Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Aim: There is a paucity in the literature regarding the effectiveness of the Impulse Adjusting Instrument® (IAI) in treating myofascial trigger points (MFTPs) and regarding the effectiveness between dry needling and the IAI in the treatment of MFTPs. There are many limitations and an array of contraindications for dry needling. Therefore, an alternative method should be sought as this will be beneficial to the patient. Thus, the aim of this study was to determine the effectiveness of the IAI compared to dry needling in the treatment of MFTPs found in the upper trapezius muscle. Methodology: This study was a randomised single-blinded clinical trial. This study consisted of 41 participants between the ages of 18 and 40 who were divided into two groups. The participants were randomly allocated into their respective groups using a blinded allocation method that was drawn up by the statistician. Groups were divided into dry needling (Group one (n=18)) and IAI (Group two (n=23)) treatment groups. Subjective neck pain level was determined using a numerical pain rating scale (NRS). The neck disability index (NDI) subjectively assessed the effect neck pain had on the participants’ activities of daily living before and after treatment. The Patients Global Impression of Change (PGIC) tool was used to determine the participants’ subjective impression of treatment outcomes since the beginning of the treatment. Objective pain pressure thresholds (PPT) were measured with an algometer. Objective cervical range of motion (CROM) in lateral flexion (LF) was measured with a goniometer. Each participant had four visits over a two week period, which included three treatments and a final visit for final measurements. Data was analysed using IBM SPSS version 23. Repeated measures ANOVA was used to examine the effect on each outcome measure. Directional trends in effectiveness were drawn up using profile plots to assess the direction and trends of the effects. A p value of < 0.05 was considered to be statistically significant. Results: Intra-group and inter-group statistical analysis revealed all subjective measurements improved in both groups with no significant differences between the groups. With respect to objective measurements, there was no statistical improvement in LF CROM and dry needling had no improvement in PPT. Impulse Adjusting Instrument trigger point therapy showed an increase in PPT, however, when compared to dry needling there was no statistical difference in PPT. Conclusion: The conclusion for this study states that the trends in each of the outcomes suggest that the IAI is as effective as dry needling for the treatment of MFTPs. / M

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. / This study was conducted to determine the effect of Sacroiliac joint adjustment to the restricted Sacroiliac joint in combination with myofascial dry needling to the active/latent Rectus Femoris muscle trigger point and Rectus Femoris myofascial dry needling on its own on Quadriceps Femoris muscle strength. Thirty participants between the ages of 18 and 40 years were recruited through the use of advertisements placed in and around the University of Johannesburg’s Chiropractic Day Clinic. Participants were assessed for exclusion criteria by performing a Full Case History, Pertinent Physical Examination, Lumbar Spine and Pelvis Regional Examination and S.O.A.P note. The participants who conformed to the specific inclusion criteria were accepted for this study. These participants were randomly placed into two groups of sixteen participants each. Group One receive Sacroiliac joint adjustment to the restricted Sacroiliac joint and ipsilateral myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger points. Group two received myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger point on the same side as the Sacroiliac joint restriction. Each participant received five treatments over a three week period, i.e. two treatments for the first two weeks and one follow-up treatment in the third week. The subjective data of the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the Isometric Dynamometer measuring the Quadriceps Femoris muscle strength before and after each treatment. In addition the Algometer was used for measuring the pressure pain threshold of the Rectus Femoris trigger points. An analysis was performed using Repeated Measures Analysis, t-Test, Frequencis, Descriptives and Friedman’s Tests. The results of this study demonstrate that Sacroiliac joint adjustment to a restricted Sacroiliac joint with ipsilateral myofascial dry needling of the Rectus Femoris muscle showed a statistically significant, but temporary increase in Quadriceps Femoris muscle strength. Myofascial dry needling of the Rectus Femoris muscle on its own was found to be statistically insignificant for the increase in Quadriceps Femoris muscle strength.

M.Tech. / Purpose: A study to determine the efficacy of Traumeel® gel using phonophoresis in the treatment of a latent trapezius myofascial trigger point, with regards to pain perception, cervical spine range of motion and pressure pain tolerance.Methods: A single-blinded, controlled study design was utilised. Thirty participants who all presented with a latent trapezius myofascial trigger point were randomly divided into two groups of fifteen. Each individual was subjectively and objectively assessed from baseline values prior to receiving treatment. Group A received ultrasound utilising ultrasound gel over the trapezius myofascial trigger point, as the control group. Group B received phonophoresis with Traumeel® gel over the trapezius myofascial trigger point. All participants received two treatments per week, with a total of seven consultations, over the three week study period. The subjective data was obtained utilising a Numerical Pain Rating Scale (NPRS) whilst a hand held Algometer tested pressure pain tolerance and a Cervical Range of Motion Measuring Instrument (CROM) measured cervical spine range of motion. These were utilised to form the objective data. The Data was analysed using non-parametric tests. The two independent treatment groups were assessed for capability at treatments one, four and seven using the Mann-Whitney U-test (non-parametric version of the independent sample T-test). Changes over the three week period were observed and analyzed using the Repeated Measures test or the Friedman Test (Devey, 2010). Results: In this study ultrasound utilising ultrasound gel had a statistically significant impact on the trapezius myofascial trigger point. Statistical analysis of the Traumeel® gel suggests that there was no statistical significance with regards to any of the treatment parameters or variables measured. Subjectively ultrasound gel proved to be statistically and clinically significant in decreasing the participant’s pain perception. There was no statistical improvement but there was a clinical improvement in the Traumeel® gel group.

M.Tech. (Chiropractic) / Myofascial trigger points (MTrP’s) cause acute discomfort to intense pain and often lead to the use of pain medication as well as loss of man hours (Simons, Travell and Simons, 1999a; Tough, White, Cummings, Richards and Campbell, 2009). Dry needling is very effective and is widely used for the treatment of MTrP’s (Vulfsons, Ratmansky and Kalichman, 2012), but comes with various significant drawbacks, such as the experience of pain during or after treatment (post-needling soreness) or individuals with needle phobias (Unruh, Strong and Wright, 2002). More serious risks also exist, including damage to the viscera (Dommerholt and Fernández-de-las-Peñas, 2013). Low level laser therapy (LLLT) is a non-invasive technique and very little discomfort or pain is experienced by the patient during and after treatment. LLLT is effective in the short- and long-term relief of trigger points and myofascial pain syndrome. Therefore it can easily serve as an alternative to myofacial dry needling (Chow and Barnsley, 2005). This study aimed to determine whether LLLT or myofascial dry needling is more effective in the treatment of active MTrP’s, specifically those of the gluteus medius muscle. It also aimed to determine if LLLT could serve as an alternative treatment to dry needling in cases where dry needling is contraindicated or not desired. Thirty participants who complied with the inclusion criteria were divided into one of two groups. Group 1 (n=15) received dosages of LLLT directly to the active MTrP’s in the gluteus medius muscle and Group 2 (n=15) received myofascial dry needling to active MTrP’s in the gluteus medius muscle. Each participant attended 6 treatment sessions over a course of 2 weeks as well as a 7th measurements-only session.

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) / Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.

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. (Chiropractic) / Purpose: Patients presenting with mechanical cervical spine pain demonstrate myofascial trigger points of the surrounding cervical spine musculature (De Las Penas, Alonso-Blanco, Alguacil-Diego and Miangolarra-Page, 2006). Myofascial trigger points, from specifically the cervical spine musculature, have been seen to be involved to a large extent with not only the local mechanical cervical spine pain but also the accompanying referred pain patterns and symptoms (De Las Penas, Alonso-Blanco and Miangolarra-Page, 2007). The purpose of this study is to compare the efficacy of ischaemic compression and laser therapy respectively, applied to an active myofascial trigger point in participants with acute mechanical cervical spine pain associated with an active trapezius myofascial trigger point TP1, with regards to pain, activities of daily living, pressure pain threshold and cervical spine range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and the laser group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1. Treatment was applied to the active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each participant was treated six times over a period of two consecutive weeks. Prior to initiation of the treatment, each participant was requested to complete the Vernon-Mior Neck Pain and Disability Index questionnaire and the Visual Analogue Scale. Algometer readings were obtained over the trapezius myofascial trigger point 1, bilaterally. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion: flexion, extension, lateral flexion, and rotation. Ischaemic compression and laser therapy, group 1 and group 2 respectively, then each received treatment of the active trapezius myofascial trigger point 1, for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th, and at the 7th final consultation.

