Anda di halaman 1dari 20


Boxer’s Fracture results to functional limitations and participation restriction, leading to poor
Punching Power. The study will evaluate the effect of Plyometric Exercise on Punching
Power among Boxer’s Fracture. The study will use a quantitative multiple time series
quasi-experimental research design. The subjects will be chosen purposively and assigned to
Plyometric Exercise based on Gym affiliation. Punching Bag with power gauge will be used
for the measurement of Punching Power. Pearson, Spearman rho correlations and Chi-square
will be used in determining the relationship between PBWOG and Boxer’s Fracture
prognosticators while Percussion Test will be used to test the hypothesis.

Keywords: boxer’s fracture, plyometrics exercise, physical therapy, punching power


Fractures of the neck of the fifth metacarpal, the so called ‘‘Boxer’s Fracture’’, are
very common injuries of the hand. The patients are usually active young men and these are
typical injuries of Boxers (Greer and Williams, 1999; Mercan et al., 2004). Commonly, the
dominant hand is the punching hand and this hand is affected. When palmar angulation
exceeds 451, or when the patient presents a rotational deformity of the little finger in flexion,
reduction, with or without surgical treatment, is mandatory (Ali et al., 1999)

Punching power is defined as skill and ,localized below the shoulder and above
the anterior axillary folds, with or without force. Punching power can be a muscle memory,
the main function of Punching power is to bear the weight of the body(Anakwe, et al,. 2000).
It also absorbs the stress of ligting and carrying heavy objects.( Hislop, et al,. (2007. Punching
power is caused by a multi mechanism in individuals who is possibly have a dynamic
Movement stability. The Nelaton’s Line test had the highest specificity but lacked
sensitivity ,while the fulcrum test is better for diagnosis of chronic injuries than acute but is
not sensitive enough for routine use alone(Vossen et al,. 2000). The negative effects of
punching power will decrease the boxer performance and it can lead to functional impairment
and inability to join in sports acivities it affects up to 50% of infividuals that have had an
abnormal punching power (Duncan,et al,. 2014).

The Risk Factors of power punching among boxer such as training errors ,Flexibility
issues and biomechanical abnormalities, with the result of injury such as Boxer’s Fracture
along with symptom reduction using relative rest Plyometric exercises have been suggested in
chronic,long-standing cases,a complete rehabilitation program incorporating strengthening
(Altizer,2006). Flexibility proprioception,massage and endurance has been
recommended.eccentric exercise strengthening programs have been emphasized recently as a
key element of strength training in rehabilitation (Albu,Daniel-Emil et al,. 2015). However, in
the Philippines, age, sex, and wieght are the modifiable risk factors of Boxer’s Fracture
(Jeanmonod et al., 2014). Limited local studies were conducted regarding the prognosticating
factors for Punching power among Filipino boxer’s with BF.

The Plyometric Exercise method exists of 3 steps: evaluation, treatment and

prevention. The evaluation is received using repeated movements and sustained positions.
With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the
Upper limbs and lower back are classified into 3 subgroups: Patientswill performing
Plyometric exercise such as walking, jogging, running, or cycling (Geneen, Moore, Clarke,
Martin, Colvin, & Smith, 2017) withparameters being: 50%-70% of maximal oxygen
consumption or Maximal Heart rate for 30 mins, 3-4 times/week (Clark, 2015).
2.1Literature Review
Boxer’s Fracture fracture of one of the metacarpal bones of the hand. Classically, the
fracture occurs across the metacarpal neck, after the person strikes an object with a closed fist.
(Greer and Williams, 1999), Majority of amateur boxers suffer this kind of injury each year.
Among these 90% have BF and another 52% are all injuries. Four out of five BF occur among
boxers while the other by other causes (Mercan et al., 2004).

