Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xv, 81 leaves ; 30 cm / The purpose of this study was to investigate the association between active Myofascial Trigger Points in the dominant shoulder external rotator muscle group in overhead throwing athletes and an altered internal/external rotation peak torque and single repetition work ratio of the involved shoulder. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / 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.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, 2005. / To document the relationship between total work and myofascial trigger points in the vastus lateralis and vastus medialis portion of the quadriceps femoris muscle, whilst providing baseline graphs of these muscles with the use of a Cybex 700 Isokinetic Dynanometer in long distance runners both with and without patellofemoral pain syndrome. Methods: A quantitative, non-intervention clinical exploratory study. Fifty participants were divided into two groups, Group A (40 symptomatics) and Group B (10 asymptomatics). Both groups were screened for vastus lateralis and vastus medialis trigger points. Subjective data was obtained from Group A only, using the Numerical Pain Rating Scale and the Patient Specific Functional Scale. Objective data was obtained from both groups using the algometer, Myofascial Diagnostic Scale, and the Cybex 700 Isokinetic Dynanometer. For descriptive analysis frequency tabulations, box and whisker plots were used to display distributions graphically. Comparisons of categorical and quantitative variables between independent groups were run using chi square and Mann-Whitney testing consecutively. Finally Spearman’s correlation, multivariate generalized linear modelling and repeated measures ANOVA were also used. All statistical analysis was completed at the 95% (p<0.05) level of confidence. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Aim: This study aimed to compare the effectiveness of the Impulse iQ® Adjusting Instrument and ischaemic compression on trigger points in pain relief and quality of life in adults presenting with non-specific neck pain. Methodology: This study was a randomised single-blinded clinical trial which consisted of 40 participants residing in the eThekwini municipality, divided into two groups of 20 each. The participants were randomly assigned using concealed allocation to one of two treatment groups of 20 viz. Impulse iQ® Adjusting Instrument (IAI) trigger point therapy group and ischaemic compression (IC) group. Neck pain level was determined using a numerical pain rating scale (NRS). Degree of lateral flexion (LF) was determined by a cervical range of motion (CROM) goniometer. Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of neck pain on participants’ activities of daily living was assessed using the Canadian Memorial Chiropractic College (CMCC) Neck Disability Index (NDI). The participants’ overall perception of improvement since the initiation of treatment was assessed using the Patients Global Impression of Change (PGIC). The participants received three treatments over a two and half week period with the fourth consultation being used for the final subjective and objective measurements. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS, algometer readings and CROM goniometer measurements. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. It was noted that there was a higher rate of improvement in IAI Group with respect to algometer readings over time; however, this difference was not statistically significant. Conclusion: This study concluded that neither IAI nor IC is more effective than the other with respect to participants’ pain perception and CROM. However, the IAI was more effective on pain pressure threshold. Based on the results collected from this study, both therapies can used in the treatment protocols of neck pain associated with MFTPs. / M

Avaliou-se a eficácia do tratamento através da técnica de agulhamento a seco, com injeção de lidocaína a 0,5% e injeção de lidocaína a 1% em pacientes portadores de dor miofascial e na presença de pontos-gatilho em músculos da mastigação. Foram selecionados 26 pacientes e divididos em três grupos: Grupo I: pacientes submetidos a injeção de lidocaína a 0,5%. Grupo II: Pacientes submetidos à injeção de lidocaína a 1%. Grupo III: Pacientes submetidos ao agulhamento a seco. Avaliou-se os pacientes através do limiar de dor a palpação (LDP) e da escala de análise visual de dor (EAV) nos períodos: inicial (antes da infiltração), imediatamente após a infiltração, 24 horas depois, 7, 15, 21 e 30 dias respectivamente. Os resultados foram coletados e analisados através do teste anova a 2 critérios adotando-se nível de significância de 0,05%. Onde houve diferenças estatísticas significantes, aplicou-se o Teste de Tukey. Não houve diferenças estatísticas significantes entre os três grupos quando comparados o LDP entre os grupos, porém houve diferenças significantes quando comparado o LDP ao longo do tempo, sendo que este aumentou significativamente. Em relação à EAV, acharam-se diferenças tanto entre os grupos quanto ao longo do tempo, sendo que o grupo X teve uma diminuição mais rápida do que os outros dois. Porém, ao final, todos os grupos tiveram reduções significantes e sem diferenças entre si. Conclui-se que todos os tratamentos foram eficazes na redução dos sintomas da dor miofascial no tempo avaliado, não havendo diferenças entre os tratamentos. / The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine 0,5%, lidocaine 1% and dry needling without any kind of home-based rehabilitation program. 26 patients with myofascial pain and trigger points in masticatory muscles. They were randomly assigned in three groups and received only one application session. The pressure pain threshold (PPT) was recorded before the injection, ten minutes after, 24 hours later, 7, 15, 21 end 30 days after the treatment. Visual analogue scale (VAS) was used to in all evaluation periods. There were no differences between groups for PPT. but for all groups, the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. VAS was significant lower when compared 30 days to before treatment. Among the groups, 0,5% lidocaine ha the lowest VAS values when compared to the others, but at 30 days there were no differences among them. Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, all groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

Introdução: a relação entre zumbido e pontos-gatilho miofasciais têm sido debatida, mas poucas são as condutas terapêuticas propostas. Este estudo teve os objetivos de verificar: (1) a eficácia da desativação dos pontos-gatilho miofasciais para o alívio do zumbido em pacientes com síndrome dolorosa miofascial, (2) a correlação de lateralidade entre zumbido e dor e a associação entre a melhora de ambos e (3) se o fenômeno da modulação do zumbido durante a palpação dos pontos-gatilho apresenta bom prognóstico para este tratamento. Métodos: um ensaio clínico randomizado duplo-cego e placebo controlado foi desenvolvido para verificar a eficácia de 10 sessões de desativação dos pontos-gatilho em uma população com zumbido e síndrome dolorosa miofascial. Os critérios de inclusão eram: presença de zumbido e pelo menos um ponto-gatilho ativo em oito possíveis músculos da região da cabeça, pescoço ou cintura escapular, excluindo-se aqueles com dor generalizada ou tratamento recente para ambos os sintomas. Depois de triados por um otorrinolaringologista e avaliados por uma \"pesquisadora cega\" no início e após a quinta e décima sessões de tratamento, os indivíduos foram encaminhados para uma fisioterapeuta, que realizou a randomização em dois grupos e o tratamento de ambos. O grupo experimental foi submetido à desativação dos pontos-gatilho por digito-pressão e a orientações de condutas domiciliares e o grupo controle, a uma leve pressão em pontos adjacentes aos pontos-gatilho existentes. Resultados: o tratamento do grupo experimental foi mais eficaz em relação à intensidade do zumbido, número de sons, valor total do questionário de gravidade do zumbido e intensidade da modulação (p< 0,001). Houve associação entre a melhora da dor e a melhora do zumbido (p= 0,013; correlação de Spearman= 0,426) e o tratamento foi eficaz em todas as variáveis relacionadas à dor (p< 0,001) como: a intensidade da dor, valor do algômetro e número de pontos-gatilho ativos e latentes totais. Houve correlação de lateralidade entre os lados de pior zumbido e de dor em 54,4% dos casos (Kappa= 0,32; p< 0,001). A modulação do zumbido foi bastante freqüente no grupo experimental e controle (75,7% e 83,3% respectivamente), porém este fenômeno não influencia o prognóstico deste tratamento. No entanto, diminuir a intensidade do zumbido na modulação foi uma condição importante para um bom resultado de alívio do zumbido (p= 0,002). Conclusões: o grupo experimental foi mais eficaz em todas as variáveis analisadas após o tratamento de desativação dos pontos-gatilho miofasciais. Também foi observada uma correlação de lateralidade de ambos os sintomas e a existência de uma relação direta entre a melhora da dor e a melhora do zumbido. Modular o zumbido na avaliação dos pontos-gatilho não influencia o prognóstico do tratamento, porém, diminuir a intensidade durante a modulação promove uma resposta maior de alívio do zumbido do que aqueles que aumentam a intensidade ou modificam o tipo de som. / Introduction: the relationship between tinnitus and myofascial trigger points has been subject to debate but few therapeutic guidelines have been proposed. This study aims at analyzing (1) efficacy of myofascial trigger point deactivation for the relief of tinnitus in patients with myofascial pain syndrome; (2) correlation of laterality between tinnitus and pain - and the relief of both of them - as well as (3) whether the presence of tinnitus modulation upon trigger point palpation represents good prognosis for the treatment. Methods: a double-blind randomized placebo controlled clinical trial was developed in order to ascertain efficacy of 10 sessions of myofascial trigger point deactivation in a population suffering from both tinnitus and myofascial pain syndrome. Inclusion criteria were: presence of tinnitus and at least one active trigger point in eight possible muscles of the head, neck or shoulder girdle, excluding patients with generalized pain or undergoing recent treatment for both symptoms. After having been selected by an otologist and evaluated by a \"blind researcher\" in the beginning and after the fifth and tenth session, subjects were directed to a physiotherapist, who randomized them in two groups and treated both. The experimental group was subject to myofascial trigger point deactivation by means of digital pressure and guidance related to procedures to be followed at home, whereas the control group was subject to light pressure in spots adjacent to the existing trigger points. Results: treatment of the experimental group was more effective in relation to tinnitus loudness, number of sounds, total value of the Tinnitus Handicap Inventory as well as modulation intensity (p< 0,001). There was an association between pain relief and tinnitus relief (p= 0,013; Spearman correlation = 0,426) and treatment was effective in all pain-related variables (p< 0,001) such as: pain intensity, algometer value and amount of active and latent trigger points. Laterality correlation was also observed between the side with the worst tinnitus and the side with pain in 54.4% of the cases (Kappa= 0,32; p< 0,001). Tinnitus modulation was frequent in both experimental and control groups (75.7% e 83.3% respectively), even though such phenomenon does not influence the prognosis of the treatment. Nevertheless, diminishing tinnitus intensity was an important condition for tinnitus relief (p= 0,002). Conclusions: the experimental group was more effective in all variables subject to evaluation after treatment with myofascial trigger point deactivation. Laterality correlation of both symptoms was also observed as well as the existence of a direct link between pain relief and tinnitus relief. Modulation of tinnitus during trigger point evaluation does not influence the treatment prognosis, even though diminishing intensity during modulation allows more tinnitus relief than raising intensity or modifying the type of sound.

Introdução: a relação entre zumbido e pontos-gatilho miofasciais têm sido debatida, mas poucas são as condutas terapêuticas propostas. Este estudo teve os objetivos de verificar: (1) a eficácia da desativação dos pontos-gatilho miofasciais para o alívio do zumbido em pacientes com síndrome dolorosa miofascial, (2) a correlação de lateralidade entre zumbido e dor e a associação entre a melhora de ambos e (3) se o fenômeno da modulação do zumbido durante a palpação dos pontos-gatilho apresenta bom prognóstico para este tratamento. Métodos: um ensaio clínico randomizado duplo-cego e placebo controlado foi desenvolvido para verificar a eficácia de 10 sessões de desativação dos pontos-gatilho em uma população com zumbido e síndrome dolorosa miofascial. Os critérios de inclusão eram: presença de zumbido e pelo menos um ponto-gatilho ativo em oito possíveis músculos da região da cabeça, pescoço ou cintura escapular, excluindo-se aqueles com dor generalizada ou tratamento recente para ambos os sintomas. Depois de triados por um otorrinolaringologista e avaliados por uma \"pesquisadora cega\" no início e após a quinta e décima sessões de tratamento, os indivíduos foram encaminhados para uma fisioterapeuta, que realizou a randomização em dois grupos e o tratamento de ambos. O grupo experimental foi submetido à desativação dos pontos-gatilho por digito-pressão e a orientações de condutas domiciliares e o grupo controle, a uma leve pressão em pontos adjacentes aos pontos-gatilho existentes. Resultados: o tratamento do grupo experimental foi mais eficaz em relação à intensidade do zumbido, número de sons, valor total do questionário de gravidade do zumbido e intensidade da modulação (p< 0,001). Houve associação entre a melhora da dor e a melhora do zumbido (p= 0,013; correlação de Spearman= 0,426) e o tratamento foi eficaz em todas as variáveis relacionadas à dor (p< 0,001) como: a intensidade da dor, valor do algômetro e número de pontos-gatilho ativos e latentes totais. Houve correlação de lateralidade entre os lados de pior zumbido e de dor em 54,4% dos casos (Kappa= 0,32; p< 0,001). A modulação do zumbido foi bastante freqüente no grupo experimental e controle (75,7% e 83,3% respectivamente), porém este fenômeno não influencia o prognóstico deste tratamento. No entanto, diminuir a intensidade do zumbido na modulação foi uma condição importante para um bom resultado de alívio do zumbido (p= 0,002). Conclusões: o grupo experimental foi mais eficaz em todas as variáveis analisadas após o tratamento de desativação dos pontos-gatilho miofasciais. Também foi observada uma correlação de lateralidade de ambos os sintomas e a existência de uma relação direta entre a melhora da dor e a melhora do zumbido. Modular o zumbido na avaliação dos pontos-gatilho não influencia o prognóstico do tratamento, porém, diminuir a intensidade durante a modulação promove uma resposta maior de alívio do zumbido do que aqueles que aumentam a intensidade ou modificam o tipo de som. / Introduction: the relationship between tinnitus and myofascial trigger points has been subject to debate but few therapeutic guidelines have been proposed. This study aims at analyzing (1) efficacy of myofascial trigger point deactivation for the relief of tinnitus in patients with myofascial pain syndrome; (2) correlation of laterality between tinnitus and pain - and the relief of both of them - as well as (3) whether the presence of tinnitus modulation upon trigger point palpation represents good prognosis for the treatment. Methods: a double-blind randomized placebo controlled clinical trial was developed in order to ascertain efficacy of 10 sessions of myofascial trigger point deactivation in a population suffering from both tinnitus and myofascial pain syndrome. Inclusion criteria were: presence of tinnitus and at least one active trigger point in eight possible muscles of the head, neck or shoulder girdle, excluding patients with generalized pain or undergoing recent treatment for both symptoms. After having been selected by an otologist and evaluated by a \"blind researcher\" in the beginning and after the fifth and tenth session, subjects were directed to a physiotherapist, who randomized them in two groups and treated both. The experimental group was subject to myofascial trigger point deactivation by means of digital pressure and guidance related to procedures to be followed at home, whereas the control group was subject to light pressure in spots adjacent to the existing trigger points. Results: treatment of the experimental group was more effective in relation to tinnitus loudness, number of sounds, total value of the Tinnitus Handicap Inventory as well as modulation intensity (p< 0,001). There was an association between pain relief and tinnitus relief (p= 0,013; Spearman correlation = 0,426) and treatment was effective in all pain-related variables (p< 0,001) such as: pain intensity, algometer value and amount of active and latent trigger points. Laterality correlation was also observed between the side with the worst tinnitus and the side with pain in 54.4% of the cases (Kappa= 0,32; p< 0,001). Tinnitus modulation was frequent in both experimental and control groups (75.7% e 83.3% respectively), even though such phenomenon does not influence the prognosis of the treatment. Nevertheless, diminishing tinnitus intensity was an important condition for tinnitus relief (p= 0,002). Conclusions: the experimental group was more effective in all variables subject to evaluation after treatment with myofascial trigger point deactivation. Laterality correlation of both symptoms was also observed as well as the existence of a direct link between pain relief and tinnitus relief. Modulation of tinnitus during trigger point evaluation does not influence the treatment prognosis, even though diminishing intensity during modulation allows more tinnitus relief than raising intensity or modifying the type of sound.

Embora as causas de DTM tenham sido muito estudadas e discutidas na literatura atual, a associação entre a dor muscular e sua temperatura não está totalmente clara. Para esta investigação, 40 pacientes com dor muscular foram encaminhados da clínica odontológica e foram examinados. Um total de 31 pacientes foram diagnosticados com dor miofascial no musculo masseter pelo RDC e foram incluídos neste estudo. O musculo masseter no lado com dor foi anestesiado e foi comparado ao lado oposto ao longo do tempo. Na análise estatística de comparação, foi encontrada associação entre o aumento de temperatura e a diminuição da dor relatada. Possíveis fatores de confusão, como tempo da dor crônica, idade, índice de massa corpórea, pontos de incapacidade, ICD, pior dor sentida nos últimos meses e dor media nos últimos meses foram levados em consideração e foram estatisticamente analisados e o único fator que mostrou estatisticamente correlação com a diminuição da dor foi o fator tempo. Conclusão: existe uma correlação negativa entre o aumento de temperatura e a diminuição da dor. / Although, TMD causes have been widely studied in the last years, the association between muscle pain and temperature remains unclear. For this investigation, 40 muscle pain patients were referred from dental clinic and were examined. A total of 31 patients were diagnosed with masseter myofascial pain by RDC criteria and were included in this study. Masseter muscle was blocked in the pain side and was compared among the time to opposite side. In the matching statistics association analysis, it was found association between temperature increase and related pain decrease. Possible confounders (time of chronic pain, age, Body Mass Index, ICD, incapacity points, worst pain in the last six months, average pain in last six month) were took in consideration and only time since the pain started seems to be related to decrease in pain. Conclusion: there is a negative association between muscle pain and muscle temperature.