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ASSOCIATION OF HAND GRIP STRENGTH WITH THUMB

FLEXIBILITY, STRENGTH AND PAIN IN MANUAL THERAPISTS

Research Supervisor
Dr. Saba Riaz
Head Supervisor
Prof. Dr. Muhammad Salman
Bashir

Submitted By

Name ID
TOOBA MAZHAR F2016241146
SUMBAL RIAZ F2016241144
AYESHA BATOOL F2016241041
AWISHBAH KHAN F2016241087
SADIA S2019241095

DOCTOR OF PHYSIOTHERAPY
Session 2016-2021

School of Health Sciences

University of Management and Technology
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DEDICATION

We, hereby declare that all the information in this thesis is the result of our concerted efforts and

our original work. This research work, to the best of our knowledge and belief, reproduces no

material previously published or written, or that has been accepted for the award of any other

degree or diploma, except where due acknowledgement has been made in the
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ACKNOWLEDGEMENT

First and foremost, praise and thanks to the Almighty for His showers of blessings throughout

our research project to complete the research successfully.

We would like to express our deep and sincere gratitude to our Mam Saba Riaz from University

of Management and Technology. She has taught us the methodology to carry out the research

and to present the research work. It’s a great privileged and honor to work under the guidance of

our respected mam.

We would like to pay our regards to our dearest parents for their prayers, care and sacrifices for

our education and preparing us for our future. Special thanks to the participants for helping us

achieving our results.

Furthermore, we would like to express our gratitude towards our Respective institute, University

of Management and Technology for giving us opportunity to study in this prestigious institute.

Special thanks to our Groupmates for helping us throughout the project

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DECLARATION

We declare that that the research project association of hand grip strength with thumb
flexibility, strength and pain in manual therapists is based on our own work carried out during
our study under the supervision of Dr. Saba Riaz PT. We assert that statements made, and
conclusions drawn are an outcome of our research work. We further certify that the work
contained in the report is original and has been done by us under the general supervision of our
supervisor.

The work has not been submitted to any other institution for any other degree in this university.

We have followed the guidelines provided by the university in writing the report.

Whenever we have used materials (data, theoretical analysis, and text) from other sources, we

have given due credit to them in the text of the report and have given their details in the

references.

Researcher’s Signatures

TOOBA MAZHAR
SUMBAL RIAZ
AYESHA BATOOL
AWISHBAH KHAN
SADIA
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APPROVAL CERTIFICATE

Research Project entitled Association of hand grip strength with thumb flexibility, strength and

pain in manual therapists is accepted by the faculty of School of Health Sciences, University of

Management and Technology, Lahore, in partial fulfillment of the requirement for the degree of

Doctor of Physiotherapy.

Supervisor
Dr. Saba Riaz PT

Head Supervisor
Dr. Rabia Jawa
(Chairperson of department of physical Therapy & rehabilitation)

Head Supervisor (Dean SHS)

Prof. Dr. Muhammad Salman Bashir
(Dean, School of Health Sciences)
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LIST OF TABLES

Table 4. 1 DESCRIPTIVE STATISTICS..................................................................34

Table 4. 2 GENDER DISTRIBUTIONS....................................................................39

Table 4. 3 LIMB DOMINANCE BETWEEN UNIVERSITY AND SCHOOL STUDENTS

.....................................................................................................................................41
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LIST OF FIGURES

Figure 5. 1 HISTOGRAM OF...................................................................................35

Figure 5. 2 HISTOGRAM OF ...................................................................................36

Figure 5. 3 .................................................................................................................37
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Table of contents

Contents
DEDICATION............................................................................................................. i
ACKNOWLEDGEMENT...........................................................................................ii
DECLARATION........................................................................................................ 3
APPROVAL CERTIFICATE.....................................................................................4
ABSTRACT..............................................................................................................11
CHAPTER 1............................................................................................................. 12
INTRODUCTION.....................................................................................................12
1.1 Background......................................................................................................... 12
1.2 Problem Statement:.............................................................................................17
1.3 Significance:........................................................................................................17
1.4 Objectives:...........................................................................................................18
1.5 Hypothesis:..........................................................................................................18
CHAPTER 2............................................................................................................. 19
LITERATURE REVIEW..........................................................................................19
CHAPTER 3............................................................................................................. 27
METHODOLOGY....................................................................................................27
3.1 Research design:................................................................................................27
3.2 Sample/ participants:...........................................................................................27
3.3 Data collection techniques:..................................................................................27
3.3.1 Tool.................................................................................................................. 27
3.3.2 Data, collection, procedure:..............................................................................33
3.4 Analysis technique:............................................................................................. 33
3.5 Ethical consideration...........................................................................................33
CHAPTER 4............................................................................................................. 34
RESULTS................................................................................................................. 34
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CHAPTER 5............................................................................................................. 70
DISCUSSION AND LIMITATION..........................................................................70
5.1 Discussion........................................................................................................... 70
5.2 Limitation:...........................................................................................................73
CHAPTER 6............................................................................................................. 74
CONCLUSION AND RECOMMENDATION.........................................................74
6.1 Conclusion:......................................................................................................... 74
6.2 Recommendation:................................................................................................75
Appendices................................................................................................................76
REFERENCES..........................................................................................................78
PLAGIRIASM REPORT ………………………………………………………………………………………………………..83
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ABSTRACT:

General Formatting Guidelines (check comment)

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Chapter 1

INTRODUCTION:

1.1 BACKGROUND:

Musculoskeletal disorders risks are higher for Health care professionals as they commonly work

in hospitals and handle patients. They also provide direct care to the patients during the course of

patients stay in hospitals.(Ganiyu et al., 2015)

There is possibility of work-related injuries because of the challenging nature of their work.

There is a need of further clarification of tissue response mechanism in order to completely

understand the important problems of physiotherapists. Although there are many epidemiological

indications for the role of repetition and force in the inception and advancement of work related

MSDs.(Barbe & Barr, 2006)

Work Related Musculoskeletal disorders (WRMSD) are the cause of almost one-third of all sick

leave cases among health care workers. Work Related Musculoskeletal Disorder (WRMSDs) is

an area that requires further study on the relation of modern exposure to its risk. A new study has

evaluated the current exposure and risk of developing Work Related Musculoskeletal Disorders

among different clusters of healthcare professionals. The exposure and risk assessment on

occurrence of Work-Related Musculoskeletal Disorders indicates that nurses are at the highest

risk for developing WMSDs. It is followed by physiotherapists and dentists whereas physicians

and laboratory technicians are at the least risk. Many Participants who had suffered from MSDs

pain, more than half of those cases were related to work.

(Yasobant & Rajkumar, 2015)

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Numerous workplace hazard exposures and psychosocial and demographic risk factors have

been demonstrated to be associated with MSDs. It includes repetitive movements, high-pressure

forces, awkward postures and other factors, including sex, body mass index (BMI), Age and

stress. Moreover, MSDs could be aggravated by prolonged working periods and extreme

schedules. The reason is that they lead to high levels of mental stress and fatigue in the

workplace. (Dong et al., 2019)

1.2 Statement of Problem:

1.3 Significance:

1.4 Objective:

1.5 Hypothesis:

• NULL HYPOTHESIS:

• ALTERNATE HYPOTHESIS:
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Chapter 2

LITERATURE REVIEW:

A study was conducted in 2020 to find out prevalence of Thumb Pain in physiotherapists

practicing Manual therapy: The prevalence of thumb pain was observed as 38.98% that had

following impact on work practice of physiotherapists: 32.61% changed the application of their

treatment techniques, 32.61% changed the selection of their treatment techniques, 15.22%

reduced their number of patients for treatment in daily routine, 10.87% reduced their working

hours and 8.70% reduced the use of manual technique. 38.98% physiotherapists had thumb pain.

It further demonstrated that 22.88% physiotherapists had mild pain (5-44mm), 16.10%

physiotherapists had moderate pain (45- 74mm), and 0% physiotherapists had severe pain (75-

100mm).(Mahajan et al.)

A study was conducted in 2020 with the tile of Work related thumb pain and associated risk

factors among manual therapists which stated that from a total of 60 physiotherapists, 33 (55%)

physiotherapists specified thumb pain once in their career. Out of 60 people, 25 (41.75) had

thumb pain at the time of survey. 27 (45%) out of 60 physiotherapists never suffered from thumb

pain. Most commonly affected were males with thumb pain (58. 3%).It was reported that their

thumb pain was aggravated by trigger point pressure release technique with soft tissue

mobilization and manual techniques. (Akram et al., 2020)

A study was reported in 2019 with the title of Prevalence and associated factors of

musculoskeletal disorders among Chinese healthcare professionals working in tertiary hospitals

which states that The 12-month period occurrence rate of experiencing an MSD in at least one

body region for at least 24 h, experiencing an MSD for at least three months, and seeking health
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care for this condition were 91.2, 17.1 and 68.3%, respectively; these rates were highest for the

knees (65.7, 8.1, 46.7%), and lower back (72.8, 14.3, 60.3%) followed by the ankles/feet (23.6,

1.9, 13.4%), wrists/hands (31.1, 3.2, 23.1%), shoulders (52.1, 6.2, 38.9%), neck (47.6, 4.8,

32.6%), hips/thighs, elbows and upper back. (Dong et al., 2019)

A study was reported in 2019 w……

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Chapter 3

Methods

3.1 Research Design:

3.2 Sample:

 Sampling Strategy:

 Inclusion Criteria:

 Exclusion Criteria:

 Sample Size:

3.3 Data Collection tools/ sampling measure:

3.3.1 Data Collection Tools:

3.3.2 Data Collection Procedure

3.4 Data Analysis:

3.5 Statistical procedures/ analysis techniques  Describe software, statistical tests and

procedures, display of data 3.5.