2.1.1Factors that Affect Punching among Boxer’s Fracture Age

Studies showed around age 22 to 32 who experience this type of injury. Also, men
were considerably, on average, 3 years younger than women when they are injured (Leclerc et
al., 1999) Age is the single most important risk factor for BF. For each successive 10 years
after age 22, Boxer’s Fracture rate more than doubles in men than women (Anakwe et al,
2011). Sex

Men are more likely to have BF injury and are less likely to recover. There is no
Age-specific BF rates are higher in men; however, because of women's longer life expectancy
and the much higher incidence of BF at older ages, women have more BF events than men
overall. It is shown that the majority of studies (13 studies) found stroke more commonly in
females than males and ranged from 50.5% to 62.1% for females (Salihovic et al., 2009). Weight

It has been a well-known risk factor in the onset risk factor for many other diseases of
the musculoskeletal system. Obesity has recently been indicated as important but potentially
non-modifiable risk factor in the onset and progression of Boxer’s Fracture. (Yochum et. al,
2014). Strength

Strength is a well-known risk factor for BF since the athlete may use excessive
force on punching which may result to being injured. And not everyone has the same power
strength and may change (Mercan et al.,2004) Speed

Speed can be caused by biochemical changes in the body caused by Boxer’s Fracture.
It is an important contribution to poor punching power. It occurs in about a many of Boxer in
the first months after BF (Hackett et al., 2006). Dependency of ADL/Disability

ADL involves activities of self-care, such as eating, washing and dressing, and are
usually defined as physical self-maintenance tasks. BF has a huge impact on the Boxers
capacity to perform activities of daily living (ADL) (Haghgoo et al., 2013). Disability

People are able to recover from the effects of BF but others are left with lifelong
disabilities. BF victims may lose the ability to Perform hand task, have significant trouble
with other task which related to hand movement. The most common cause of adult disability;
of the survivors, about 50% will have a significant long-term disability (Wolfe 2000). BMI

People have different BMI while Reduced bone mass in Boxer may be a
consequence of reduced energy availability in response to chronic weight restriction and
could have particular implications for these athletes in light of the high risk nature of the
sport. In contrast, the high intensity, high impact training associated with boxing may have
conveyed an osteogenic stimulus on these athletes. (Crabtree et al.,2012)

2.1.2 Effect of Plyometric Exercise on Punching Power after Boxer’s Fracture

In the study of Frazier, Miller, Fox, Brand, &Finseth (2002), those who were given
Plyometric Exercise on the Upper Extemities intervention showed significant improvement
on the paralyzed and/or spastic laterality of the Upper Extremities, thus showing positive
effect on their typical asymmetrical ROM. PE on the Arms showed minimal improvement on
a patient with Boxer’s Fracture, despite application PE it helped also in assisting in flexion
parameter of the affected extremity,(Duda 1999). As stated by the study of Frazier et al.,
(2002), Plyometric Exercise may be an alternative for Exercise Regime for Boxers.
According to study of Frazier, Miller, Fox, Brand, & Finseth (2002) Plyometric Exercise has
an effect because the mechanism of the Exercise has improved of muscle strength by
excitation of gamma motor nerve in skeletal muscles, as the Exercise raises the tension of the
muscle. PE is well-known to be effective for increasing functional movements by improving
muscles strength and endurance but does not provide long-term relief from other symptoms.
PE showed no significant difference of effect in both groups other than passive ROM
improvement in regards to the subjects’ Punching Power (Duda, 1988).

2.2 Purpose Statement

The study will prove the effect of Plyometric Exercise on Punching power among
Boxers with boxer’s fracture

2.2.1 Significance of the Study

The study will benefit the following: Amateur Boxers will highly benefit from the
study, not only will they learn of Plyometric Exercise it will also improve their Punching
Power. Their Instructor will have an idea of other ways to help the Boxer with BF in
performing Plyometric Exercise with lesser assistance until they may do it independently.
This study will also provide guidance to physical therapists in dealing with Boxer’s Fracture,
this will help them in giving effective interventions that would improve Punching Power and
since the effects of PE on Boxers has been great, and the demand for Plyometric exercise will
prompt the Gym can benefit by earning extra income because we conduct this exercise inside
the gym thus also increase clinical experience of the Physical Therapist., this will be of great
help to future researchers as this may serve as their ground for further research on the effects
Plyometric exercise on punching power among Boxer’s Fracture

2.3 Problem Statement

2.3.1 What are the characteristics of the subjects in terms of: Age Gender Weight Strength Speed Power Disability BMI
2.3.2. What is the Boxers performance level of Punching Power
2.3.3. What is the relationship between Plyometric exercise on Boxer’s Fracture?

