Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of muscle energy technique in the treatment of chronic mechanical neck pain. This was a randomized placebo controlled study. Two groups of thirty subjects from Durban and the surrounding areas were selected to participate in the study, which was carried out at the Technikon Natal Chiropractic Day Clinic. Subjects were diagnosed with the condition by the researcher. Each subject received six treatments within a period of three weeks. Group A received muscle energy technique and de-tuned laser therapy applied to joint fixations. Group B received de-tuned laser therapy applied to the fixated areas. Subjective assessment was by means of the Short-Form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101. Objective assessment was by means of the digital algometer (The Commander\x99 Algometer by Jtech Medical Industries) and the Cervical Range of Motion Device. Both the subjective and objective readings were taken prior to the first treatment and a day following the final (sixth) treatment. / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this investigation was to determine the relative effect of the four-electrode as opposed to the pen-electrode interferential current method in the treatment of myofascial pain syndromes. This was a randomised clinical trial consisting of two groups. Group A received four-electrode interferential current therapy, while Group B received pen-electrode interferential current therapy. Each group consisted of 15 subjects, between the ages of 18 and 55 years, selected from the general population. Subjects diagnosed with active myofascial trigger points in any of the following muscles: trapezius, levator scapulae, supraspinatus, infraspinatus and rhomboid major and minor, were admitted into the study. Each subject received five treatments over a period of three weeks followed by a one-month follow-up consultation. Each subject was assessed by means of the CMCC Neck Disability Index, short-form McGill Pain Questionnaire and the Numerical Pain Questionnaire; as well as pain threshold readings by means of an algometer and cervical spine ranges of motion measurements by means of a cervical goniometer. Readings were taken at the first, fifth and follow-up consultations for all subjective and objective measurements. / M

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of Myofascial Adhesion Manipulation (grip and rip) in the treatment of Myofascial Pain Syndrome. The study was a prospective, unblinded, randomized, placebo-controlled, clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients diagnosed with active trigger points in either the Trapezius and/or the Levator Scapulae muscles were accepted into the study. The sample was divided into two groups of 30 patients each. One group received Myofascial Adhesion Manipulation, whilst the other group received placebo ultrasound. Each patient received four treatments over a maximum period of 3 weeks. Data was obtained from the patients at the first and second consultations, prior to treatments, and at the fourth consultation, immediately following the treatment. Subjective data was obtained with the Numerical Pain Rating Scale (NRS 101) and the Short-Form McGill Pain Questionnaire (S-FMPQ). Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale (MDS) / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the efficacy of dry needling latent myofascial trigger points, in the treatment of Myofascial Pain Syndrome. The study was a prospective, randomized placebo controlled study. Sixty patients, between the ages of 18-60, from the greater Durban area participated in the study. They underwent a case history, relevant physical examination and a cervical spine examination. The sixty subjects were randomly allocated into two groups of thirty. Group one received sham/ placebo needling while group two received dry needling, after being diagnosed systematically as suffering from latent myofascial trigger points of the trapezius and/or the levator scapulae muscle/muscles. Each patient received two treatments within a week with a one-week follow-up. Subjective and objective measures were taken at all three visits. Subjective data was obtained from the Numerical Pain Rating Scale 101 and objective data was obtained from the use of the algometer. This data was used to perform statistical analysis using parametric unpaired and paired t-tests to compare inter- and intra-group data respectively, at a 95% level of confidence. / M

It is believed by many researchers that little attention has been given to patients' perceptions of the impact of chronic pain on their lives. In recognition of this need, G. Frank Lawlis, C. Edward McCoy, and David K. Selby developed the Dallas Pain Questionnaire (DPQ) to assess the amount of chronic pain that affects four aspects (daily activities, work-leisure activities, anxiety-depression, and social interest) of the patients' lives. The present study, conducted to validate the DPQ's statistical properties, first reviews the literature addressing the various theories and varieties of pain, its opiates, and the two current approaches to quantify pain. This study included a total of 143 subjects. Clinical subjects were 104 inpatients in the Spinal and Chronic Pain Center at Medical Arts Hospital and 15 chronic pain outpatients released to work. Normal subjects consisted of staffing personnel (n = 13) and flight assistance employees (U = 11)- Both clinical and normal groups completed the DPQ. The Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the clinical population. Results suggest that the DPQ is both externally reliable (stability reliability coefficient of .970) as well as an internally consistent instrument. Two factors emerged from factor structure analysis. Factor one (63.2% of variance) represents functional activities. Factor two (8.3% of variance) represents emotional capacities. A correlation analysis suggests the concurrent validity of the psychological and functional factors of the DPQ. A t-test demonstrated that chronic pain patients have significantly higher DPQ's scores than normals. Because these findings support its psychometric properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. xii, 62, [18] leaves / The purpose of this study was to determine the comparative effectiveness of cryo-ischaemic compression, using the Cold Tennis-ball Technique, and ischaemic compression, using normal tennis balls, in the treatment of Myofascial Pain Syndrome The study was a randomised, controlled, comparative clinical trial. The samlpe population comprised of sixty patients between the ages of 18-35 years. Patients were screened according to the inclusion and exclusion criteria, were selected and randomly divided into two groups. One group, of thirty patients, received ischaemic compression using normal tennis balls, whilst the second group, of thirty patients, received ischaemic compression using the Cold Tennis-ball Technique. Patients received four treatments over a period of two weeks. Data was obtained from each patient prior to and immediately after each treatment. Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale. Subjective data was obtained from the Numerical Pain Rating Scale (NRS) and patients were required to give a sensory description of their pain at two-minute intervals during the course of the treatment. Statistical analysis of the data was performed using the SPSS version 11.5 and Stata version 9.0 software. Treatment effects for quantitative outcomes were analysed using repeated measures ANOVA. Profile plots were examined in order to assess in which direction the significance lay. Ordinal outcomes were examined for a treatment effect using ordinal logistic regression modelling. These models also examined a time by group interaction. Nonparametric Spearman’s correlation coefficients were used to examine intra-group relationships. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the immediate and short term effectiveness of dry needling the primary, active Biceps TrP on the pain experienced during shoulder flexion and abduction range of motion, as well as on an associated bicipital tendonitis and satellite TrP's. The study was a prospective, controlled, pilot study that included 30 patients from the greater Durban area. All patients were between the ages of 20 and 45 years and all were diagnosed with an active trigger point (TrP) in the Biceps muscle. Each patient was required to attend three visits on three consecutive days. The treatment intervention was dry needling of the active Biceps TrP. Subjective and objective data was obtained from the patients before and after the first consultation. At the second consultation, if the Biceps TrP was still present andactive, the subjective and objective data was obtained before and after the treatment again (Group lA). If, however, at this consultation, the TrP had resolved,no treatment intervention wasgivenand both types of data were obtained only once (Group lB). The third consultation was reserved for data collection only, no treatment intervention wasgiven to the patients. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute Of Technology, 2006. xviii, 134, 7 leaves. / Shoulder injuries, which account for 8% to 20% of volleyball injuries, are usually rotator cuff and / or biceps tendinosis caused by overuse (Briner et al.1999); in addition 38-75% of competitive swimmers have had a history of shoulder pain, while 9 - 35% of these swimmers were currently experiencing pain (McMaster and Troup, 1993). Rotator cuff tendinosis is also found in laborers involved in repeated overhead activities (i.e. among shipyard welders and steel plate workers), with a prevalence of 18, 3% and 16, 2% respectively (Herberts et al. 1984). Fricker and Hoy (1995), suggest that the principal cause of tendinosis of the rotator cuff muscles is repetitive microtrauma, due to overfatigued muscles and / or weakening of the rotator cuff and scapulothoracic muscles. The etiology of impingement syndrome is therefore multifactorial and is commonly associated with other clinical entities such as weak or dysfunctional scapular musculature, posterior glenohumeral capsule tightness, inflammation of tendons (viz. supraspinatus and long head of biceps), bursal inflammation and glenohumeral instability (Michener et al., 2003). Shoulder syndromes are often related to the development and perpetuation of myofascial trigger points (TrPs) as found by Hains (2002), who suggested that these TrPs become activated during mechanical stress and overload of the involved shoulder musculature. Hammer (1991), suggests that the most valuable modality to treat chronic overuse soft tissue syndromes (irrespective of muscular or tendinous in origin) is friction massage to both regions. Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. / M

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