Dissertation submitted to the Faculty of Health in compliance with the requirements for a Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2005 / Due to sustained partial neck flexion when operating a computer terminal for prolonged periods and by holding a stooped posture being proposed aetiologies for hypertonic posterior cervical muscles and subsequent mechanical neck pain, subjects for this research study were chosen according to their occupation and had to sit at a desk for more the three hours and less than eight hours a day. The purpose of this study was to investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation combined with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles. This was a comparative, randomised, clinical trial consisting of two groups. Group A received proprioceptive neuromuscular facilitation (PNF) combined with heat therapy as their treatment protocol. Group B received proprioceptive neuromuscular facilitation combined with cryotherapy as their treatment protocol. Each group consisted of thirty people between the ages of 25 and 50 who were randomly allocated to their respective groups. It was hypothesized that the analgesic properties related to cryotherapy would result in the treatment group that received PNF stretching combined with cryotherapy yielding better results in terms of objective clinical findings. It was also hypothesized that the therapeutic effects of heat therapy would result in the treatment group receiving PNF stretching combined with heat therapy would yield better results in terms of subjective clinical findings and it is hypothesized that there is an association between the subjective and objective clinical findings between the cryotherapy and the heat therapy groups. The treatment regimen consisted of each participant receiving three treatments over a period of one week and then a one-week follow-up consultation. Subjective data monitored consisted of the Numerical Pain Rating Scale –101 (NRS-101) and the CMCC Neck Disability index. Objective data was collected using the Cervical Range of Motion goniometer (CROM) and the Algometer. At the end of all treatment protocols, statistical (quantitative) analysis was performed to determine whether one treatment protocol was more effective than the other. The analysis of the data collected showed that for all outcomes measured, either of the two treatments was effective overall. Trends suggested optimum treatments were dependent on the age of the patient. Age groups of 46-50 years old, 41-45 years old and the 31-35 years old responded best and improved the most with heat intervention, while age group of 36-40 years old responded best to the cryotherapy intervention. For the youngest age group of 25-30 years old, it did not make a difference whether they received heat therapy or cryotherapy as an intervention. It would seem that the older the patient the more effective the application of heat therapy as a result of the effect of heat therapy on the collagen and elastin fibers within the muscle and its fascia which allowed for increased and sustained improvement of the majority of the age groups represented in this study. Conversely it would seem that the cryotherapy group had only immediate and unsustained effects in the long term, which suggests that the cryotherapy had only a pain relieving function that allowed for the improvement of patients in the study, which when removed resulted in regression to the initial clinical syndrome severity. Most of the outcomes did not show a statistically significant interaction between time, age group and treatment group. The study was underpowered at the age group level, with only 12 subjects per age group. Further studies with a larger sample size in each of the age groups are needed in order to determine whether age is a definitive factor in one treatment being preferred over the other.

Dissertation submitted to the Faculty of Health in compliance with the requirements for a Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2005 / Due to sustained partial neck flexion when operating a computer terminal for prolonged periods and by holding a stooped posture being proposed aetiologies for hypertonic posterior cervical muscles and subsequent mechanical neck pain, subjects for this research study were chosen according to their occupation and had to sit at a desk for more the three hours and less than eight hours a day. The purpose of this study was to investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation combined with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles. This was a comparative, randomised, clinical trial consisting of two groups. Group A received proprioceptive neuromuscular facilitation (PNF) combined with heat therapy as their treatment protocol. Group B received proprioceptive neuromuscular facilitation combined with cryotherapy as their treatment protocol. Each group consisted of thirty people between the ages of 25 and 50 who were randomly allocated to their respective groups. It was hypothesized that the analgesic properties related to cryotherapy would result in the treatment group that received PNF stretching combined with cryotherapy yielding better results in terms of objective clinical findings. It was also hypothesized that the therapeutic effects of heat therapy would result in the treatment group receiving PNF stretching combined with heat therapy would yield better results in terms of subjective clinical findings and it is hypothesized that there is an association between the subjective and objective clinical findings between the cryotherapy and the heat therapy groups. The treatment regimen consisted of each participant receiving three treatments over a period of one week and then a one-week follow-up consultation. Subjective data monitored consisted of the Numerical Pain Rating Scale –101 (NRS-101) and the CMCC Neck Disability index. Objective data was collected using the Cervical Range of Motion goniometer (CROM) and the Algometer. At the end of all treatment protocols, statistical (quantitative) analysis was performed to determine whether one treatment protocol