2.3.4. What is the effect of Plyometric Exercise on Punching Power

2.4 Hypothesis

HO1: There is no significant relationship between Boxer’s Fracture and

Punching Power

HO2: Plyometric Exercise has no significant difference with Boxer’s Fracture

on Punching Power

2.5 Theoretical Framework

2.3.1 Newton’s First and Second Law of Motion

On his study Newton's first law of motion states that an object in motion tends to stay in
motion unless an external force acts upon it. While Newton's 2nd Law of Motion
Newton's second law of motion states that when a force acts on an object, it will cause the
object to accelerate Depending on the Boxer’s Peak Performance. Holbourn et al., (2002)

2.3.2 T he International Classification of Functioning, Disability, and Health (ICF)

The International Classification of Functioning, Disability, and Health (ICF) is a

framework used for describing and organizing info on function and disability (Betto et al.,
2010). Buchalla et al., (2015) stated that it is based on a biopsychosocial approach that is used
to integrate health’s biological, individual, and social dimensions, having the environment of
the subjects with Boxer’s Fracture are being seen as either a facilitator or a barrier to their
functional recoveries.

2.3.3Self-Concept Theory

The perception of one’s self, are formed through their environments and experiences that
can be influenced by other significants and/or environmental reinforcements. Having an
injury is a huge impact on their lives especially on their carreer, giving them a negative sense
in themselves, and psychological morbidity. Those factors can help decide there self-concept
on whether they want to live with many disabilities and lower their, or improve their
conditions to increase their Perfomance (Ellis-Hill, & Horn 2007).

2.3.4 Power Strike Theory

The power of a strike can be calculated according to [m×v²]¥2 M – Mass – the
weight of the object moving.V – Velocity – the speed at which the object is moving.As we
can see, the V is square, meaning that it has a much bigger influence on the power than the
mass. Striking at the target - a “whip” like punch which explodes on the point of impact
(Boxing usually has this sort of punch) Striking through the target – a “battering ram” like
punch which crushes the point of impact and affects the balance of the structure. (Sugden&
Tomlinson 2013)


The simulacrum is based on the International Classification of Functioning, Disability,

and Health model (WHO, 2001). It also helps in identifying the Plyometric effects for our
subjects in the sense that gives us what are needed to maximize out of the capabilities even
after Boxer’s Fracture (Crowder et al., 2010).

PP Risk factors: HO1 HO2 Exercise
Punching Power
-Disability R D
Figure 1. Simulacrum


3.1 Research Design

This study will use a quantitative multiple time series of experimental research design.
This design was based on the Law of Velocity and power which there is a biological to
exercise-induced improvements in function. As, this ceiling is approached, greater Velocity is
needed to achieve maximum power (Adler, Bonner, Graham, &Katsuri, 2010).

3.2 Site and Sampling

The study will be conducted at Elorde Boxing Gym in Quezon City.this place were
chosen because of the availability and accessibility of the subjects and Tools

A total of 10 subjects will be recruited to participate in the study. This sample size
was based on the 80’/. incidence of rate of power among well trained Boxers in the Gym.

The subjects will be selected using non-probability purposive sampling. The

prospect subject should be 1) phisicaly fit and ready for the experiment 2) male. without any
injury or health condition such as Highblood and Hypertension 4) Ambulatory with/without
assistive device; 5) can follow steps and commands 6) intact cognition with MMSE score >27
(Crowder et al., 2010); 7) no depressive signs with emotional subscale of SIS score of <60
(Nichols-Larsen et al., 2005); 8) intact visual acuity with 15/20 score on Snellen chart (Duda,
1988) will be included.

Subject will be excluded if they have:( 1) other condition such as dislocation or

muscle injury (2) inability to follow simple visual and verbal instruction; 3) motor skills
hypersensitivity ; and (4) uncontrolled HTN. Those who will qualify based on the criteria and
consent to participate will be assigned to EG1, EG2 and CG based on hospitalization
affiliation; Hospital A to EG1, Hospital B to EG2, and Hospital C to CG.

3.3 Research Instruments

3.3.1 Personal Demographic Sheet (Appendix A)

A personal demographic sheet will be used to gather confounding variables like age,
sex, weight, BMI, site of Injury, duration of Pain, no. of medication, and co-morbidities.
These variables were found to influence the Punching Power based on the systematic review
of Chen et al. (2015).

3.3.2 Mini-Mental State Examination (Appendix E) for cognition

MMSE is used for the measurement of cognition. It is a brief 11-question test widely
used for the evaluation of cognitive impairment. It measures orientation, registration,
attention and calculation, recall, and language. The maximum total score is 30 points with
lower total scores suggesting more severe cognitive impairment. Concluding that an MMSE
score of 26 or 27 should be used as a cutoff score in symptomatic populations with similar
educational and socioeconomic backgrounds when the goal is to miss few true cases.
Population surveys where the expected prevalence is low may require a different cutoff score
to indicate the need for further diagnostic evaluation (Chen1 et al., 2015).

3.3.3BeckDepression Inventory (Appendix F) for depression

A self-report depression inventory that identifies overt behavioral characteristics of

depression. Items on a four-point scale that ranges from 0 to 3. Ratings are summed to
provide a total score ranging from 0 – 63. Scores >10 generally meet the threshold for a
diagnosis of depression. It has a high coefficient alpha, (.80) its construct validity has been
established, and it is able to differentiate depressed from non-depressed patients. Test-retest
reliability was studied using the responses of 26 outpatients who were tested at first and
second therapy sessions one week apart. There was a correlation of .93, which was significant
at p < .001. The mean scores of the first and second total scores were comparable with a
paired t (25)=1.08, which was not significant (Beck et al., 1988).
3.3.4National Institutes of Health Stroke Scale (Appendix G) for stroke severity

The NIHSS is a tool used for Stroke Severity Measurement. It is a 15-item assessment
tool that provides a quantitative measure of stroke-related neurological deficit. NIHSS
evaluates levels of consciousness, visual field loss, extraocular movement, facial muscle
function, UE and LE motor strength, coordination, aphasia, dysarthria, sensory loss,
extinction, and loss of attention. Total NIHSS scores range from 0 to 42 (Saposnik et al, 2011),
with higher scores meaning more severe neurological deficit (Wardlaw et al, 2009). Stroke
severity may be stratified on the basis of NIHSS scores as follows (Brott et al, 1989): 1) Very
Severe: >25; 2) Severe: 15 – 2; 3) Mild to Moderately Severe: 5 – 14; 4) Mild: 1 – 5; 5)
Acute Stroke: (Schlegel et al, 2003; Rundek et al, 2000). Outcomes related to NIHSS scores
at admission: Scores of <5; 80% of stroke survivors will be discharged to home. Score
between 6 and 13 typically require acute inpatient rehabilitation. Scores of >14 frequently
require long-term skilled care (Chen et al., 2015).

3.3.5Mini Nutritional Assessment (Appendix H) for nutritional assessment

The Mini Nutritional Assessment is an effective, easily administered tool designed to

identify older adults who have or are at risk for developing malnutrition. It consists of 18
questions and can be completed in about 15 minutes. A short form, containing the first 6
questions, can be used for screening if they’re experiencing first signs of malnutrition or not
(DiMaria-Ghalili 2008).

3.3.6 Pedometer for energy expenditure

The pedometer is used as a measurement of physical activity, this device measure the
energy expenditure and/or ambularoty effort of a person with stroke, providing immediate
feedback to the patient’s physical activity level, the device is placed on the hip in a form of a
belt, and on the patella of the knee with a strap support on the non-affected side (Cras et al.,
2013; Carrol et al., 2012).6-minute walk test (6-MWT) will be used as the device’s activity
for measuring the number of steps of the subjects on a flat surface (Carrol et al., 2012). 6-Minute Walk Test

When the timer starts, the subjects will walk continuously with or without assistive
device as much as possible for 6 minutes on a flat surface with the possibility of slowing
down, or resting within the time limit (Dunn et al., 2015).

3.3.7 Perceived Social Support Scale (Appendix I) for social support

The perceived Support scales include Tangible Support (3 items); Emotional Support,
such as having others listen and show interest (4 items); and Informational Support, such as
sharing suggestions and information (4 items). Satisfaction with Support (3 items), and
Negative Social Interaction, such as criticisms and demands by others (3 items), are also
included (Malecki 2006).

3.3.8Stepping subscale of Brunel Balance Assessment (BBA) (Appendix J) to assess functional


The stepping subscale of BBA will be used to evaluate the difficulty in stepping of
the patients with stroke. The Brunel Balance Assessment (BBA) is designed to assess
functional balance for people with a wide range of abilities and has been tested specifically
for use post-stroke. It consists of a hierarchical series of functional performance tests that
range from supported sitting balance to advance stepping tasks. Inter-item correlations were
<0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively.
Reliability was high (100% agreement) and excellent test-retest reliability (K=1) 100%
agreement (Tyson and Desouza, 2004).

3.3.9Goniometer for Range of Motion measurement

Goniometer is an instrument used in measuring angles, particularly measurements of the

joint angles of the body, and determining both particular joint position and total amount of
motion available, therefore stroke survivors who are particularly sensitive to movement
velocity needed further assessment in their spasticity affectation of the tested or assessed joint
(Jung, Kim, Lee, Oh, & Yu 2015; Norkin, & White 2009). Hip Flexion

Subject is placed in a supine position with the knee extended, the goniometer’s fulcrum
is placed over the lateral aspect of the hip having the greater trochanter as a point of reference.
The proximal arm is aligned to the lateral midline of the pelvis, and the distal arm is also
aligned with the lateral femur having the lateral condyle as a point of reference (Norkin, &
White 2009). Hip Extension

Subject is placed in a prone position with both knee extended and the hip in neutral
position, the fulcrum is over the greater trochanter at the lateral aspect of the hip joint.
Proximal arm is aligned to the pelvis’ lateral midline, and the distal arm is aligned to the
lateral epicondyle (Norkin, & White 2009). and Plantarflexion

Subject is placed in a short sitting position on the edge of a table with knees flexed to 90o.
Fulcrum is over the lateral malleolus. The proximal arm is aligned over the lateral midline of
the fibula, and the distal arm is parallel to the fifth metatarsal (Norkin, & White 2009).

3.3.10 Upright Motor Control Test (Appendix K)

The UMCT is used for voluntary control or functional strength of the lower limb.
This was designed so to incorporate upright posture and weight bearing effects. Its intertester
reliability is established at 96% for flexion portion and 90% for extension portion (Gorgon, &
Lozano 2016; Hislop, & Montgomery 2007). Hip Flexion

Subject will be asked to stand as straight as he/she can, and bring their knee up to
their chest as high and as fast as they can (Hislop, & Montgomery 2007). Dorsiflexion

Subject will be asked to stand as straight as they can, and bring their knee and foot
upward to their chest as high and as fast as they can (Hislop, & Montgomery 2007). Hip Extension

Subjects then will be asked to stand on both legs as straight as they can, and next is to
stand as straight as they can on their right/left leg then lift the leg up, and keep standing as
straight as they can (Hislop, & Montgomery 2007). Plantarflexion

The assistant is positioned behind to maintain trunk erection at hip, and the examiner
is positioned to prevent knee hyperextension. Subject then will be asked to stand on both
legs as straight as they can, then lift their and hold their right/left leg (Hislop, & Montgomery

3.3.11 Modified Ashworth Scale for spasticity

The Modified Ashworth Scale (MAS) is a valid and reliable tool to measure the
spasticity of a patient that affects the Arms. To score the MAS, the examiner must take an
average based on the four passive extensions and disregard any volitional resistance or
assistance to movement. Any limitations to full range of passive movement on the affected
and unaffected side are measured with a goniometer and recorded. Tonal abnormality was
measured and was scored using the modified ashworth score. The reliability of the Modified
Ashworth scale was very good (Kw = .84 for interrater and .83 for intrarater comparisons)
(Gregson et al., 1999).

