Ranganth Gangavelli

@gitam.edu

Associate Professor, GITAM School of Physiotherapy
GITAM

https://researchid.co/ranganath.g

RESEARCH INTERESTS

Musculoskeletal sciences
Cervical Radiculopathy
Foot and Ankle rehabilitation
Manual Therapy

Scopus Publications

205

Scholar Citations

Scholar h-index

Scholar i10-index

Scopus Publications

Effectiveness of Deep Cervical Fascial Manipulation<sup>®</sup> and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial
Prabu Raja G, Shyamasunder Bhat, Ranganath Gangavelli, Anupama Prabhu, Antonio Stecco, Carmelo Pirri, Vennila Jaganathan, and César Fernández-de-Las-Peñas
MDPI AG
Background: This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP). Method: Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken. Results: A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of −1.009 (p < 0.05) and −1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was −5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up. Conclusion: FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Influence of Shoulder External Rotation Component on Median Nerve Neurodynamics in Neurogenic Cervicobrachial Pain Syndrome: A Cross-Sectional Study
P. Kumar, A. Prabhu, and R. Gangavelli
Edra SpA

Effectiveness of posture-correction interventions for mechanical neck pain and posture among people with forward head posture: protocol for a systematic review
Ganesh M Balthillaya, Shradha S Parsekar, Ranganath Gangavelli, Narayan Prabhu, Shyamasunder N Bhat, and Bhamini Krishna Rao
BMJ
IntroductionForward head posture (FHP) is the most common postural deviation of the upper back. It is believed to be one of the predisposing factors for the development of mechanical neck pain (MNP). We propose doing a systematic review to find the effectiveness of interventions targeted on FHP with MNP and assess implementation fidelity associated with these interventions.Methods and analysisMedline (PubMed), Web of Science (Social Science Citation Index), EMBASE, Scopus, PEDro and CINAHL databases will be searched for studies published in English from their inception. Forward and backward citations of the included studies will be investigated for identifying additional records. We will include randomised controlled trials and non/quasi-experimental studies with two groups assessing the effectiveness of interventions targeted on FHP with MNP. Observational studies, non-randomised studies with single group and reviews will be excluded. We will consider the following outcome measures: postural variables of FHP, neck pain, performance-based functional disability scores of the neck, quality of life, basic activities of daily living and work-related outcomes. The unique citations will be screened by titles/abstracts and full texts, independently. The Cochrane Risk of Bias 2 tool will be used to critically appraise the included studies. The risk of bias and data abstraction of included studies will be undertaken independently. A qualitative synthesis will be conducted and, if sufficient studies with comparable outcome measures are available, we will statistically pool the result.Ethics and disseminationWe will undertake a systematic review of primary studies, and will not directly recruit participants hence, ethical clearance is not applicable. We will aim to present the findings of the completed systematic review at an international conference and subsequently submit the manuscript in a peer-reviewed journal for publication.PROSPERO registration numberCRD42021250310.

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial
Prabu Raja G, Shyamasunder Bhat N, César Fernández-de-las-Peñas, Ranganath Gangavelli, Fiddy Davis, Ravi Shankar, and Anupama Prabhu
Springer Science and Business Media LLC
Abstract Introduction Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. Methods This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. Discussion If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. Trial registration ClinicalTrials.gov CTRI/2020/01/022934. Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry – India.

Influence of lumbar spinal canal dimensions on neurological claudication symptomatology - A case control study
Monika Reddy, Dr Ranganath Gangavelli, Priyanka Priyanka, and Dr P Saikiran
Oriental Scientific Publishing Company
Lumbar spinal stenosis (LSS) is abnormal narrowing of spinal canal of lumbar vertebrae causing compression of neural tissue which leads to a neurologic deficit. LSS is diagnosed based on clinical symptoms of patient and it is confirmed using MRI (Magnetic Resonance Imaging). The aim of the study is to determine the association between MRI lumbar spinal canal and foraminal dimensions in on neurological claudication symptomology. A total of 89 patients (45 males ,44 females, age range: 20-60 years) referred for MRI Lumbar spine were included in this prospective study. Patients were categorized into symptomatic (49 cases) and asymptomatic (40 controls) based on Edinburgh claudication questionnaire (ECQ). The Antero-posterior diameter of dural sac, Transverse diameter of dural sac, Cross sectional area of dural sac, Cross sectional area of lateral recess, Lateral recess depth, Angle of lateral recess, Ligamentous interfacet distance was measured from L3 to S1 on Axial T2 weighted MRI images. The strength of association between MRI measurements and clinical symptoms were assessed using logistic regression analysis and Cramer’s V test. The Phi coefficient value for the lumbar spinal canal, foraminal dimensions with neurogenic claudication symptomology based on ECQ was 0.108 & 0.207 respectively, which showed weak positive correlation. Our study concludes that MRI measurements of lumbar spinal canal and foraminal dimensions denoting LSS were found to show weak positive correlation with clinical symptoms assessed based on Edinburgh claudication questionnaire.

