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.

Magister Artium (Psychology) - MA(Psych) / 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. / South Africa

M.Tech. (Chiropractic) / Myofascial pain syndrome has become a significant cause of chronic pain and disability in today‟s society. Conditions causing chronic pain can not only cause disability due to pain, but can also lead to other problems such as psychological and behavioural disturbances. Physical deconditioning can also occur due to lack of exercise because of myofascial pain (Rachlin, 1994). The aim of this study was to compare dry needling therapy and ultrasound therapy in the treatment of myofascial trigger points in order to demonstrate any superiority between the two modalities. Participants for this study were recruited by word of mouth and advertisements that were placed around the University of Johannesburg Doornfontein Campus. Thirty people participated in the trial, all of whom conformed to the specific inclusion and exclusion criteria. The participants were randomly placed into two groups. Group A received dry needling therapy, namely the fanning technique, and Group B received ultrasound therapy. Participants in Group A received one treatment per week for four weeks and subjective and objective measurements were taken at each visit. Participants in Group B received two treatments per week for three weeks and measurements were taken at visits one, three, five and seven. Subjective data was obtained through the use of the Visual Analogue Pain Scale, which measured the perception of pain of the participants. Objective data was obtained from pressure algometer readings, which measured pain pressure thresholds of participants, and through the Cervical Range Of Motion (CROM) device. The results of this study indicated that dry needling therapy and ultrasound therapy both significantly benefited participants in terms of the treatment of active myofascial trigger points. Based on the final results, both dry needling therapy and ultrasound therapy are equally effective modalities in the treatment of active myofascial trigger points, with neither modality showing superiority over the other.

M.Tech. / Myofascial pain has become a major cause of disability and chronic pain in our society today. Left untreated, myofascial pain syndrome can become a chronic pain condition. Chronic pain conditions can not only cause disability due to pain, but can also lead to related conditions such as depression, physical deconditioning due to lack of exercise, disturbance of sleep and other psychological and behavioural disturbances (Rachlin, 1994). The aim of this study was to determine whether cryotherapy or moist heat therapy was a superior therapeutic modality when applied to active Infraspinatus muscle trigger points post-dry needling. Participants were recruited into the study by the use of advertisements put up at various places on the university campus as well as in the University of Johannesburg Chiropractic Day Clinic. Fourty participants that conformed to the specific inclusion and exclusion criteria were recruited. The participants were randomly placed into two groups containing twenty participants in each group. Group A received cryotherapy post-dry needling and Group B received moist heat therapy post dry needling. Each participant received four treatments. The subjective and objective measurements were taken on the first, third and fifth visits. The fifth visit was scheduled to take final subjective and objective data only. The subjective data was obtained by measuring the participant‟s perception of their myofascial pain using the Visual Analogue Pain Scale. The objective data was obtained from the readings of the Algometer instrument, measuring the pressure pain threshold of the active myofascial trigger points in the Infraspinatus muscle. The results of this study indicated that both cryotherapy and moist heat therapy significantly benefited the participants in terms of the treatment of the active myofascial trigger points of the Infraspinatus muscle. However, based on the results, final conclusions could not be formulated on whether the dry needling itself would be beneficial without needing the cryotherapy or the moist heat therapy, as neither modality proved superior over the other.

Following the publishing of the Management of Myelomeningocele Study, the advantages of in utero repair for fetal myelomeningoceles became points of interest for fetal surgeons. There are many variables that must align in order to have success in this type of repair. When a patient is eligible for this prenatal procedure it is preferable to perform it rather than do the repair postnatally as neurological outcomes for the infant tend to be much better following earlier intervention. It is very important to have a clear preoperative plan before beginning any fetal surgery. In doing so, one limits unforeseen events that may arise. With this in mind, we chose to analyze factors that affect the rates of patch placement (in lieu of a primary skin closure) during the prenatal repair and rates of shunt placement after the infant is born. A retrospective study was conducted on patients who underwent in utero repair for a myelomeningocele or myeloschisis defect at the Colorado Fetal Care Center. Multivariate analyses were performed to identify which preoperative, intraoperative, and postoperative factors were statistically significant (p ≤ 0.05) in predicting patch and shunt placement. Neuroimaging was found to be a key tool in predicting patch and shunt placement. Additionally, gestational age during prenatal intervention was found to be predictive of patch placement while the preoperative degree of cerebellar descent relative to the foramen magnum as well as 2-week hindbrain herniation classification were found to be predictive of shunt placement. These crucial findings will give physicians a framework to use when creating their preoperative plans and in doing so will allow for higher chances of success with this complex procedure.