3.3.12 Stroke Impact Scale (SIS) v.16 (Appendix C and Appendix D) to assess different stroke

The Stroke Impact Scale (SIS) v.16.0 is a stroke-specific, self-report, health status
measure (REFERENCES). It was designed to assess multidimensional stroke outcomes,
including strength, hand function, activities of daily living/instrumental activities of daily
living (ADL/IADL), mobility, communication, emotion, memory and thinking, and
participation. The SIS version 16.0 includes 59 items and assesses 8 domains: Strength – 4
items, Hand function – 5 items, ADL/IADL – 10 items, Mobility – 9 items, Communication –
7 items, Emotion – 9 items, Memory and thinking – 7 items, Participation/Role function – 8
items.A score of 1 represents an inability to complete the item and a score of 5 represents no
difficulty experienced at all. An extra question on stroke recovery asks that the client rate on a
scale from 0 – 100 how much the client feels that he/she has recovered from his/her stroke
(Nichols-Larsen et al., 2005). Higher score indicates better outcomes. The SIS shows excellent
internal consistency with Cronbach’s ranging from 0.80 to 0.95. Test-retest reliability was
investigated with reported ICC ranging from 0.70 to 0.94 (Mulder, Nijland, 2016).

3.4 Conduct of the Study

3.4.1 Preparation Phase

The objective of the preparation phase is to formulate a feasible and sound

thesis proposal. A review of literature was conducted to serve as a background study.
Legitimate database like PubMed, Google Scholar, PEDro were search using key words,
boxer’s fracture, plyometrics exercise, physical therapy and punching power
The thesis proposal has drafted and presented the panel and revised on the panel’s
feedback. The identification of the prospective objects, locale of the study and then
formulating of the Informed Consent Form, letters, and questionnaires will be done during
this phase.

3.4.2 Pilot Testing Tool

The objective of the pilot testing is to determine the conceptual equivalence of

Filipino Version National Institutes Health Stroke Severity (NIHSS). The researchers will
translate the National Institutes Health Stroke Severity (NIHSS) to Filipino. A linguist without
prior knowledge will translate it back to English, Another linguist also without knowledge of
National Institutes Health Stroke Severity (NIHSS) will check the accuracy of the translation.
To determine the clarity and understandability of the questionnaire; five pilot test subjects
meeting the study’s criteria will be asked to answer Filipino Version, after the test each will
asked to give feedbacks or comments.

To determine the reliability of the study’s assessors, two licensed Physical Therapist will
be asked to administer the Mini-Mental State Examination (MMSE), Snellen’s Chart,
Modified Ashworth Scale (MAS), Upright Motor Control Test (UMCT), Pedometer,
Goniometryand Brunel Balance Assessment (BBA) in a form of interview to 5 pilot test
participants meeting the study’s criteria twice, randomly, and independently. The tests will be
repeated after a week for test retest reliability. The PT with a reliability coefficient of greater
than 0.80 will be assigned as a study’s assessor blinded to group allocation.

3.4.3 Revision Phase

The revision of the NIHSS, MMSE, MNA, and SIS v.16.0will be revised on the pilot
test subject’s feedback.

3.4.4 Pre-testing Phase

A letter (Appendix O) addressed to the medical directors will be sent personally by

the researchers. After a week, the request example will be followed upon approval, all the
subjects will be briefed about the purpose of the study. Those who will consent to participate
will be asked to sign an Informed Consent Form (ICF). Those who will qualify based on the
inclusion /exclusion criteriaand consent to participate in the study will be undergo skin testing
that will be replicated from the study of Costa et al., (2014);Djordjevic, Jovic, Katunac, and
Vukicevic (2012), byapplying a small (1 x 1 cm2) patch of KT on the volar aspect of the
forearm of the contralateral side for 24 hours and must report to the researcher if there’s any
presence of redness or other skin changes. Those who will be tested negative for KT will
answer the SIS v.16.0. Those who will score of <60 SIS scale v.16.0 (Beninato, Portney, &
Sullivan, 2009) will be assigned to EG (EG1 and EG2) or CG systematically using a list of
random numbers generated by Excel: The upper thirdto EG1, middle third to EG2 and lower
third to CG.

3.4.5 Implementation Phase

The subjects will undergo PE protocol which the PE will be applied to the in a size
4’x 5’x 2’Y-band application on vastusmedialis, and rectus femoris both with maximum
tension on the clean affected side (Aslan, Ekiz, &Özgirgin 2015). And on the lower leg, KT
will be applied in a size 4’x 5’x 2’ I-band application on fibularislongus, fibularis tertius,
extensor digitorumlongus, and tibialis anterior, all with maximum tension with some taping
support around the ankle on the clean affected side (Bae, Kim, Lee, & Min 2015).

