M.Tech. (Chiropractic) / Myofascial pain and dysfunction syndrome (MPDS) is presently considered to be the leading diagnosis amongst pain management physicians and the leading diagnosis amongst pain sufferers reporting to general practitioners (Harden, Bruehl, Gass, Niemiec & Barbick, 2000). The goal of dry needling and the other above mentioned soft tissue treatments is to alleviate the MTrP’s in the muscle, thereby restoring the muscle to its normal tissue mobility and returning it to proper functional capacity (Travell & Simons, 1999). A post-needling protocol may be used to reduce post-needling soreness at the needling site, to facilitate tissue repair after needling and to normalise muscle function and ROM after needling (Travell & Simons, 1999). The aim of this study is to compare the efficacy of dry needling on its own and in combination with a widely prescribed post-needling protocol of heat, active range of motion (ROM) exercises and passive stretches, with regards to changes in pressure pain threshold, pain and cervical spine ranges of motion, to determine which the superior treatment is. Participants who went to the University of Johannesburg Chiropractic Day Clinic were eligible to participate in the study once they met the inclusion and exclusion criteria. Participants were recruited by means of word of mouth as well as with the use of advertisements that were placed around the respective campuses of the University of Johannesburg. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received only dry needling to the upper trapezius muscle TP1 or TP2 whereas group B received dry needling to the upper trapezius muscle TP1 or TP2, moist heat, active ROM exercises and passive stretching of the upper trapezius muscles. Participants were treated for a total of 6 visits. Subjective and objective measurements were done at visits 1, 4 and a final visit 7 during which only measurements were taken.

M.Tech. (Chiropractic) / A myofascial trigger point is a hyperirritable point within a tight band of voluntary skeletal muscle. The condition causes levels of mild discomfort to intense pain to patients that usually results in loss of man hours and compulsory pain medication. Dry needling is the treatment of choice and other techniques are seldom considered. Dry needling therapy (DNT) is an effective tool in the chiropractic profession but comes with significant drawbacks, such as patients whom have needling phobias and patients who often experience post needling soreness are challenging to treat with DNT. Further and more serious risks include pneumothorax when needling the muscles over the lung fields, which also limits the treatment scope of DNT. Low level laser therapy (LLLT) is non-invasive and non-threatening to patients and could serve as an alternative to DNT. This study therefore aimed, to determine if LLLT could be an alternative treatment to DNT by comparing DNT to LLLT on a target group that all have active trapezius trigger point two myofascial trigger points. The group consisted of 40 participants with posterior trapezius myofascial neck pain caused by active myofascial trapezius trigger points. Participants were then randomly divided into two groups. Group A (20 participants) would receive DNT to the active myofascialtrapezius trigger point two (TP2) and group B (20 participants) would receive LLLT also to the active myofascial trapezius TP2. Participants would then be treated according to a set protocol, over a two week period with a total of four treatments. Subjective and objective readings were taken and noted on the first, third and fifth visits. Subjective data was collected from the visual analogue scale and the Vernon-Minor neck pain and disability index questionnaires. Whereas the cervical range of motion (CROM) and algometer readings provided the objective data.

M.Tech. (Chiropractic) / Neck pain is a common and costly complaint in society and many are made to believe that their neck pain is caused by pinched nerve, compressed disk, arthritis or displaced cervical vertebrae, when in reality the pain may be solely due to referral from myofascial trigger points in overworked or traumatized muscles of their upper back and shoulders. Travel and Simons (1999) demonstrated trapezius muscle of the neck, back and shoulder as the main cause of mechanical neck pain and stiffness. The aim of this study was to compare the effects of trigger point therapy using an activator instrument versus myofascial dry needling in combination with cervical spine adjustment in the treatment of those with acute or chronic neck pain associated with active trigger point 1 (TrP 1) or trigger point 2 (TrP 2) of upper trapezius muscle, with regards to pain and disability, pressure pain threshold and cervical spine range of motion. The clinical study consisted of forty participants, from the ages of 18 and 45, randomly allocated into two groups of twenty individuals each. Potential participants were examined and accepted based on inclusion and exclusion criteria. Group 1 received activator trigger point therapy to upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine, and group 2 received myofascial dry needling of upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine. Participants were treated four times over a period of two weeks. Subjective data was collected using the Vernon-Mior Neck Pain and Disability Index and a Visual Analog Scale. Objective data was collected using an algometer to measure pressure pain threshold of trapezius TrPs muscles, and a goniometer to measure cervical spine range of motion. All data was collected at the first and third visits prior to treatment, and at the fifth visit. The statistical analysis was conducted using nonparametric tests. Friedman’s test was used to assess whether neck pain, disability, cervical spine range of motion and pressure pain threshold varied over the three time intervals. Wilcoxon Signed Ranks Pair test was used for assessment of comparability of the results in each group separately, and the Mann-Whitney U test was used for comparison of the accumulated data in the two groups.

