title: To evaluate the efficacy of Mobilization Techniques in Post-Traumatic stiff ankle with and without Paraffin Wax Bath.
abstract: OBJECTIVE
  Mobilization techniques are frequently used by physiotherapists to reduce pain, improve joint movement and facilitate return to activities after injury. The objective of this study was to explore differences in the efficacy of Mobilization Techniques in Post-Traumatic stiff ankle with and without Paraffin Wax Bath.
  
  
  METHODS
  Thirty seven patients of Post Traumatic stiff ankle were recruited for the study at Sajid Physiotherapy & Rehabilitation center, Multan from March 2011 to February 2013. It was a randomized controlled trial and the patients with equal grades of severity were placed in control and study groups. Group A had nineteen patients and Group B had 18 patients. The inclusion criteria were age range from 20-60 years, pain, loss of ROM, with history of trauma and fracture of ankle. The patients with similar complaints but with surgical treatment were excluded. Group A was given mobilization techniques with paraffin wax bath while group B was treated without paraffin wax bath. Improvement was observed by EscolaPaulista de Medicina Range of Motion (EPM-ROM) scale and visual analogue scale (VAS). After ten weeks of treatment, the patients were re-evaluated by an orthopedic surgeon and a Physiotherapist for their symptoms and ROM. t-test was applied to compare outcome between two groups and p < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  Group A had nineteen patients and Group B had 18 patients and both were treated for ten weeks. There were 12 male and 7 female patients in group A and 10 male and 8 female in group B. At the start of treatment the basic characteristic were similar in both the groups. Deficits in dorsiflexion, planterflexion, inversion, eversion pain and stiffness were measured before and after the treatment period. Pain relief was found better in both groups which were considered statistically significant with p=0.001, group A (1.135 ± 0.359) vs. group B (1.135 ± 0.359). ROM in pre and post treatment degrees showed that dorsiflexion was significantly increased in group A (1.135 ± 0.359) vs. group B (1.135 ± 0.0359).) and planterflexion was in group A (1.337 ± 0.422) vs. group B (0.841 ± 0.264). Functional movement showed improvement in inversion in group A (0.875 ± 0.276) vs. group B (0.966 ± 0.305) and in eversion in group A (0.948 ± 0.300) vs. group B (0.674 ± 0.213). Mobilization Techniques followed by wax bath resulted in significant improvements of range of motion (ROM), clinical and functional changes. Wax bath alone had no significant effect. After ten weeks intervention treatment, t-test was applied to compare outcome between the two groups and p=0.001to 0.004 in group A and p= 0.104 to 0.168 in group B, (p<0.05) was obtained which shows statistical significance.
  
  
  CONCLUSIONS
  Joint mobilization and wax bath therapy is an effective and beneficial tool to improve the symptoms and quality of life in post traumatic stiff ankle patients. Joint mobilization techniques combined with wax bath are more effective in the management of post-traumatic stiff ankle as compared to wax therapy alone.
authors.affiliation: Dr. Sajid Rashid, BSPT, PP-DPT, HOD, Physiotherapy Department, The Children's Hospital & the Institute of Child Health Multan, Multan, Pakistan.
authors.forename: Sajid
authors.initials: S
authors.lastname: Rashid
authors.affiliation: Prof. Dr. Kamran Salick, MD(USA), FCPS, Professor, Orthopedic Department, Nishtar Medical College & Hospital, Multan, Pakistan.
authors.forename: Kamran
authors.initials: K
authors.lastname: Salick
authors.affiliation: Dr. Muhammad Kashif, FCPS, Associate Professor, The Children's Hospital & the Institute of Child Health Multan, Multan, Pakistan.
authors.forename: Muhammah
authors.initials: M
authors.lastname: Kashif
authors.affiliation: Dr. Awad Ahmad, Assistant Professor, Orthopedic Department, Nishtar Medical College & Hospital, Multan, Pakistan.
authors.forename: Awad
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Dr. Kashif Sarwar, BSPT, PP-DPT, Physiotherapist, Nishtar Medical College & Hospital, Multan, Pakistan.
authors.forename: Kashif
authors.initials: K
authors.lastname: Sarwar
keywords: Mobilization techniques; Paraffin wax bath; Stiff ankle