EG1 and EG2 will undergo the same KT procedure; EG1 will receive KT with 10%
tension, EG2 with no tension and CG with neutral tape. Two licensed PT with certificate in
KT application will apply the KT protocol to EG1 and EG2 separately.

3.4.6Post Testing

All subjects will be asked to answer if they feel any pain 30 minutes after application
for the succeeding 10 days of application.

3.5Data Analysis

Descriptive statistics like mean, median, mode and student deviation will be used to
be used to describe the subject’s characteristics. Chi square, Spearman and Pearson
correlation will be used to test the relationship between the study’s prognosticators and
Punching Power. One-way ANOVA will be used to test the effect of Plyometric Exercise on
Punching Power. All statistical levels of significance will be set at p<.05. Statistical Package
for Social Sciences (SPSS) VERSION 21 will be used to analyze data (IBM Corp. Released
2013. IBM SPSS Statistics for Windows, Version 21.0 Armonk, NY: IBM Corp.)

3.6 Ethical Considerations

All subjects will be signing an informed consent (Appendix A) at the start of the
study. No harm or injury will be inflicted upon the subject on and after the duration of the
study. Any personal information directly or indirectly related to their treatment will not be
disclosed without the subjects’ permission. All information will be dealt with full
confidentiality. Treatment protocols used all throughout the duration of the study is ensured
not to cause harm or danger or at least kept amenity. Both experimental and control groups
will be given a comparable treatment. The subjects will be free to discontinue if they so
believe that they do not want to be a part of the study anymore. The researchers will observe
the highest possible ethical standards at all time and maintained the outmost integrity in all
gathering procedure.

This research will be reviewed by the Institutional Ethics Review Board (IERB) of
Our Lady of Fatima University.


Boxer’s Fracture

Fifth metacarpal neck fractures (commonly named "boxer's fractures") are the most
common metacarpal injuries and usually affect young active people. These lesions are mainly
treated conservatively. Their surgical management, if indicated, is still a matter of debate.
Different procedures have been described (Pogliacomi et al., 2017 ).

Plyometric Exercise

Plyometrics Exercise also known as "jump training" are exercises in

which muscles exert maximum force in short intervals of time, with the goal of increasing
power (speed-strength). This training focuses on learning to move from a muscle extension to
a contraction in a rapid or "explosive" manner, such as in specialized repeated
jumping.Plyometrics are primarily used by athletes, especially martial artists, sprinters
and high jumpers to improve performance, and are used in the fitness field to a much lesser
degree.(Bruzas, Kamandulis, & Venckunas, 2016).

Punching Power

Punching power is the amount of kinetic energy in a person's punches. Knockout

power is a similar concept relating to the probability of any strike to the head to
cause unconsciousness. Knockout power is related to the force delivered and precision of the
strike (Vossen et at.,2000).


Ali A, Hamman J, Mass DP (1999). The biomechanical effects of angulated boxer’s fractures.
Journal of Hand Surgery, 24A: 835–844.

Anakwe, RE; Aitken, SA; Cowie, JG; Middleton, SD; Court-Brown, CM (Jan 2011). "The
epidemiology of fractures of the hand and the influence of social deprivation.". The Journal of
hand surgery, European volume. 36 (1): 62–
5 . PMID 20709710. doi:10.1177/1753193410381823.

Berkman EF, Miles GH (1943). Internal fixation of metacarpal fractures exclusive of the
thumb. Journal of Bone and Joint Surgery, 25: 816–821.

Birndorf MS, Daley R, Greenwald DP (1997). Metacarpal fracture angulation decreases

flexor mechanical efficiency in human hands. Plastic and Reconstructive Surgery, 99: 1079–

Bruzas V, Kamandulis S, Venckunas T, Snieckus A, Mockus P. (2016) Effects of plyometric

exercise training with external weights on punching ability of experienced amateur boxers. J
Sports Med Phys Fitness. Retrieved From:
CROWDER, V.R., S.W. JOLLY, B. COLLINS, AND J. JOHNSON. The effect of plyometric
push-ups on upper body power. Track Field Q. Rev. 93:58–59. 1993.