Submitted in partial fulfillment of the requirements for Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: Ankle sprains are a frequently occurring injury sustained by sports individuals accounting for approximately 20% to 40% of all sports injuries (DiStefano et al. 2008; LeBrun and Krause, 2005). Ankle sprains are mainly caused by excessive inversion (Takao et al., 2005; Andersen et al., 2004), when the foot is twisted inwards and lands at a high velocity damaging the lateral capsule-ligamentous complex (Beynnon et al., 2005). According to Naqvi, Cunningham and Lynch (2012) untreated or inappropriately managed ankle sprains can lead to a cascade of negative alteration to both the joint structures and the individual’s lifestyle. According to Hale, Hertel and Olmsted-Kramer (2007) 30% of ankle sprains result in chronic ankle instability (CAI) and 78% of the CAI cases develop into post-traumatic ankle osteoarthritis. This poses a negative impact on an individual’s athletic performance. Ankle sprains can be managed conservatively with the utilization of the PRICE protocol during the acute stage, cross friction massage or instrument assisted soft tissue mobilization techniques (for example Graston®, FAKTR© Concept) for both acute and subacute ankle sprains (Bleakley, 2010). Aim: The purpose of this study was to determine the effectiveness of a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy compared to cryotherapy and sham laser in the treatment of sub-acute and acute ankle inversion sprains. Objectives: 1. To determine the effectiveness of a myofascial treatment protocol combined with cryotherapy in terms of subjective (numerical pain rating scale [NRS] and foot function index [FFI]) and objective (oedema measurements [EDM], digital inclinometer readings [DIR], algometer readings [AR] and stork balance stand test score [STR]) measurements in the treatment of acute and sub-acute ankle sprains. 2. To determine the effectiveness of sham laser combined with cryotherapy in terms of subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements in the treatment of acute and sub-acute ankle sprains. 3. To compare the relative improvement between the two groups in terms of subjective (NRS and FFI) and objective measurement (EDM, DIR, AR and STR). Study design: This was a quantitative randomised controlled clinical trial. Methods: Forty participants with sub-acute or acute ankle sprains of not more than three weeks were recruited into the study. All participants had a full case history, physical, and foot and ankle regional examination to assess for their eligibility for entry into the study in terms of inclusion and exclusion criteria. These participants were randomly allocated using the hat method into one of two study groups, Group A (treatment group) or Group B. Participants in Group A received a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy and Group B received cryotherapy and sham laser. These participants had four treatments in two weeks where the appropriate treatment was administered. Pre-treatment subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements were taken at each consultation. This data was analysed using SPSS software version 24.0. Results: The General Linear Model for repeated measures was used for the intra- group and inter-group analysis of the data. Intra-group analysis of the FAKTR© treatment group showed that the group had statistically significant improvements in terms of the subjective and objective measurements of the study with the p-value < 0.05 between all treatment periods. Intra-group analysis of the control group showed no statistically significant improvements in terms of subjective and objective measurements of the study. Inter-group analysis showed no statistically significant difference in terms of the DIR and EDM. The NRS, AR, STR and FFI readings showed statistically significant differences between the two groups with a p-value of < 0.05 mainly on the last two consultations. Conclusion: This study concluded that the myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy was more effective than cryotherapy and sham laser in the treatment of sub-acute and acute inversion ankle sprains. The FAKTR© Concept treatment group appeared to show statistically significant improvements compared to the control group.