Background: Osteoarthritis (OA) is a common degenerative disease in elderly people, OA of the knee (KOA) makes up for a big part of all OA cases. Common KOA inconveniences are joint stiffness, pain and loss of muscle strength, which can have a negative impact on the quality of life. The OA process affects the kinematics of the knee joint and increases joint laxity, an impairment which can create more damage to the knee joint. Conservative treatment including exercise is the first option of choice in rehabilitation. Manual joint mobilization is another common treatment method which has effect on function and pain in patients with KOA. One muscle located in the hollow of the knee is the popliteal muscle and its function is to internally rotate the tibia, flex the knee joint and reduce ventral translation of the tibia; popliteal activity aims to maintain proper knee kinematics. Purpose: To investigate what effect myofascial release and exercise for the popliteus muscle have regarding pain, function and health related quality of life in people suffering from KOA. Method: A single subject experimental design study consisting of three participants with KOA was performed. The study started with a baseline phase measurement where the participants answered questionnaires about their pain, function and quality of life, followed by the intervention phase consisting of myofascial release (MFR) and exercise for the popliteal muscle. Result: There was not any concordant results for any of the outcome measurements even though each participant had positive changes in one or more of the different measurements mainly regarding pain, function in daily living or quality of life (QoL). Conclusion: MFR and exercise for the popliteus muscle might be effective as a treatment for people with KOA related inconveniences regarding mainly pain, function in daily living and QoL. Key words: Knee osteoarthritis, myofascial release, exercise, popliteus muscle.

No description available.

Benign masseter hypertrophy causes swelling at the angulus mandibulae and may be associated with masticatory myofascial pain due to hyperfunction from bruxism. The aim of this research was to use the systematic review process to investigate the true or reliable scientific evidence contained in four major databases pertaining to the efficacy and safety of intra-muscular injections of botulinum toxin A (BTX-A) for the treatment of masticatory myofascial pain and benign masseter hypertrophy associated with bruxism, compared with placebo or other traditional treatments prescribed for bruxism such as occlusal splints, pharmacotherapy, or lifestyle modification. Using the PICO format, a research question was formulated, MeSH terms were derived, and an electronic literature search was conducted in PubMed, Embase, Web of Science, and Cochrane. This sequence was followed by a screening and selection of articles by two independent reviewers according to defined inclusion and exclusion criteria. The selected studies were then evaluated and assessed based on study quality and identification of biases, and the results were summarized and reported. This review highlighted the lack of well-designed, randomized controlled trials to evaluate the efficacy and safety of botulinum toxin A for reducing the size/volume of the masseter muscles and for improving masticatory myofascial pain in patients who present with bruxism. Thus, the results were inconclusive.

Background: Foam rolling (FR) is a promising new trend in the world of resistance training, sports and  athletics. It is often used as a warm up activity as a substitute or addition to  stretching modalities such as static stretching (SS). The proposed benefits behind FR is that it can lead to  both acute and chronic increases in performance and flexibility. Aim: The aim of this study was to investigate the effects of two different warm­up intervention protocols  of the hamstrings musculature on: 1) Performance in the bilateral standing long jump 2) Flexibility in a  supine active­knee­extension test. Method: The study consisted of sixteen male participants who were all healthy adult recreational athletes.  The two different interventions were, a) Static Stretching protocol (SS) and b) a Foam Rolling protocol  (FR). These were compared to a baseline warm up (BLWU). The SS consisted of 1 x 30 seconds of active  SS using the lying supine active­knee­extension position after a short warm­up. The FR consisted of 1  bout of 30 seconds of FR of the hamstrings musculature of each leg after a short warm­up. BLWU  consisted of a short warm­up (5 submaximal bilateral standing long jumps). Performance was measured  using a bilateral standing long jump test. Flexibility was measured with a goniometer using a lying supine active ­knee­ extension test. The student’s t­test was used to study differences between and within groups (BLWU, SS, FR). Results: No differences between BLWU and Post­SS (p=0.89) as well as BLWU compared to Post­FR (p=0.86) was detected for performance. However, an increase in flexibility was shown favoring Post­SS over BLWU (p=0.021) as well as Post­FR over BLWU (p=0.045). No significant difference was seen  between changes in the Post­SS and Post­FR groups in either performance or flexibility (p=0.887 and  p=0.944 respectively). Conclusion: It seems that both SS and FR are similarly viable and effective methods for acute increases  in flexibility in the active­knee­extension test without subsequent decreases in performance of the bilateral standing long jump.