was more effective than the other. The analysis of the data collected showed that for all outcomes measured, either of the two treatments was effective overall. Trends suggested optimum treatments were dependent on the age of the patient. Age groups of 46-50 years old, 41-45 years old and the 31-35 years old responded best and improved the most with heat intervention, while age group of 36-40 years old responded best to the cryotherapy intervention. For the youngest age group of 25-30 years old, it did not make a difference whether they received heat therapy or cryotherapy as an intervention. It would seem that the older the patient the more effective the application of heat therapy as a result of the effect of heat therapy on the collagen and elastin fibers within the muscle and its fascia which allowed for increased and sustained improvement of the majority of the age groups represented in this study. Conversely it would seem that the cryotherapy group had only immediate and unsustained effects in the long term, which suggests that the cryotherapy had only a pain relieving function that allowed for the improvement of patients in the study, which when removed resulted in regression to the initial clinical syndrome severity. Most of the outcomes did not show a statistically significant interaction between time, age group and treatment group. The study was underpowered at the age group level, with only 12 subjects per age group. Further studies with a larger sample size in each of the age groups are needed in order to determine whether age is a definitive factor in one treatment being preferred over the other.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / The purpose of this investigation, was to determine what role cryotherapy plays in conjunction with manipulation headaches. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Dry needling is the most effective way of treating Myofascial Pain Syndrome and appears to be as effective as an injection of an anaesthetic into myofascial trigger points. However the side effect common to both dry needling and the injection of an anaesthetic, is the development of post-needling soreness. Post-needling soreness results from bleeding at the area of needle insertion. The immediate application of cold to a needled area may decrease the severity of the cellular damage by restricting local bleeding. Cryotherapy can also decrease both nerve excitability and histamine release, which may result in decreased pain experienced by patients. The purpose of this study was to determine the effectiveness of cryotherapy on post dry needling soreness. Therefore a randomised, 2 group parallel controlled clinical trial was proposed to test this hypothesis. Sixty asymptomatic volunteer participants between 18 and 50 were randomly divided into two equal groups - group A (combination group) received dry needling in conjunction with a cold gel pack, and group B received dry needling only. Algometer readings, a Numerical Pain Rating Scale (NRS 101) and a 24 Hour Pain Diary were used as assessment tools. SPSS version 15 was used for data analysis (SPSS Inc. Chicago, Ill, USA). Baseline demographics and outcome measurements (NRS 101, Algometer readings and 24 Hour Pain Diaries) were compared between the two groups using Pearson’s chi square tests or Independent Samples t-tests as appropriate For the evaluation of the treatment effect for the NRS 101 and Algometer outcomes, repeated measures ANOVA procedure was used. Twenty four hour Pain Diaries by group interactions were reported for comparison of the treatment effect in the two treatment groups. The number of participants reporting pain at various time points post treatment were compared cross-sectionally by group with Pearson’s chi square tests. A Mann-Whitney U test was used to compare time points post treatment at which the worst pain was experienced between groups. The change in the presence of pain over time was recorded as either no change, an increase (from no pain to pain) or a decrease (from pain to no pain). This wascompared between treatment groups using the Pearson’s chi square test. Intragroup correlations between changes in outcome variables were achieved with Pearson’s correlation. P values of <0.05 were considered as statistically significant. The results of the study showed no evidence of a beneficial effect of cryotherapy on objective or subjective findings. Thus it can be concluded that cryotherapy as used in this study had no significant effect on reducing post dry needling soreness.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Cryotherapy is commonly used to decrease pain, swelling and disability in acute injury. The most common form traditionally used is ice packs, with menthol based cooling gels being increasingly used by physicians in place of ice. More recently companies are experimenting with adding herbs containing anti-inflammatory properties to these menthol based gels to enhance their effectiveness. There is a paucity of literature comparing different forms of cryotherapy to one another, and more experiments are necessary to determine if cooling gels containing menthol and cooling gels with menthol and anti-inflammatory herbs are comparable to that of conventional ice pack cryotherapy. Objectives To determine the relative effectiveness of an ice pack, a menthol based gel, a menthol based gel with herbal extracts (combination gel) and placebo gel in the treatment of an acute grade 1 or 2 inversion ankle sprains, in terms of subjective and objective measurements. Any adverse reactions were also noted. Method A placebo controlled randomised, single blinded clinical trial (n=48) was conducted. Participants were randomly allocated into one of the four groups. Each group consisted of 12 people between the ages of 18 and 45. Each participant had a case history, physical and ankle examination prior to being accepted to ensure that they met the inclusion and exclusion criteria. On the initial consultation the respective treatments were administered and participants were instructed on how to apply the gel or ice pack, which they were required to