A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute Of Technology, 2006. xviii, 134, 7 leaves. / Shoulder injuries, which account for 8% to 20% of volleyball injuries, are usually rotator cuff and / or biceps tendinosis caused by overuse (Briner et al.1999); in addition 38-75% of competitive swimmers have had a history of shoulder pain, while 9 - 35% of these swimmers were currently experiencing pain (McMaster and Troup, 1993). Rotator cuff tendinosis is also found in laborers involved in repeated overhead activities (i.e. among shipyard welders and steel plate workers), with a prevalence of 18, 3% and 16, 2% respectively (Herberts et al. 1984). Fricker and Hoy (1995), suggest that the principal cause of tendinosis of the rotator cuff muscles is repetitive microtrauma, due to overfatigued muscles and / or weakening of the rotator cuff and scapulothoracic muscles. The etiology of impingement syndrome is therefore multifactorial and is commonly associated with other clinical entities such as weak or dysfunctional scapular musculature, posterior glenohumeral capsule tightness, inflammation of tendons (viz. supraspinatus and long head of biceps), bursal inflammation and glenohumeral instability (Michener et al., 2003). Shoulder syndromes are often related to the development and perpetuation of myofascial trigger points (TrPs) as found by Hains (2002), who suggested that these TrPs become activated during mechanical stress and overload of the involved shoulder musculature. Hammer (1991), suggests that the most valuable modality to treat chronic overuse soft tissue syndromes (irrespective of muscular or tendinous in origin) is friction massage to both regions. Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. / M

Dissertation presented in partial fulfilment of the requirements for the Master's Diploma in Technology: Chiropractic, Technikon Natal, 1994. / The efficacy of myofascial trigger point therapy in treatment of myofasciitis was evaluated in a single blind, randomised, placebo controlled trial. The patient population consisted of twenty individuals who presented with one of the following: upper-back pain, shoulder pain, and neck-pain and or headaches and who were diagnosed as having myofasciitis. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2004. / The purpose of this study was to investigate the association between the role of Myofascial Trigger Points of the lower extremity to the clinical presentation of lIiotibialband Friction syndrome / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / Myofascial trigger points are a frequently overlooked and misunderstood phenomenon in medical curricula, yet with correct diagnosis and appropriate treatment the prognosis is usually excellent. Many effective treatments have been devised for myofascial trigger points, but the problem is that there is very little research to substantiate which of these treatments are the most effective. The aim of this randomised uncontrolled study was to justify the hypotheses which stated that both dry needling and saline injection would prove to be effective in the treatment of myofascial trigger points, with saline injection proving to be the most effective of the two. Patients were obtained for this study by convenience sampling, whereby any patients presenting to the Chiropractic clinic at Technikon Natal with neck,\xB7 upper back or shoulder pains were considered for the study. Of these patients, only those who conformed to the specified delimitations and diagnostic criteria were accepted. The sample size of thirty patients was randomly divided into two treatment groups of fifteen, one of which received saline injection and the other dry needling of active myofascial trigger points. Both groups were educated with regards to the nature and perpetuating factors of the condition, \xB7andwere instructed to follow a specific stretching programme. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic at Technikon Natal. 2001. / The purpose of this investigation was to determine the relative efficacy of Action Potential Therapy (APT) as opposed to placebo Action Potential Therapy in the treatment of myofascial pain syndrome. The study was a prospective, randomized, placebo controlled study. The study consisted of two groups of thirty subjects each, which were selected from the Durban Metropolitan area. Only subjects diagnosed as having active trigger points in either the trapezius or gluteus medius muscle were accepted into the study. Each subject received four treatments over a period of seven to ten days. Group one received an active form of Action Potential Therapy while group two received placebo Action Potential Therapy. Subjective assessment was by means of the short form McGill pain Questionnaire and the N wnerical Pain Rating Scale-l Ol. Objective assessment was by means of an algometer and the Myofascial Diagnostic Scale. Readings were taken twice for each patient. The first assessment was conducted at the initial consultation prior to the first treatment, and the second assessment was completed during the last consultation after the treatment. Intra-group comparisons were made using the parametric two-sample paired t-test and the nonparametric Wilcoxon signed rank test. For the inter-group comparison, the parametric twosample unpaired t-test and non-parametric Mann-Whitney unpaired U test were used. Statistical analysis was completed at a 5% significance level. / M

Les PTM sont une source de douleur régionale et de dysfonctionnements neuromusculaires. Ils sont couramment associés à une hyperalgésie, à des troubles comportementaux et des restrictionsfonctionnelles. La douleur est bien documentée dans la littérature scientifique mais les études de ses conséquences sur le mouvement reposent exclusivement sur l’analyse de gestes simples. L’objectif dece travail est d’étudier la douleur myofasciale du membre supérieur et de vérifier si une technique de thérapie manuelle influençant cette douleur permet de rétablir la performance motrice d’un mouvement fonctionnel. Quatre études ont été réalisées afin d’analyser : 1) la performance motrice d’un mouvement elliptique dans le plan horizontal ; 2) dans le plan frontal et d’une tâche de tapement ; 3) la douleur sur le membre supérieur non atteint chez des sujets ayant subi un AVC ; 4) l’incidence de la douleur chez le personnel soignant d’un centre hospitalier. Les résultats indiquent que la présence de PTM produit la douleur myofasciale et : 1) n’influence pas significativement la performance motrice d’un mouvement elliptique horizontal ; 2) altère la performance motrice d’un mouvement elliptique frontal et d’une tâche de tapement chez les sujets présentant des PTM ; 3) modifie aussi la fonction motrice de l’extrémité supérieure ipsilatérale à la lésion ; 4) touche 8,43% du personnel soignant, étant bilatérale et pouvant conduire à des arrêts maladie dans 14,28 % des cas. L’application d’une technique de compression ischémique locale permet de retrouver la quasi-totalité de la fonction motrice. Il semblerait qu’une reprogrammation du mouvement s’avère nécessaire pour récupérer totalement la fonction motrice. / Myofascial Trigger Points (MTrPs) are source of regional pain and neuromuscular dysfunctions. They are associated to hyperalgesia, psychological disturbances and functional restrictions. Despite myofascial pain has been extensively studied, researches about its influence have only analyzed uniarticular motions. The mains goals of this research were to study the upper limb myofascial pain and to verify whether the application of manual therapy, influencing this pain, could contribute to the motor performance recovery of multiarticular motion. Four studies were carried out in order to analyze: 1) motor performance of an elliptic motion in the horizontal plane, 2) motor performance of an elliptic motion in the frontal plane including an analysis of a tapping task, 3) non-paretic upper limb pain of the stroke patients, 4) myofascial pain incidence at the medical staff in a hospital. The results showed that the presence of TrPs produces myofascial pain. This pain: 1) does not influence significantly the horizontal elliptical motions motor performance, 2) deteriorates the frontal elliptical motions motor performance and the execution of the tapping task, 3) modifies the non-paretic upper limb motor function of the stroke patients, and 4) 8,43 % of medical staff suffers from bilateral myofascial pain, leading to absence at workplace in 14,28% of the cases. The application of local ischemic compression technique allows high recovery of the upper limb motor function. Motor reprogramming therapies could contribute to recover the motor function completely.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xii, 62, [18] leaves / The purpose of this study was to determine the comparative effectiveness of cryo-ischaemic compression, using the Cold Tennis-ball Technique, and ischaemic compression, using normal tennis balls, in the treatment of Myofascial Pain Syndrome

Thesis (M.Tech.: Chiropractic)- Dept.of Chiropractic, Durban Institute of Technology, 2006 xxiv, 139, [17] leaves / This pilot study was a pre-post clinical investigation assessing the influence of component materials on the effectiveness of GTISTM in the treatment of MPS, in terms of clinical outcomes.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 1 v. (various pagings) / The purpose of this study was to investigate the immediate and short term effectiveness of dry needling the primary, active Biceps TrP on the pain experienced during shoulder flexion and abduction range of motion, as well as on an associated bicipital tendonitis and satellite TrP’s.