Immediate effects of Mulligan's techniques on pain and functional mobility in individuals with knee osteoarthritis: A randomized control trial
Madhura Bhagat, Y.V. Raghava Neelapala, and Ranganath Gangavelli
Wiley
BACKGROUND AND PURPOSE Mulligan's mobilization with movement was shown to be effective when implemented in multimodal therapy for knee osteoarthritis. However, no study has evaluated the Mulligan's technique in isolation and compared the relative effectiveness with sham-controlled interventions. Hence, the present study examined the immediate effects of Mulligan's techniques with sham mobilization on the numerical pain rating scale (NPRS) and timed up and go (TUG) test in individuals with knee osteoarthritis. METHODS Thirty participants (mean age: 55.3 ± 8.3 years) with symptoms at the knee and radiographic diagnosis of knee osteoarthritis were randomized into sham (n = 15) and intervention (n = 15) groups. The intervention (I) group received Mulligan's mobilization glides that resulted in relative pain relief for three sets of 10 repetitions. For the sham (S) group, the therapist's hand was placed over the joint surfaces mimicking the pain-relieving glides, without providing the gliding force. The outcome measures NPRS and TUG were recorded by a blinded assessor pre- and post-intervention. RESULTS Statistically significant differences were identified between the groups in post-intervention median (interquartile range) NPRS (I group: 4.00 [2.00-5.00]; S group: 6.00 [4.00-7.00]) and TUG scores (I group: 10.9 [9.43-10.45]; S group: 13.18 [10.38-16.00]) with the intervention group demonstrating better outcomes (p < .05). Within-group, the post-intervention scores of NPRS and TUG were significantly lower (p < .05) compared to the pre-intervention scores in the intervention group. In the sham group, a statistically significant pre-post change was noticed only in the NPRS scores but not in the TUG scores. CONCLUSION Mulligan's techniques were effective in improving pain and functional mobility in individuals with knee osteoarthritis. The underlying mechanisms for observed effects must be examined further, as participants reported pain relief following sham mobilization.

Reliability of a novel method for measuring maximal voluntary mouth opening in patients with oral carcinoma
Ranganath Gangavelli, Anupama Prabhu, Priyadarshini Sundaresan, and Quratul Ain Sameera
Mark Allen Group
Background/Aims Mouth opening is a routine and vital activity of daily life that facilitates ingestion and speech. It is often found to be limited in patients with oral carcinoma. Measuring mouth opening is essential to detect the therapeutic effect of an intervention aiming to improve it. During measurement, the procedure needs to be reliable, simple, inexpensive and safe. This study aimed to determine the intrarater and interrater reliability of a novel method of measuring maximal voluntary mouth opening in patients with oral carcinoma. Methods Patients aged between 40 and 60 years of either gender with a diagnosis of oral carcinoma and presenting with difficulty in mouth opening were recruited. The distance between incisors was marked on standard sized paper slips as the participants performed maximal voluntary mouth opening. Distance between the markings was measured with a ruler in millimeters. The measurement procedures were carried out by two independent investigators. Results A total of 15 patients (12 male and 3 female) with a mean age of 52.53 ± 8.28 years participated in the study. Mean maximal voluntary mouth opening measure was <35 mm, indicating restricted mouth opening in these patients. Intrarater reliability of 0.95 (0.87–0.98) and interrater reliability of 0.96 (0.89–0.98) were found for the measurements. Conclusions The reliability of maximal voluntary mouth opening measurement using this novel technique was found to be excellent. This technique can be used in the routine clinical evaluation of patients with oral carcinoma.

