A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The purpose of this study is to determine the relative effectiveness of (Contract-Relax- Agonist-Contract) CRAC stretching, a component of Proprioceptive Neuromuscular facilitated (PNF) stretching, as opposed to static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. This was a randomised clinical trial consisting of two groups. Group A received static stretching as their treatment protocol and Group B received PNF (CRAC) as their treatment protocol. Each group consisted of fifteen people between the ages of 18 and 55 who were randomly allocated to their respective groups. It is hypothesised that PNF (CRAC) stretching would be relatively more effective than Static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. Subjects diagnosed with active myofascial trigger points in the Trapezius, Infraspinatus and Rhomboid muscles were included in the study. The treatment regime consisted of a course of five treatments spread over a period of two weeks and then a one - month follow up consultation. Subjective and objective measurements were taken at the first, fifth and follow up consultations. Subjective data consisted of the Short Form McGill Pain Questionnaire, the CMCC Neck Disability Index and the Numerical Pain Rating Scale -101. The objective data was collected by means of algometer and goniometer measurements. This data was used to perform statistical analysis using the non-parametric Wilcoxin signed-rank test and the Mann Whitney unpaired test to compare intra-group and intergroup data respectively, at a 95% confidence level. This study suggests that both static and PNF (CRAC) stretching are effective in the treatment of active myofascial trigger points. However there is no clinical statistical difference between these two treatments. Further studies with a larger sample size are needed to clearly evaluate the use of stretching in the treatment of active myofascial trigger points. / M

Despite a paucity of experimental evidence, clinical opinion remains that though LTrPs allow pain-free movement, they are primarily associated with deleterious motor effects and occur commonly in 'healthy' muscles. The primary aim of this study was to investigate the effects of LTrPs on the muscle activation patterns (MAPs) of key shoulder girdle muscles during scapular plane elevation of the arm in the unloaded, loaded and fatigued states. In connection with the main aim, a preliminary study was carried out to examine the frequency with which LTrPs occur in the scapular positioning muscles in a group of normal subjects. After establishing intra-examiner reliability for the clinical examination process, 154 healthy subjects volunteered to be screened for normal shoulder girdle function, then undergo a physical examination for LTrPs in the trapezius, rhomboids, levator scapulae, serratus anterior and the pectoralis minor muscles bilaterally. Of these 'healthy' subjects, 89.8% had at least one LTrP in the scapular positioning muscles (mean=10.65 ± 6.8, range=1-27), with serratus anterior and upper trapezius harbouring the most LTrPs on average (2.46 ± 1.8 and 2.36 ± 1.3 respectively). Consistent with clinical opinion, this study found that LTrPs occur commonly in the scapular positioning muscles. To investigate the motor effects of LTrPs, surface electromyography (sEMG) was used to measure the timing of muscle activation of the upper and lower trapezius and serratus anterior (upward scapular rotators), the infraspinatus (rotator cuff) and middle deltoid (arm abductor). These studies found that LTrPs housed in the scapular upward rotator muscles affected the timing of activation and increased the variability of the activation times of this muscle group and were also associated with altered timing of activation in the functionally related but LTrP-free infraspinatus and middle deltoid. Compared with the control group (all muscles LTrP-free), the MAPs of the LTrP group appeared to be sub-optimal, particularly in relation to preserving the subacromial space and the loading of the rotator cuff muscles. After the initial sEMG evaluations, the LTrP subjects were randomly assigned to one of two interventions: superficial dry needling (SDN) followed by post-isometric relaxation (PIR) stretching to remove LTrP s or sham ultrasound, to act as a placebo treatment where LTrPs remained. Where LTrPs were removed, a subsequent sEMG evaluation found MAPs to be similar to the control group in most of the experimental conditions investigated. Of particular note, when LTrPs had been treated and the subjects repeated the fatiguing protocol, the resultant MAP showed no significant difference with that of the control group in the rested state, suggesting treating LTrPs was associated with an improved response to fatigue induced by repetitive overhead movements. In conclusion, the findings indicate that LTrPs commonly occur in scapular positioning muscles and have deleterious effects on MAPs employed to perform scapular plane elevation and thus affect motor control mechanisms. Treating LTrPs with SDN and PIR stretching increases pressure-pain thresholds, removes associated taut bands and at least transiently optimises the MAP during scapular plane elevation. Discussion includes possible neuromuscular pathophysiology that might explain these results.

No description available.

<p>Bruxism is an oral parafunctional habit involving clenching and grinding of the teeth that occurs mainly unconsciously, diurnally and nocturnally. It is considered an important contributory factor in the aetiology of myofascial pain (MFP) and temporomandibular disorders (TMD). The aetiology of bruxism is considered to be multifactorial, involving physiological and psychological factors. The aim of this study was to examine the relationship between the subthreshold symptoms (subtle, prodromal, atypical and subclinical symptoms of which the severity precludes diagnosis as a disorder) of anxiety and bruxism in a sample of subjects using a spectrum model.</p>

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 / The purpose of this randomized controlled clinical trial was to investigate the relative effectiveness of proprioceptive neuromuscular facilitation (PNF) versus ultrasound therapy for the treatment of Temporomandibular joint (TMJ) dysfunction caused by masticatory myofascial trigger points, in terms of subjective and objective clinical findings.

A dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2009 / Introduction: The aetiology of Temporomandibular Joint Dysfunction (TMJD) is not fully understood and the treatment of TMJD is controversial. Most treatment plans are based on postulated aetiology. Treatment plans currently range from pharmacological to surgical and occasionally physical therapy is also used for any myofascial component. Myofacial Trigger Points (MFTP’s) in the head and neck region have similar pain referral patterns as TMJD and there is overlap in aetiology and epidemiology. If correlation can be proved to exist between the severities of TMJD and MFTP’s then the treatment of MFTP’s can potentially decrease the severity of TMJD and then the more radical treatments can be avoided. Objectives: To determine whether TMJD was present and establish severity. To locate any MFTP’s in the Sternocleidomastiod (SCM), Temporalis, Masseter, Posterior Cervical (PC), Lateral and Medial Pterygoid muscles and determine their severity. Methods: A random sample of 25 participants were evaluated. A p value <0.05 was considered as statistically significant. Quantitative variables were summarized using median, inter-quartile range and range due to skewness of distribution, while categorical variables were described using frequency distributions and bar charts. Spearman’s nonparametric correlation analysis, and curve estimation were used to determine the existence of a relationship between TMJ severity and MFTP severity. A scatterplot was used to graphically assess the relationship. Conclusion: The results suggested that the participants were actually chronic neck pain suffers that developed TMJD over the long term as a result of chronic neck pain changing the kinematic biomechanics or as a result of a completely different and independent event as suggested by Foreman and Croft (1995).

Dissertation submitted to the faculty of health in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, at the Durban University of Technology, 2008 / Introduction: Myofascial Pain Syndrome (MPS) is a painful and prevalent muscular condition. It is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active and which can refer pain through specific patterns to other areas of the body distal from the trigger point. There exist many types of treatments for MPS of which dry needling is one of the most effective forms. However, a very common side-effect experienced is postneedling soreness, which when compared to trigger point injections are more painful, with respect to both intensity and duration. Studies have shown that the exact cause of post-needling soreness has not been clearly documented. Action Potential Simulation (APS) Therapy operates using a direct electric current (DC) on muscles. It stimulates action potentials that are stronger than the natural nerve impulses. It operates on a similar principle to the gate control theory of Melzack and Wall (1988) which results in the inhibition of nociceptive signals. Stimulation by the APS unit creates a normal action potential that restores the inherent biochemical processes in the region. This low to medium frequency current (below 150 Hz) has been reported to alleviate pain, decrease inflammation, enhance blood circulation and aid in wound and bone fracture healing. Methodology: This study was designed as a prospective, randomised, controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups of 20 subjects each. Group One received the fanning dry needling technique; Group Two received a combination of fanning dry needling plus APS Therapy. Group Three was the control group in which the subjects were treated with fanning dry needling with „Sham‟ APS Therapy. Algometer and Numerical Pain Rating Scale 101 (NRS 101) readings were taken immediately before and after the dry needling procedure and again at the follow-up visit 24 hours later. Subjects used a 24-hour pain diary and the NRS 101 scale which was filled out at 3 hour intervals, to record any post-needling soreness. Results: An intra-group analysis revealed that, objectively and subjectively, all groups experienced some degree of post-needling soreness, which deceased significantly over time. This decrease of pain was not significantly related to the treatment group, and there is no evidence of the differential time effect with the treatment. An inter-group analysis yielded no statistically significant results regarding the effectiveness of the treatments received by the patients. This could be because of the small sample size or because „„Sham‟‟ APS is not a useful intervention. Conclusion: The results from this study revealed that all three treatment groups responded equally in the alleviation of pain. However, the dry-needling treatment group alone (Group One) revealed a much more significant decrease in pain compared to the other two. It can thus be concluded that APS Therapy had no significant beneficial effects on post-needling soreness.

Dissertation submitted to the Department of Chiropractic in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2006. / Myofascial pain syndrome (MPS) is defined as the sensory, motor and autonomic symptoms caused by myofascial trigger points (MFTPs), or hyperirritable spots within skeletal muscles that are associated with palpable nodules in a taut band. The fact that MFTPs have been described in the literature for acupuncturists, anaesthesiologists, chronic pain managers, dentists, family practitioners, gynaecologists, neurologists, nurses, orthopaedic surgeons, paediatricians, physical therapists, physiologists, rheumatologists and veterinarians is evidence of the syndrome’s clinical importance. As a result of a large amount of research, a large number of different treatments have been shown to be clinically effective in the treatment of MFTP. These treatments include amongst others: - Ischaemic compression. - Myofascial manipulation. - Spray and stretch. - Ultrasound. - Transcutaneous electrical nerve stimulation. - Dry needling. As can be seen from the above, it is important to be able to treat MPS effectively because it is such a common disorder. According to Schneider an effective treatment is needed for MPS, despite the array of treatments available to a clinician. Han and Harrison agree that more studies are required to determine the efficacy of these treatments. The aim of this study is to evaluate the relative effectiveness of Myofascial Trigger point Manipulation (MFTPM) as compared to Proprioceptive Neuromuscular Facilitative (PNF) stretching in the treatment of active Myofascial Trigger Points (MFTPs) in the trapezius muscle (TP 1 and/or TP 2) in terms of subjective and objective clinical findings. The study required a total of 60 patients, which following acceptance were then randomly divided into two groups of 30, with an equal number of male patients in Group one (MFTPM) and two (PNF), and female patients in Group one and Group two. Each patient had four consultations (three treatments and one follow up visit) in a two week period. Subjective and Objective Data was recorded at each consultation prior to the treatment. Subjective measurements (Numerical Pain Rating Scale and Short Form McGill Pain Questionnaire) were taken prior to the treatment at all four visits. Objective measurements (Cervical Range of Motion Meter and Algometer) were also taken prior to the treatment at all four visits, except for Algometer readings which were taken at the initial consultation and the fourth treatment only. SPSS version 11.5 was used for analysis of data (SPSS Inc, Chicago, Ill, USA). Baseline comparisons were done between treatment groups using Pearson’s chi square tests or Fisher’s exact tests as appropriate for categorical variables, and student’s t-tests for quantitative normally distributed variables. Treatment effect was assessed with repeated measures ANOVA. A significant time by group interaction indicated a significant differential treatment effect. A p value <0.05 designated statistical significance. The direction of the treatment effect was assessed with profile plots. Evaluation of data collected from both groups showed a significant improvement in terms of objective and subjective clinical findings to a value of p=< 0.001. There was no statistical difference between the two groups in terms of objective and subjective clinical findings, although a trend was shown when looking at the objective findings that suggest that MFTPM was more effective than PNF stretching. The sample population was drawn from a very homogenous group of people (i.e. SARS call centre), in order to achieve greatest emphasis on clinical outcomes. This process however limits the clinical applicability of the results and thus will not always be applicable to all patients within the population. It is therefore the researcher’s conclusion that there is no statistical difference between MFTPM and PNF stretching in terms of objective and subjective clinical findings. Both treatment modalities have been shown to be equally effective in the treatment of subacute active TPs in the upper tarpezius. There is a definite trend when looking at the objective data that may support the hypothesis that MFTPM is as effective as, if not more effective than PNF stretching. It is of the opinion of the author that a larger sample size is needed to make it clinically significant.

<p>Bruxism is an oral parafunctional habit involving clenching and grinding of the teeth that occurs mainly unconsciously, diurnally and nocturnally. It is considered an important contributory factor in the aetiology of myofascial pain (MFP) and temporomandibular disorders (TMD). The aetiology of bruxism is considered to be multifactorial, involving physiological and psychological factors. The aim of this study was to examine the relationship between the subthreshold symptoms (subtle, prodromal, atypical and subclinical symptoms of which the severity precludes diagnosis as a disorder) of anxiety and bruxism in a sample of subjects using a spectrum model.</p>

In recent years, self-myofascial release has gained popularity as a post-exercise therapeutic technique in regards to alleviating pain or muscle soreness. New developments have led many researchers and practitioners to examine self-myofascial release, in the form of foam rolling, pre-exercise. The effects of foam rolling, in combination with a dynamic warm-up, is not quite understood. Minimal research has been published on this topic. To date, there has been one article that examines how a dynamic warm-up and foam rolling can improve performance. Therefore, the purpose of this study is to determine if an acute bout of foam rolling in the form of self-myofascial release in addition to a dynamic warm-up could improve performance. Fourteen active male and female participants (N = 14; age: 20.931.44; height: 68.043.21, weight: 80.0922.82, BMI: 26.47 5.89) with no prior experience foam rolling volunteered to engage in this counterbalanced, within-subjects design. Participants engaged in experimental condition groups: a general warm-up (GW) group, a dynamic warm-up (DYN) group, and a foam rolling (FM) group. Following each condition, participants performed a series of performance tests. One-way repeated measures ANOVA was conducted to compare the effect of the independent variable (group: general warm-up, dynamic warm-up, and foam rolling group) on the dependent variable (scores: flexibility, vertical jump, standing long jump, and sprint scores) to determine if significant differences exist. When the omnibus F-test statistic was significant, pairwise comparisons using Sidak comparisons were performed. The data indicated that the foam rolling group showed significant differences in flexibility and power (specifically in the standing long jump) when compared to a general or dynamic warm-up. Furthermore, no significant differences were found in the vertical jump or the speed test among the three groups. The results suggest that total-body foam rolling session may be valuable for improvements in certain aspects of performance. Implications from this study suggest foam rolling can be used before a workout routine.