DUDA, M. Plyometrics: A legitimate form of power training? Phys. Sportsmed. 16:213–218.


Jeanmonod, RK; Jeanmonod, D; Damewood, S; Perry, C; Powers, M; Lazansky, V (Feb

2011). "Punch injuries: insights into intentional closed fist injuries.". The western journal of
emergency medicine. 12 (1): 6–10. PMC 3088367  . PMID 21691465.


Comparison of Dynamic Push-Up Training and Plyometric Push-Up Training on Upper-Body
Power and Strength. Journal of Strength and Conditioning Research, 2000 Retrieved from

Leclerc S, Herrera CD Sport medicine and the ethics of boxing. British Journal of Sports
Medicine 1999;33:426-429. Retrieved from: Retrieved date; September 28,

M. Arafa, J. Haines, J. Noble, D. Carden. Immediate Mobilization of Fractures of the neck of

the fifth metacarpal. Injury 1998 Retrived from:

Stephen Edward Greer, Janet Marie Williams. Boxer’s Fracture: An indicator of Intentional
and recurrent injury. The Amercian Journal of Emergency Medicine 1999 Retrieved from:
William H. Frazier, Marilyn Miller, Richard S. Fox, Donald Brand, Frederick Finseth. Hand
Injuries: Incidence and epidemiology in an emergency Service. Journal of the American
College of Emergency Physicians 1978. Retrieved From

HOLCOMB, W.R., D.M. KLEINER, AND D.A. CHU. Plyometrics: Considerations for safe
and effective training. Strength Cond. 20: 36–39. 1998.

Altizer, L. 2006. Boxer's Fracture. Orthopedic nursing journal, 25(4), pp. 271–273.

Terry R. Yochum; Lindsay J. Rowe (2004). Essentials of Skeletal Radiology (3rd ed.).
Baltimore, MD: Lippincott Williams & Wilkins. ISBN 0781739462.

Mercan S, Uzun M, Ertugrul A, Ozturk I, Demir B, Sulun T (2004). Psychopathology and

personality features in orthopaedic patients with boxers fractures. General Hospital
Psychiatry, 27: 13–17.

Hislop, H. J., & Montgomery, J. (2007). Daniels and Worthingham’s muscle testing:
techniques of manual examination (8th ed). St. Louis, Mo: Saunders/Elsevier. Retrieved date:
September 29, 2017.

A.H.S.Holbourn,MA EDIN, D PHIL (2001). Mechanics of Head Injury Lancet. Retrieved

Date: September 29, 2017 Retrieve From:

Eimear Dolan, Nicola Crabtree, Adrian McGoldrick, David. T. Ashley, Noel McCaffrey,
Giles. D. Warrington (2012) Weight regulation and bone mass: a comparison between
professional jockeys, elite amateur boxers, and age, gender and BMI matched controls,
Journal of Bones and Minerals Metabolism. Retrieved From
Scott M. Lephart , Timothy J. Henry (1996) The Physiological Basis for Open and Closed
Kinetic Chain Rehabilitation for the Upper Extremity. Journal of Sports Rehabilitation
Retrieved From

Gregson, J. M., Leathley, M., Moore, A. P., Sharma, A. K., Smith, T. L., & Watkins, C. L.
(1999). Reliability of the tone assessment scale and the modified ashworth scale as clinical
tools for assessing poststroke spasticity. Archives of Physical Medicine and Rehabilitation,
80(9), 1013–1016. Retrieved: March 01,

John Sugden, Alan Tomlinson (2013) Power Strike Theory Power Games: A Critical
Sociology of Sport Retrieved From:

Ebben, William P., Blackard, Douglas O. (1997) Developing a Strength Power Program for
Amateur Boxing:Strength & Conditioning: Retrieved From:

Pogliacomi F1, Mijno E, Pedrazzini A, Tocco S, Tonani M, Ceccarelli F, Vaienti E.(2017)

Fifth metacarpal neck fractures: fixation with antegrade locked flexible intramedullary nailing.
Acta Biomed. Retrieved From:

Samir Chadliab,Noureddine Ababoua,Amina Ababoua(2014)A New Instrument for Punch

Analysis in Boxing. Procedia Engineering Retrieved From: