle in eumenorrheic females.

Methodology: The research was a cross-sectional comparative study that assessed physical activity during the follicular and luteal phases of the menstrual cycle. The study included 40 women who had regular menstrual cycles, aged from 18 to 24. A non-probability purposive sampling technique was used. Physical activity measurement used the short version of the International Physical Activity Questionnaire (IPAQ-SF). Data analysis was conducted with SPSS version 26. The study variables were reported using descriptive statistics, including tables, graphs, and percentages.

Results: The comparison of the mean and standard deviation of the follicular phase and luteal phase was done. Studies revealed that participants achieved an average of 1147.98 total METS during the follicular phase with a SD of 14. 12, yet displayed an average total METS of 912.0375 along with an SD of 11.23 during the luteal phase.

Conclusion: The physical activity levels of eumenorrheic females were significantly higher during the follicular phase than during the luteal phase.

Keywords: Eumenorrheic, Follicular phase, Luteal phase, Menstrual cycle, Physical activity

Impact of Body Dysmorphia, Social Media on Mental Health and Academic Achievement Among Medical Students: A Cross-Sectional Study

Erum Tanveer — 2026-06-29

Background: People who suffer from Body Dysmorphic Disorder (BDD) focus too much on their perceived imperfections in physical appearance that may or may not actually exist in reality. Social media's representation of perfect bodies creates dissatisfaction and a subsequent negative impact upon psychological well-being, which could have implications for one's academic performance as well. Medical Students represent an interesting cohort because they are under extreme academic stress, are continually subjected to push for excellent performance, and will be continually exposed to ideals of perfection.

Objective: To determine the prevalence and severity of body dysmorphia symptoms and its association with social media, mental health and academic performance.

Methodology: In 2024, a cross-sectional study examining a population of 288 medical students took place in Karachi. The focus was to measure relationships between key areas of concern: dysmorphic body image, intense use of Facebook, depression, anxiety and stress, as well as academic performance using various scales. The study analyzed the data using descriptive statistics and a chi-square test to provide valuable insights into these relationships.

Results: There was a total of 288 individuals who were eligible to be included in this study, with an average age of 22 - 23 years. In this group of individuals, 50.3% were found to be BDD positive, with females being found to have a higher prevalence (89.6%) than males and those in the Doctor of Physical Therapy (DPT) discipline had the highest proportion of individuals with BBD (59.4%). 74.4% exhibited mild dysmorphic concerns, 66% had low Facebook use and did not exhibit signs of depression (79.5%), anxiety (69.4%) or stress (91.3%). 42.7% received good academic performance scores. A marginal and not statistically significant association between BDD and social media intensity was found (k=0.103; p=0.052), while moderate correlations were noted between BDD and depression (r=0.258; p<0.05) and BDD and anxiety (r=0.163; p<0.05)

Conclusion: The research highlights the association between how bodies are depicted in online media and medical students' mental well-being and academic achievement. Continuous exposure to 'perfect' body images creates anxiety and distorts self-image perception. Medical schools should provide coping mechanisms for students by focusing on providing support for mental health issues, digital literacy, and supporting open conversation about body image.

Keywords: Academic Performance, Body Dysmorphic Disorder, Mental Health, Medical Students, Social Media

Urdu Translation of Denver Sacroiliac Joint Questionnaire (DSIJQ) and Its Validity and Reliability in Sacroiliac Joint Dysfunction (SIJD) Patients: A Cross-Sectional Study

Sumbal Salik — 2026-06-29

Background: Sacroiliac joint dysfunction (SIJD) is a significant contributor of both chronic low back pain and disability. The Denver Sacroiliac Joint Questionnaire (DSIJQ) is a condition-specific tool designed to evaluate severity of symptoms and functional limitations related to SIJD. However, the lack of Urdu version, limited its accessibility for Urdu speaking populations.

Objective: To translate the DSIJQ into an Urdu version and evaluate its reliability and validity among patients with SIJD.

Methodology: The translation of the questionnaire was conducted according to a conventional method of cross-cultural adaptation, which comprises a forward and a backward translation, expert validation, and pilot testing. The Urdu DSIJQ was used to evaluate 110 patients with clinically confirmed SIJD. Psychometric evaluation included content validity (I-CVI and S-CVI/Ave), internal consistency (Cronbach’s alpha), test-retest reliability (intraclass correlation coefficient, ICC), and construct validity through exploratory factor analysis.

Results: The I-CVI ranged between 0.75-0.95 and S-CVI/Ave was 0.85, thus confirming content validity. Internal consistency was strong (Cronbach alpha = 0.858) and test-retest reliability was excellent (average ICC = 0.858). Factor analysis identified two components explaining 71.62% of the total variance.

Conclusion: Strong validity and reliability make the Urdu version of the DSIJQ an appropriate tool for evaluating sacroiliac joint dysfunction in Urdu-speaking communities. It provides a culturally appropriate choice for clinical assessment and research in Pakistani settings.

Keywords: Denver Sacroiliac Joint Questionnaire, ICC, Low Back Pain, Reliability, SIJD, Urdu Translation

The Future of Rehabilitation Practice in the Era of Artificial Intelligence and Robotics

Asghar Khan — 2026-06-29

Artificial intelligence (AI) is rapidly transforming healthcare delivery and is expected to significantly influence the future of rehabilitation practice. Rehabilitation professionals, including physical therapists, occupational therapists, speech-language pathologists, prosthetists, orthotists, and other allied health practitioners, are increasingly utilizing AI-driven technologies to support assessment, diagnosis, treatment planning, outcome prediction, and patient monitoring (Rasa et al., 2024). As healthcare systems become more digitalized, AI offers unprecedented opportunities to improve the efficiency, accessibility, and quality of rehabilitation services.

Trends of Physical Therapy Management of Low Back Pain: A Mini Systematic Review of Randomized Controlled Trials

Madiha Anees — 2026-06-29

Background: Low back pain usually presents below the costal margins and above the inferior gluteal folds i.e., between the 12th rib and the gluteal folds. Globally it has become the leading cause of disability. The lifetime Prevalence of LBP episode varies from 60% to 90%. Many physical therapy treatment options are available for low back pain treatment.

Objective: This systemic review study is conducted on trends of physical therapy management in low back pain. In this study the clinical trials and investigative interventions are excluded. Data from different databases was collected to find the management of lower back through exercise.

Methodology: A systematic review was conducted that included 8 databases i-e CINAHL, MEDLINE, PEDro, PubMed, PakMediNet, Cochrane Library, Scopus and Web of Science. Only those RCTs were included in the study that had a minimum score of 6 or above on the PEDro Scale. The articles between the years 2015 to 2025 were included. The search strategy included both key terms and MeSh terms.

Results: A total of 10 studies were included in the systematic review were falling under the inclusion criteria. 4 studies compared different modes of exercise intensities, loads and resistance training. 2 studies compared the effects of manual therapy, one study focused on trunk muscle exercises, one study evaluated the effect of sensorimotor training, and two studies added ankle dorsiflexion and hip strengthening exercises. Out of which 9 studies resulted in 40% to 63% with effect size of 0.4028 reduction in pain and one study resulted in no positive effect on LBP.

Conclusion: The review concludes that physical therapy interventions such as core strengthening with ankle dorsiflexion, hip and trunk exercises, active exercises, manual and massage therapy, and high-load or high-intensity training are effective for managing acute and chronic low back pain, whereas sensorimotor training showed no benefit.

Keywords: Low back pain, Manual therapy, Physical therapy modalities, Musculoskeletal manipulation.