A síndrome dolorosa miofascial (SDM) é uma disfunção musculoesquelética não articular caracterizada por pontos-gatilho miofasciais. Estes pontos, identificados por meio da palpação, são descritos como bandas tensas na fibra muscular, podendo apresentar dor referida à compressão. Sabe-se que os pontos-gatilho miofasciais provocam hiperatividade simpática regional de temperatura local devido à atividade vasoconstritora cutânea. Para documentação objetiva por imagem desta alteração funcional, a termografia tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi correlacionar os exames clínico e termográfico dos pontos-gatilho nos músculos da mastigação masseter e temporal parte anterior. A amostra constituiu-se por 26 mulheres voluntárias com 41 ± 15 anos. Os resultados demonstraram correlação diretamente proporcional entre algometria e termografia na avaliação do ponto-gatilho miofascial, onde, quanto menor a força aplicada, menor a temperatura local (p<0,001). As áreas com dor referida apresentaram níveis de limiar de dor à pressão (1.28±0.45 kgf) menores quando comparados às áreas de dor local (1.73±0,59 kgf; p<0.001). Sendo assim, a imagem termográfica de um ponto-gatilho apresentou-se hiporradiante quando comparada à região de ausência de ponto-gatilho (&#916;T>0,4ºC; p<0.001). Além disso, a avaliação termográfica dos pontos-gatilho nos músculos masseter e temporal pelo gradiente térmico (&#916;T e &#916;&#952;) apresentou maior sensibilidade e especificidade em comparação com a temperatura absoluta (T), mesmo quando corrigidos estes valores para a temperatura ambiente e temperatura timpânica da voluntária durante o exame (&#952;). A termografia isoladamente identificou pontos-gatilho com sensibilidade de 62,5% e especificidade de 71,31%. Os autores concluíram que a termografia é um método de imagem não invasivo, com potencial de identificação de pontos-gatilho miofasciais na região facial. / Myofascial pain syndrome is a myalgic dysfunction characterized by myofascial trigger points (MTP). The taut band is a constant feature of a trigger point characterized by referred pain when stimulated. It is known that the myofascial trigger points cause regional sympathetic hyperactivity in local temperature due to the cutaneous vasoconstrictor activity. For detection of functional changes, thermography may be used as an auxiliary diagnostic imaging. The aim of this study was to correlate clinical and thermographic myofascial trigger points in the masticatory muscles masseter and temporalis. Twenty six women volunteers were included, having a mean age of 41 ± 15 years. The results showed directly proportional relationship by algometry and thermography in the assessment of MTP, where smaller the force applied, lower the local temperature will be (p<0.001). Moreover, when the soreness was evaluated and local vasomotor response, the temperature decreases as the worst local situation. PPT (pressure pain threshold) levels measured at the points of referred pain in MTP (1.28±0.45 kgf) were significantly lower than the areas of local pain in MTP (1.73±0,59 kgf; p<0.001). Thus, the thermographic image of a MTP presented colder than the area without trigger point (&#916;T>0,4ºC; p<0.001). In the thermographic assessment of MTP in the masseter and temporalis muscles, the results suggest that the parameters of thermal asymmetry (&#916;T and &#916;&#952;) show greater sensitivity and specificity in comparison to local absolute temperature values (T), even when corrected for the volunteer\'s core temperature and the temperature of the room during the exam (&#952;). Thermography can identify trigger points (referred pain) with sensitivity of 62,50% and specificity of 71,31%. The authors concluded that thermography is a noninvasive imaging method with potential for screening patients with MTP in the facial region.