Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / There are mechanical loads applied to the patella tendon in almost all sporting activities and as a result is commonly injured (Peterson and Renström, 2003:321). Patellar tendinopathy is a common chronic tendinopathy (Hamilton and Purdman, 2004) and occurs commonly in athletes who impose rapid eccentric loading of the knee extensor mechanism (Norris, 2004:246). Deep Transverse Friction Massage (DTFM) and soft tissue mobilization are the two most common forms of manual therapy used to treat patellar tendinopathy (Rees et al., 2006). DTFM is considered the most effective treatment for patellar tendinopathy (Brunker and Khan, 2002:487). It is theorised that DTFM causes the softening of scar tissue and the breakdown of adhesions, promoting the realignment of disrupted connective tissue fibrils within the affected tendon (Stasinopoulos and Johnson, 2007). Graston Instrument Assisted Soft Tissue Mobilization (GIASTM) consists of a set of stainless steel instruments (Carey 2003:2) and is an advanced form of soft tissue mobilization used in detecting and releasing scar tissue, adhesions and fascial restrictions (Carey, 2003:7). The controlled microtrauma created by these instruments is hypothesised to create a localised inflammatory response (Hammer, 2004) in a similar mechanism to that of DTFM. The aim of this study was to determine the relative effectiveness of GIASTM versus DTFM in treating patellar tendinopathy. The study included a total of twenty-six knees among twenty-one patients. Patients were placed randomly into either the GIASTM group or the DTFM group. Each patient received a total of twelve treatments over a three month period. Algometer and inclinometer readings were recorded at set intervals and compromised objective measures. Two questionnaires and a numerical pain rating scale (NRS) were administered at set intervals and compromised subjective measures. SPSS version 13.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data. Repeated measures ANOVA was used to examine changes in quantitative outcomes over the time points (intragroup analysis) and a treatment effect (intergroup analysis). To control for the partial pairing in the intergroup analysis, a variable which classified each subject as paired (both left and right knee used in study) or non-paired (only used once in study) was used as a factor in the model. Correlations between the intragroup changes in the various outcome variables were assessed using Pearson’s correlation coefficients. Statistical analysis of both objective and subjective data revealed significant improvements for most outcome measures in the study. Findings imply that GIASTM is as effective as DTFM in treating patellar tendinopathy.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background : Many treatment options provide symptomatic improvement of joint function for osteoarthritis (OA) of the knee. Research suggests full kinetic chain (FKC) manual and manipulative therapy (MMT) and rehabilitation yields greater benefits than home rehabilitation alone. However this treatment combination has never been compared against FKC MMT alone. Objectives : Objectives: To determine the effectiveness of three FKC treatment protocols in the management of knee OA. Method : A single-blinded, randomised comparative trial of sixty-six patients with knee OA, equally allocated to three treatment groups: manipulation only, rehabilitation only or manipulation plus rehabilitation (a.k.a. combination group). Manipulation groups received bi-weekly FKC treatment, while a daily at-home stretching and exercise programme was prescribed to the groups receiving rehabilitation. Treatment lasted three weeks, with outcomes measure taken at baseline, pre-visit 4 and 1-week follow up. Primary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and McMaster Overall Therapeutic Effectiveness (OTE) Tool. Results : There was a drop-out rate of 7.6% (n=5), with intent to treat analysis providing the missing data. All three treatment groups showed clinically and statistically significant changes in overall WOMAC scores from baseline to 1-week follow up. The combination group showed the largest improvement (50.5%), followed by manipulation (44.4%) and rehabilitation (33.6%). However, this difference between group improvement was not statistically significant (p= 0.156). Conclusion : All three intervention protocols showed statistically significant improvement in most outcome measures at 1-week follow-up. However, there was no statistically significant difference between groups and therefore it is concluded that the interventions appear to be equally effective in the short-term management of knee OA.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction ACL injuries are among the most serious injuries that professional and amateur sports men and women sustain. More than 120 000 ACL injuries occur annually in the USA alone. The highest incidence of ACL injuries are seen in multi-directional and multi-factorial sports such as soccer, basketball, lacrosse, American football, rugby and Australian rules football. It is hoped that the proposed review will clarify issues relating to the effect of fatigue on knee control, as it will focus on multiple movements found in different sporting codes. By including both studies on healthy adults as well as subjects who have sustained ACL injuries, a clearer picture can be formed on the global effect of fatigue on knee control. Objective The objective of this review was to identify, collate and analyse the current evidence on the effect of fatigue protocols on knee control during functional tasks, such as side-stepping, bilateral jumping/landing and crossover-cutting. Methodology A comprehensive search of electronic databases was conducted between April 2013 and August 2013 (updated in April 2014) for eligible articles for inclusion in the review. Methodological quality was assessed using a modified Downs and Black checklist. Results Ten studies met the eligibility criteria and were included in the review. The included studies reported a wide variety of fatigue protocols. Several different test movements were utilised in the studies. The test movements included cutting movements, drop jumps, stop jumps, vertical jumps, bilateral drop landing and rotational movements. The overall results indicated that fatigue had a negative impact on knee control. There were however studies which reported conflicting results. Gender differences were also highlighted in the results of included studies where it became evident that females tend to be more susceptible to knee injuries due to altered kinematics as a result of fatigue. Conclusion Fatigue generally seems to affect knee control negatively across various fatigue protocols. Future research should investigate using a standardised fatigue protocol to achieve more accurate and consistent results during the different functional activities. / AFRIKAANSE OPSOMMING: Nie beskikbaar

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: This review aims to present the available evidence for the effect of McConnell taping on knee biomechanics in individuals with Anterior Knee Pain (AKP). Pubmed, Medline, Cinahl, Sportdiscus, Pedro and Science Direct electronic databases were searched from inception until September 2014. Experimental research into knee biomechanical or EMG outcomes of McConnell taping compared to no tape or placebo tape were included. Two reviewers completed the searches, selected the full text articles and assessed the risk of bias of eligible studies. Authors were contacted for missing data. Eight heterogeneous studies with a total sample of 220 were included in this review. All of the studies had a moderate to low risk of bias and compared taping to no tape and/ or placebo tape. Pooling of data was possible for three outcomes; average knee extensor moment, average VMO/VL ratio and average VMO-VL onset timing. None of these outcomes revealed significant differences. The evidence is currently insufficient to justify the routine use of the McConnell Taping technique in the treatment of Anterior Knee Pain. There is a need for more evidence on the aetiological pathways of Anterior knee Pain; level one evidence and studies investigating other potential mechanisms of McConnell taping. / AFRIKAANSE OPSOMMING: Die objektief van hierdie resensie was om te bepaal wat die effekte van McConnell Patellar Vasbinding is op knie kinematika, kinetiek en spier aktivering in diegene met Voorafgaande Knie Pyn (VKP). Die navorsers het elektroniese databases soos Pubmed, Medline, Cinahl, Sportdiscus, Pedro en Science Direct, van aanvang tot September 2014, ondersoek. Eksperimenteel studie ontwerpe wat biomeganiese of EMG gevolge van McConnell Vasbinding vergelyk met geen vasbinding of placebo vasbinding, is ingesluit. Twee resente het die ondersoek voltooi, die volle tekse artikels gekies en die partydigheid risiko van die ingeslote studies, geskat. Skrywers is gekontak vir enige verlore data. Agt heterogeen studies uit ‘n totalle monster van 220 is in hierdie resensie ingesluit. Al die studies het ‘n gematigde tot laag risiko vir eensydigheid en vergelyk vasbinding met geen of placebo vasbinding. Data saamvoeging was moontlik vir drie uitslae, naamlik: gemiddelde knie ekstensor moment; gemiddelde VMO/VL ratio en gemiddelde aanval tydmeting. Geen gevolge het veelseggende verskille of afwykings vertoon. Tans is die bewys nie genoegsaam om die routiene gebruik van McConnell Vasbinding tegniek te regverdig nie in die behandeling van VKP. Meer bewyslewering op die etiologiese paaie van VKP; Graad een bewys en studies wat ander moontlike meganisme van Mc Connell Vasbinding ondersoek, is noodsaaklik.

No description available.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / According to Wood (1998), patellofemoral pain syndrome (PFPS) refers to a syndrome that comprises of the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof. Prevailing literature suggests that the presence of myofascial trigger points (MFTP’s) in quadriceps femoris (QF) muscle could result in a combination of the following signs and symptoms: - Retro- or peripatella pain, - Weakness of the quadriceps muscle (Chaitow and DeLany, 2002) - Loss of full lengthening (Travell and Simons, 1983:248-250) The aetiology of PFPS is poorly understood (Kannus et al. 1999). The current trend in literature suggests an extensor mechanism dysfunction as the most probable aetiology (Galantly et al., 1994; Juhn, 1999). There appears to be a clinical overlap between the two syndromes, in terms of an extensor mechanism dysfunction and of signs and symptoms. The aim of this investigation was to evaluate the role of active myofascial trigger points in the vastus lateralis (VL) muscle as perpetuating, causative or concomitant factors in the alteration of VL/VM Total Work (TW) in PFPS in distance runners.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, 2005. / To document the relationship between total work and myofascial trigger points in the vastus lateralis and vastus medialis portion of the quadriceps femoris muscle, whilst providing baseline graphs of these muscles with the use of a Cybex 700 Isokinetic Dynanometer in long distance runners both with and without patellofemoral pain syndrome. Methods: A quantitative, non-intervention clinical exploratory study. Fifty participants were divided into two groups, Group A (40 symptomatics) and Group B (10 asymptomatics). Both groups were screened for vastus lateralis and vastus medialis trigger points. Subjective data was obtained from Group A only, using the Numerical Pain Rating Scale and the Patient Specific Functional Scale. Objective data was obtained from both groups using the algometer, Myofascial Diagnostic Scale, and the Cybex 700 Isokinetic Dynanometer. For descriptive analysis frequency tabulations, box and whisker plots were used to display distributions graphically. Comparisons of categorical and quantitative variables between independent groups were run using chi square and Mann-Whitney testing consecutively. Finally Spearman’s correlation, multivariate generalized linear modelling and repeated measures ANOVA were also used. All statistical analysis was completed at the 95% (p<0.05) level of confidence. / M

[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.

The purpose of this study was to determine the effectiveness of a modified sitting position straight leg raise on vastus medialis oblique (VMO) strength and EMG activity as compared to a traditional straight leg raise. A total of twenty-three subjects were recruited for this study. The subjects were randomly assigned to one of the following groups: (group I) modified straight leg raise (MSLR), and (group II) straight leg raise (SLR). The exercise program was three weeks long. University procedures for the protection of human subjects were followed. The subjects began with a 5 minute warm-up on a Cybex stationary bike set at 90 revolutions / minute. The subject then had electrodes placed on the Vastus Lateralis (VL) and Vastus Medialis Oblique (VMO). A Macintosh computer was used to record the EMG data. The subject then performed a standard Cybex test for knee flexion and extension. The Cybex dynamometer was placed at the knee joint line, the chair back tilt was at 85 degrees, the hip, chest, and thigh restraints were all fastened. The subjects in group I (Modified sitting SLR) and II (SLR) then returned the next day for their first rehabilitation lesson. Each subject group then participated in their respected exercise program for a total of three weeks. After three weeks of rehabilitation, the subjects retested using the same procedures followed in the pretest. A two tailed t-test was used to determine significance of the difference between means of the two groups. No significant differences were found between the two groups. / School of Physical Education

The purpose of this study was to determine the vastus medialis oblique muscular electromyographical (EMG) activity during two therapeutic exercises: the modified straight leg raise and the traditional straight leg raise. Two subject groups of 10 subjects each, one with anterior knee pain (PHY) and the other group with no history of patellofemoral pathology (NORM), performed the traditional straight leg raise (SLR) and a modified straight leg raise with external hip rotation (MOD). Each subject performed an isometric maximum voluntary contraction and three trials of each of the two therapeutic exercises. The EMG variables analyzed were the percent of the maximum voluntary contraction for each muscle, vastus medialis oblique, vastus lateralis, and rectus femoris: the percent of the maximum voluntary contraction of the ratio between the vastus medialis oblique and the vastus lateralis; the percent of the maximum voluntary contraction for the integrated EMG for each muscle; and the percent of the maximum voluntary contraction for the root mean square for each muscle. The statistical analysis was conducted with two-way analysis of variance procedures. The statistical analysis revealed no significant differences; however, the data appeared to illustrate a trend toward more electromyographical activity in the vastus medialis oblique in the PHY subject group during the MOD therapeutic exercise. This suggests that the MOD therapeutic exercise may be able to isolate the vastus medialis oblique muscle in persons with anterior knee pain and allow them to regain strength and normal function earlier than with the use of the SLR therapeutic exercise. / School of Physical Education