Effect of upper limb neural mobilization on vibration threshold and hand grip strength in asymptomatic individuals: A randomized controlled trial
Apoorva Sunil Likhite, Ganesh Miyaru Balthillaya, Anupama Prabhu, and Ranganath Gangavelli
JCDR Research and Publications
Introduction: Neural Tissue Mobilization (NTM) is a common technique used in clinical presentation with increased neural mechanosensitivity and was found to improve signs and symptoms. However, there is dearth in the literature indicating the physiological effects of NTM on asymptomatic subjects with reduced neural extensibility. Aim: To determine the immediate and short-term effect of upper limb neural tissue mobilization on hand grip strength, vibration threshold (VT) and neural extensibility in asymptomatic individuals. Materials and Methods: A prospective, parallel group, single-blinded randomized controlled trial was conducted on 40 participants. The subjects in the experimental group were administered five sessions (on alternate days) of median and ulnar nerve mobilization techniques, whereas the subjects in the control group received no intervention. Outcomes were assessed at three time-points i.e., at baseline, immediately after the first session and two days following the fifth session. Means for outcomes were compared. Results: Statistically significant improvement was observed in VT in the experimental group. Both groups demonstrated an improvement in neural extensibility measured as Elbow Extension Range of Motion (EEROM) while performing neural provocative testing. No within group or between group significance was noted in grip strength. Conclusion: There is no immediate or short-term effect of neural mobilization on grip strength in asymptomatic subjects but, it is seen to improve neural tissue extensibility and VT.

Cervicobrachial pain - How often is it neurogenic?
Ranganath Gangavelli
JCDR Research and Publications
INTRODUCTION Neck pain associated with pain in the arm (cervicobrachial pain) is a common complaint in patients seeking physiotherapy management. The source of symptoms for this complaint is commonly presumed to be neural. However, this pain pattern could also result from various other innervated tissue structures of the upper quarter. Knowledge about frequency of neural structures being a predominant source of symptoms would help in implementing appropriate therapeutic strategies such as neural tissue mobilization along with other complimentary therapies for optimal outcomes. AIM To determine the frequency of cervicobrachial pain being neurogenic. MATERIALS AND METHODS Participants (n=361) aged between 20-65 years, reporting cervicobrachial pain were screened for neurogenic nature of symptoms. These physical signs included: active and passive movement dysfunction, adverse responses to neural tissue provocation tests, tenderness on palpating nerve trunks and related cutaneous tissues and evidence of a related local area of pathology (Clinical/radiological). The consistency of all these signs was checked to identify a significant neural involvement. RESULTS Descriptive statistics were used to analyse data. Of 361 participants, 206 were males (44.6 ±10.8 years) and 155 were females (41.8 ± 11.2 years). The frequency of neurogenic cervicobrachial pain was determined to be 19.9% (n=72) and the non-neurogenic sources for symptoms were attributed to 80.1% (n=289) of screened participants. CONCLUSION Lower frequency of cervicobrachial pain being neurogenic indicates thorough screening for appropriate therapeutic interventions to be successful.

Erratum: Effect of training on interlimb transfer of dexterity skills in healthy adults (American Journal of Physical Medicine and Rehabilitation (2011) 90 (25-34))
&NA;
Ovid Technologies (Wolters Kluwer Health)

Effect of training on interlimb transfer of dexterity skills in healthy adults
Eliza Annie Hillary Pereira, Kavitha Raja, and Ranganath Gangavalli
Ovid Technologies (Wolters Kluwer Health)
Objective: To examine transference of dexterity skills to the contralateral hand after ipsilateral hand training, retention of skills at 1 mo, and the influence of hand dominance, sex, and age on interlimb transfer of these skills. Design: This is an interventional study involving 200 healthy adults in the age group of 20-30 yrs and >30 yrs, who were block randomized into experimental and control groups. Experimental group was further subdivided into dominant and nondominant hand training group and participants underwent 5 days unsupervised training on tasks aimed at improving precision and dexterity. Jebsen-Taylor hand function test was administered at baseline, postintervention, and 1-mo follow-up. Analysis was done by nonparametric tests of comparison. Results: One hundred sixty-nine subjects completed the study. Transfer effect was noted from the dominant to the nondominant hand (P ≤ 0.001) and vice versa (P = 0.003) on the total test scores. This effect was retained at 1-mo follow-up. Conclusions: Dexterity skills are not consistently transferred to the contralateral hand after ipsilateral hand training. However, transference of gross motor skills of hand function does occur with retention effects up to 1 mo. Transfer of skills differs based on the hand trained and age of the individual.

RECENT SCHOLAR PUBLICATIONS

Effectiveness of Deep Cervical Fascial Manipulation and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised
P Raja G, S Bhat, R Gangavelli, A Prabhu, A Stecco, C Pirri, ...
Life 13 (11), 2173 2023

Influence of Shoulder External Rotation Component on Median Nerve Neurodynamics in Neurogenic Cervicobrachial Pain Syndrome: A Cross-Sectional Study
P Kumar, A Prabhu, R Gangavelli
Muscles, Ligaments and Tendons Journal 13 (2) 2023

Protocol: Effectiveness of posture-correction interventions for mechanical neck pain and posture among people with forward head posture: protocol for a systematic review
GM Balthillaya, SS Parsekar, R Gangavelli, N Prabhu, SN Bhat, BK Rao
BMJ Open 12 (3) 2022

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a
P Raja G, S Bhat N, C Fernndez-de-las-Peas, R Gangavelli, F Davis, ...
Trials 22 (1), 1-14 2021

Influence of Lumbar Spinal Canal Dimensions on Neurological Claudication Symptomatology-A Case Control Study
M Reddy, R Gangavelli, P Saikiran
Biomedical and Pharmacology Journal 14 (2), 1019-1024 2021

Immediate effects of Mulligan's techniques on pain and functional mobility in individuals with knee osteoarthritis: A randomized control trial
M Bhagat, YVR Neelapala, R Gangavelli
Physiotherapy Research International 25 (1), e1812 2020

Reliability of a novel method for measuring maximal voluntary mouth opening in patients with oral carcinoma
R Gangavelli, A Prabhu, P Sundaresan, QA Sameera
International Journal of Therapy And Rehabilitation 26 (9), 1-7 2019

Effect of Upper Limb Neural Mobilization on Vibration Threshold and Hand Grip Strength in Asymptomatic Individuals: A Randomized Controlled Trial.
AS Likhite, GM Balthillaya, A Prabhu, R Gangavelli
Journal of Clinical & Diagnostic Research 11 (11) 2017

Cervicobrachial pain-How often is it neurogenic?
R Gangavelli, NS Nair, AK Bhat, JM Solomon
Journal of clinical and diagnostic research: JCDR 10 (3), YC14 2016

Role of Mettler’s Release as an Adjunct in the Management of Post-Immobilization Knee Stiffness-A pilot study
RD Roopa, G Ranganath, SR Ravi
Indian Journal of Physiotherapy and Occupational Therapy 6 (1), 23.25 2012

Effect of Training on Interlimb Transfer of Dexterity Skills in Healthy Adults (vol 90, pg 25, 2011)
EAH Pereira, K Raja, R Gangavelli
AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION 90 (5), 433-433 2011

Effect of deep cervical flexor muscle fatigue on cervicocephalic kinesthetic sensibility
SR Ravi, G Ranganath
Physiotherapy and Occupational Therapy 5 (2), 124 2011

Comparing effectiveness of antero-posterior and postero-anterior glides on shoulder range of motion in adhesive capsulitis-a pilot study
K Harsimran, G Ranganath, SR Ravi
Indian Journal of Physiotherapy and Occupational Therapy—An International 2011

Effect of training on interlimb transfer of dexterity skills in healthy adults
EAH Pereira, K Raja, R Gangavalli
American Journal of Physical Medicine & Rehabilitation 90 (1), 25-34 2011

The sciatic nerve neurodynamic tension testing: An investigation of responses in asymptomatic subjects
G Ranganath
Physiotherapy-The Journal of Indian Association of Physiotherapists 4 (12 2009

MOST CITED SCHOLAR PUBLICATIONS

Effect of training on interlimb transfer of dexterity skills in healthy adults
EAH Pereira, K Raja, R Gangavalli
American Journal of Physical Medicine & Rehabilitation 90 (1), 25-34 2011
Citations: 46

Cervicobrachial pain-How often is it neurogenic?
R Gangavelli, NS Nair, AK Bhat, JM Solomon
Journal of clinical and diagnostic research: JCDR 10 (3), YC14 2016
Citations: 41

Effect of deep cervical flexor muscle fatigue on cervicocephalic kinesthetic sensibility
SR Ravi, G Ranganath
Physiotherapy and Occupational Therapy 5 (2), 124 2011
Citations: 3