M.Tech. (Chiropractic) / Objective: The purpose of this study was to compare dry needling with cervical spine manipulation combined with dry needling, in the treatment of infraspinatus muscle myofascial trigger points. Study Design: This was a randomized experimental study Setting: The participants were treated at the University of Johannesburg chiropractic day clinic Subjects: 30 participants volunteered for the study. The participants were divided into groups by randomly drawing thirty numbers from a hat, and placing them into two groups: either dry needling combined with spinal manipulation (group 1) or dry needling only (group 2). Participants had to be between eighteen and fifty years old and they could have been male or female. Participants had to present with active infraspinatus muscle myofascial trigger points and also had to present with shoulder or lateral arm pain reproduced by infraspinatus trigger point palpation. Method: Participants were either treated using dry needling only or dry needling combined with spinal manipulation. There were seven consultations. The first six consultations were treatment consultations. Measurements were taken at consultations one, four and seven. Results: The results indicate statistically that participants who had dry needling on its own had a faster increased pressure pain tolerance and a faster decrease in resting electrical activity of the muscle over the treatment period than those that recieved dry needling in combination with spinal manipulation. We must emphasize however that this did not show in the numerical pain rating scale. Participants felt a relatively even relief of their pain in both groups. These overall results might have been skewed by outliers in groups and a small demographic study size. The rest of the results were statistically insignificant, however there was a clinically desired therapeutic effect noted in both groups throughout the study. Conclusion: Dry needling only and dry needling combined with spinal manipulation, individually have desired therapeutic effects in the treatment of infraspinatus myofascial trigger points. There is however no conclusive statistical results in this study that shows one treatment protocol to have a greater therapeutic effect when compared to the other. However this study size was small and therefore the results may have been coincidental.

M.Tech. / OBJECTIVE: An association between cervicogenic headache, cervical joint dysfunction and the presence of myofascial trigger points in the sternocleidomastoid muscle exists. This study is aimed at determining the most effective Chiropractic treatment protocol in the management of cervicogenic headache by comparing the objective and subjective measurements gained in delivering Chiropractic spinal manipulative therapy to the upper cervical spine, myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle and/or a combination of both therapies. DESIGN: Forty-eight participants suffering from cervicogenic headache were allocated into one of three groups of equal male to female ratio. Each patient was examined and cleared for participation in a clinical trial in which Diversified Chiropractic techniques and/or myofascial dry needling therapy were delivered. Group 1 received Chiropractic spinal manipulative therapy to the upper cervical spine. Group 2 received myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle. Group 3 received a combination of the mentioned therapies. DURATION AND MEASUREMENTS: Participants were consulted seven times in a four week period. They were treated twice per week for three weeks and a final, follow-up assessment was performed at the start of the fourth week. Subjective and objective measurements were taken and recorded on the first, fourth and seventh consultations. Subjective measurements were taken via the Vernon-Mior Neck Pain and Disability Questionnaire, Triple Visual Analogue Scale and the Headache Disability Index. Objective measurements included cervical spine ranges of motion which were measured using the Cervical Range of Motion Instrument (CROM). The data was statistically analysed using the Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney, Friedman and Wilcoxon Signed Ranks tests. RESULTS: Clinically and statistically significant improvements in all three groups were noted over the course of the study, with regards to perception of pain, disability and cervical spine range of motion. Statistically significant changes in ranges of motion were demonstrated in Group 1 for flexion, extension, lateral flexion (right and left) and right rotation; in Group 2 for right lateral flexion and left rotation and in Group 3 for all cervical ranges of motion. The comparison between the groups (intergroup analysis) showed no statistically significant changes except for right lateral flexion at the first consultation (pre-treatment). CONCLUSION: The results show that Chiropractic spinal manipulative therapy and dry needling are both effective treatment protocols in decreasing pain and dysfunction and increasing cervical range of motion in patients suffering from cervicogenic headache. This was demonstrated clinically, and to a lesser degree, statistically. The results carry a possible suggestion that although the different treatment options are effective individually, no treatment option proves to be statistically superior.