utilise at home three times per day for 3 days. Those receiving the gels were blinded as to which gel they were receiving, all gels looked and smelt the same. On the 4th day the participants returned for data collection and were instructed to stop using the treatment and return 7 days later for further data collection. Statistical analysis consisted of repeated measures of ANOVA and Bonferroni post hoc tests, with a p-value of <0.05 considered statistically significant. Results Intra-group and inter-group analysis showed that all four groups had statistically significant improvements in terms of subjective and objective measurements. The results of the study demonstrated that the effects produced by the two cooling gels containing menthol, are comparable with those of conventional/traditional ice pack cryotherapy in the treatment of acute grade 1 or 2 inversion ankle sprains. No adverse reactions were reported. Conclusion This study found that all four treatment interventions were effective and safe in treating acute grade 1 and 2 inversion ankle sprains, however the ice pack and both cooling gel groups appear to statistically significantly improve treatment outcomes at a similarly higher rate when compared to the placebo gel group.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal. / Myofasciitis IS a very common yet misunderstood problem. There are many treatments available yet there is no research to substantiate which of the many treatments available is the most effective (Travell and Simons 1983:6). The purpose of this study was to investigate the relative effectiveness of Cryotherapy versus moist heat in the treatment of myofasciitis of the shoulder girdle muscles. Patients for this comparative, randomized clinical trial were obtained by consecutive sampling. Any patient between eighteen and fifty-five presenting to the Chiropractic Clinic at Technikon Natal with neck pain, upper back pain or shoulder paIn was considered a potential candidate. Thirty patients underwent a screening process to assess their viability for the study. This screening procedure consisted of questions regarding the pattern of pain referral and of palpation of the relevant zones for muscle spasm, twitch responses, patient jump sign and/or referred palll. The thirty patients were randomly divided into two groups of fifteen. One group received cold and passive stretching and the other group received moist heat and passive stretching. Each patient was treated five times within a three week period. Thereafter a follow-up appointment was scheduled one month after the final treatment to assess the long term effects of the treatments . The subjective information was questionnaires: (1) the CMCC Neck Numerical Pain Rating Scale-l0l assessed us Ing three Disability Index, (2) the and (3) the Short Form McGill Pain Questionnaire. These three forms were used to subjectively assess vanaus aspects of the patient's pain. Patients were required to fill these forms out at the first and final appointment. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal / Myofasciitis IS a very common yet misunderstood problem. There are many treatments available yet there is no research to substantiate which of the many treatments available is the most effective (Travell and Simons 1983:6). The purpose of this study was to investigate the relative effectiveness of Cryotherapy versus moist heat in the treatment of myofasciitis of the shoulder girdle muscles. Patients for this comparative, randomized clinical trial were obtained by consecutive sampling. Any patient between eighteen and fifty-five presenting to the Chiropractic Clinic at Technikon Natal with neck pain, upper back pain or shoulder paIn was considered a potential candidate. Thirty patients underwent a screening process to assess their viability for the study. This screening procedure consisted of questions regarding the pattern of pain referral and of palpation of the relevant zones for muscle spasm, twitch responses, patient jump sign and/or referred palll. The thirty patients were randomly divided into two groups of fifteen. One group received cold and passive stretching and the other group received moist heat and passive stretching. Each patient was treated five times within a three week period. Thereafter a follow-up appointment was scheduled one month after the final treatment to assess the long term effects of the treatments . The subjective information was questionnaires: (1) the CMCC Neck Numerical Pain Rating Scale-l0l assessed us Ing three Disability Index, (2) the and (3) the Short Form McGill Pain Questionnaire. These three forms were used to subjectively assess vanaus aspects of the patient's pain. Patients were required to fill these forms out at the first and / M

Oral mucositis is a common adverse side-effect caused by cancer treatments and can lead to mucosa toxicity. Patients with oral mucositis may experience extreme pain and may not be able to eat, drink and talk and, as a result, their quality of life is impaired. Thirty to eighty five percent of patients undergoing chemotherapy would develop oral mucositis. Preventing or reducing incidence of oral mucositis and its severity can help reduce patients’ sufferings. One of the methods to achieve this objective is the oral cryotherapy, which is a prophylactic intervention. However, there is no evidence-based guideline to instruct nurses on providing oral cryotherapy to cancer patients. The aims of this study are 1) to establish an evidence-based guideline on applying cryotherapy to reduce the incidence and severity of chemotherapy-induced oral mucositis, 2) to develop a standard nursing care and assess its transferability and feasibility, and 3) to develop a communication plan and evaluation plan for this guideline in an oncology ii- department for the targeted local hospitals in Hong Kong. A systematic search of four electronic journal databases identified seven articles corresponding to 6 randomized controlled trials (RCTs) on using oral cryotherapy for adult cancer patients. Five RCTs with high to weak quality reported supporting evidence for the beneficial effect of oral cryotherapy on chemotherapy-induced oral mucositis, whereas 1 RCT with moderate quality failed to identify supportive evidence for the use of oral cryotherapy. However, potential confounding factors were identified to be presented in that insignificant RCT. Hence, there was sufficient evidence to show that oral cryotherapy can significantly reduce chemotherapy-induced oral mucositis in adult cancer patients. An evidence based guideline for using cryotherapy on chemotherapy-induced oral mucositis in adult cancer patients was established. The transferability and feasibility of the proposed oral cryotherapy guideline were assessed. As identified, the clinical situation and patient characteristics in the local settings are similar to those who reported in the reviewed studies. Staff readiness, skills and resources are also readily available in the target clinical settings. Findings from the reviewed studies of oral cryotherapy can be transferred to the local target settings and are feasible to be implemented. It is also estimated that the innovated guidelines for cryotherapy can save HK$3,210,745 per year for the target setting. Stakeholders for the innovated guideline in the local setting were identified. And a communication plan was developed. A pilot study lasting for 10 weeks will be conducted to test the feasibility of the staff training session and the implementation of the oral cryotherapy guideline. Modification of innovated guidelines will be made after evaluating the data collected from the pilot study. Eventually, the final version of the evidence-based guideline will be established. A six months evaluation plan will be used to evaluate the implementation of the new guideline. The policy for adopting the oral cryotherapy will be determined with the outcome measures, including the incidence of chemotherapy-induced oral mucositis, mean of the oral mucositis score, staff satisfaction level, and the cost and benefit ratio of the innovated guideline. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Athletic trainers frequently are required to design rehabilitation and treatment programs for injured athletes. These treatment programs oftentimes involve the use of cryotherapy or ankle taping to create an optimal environment for healing. The purpose of this study was to identify the individual and simultaneous effects of ankle taping and cryotherapy on mechanical power and velocity.Sixteen (16) Division IA Baseball players (Age 20.53+/- 1.15 yrs, Wt 878.45+/105.68 N, Ht 1.85+/- 0.087 m) served as subjects for this study. Subjects met the following criteria: 1) all were asymptomatic from any lower extremity injury for at least six months prior to testing. 2) none had any known cold allergy (ie. hives, hypersensitivity to cold).This study utilized a counterbalanced repeated measures design, in which subjects participated in three treatments, cryotherapy, ankle taping and a combination treatment of cryotherapy and ankle taping. For the taping treatment, each subject was taped using a standard closed basket weave technique` with porous 1.5" cloth athletic tape (Johnson and Johnson, Coach). The cryotherapy treatment was administered a 20 minute ice immersion treatment at 10 deg Celsius to the leg and ankle. In the combination treatment, both treatments were administered with the ice immersion preceding ankle taping. The effects of these treatments on mechanical power and velocity were measured by a Kistler amplifier and force plate platform during a one leg standing vertical jump.The two-way repeated measures ANOVA's for power and velocity showed no significant interaction between cryotherapy, taping or combination treatment. However, significant pre-post treatment effects for power were discovered after cryotherapy and combination treatment. As a result of these findings, it is evident that immediate return to participation after cryotherapy or combination treatment will lead to decreases in muscular performance or injury. / School of Physical Education

M.Tech. / Myofascial pain has become a major cause of disability and chronic pain in our society today. Left untreated, myofascial pain syndrome can become a chronic pain condition. Chronic pain conditions can not only cause disability due to pain, but can also lead to related conditions such as depression, physical deconditioning due to lack of exercise, disturbance of sleep and other psychological and behavioural disturbances (Rachlin, 1994). The aim of this study was to determine whether cryotherapy or moist heat therapy was a superior therapeutic modality when applied to active Infraspinatus muscle trigger points post-dry needling. Participants were recruited into the study by the use of advertisements put up at various places on the university campus as well as in the University of Johannesburg Chiropractic Day Clinic. Fourty participants that conformed to the specific inclusion and exclusion criteria were recruited. The participants were randomly placed into two groups containing twenty participants in each group. Group A received cryotherapy post-dry needling and Group B received moist heat therapy post dry needling. Each participant received four treatments. The subjective and objective measurements were taken on the first, third and fifth visits. The fifth visit was scheduled to take final subjective and objective data only. The subjective data was obtained by measuring the participant‟s perception of their myofascial pain using the Visual Analogue Pain Scale. The objective data was obtained from the readings of the Algometer instrument, measuring the pressure pain threshold of the active myofascial trigger points in the Infraspinatus muscle. The results of this study indicated that both cryotherapy and moist heat therapy significantly benefited the participants in terms of the treatment of the active myofascial trigger points of the Infraspinatus muscle. However, based on the results, final conclusions could not be formulated on whether the dry needling itself would be beneficial without needing the cryotherapy or the moist heat therapy, as neither modality proved superior over the other.