M.Tech. (Chiropractic) / PURPOSE: Shoulder pain has been identified to be one of the most common musculoskeletal problems found in a variety of different countries, showing characteristics of chronicity and recurrence. It is considered to be a main contributor towards nontraumatic upper limb pain. One of the identifiable causes of chronic or reoccuring shoulder pain may be attributed to myofascial pain syndrome which is caused by MTrP’s and produces symptoms that are similar to that of other shoulder pain syndromes. The infraspinatus muscle as an integral component of the rotator cuff complex is subject to high tension biomechanical strain as well as neuromuscular tension. While therapeutic interventions have been devised to treat varying degrees of biomechanical and neuomuscular tension, little evidence exists establishing which of these treatment regimes is most effective in treating myofascial trigger points. The purpose of this study was to compare different regional chiropractic adjustments relative to the attachment site and the innervation segment of the infraspinatus muscle and to identify the most effective treatment protocol with regard to chronic, active infraspinatus myofascial trigger point dysfunction. DESIGN: A selection of thirty participants were recruited for this study. The participants were divided into two groups of fifteen participants each. Group A received a chiropractic adjustment to the glenohumeral joint, the attachment site for infraspinatus muscle. Group B received a chiropractic adjustment to the cervical spine segments associated with the innervation to the infraspinatus muscle. Cervical spine restrictions specific to levels C4/C5 and/or C5/C6, and glenohumeral joint restrictions were determined using motion palpation techniques. All participants received a total of six treatments over a three-four week period. MEASUREMENTS: Subjective measurements were obtained by the Functional Rating Index Questionnaire and the Numerical Pain Rating Scale. Objective measurements were obtained using the hand-held pressure algometer and counting the number of active infrapsinatus myofascial trigger points. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the Functional Rating Index Questionnaire for the intragroup analysis indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (15.5%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (68.8%). The intergroup analysis indicated that there were no statistically significant differences. vii With regard to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (21.7%). There were no statistically significant differences with the intergroup analysis. The intragroup and intergroup analysis of the number of active infraspinatus myofascial trigger point dysfunction showed no statistically significant differences between the groups or within each of the groups over time. CONCLUSION: The results showed that both treatment groups protocols were effective in reducing chronic, active infraspinatus myofascial trigger point dysfunction. Small differences were noted between the two treatment groups with regards to the subjective and objective findings. The glenohumeral joint adjustment group showed the greatest clinical and statistical improvements over the three-four week trial period.

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.

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.

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.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / BACKGROUND: Temporomandibular disorders (TMDs) affect up to fifteen percent of adults. It produces craniofacial pain of musculoskeletal structures within the head and neck. One particular cause of TMDs is said to be myofascial pain syndrome (MFPS), which according to various research papers, if not considered and/or assessed, the general cause of a patient’s pain could be disregarded and incorrect treatment offered. Numerous studies conducted internationally on dental management of temporomandibular joint disorder (TMJD) concluded that there is a significant gap in dentists’ education and training regarding the identification and management of MFPS. Upon reviewing the current literature available in South Africa, very little research existed on dentists’ knowledge and the management strategies that they utilised regarding MFPS in TMJD patients. OBJECTIVES: To determine the dentists’ knowledge regarding MFPS of the temporomandibular joint (TMJ). What assessment and treatment/management strategies they use, and whether they make use of referral networks and if the respondents’ demographics influence their knowledge, utilisation, perception and referral patterns. METHODOLOGY: The researcher developed a research questionnaire, which was validated by both an expert and a pilot study group. This questionnaire was then used as a research tool in this cross-sectional study. General dental practitioners from the Greater eThekwini Region received an invitation to participate. The questionnaire-based survey consisted of five sections: biographical profile of respondents; topic background; perception; knowledge; utilisation and management (including referral patterns) of MFPS. RESULTS: The majority of respondents did receive basic education in MFPS, with 76.9% reporting that they received undergraduate education and 57.7% indicating that they had attended post-graduate courses/talks on MFPS. There was a 100% response from dentists indicating their willingness to attend post-graduate courses/talks on MFPS. The results indicated that the respondents, who felt that their curriculum regarding MFPS was sufficient, were more knowledgeable and more competent in diagnosing and managing MFPS. Overall, the average score for knowledge was 65.17%. Clinical features (78.85%) and the perpetuating and relieving factors (72.11%) scored the highest while causes (58.06%) and differential diagnoses (51.16%) scored the lowest knowledge levels. Respondents mostly made use of allopathic medical fields, and not of alternative medical fields, however a high number of respondents (73.1%) indicated that they would consider chiropractic co–management of patients with MFPS. CONCLUSION: This study adds new information in the South African context regarding dentists’ understanding of the myofascial component of TMDs. It also provides the dental profession with information about the knowledge and practices related to MFPS as well as information regarding the strengths and weaknesses on its educational component. It is recommended that dentists receive additional training on differential diagnoses and causes. It is also recommended that the chiropractic profession take this opportunity to offer courses/talks on MFPS and join forces with the dentistry profession on how they can assist in managing patients with MFPS. / M

Thesis (M.Thec.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 110 leaves ; ill. ; 30 cm / 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.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 x, 80 leaves / The aim of this study was to evaluate the Myofascial Diagnostic Scale, for its inter-examiner reliability and to assess its reliability and validity as an assessment tool in the diagnosis and treatment of Myofascial Pain Syndrome.