3.6 Operational Definitions of the Variables (optional) 3

3.7 Ethical Considerations

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Chapter 4

RESULTS

Our study showed that out of 135 Physiotherapists,

Table 4.1 Demographic Results

Working Hours Thumb Pain

Age Body Mass Index Continuous Continuous Values

N Valid

Missing

Mean

Std. Deviation

Minimum

Maximum

Table 4.1 shows the population of 135 subjects with the age range of 22 to 45 years with Mean

age 26.19 ± 2.989 with minimum age of 22 years and maximum age of 39 years with mean Body

Mass Index (BMI) 22.62 ±3.13. The Minimum BMI was 14.70 and Maximum BMI was 32.30.

The Mean working Hours were 6.49 ± 1.41 with Minimum working hours 4 and Maximum
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Table 4.2 shows that out of 135 Physiotherapists, 32 (23.7%) were male and 103 (76.3%)

Table 4.2 Gender were

Cumulative female.

Frequency Percent Valid Percent Percent

Valid Male

Female

Total
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Figure 4.1

Figure 4.1 Shows the Frequency and Percentages of Male and Female Physio Therapists out of

135 Physiotherapists with 76.30 % Females and 23.7% Males.

Table (number and its title)

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ALWAYS OFTEN SOMETIMES RARELY NEVER

n (%) n(%) n(%)

1 PERIPHERAL JOINT
MOBILIZATION
2 VERTEBRAL JOINT
MOBILIZATION
3 SPINE HVLA
MANIPULATION
4 SOFT TISSUE
RELEASE
5 TRIGGER POINT
RELEASE
6 VIBRATION &
SHAKING
7 PERCUSSION

8 TRACTION
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Dominant Hand Non Dominant Hand

Frequency Percent% Frequency Percent%

Below Normal

Normal

Above Normal

Total
Table 4.8 Grip Strength Result

Table 4.8 shows that Out of 135 Physiotherapists, 116 (85.9%).

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Table 4.11 Wrist Hand and Thumb Pain of Dominant Hand

Wrist Hand Pain Thumb Pain
Frequency Percent Frequency Percent
Valid 0 No Pain
1-3 Mild Pain
4-7 Moderate Pain
8-10 Severe Pain
Total
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Table 4.25 Correlations Grip Strength of Dominant Hand * Thumb Strength of Dominant
Hand
Grip strength of Thumb Strength
Dominant Hand in result of Dominant
Kgs hand
Grip strength of Dominant Hand Pearson Correlation
in Kgs Sig. (2-tailed)
N
Thumb Strength result of Pearson Correlation
Dominant hand Sig. (2-tailed)
N

Table 4.25 shows that there is enough evidence to prove that there is Positive association

(correlation) between Grip Strength of Dominant hand and Thumb Strength of dominant hand.
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Chapter 5

DISCUSSIONS AND LIMITATIONS:

5.1 Discussions:
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5.2 Limitations:

We couldn’t use Digital Dynamometer instead of Analog dynamometer for precise Results of

Grip Strength.
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Chapter 6

CONCLUSIONS AND RECOMMEDATIONS:

6.1 Conclusion:

6.2 Recommendations:
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APPENDICES

QUESSTIONNARE:

Name: ___________________ Age: __________

Gender: ____________________ Weight: _________

Height: ____________________ BMI: ___________

Clinical Working Hours: __________ Dominant Hand: Right / Left

Working Experience (in Manual therapy):

Department:

OPD ICU Wards All of the above

Hand / Wrist Pain Dominant hand (Numeric Pain Scale):

Hand/ Wrist Pain non-dominant Hand (Numeric Pain Rating scale):

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Thumb Pain Dominant Hand (Numeric Pain Rating Scale):

Thumb Pain Non-Dominant (Numeric Pain Rating scale)

Techniques Used:

Always Often Sometimes Rarely Never

Peripheral Joints
Mobilization

Vertebral Joints
Mobilization

Spine HVLA
Manipulation

Soft Tissue release

Trigger point pressure

release
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Vibration & Shaking

Percussion

Traction

Grip Strength:

Dominant Hand Non-Dominant hand

Finkelstien Test:

Dominant Non Dominant

+ve -ve +ve -ve

Flexibility of thumb (via Goniometer):

Dominant Side CARPOMETACARPAL Non-Dominant Side

JOINT
Flexion

Extension

Abduction

Adduction

Opposition

METACARPOPHALANGEAL
Joint
Flexion

Extension
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Strength measurements (Via MMT):

Dominant Thumb Joint Non-Dominant

MP flexion

MP extension

Abduction

Adduction

Opposition
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REFERENCES: