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.

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

O objetivo do estudo foi investigar o efeito da adição de exercícios de controle motor da escápula a um programa de exercícios de fortalecimento convencional em desfechos clínicos, força muscular e amplitude de movimento em pacientes com síndrome do impacto subacromial. Métodos: Sessenta pacientes com SIS foram alocados aleatoriamente em dois grupos distintos: fortalecimento ou exercícios focalizados na escápula de controle motor. As intervenções foram realizadas três vezes por semana durante oito semanas. Função, dor, cinesiofobia, efeito percebido global, satisfação com o tratamento, força muscular, amplitude de movimento e posição da escápula foram medidos antes da intervenção (baseline), 4 semanas após o início, no final da intervenção (8 semanas após o início) e 16 semanas após a linha de base. A dor e a função do ombro foram avaliadas pela versão brasileira do Índice de Dor e Incapacidade no Ombro (SPADI-Br). Um avaliador cego para a atribuição de grupo mediu todos os resultados. Não houve diferenças entre os grupos nos desfechos primário e secundário. Em conclusão, a adição de exercícios de controle motor ao fortalecimento muscular forneceu pouco valor agregado para melhora da função e da dor em pacientes com SIS / The objective of the study was investigate the effect of adding scapula motor control exercises to a program of conventional strengthening exercises in clinical outcomes, muscle strength and range of motion in patients with subacromial impingement syndrome. Methods: Sixty patients with SIS were randomly allocated in two different groups: strengthening or motor control scapula-focused exercises. The interventions were performed three times a week for eight weeks. Function, pain, kinesiophobia, global perceived effect, satisfaction with treatment, muscle strength, range of motion and scapula position were measured before intervention (baseline), 4 weeks after baseline, at the end of intervention (8 weeks after baseline) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of Shoulder Pain and Disability Index (SPADI-Br). An assessor blinded to group assignment measured all outcomes. There were no between-group differences in primary and secondary outcomes. In conclusion, the addition of motor control exercises to strengthening treatment provides little-added value regarding improving function or pain in patients with SIS.

Os mecanismos antecipatórios durante as tarefas de alcance são de extrema importância para o equilíbrio corporal e para facilitação da execução do movimento. Há evidências na literatura que a dor crônica é capaz de influenciar na organização funcional do córtex e alterar os ajustes posturais antecipatórios, mas, até o presente conhecimento, não existe nenhum estudo que investigou estes mecanismos posturais em indivíduos com dor crônica no ombro. Por este motivo, o objetivo principal do presente estudo foi analisar os ajustes posturais antecipatórios em uma tarefa de alcance funcional em indivíduos com dor no ombro comparados a indivíduos sem dor. Participaram do estudo 20 sujeitos, sendo 9 no grupo com dor e 11 no grupo sem dor. Dados de eletromiografia dos músculos de tronco e membro inferior direito e dados de plataforma de força foram coletados durante uma tarefa de alcance funcional realizada em diferentes velocidades (rápida e normal) e alturas (menor que 90°, igual a 90° e maior que 90°). O grupo com dor apresentou menor amplitude e velocidade de deslocamento do centro de pressão, atraso no recrutamento antecipatório do músculo tibial anterior, alteração da sinergia muscular de membro inferior e tronco, atraso no tempo de resposta, maior tempo de execução do movimento e menor variabilidade do movimento. Não houve correlação entre a intensidade da dor e as alterações de comportamento motor. Os resultados mostram que indivíduos com dor no ombro apresentam falha no ajuste postural antecipatório durante uma tarefa de alcance funcional quando comparados com indivíduos sem dor / Anticipatory mechanisms during reaching tasks are extremely important for body balance and for facilitating movement execution. There is evidence in the literature that chronic pain can influence the functional organization of the cortex and alterate the anticipatory postural adjustments, but to the present knowledge, there is no study investigating of these postural mechanisms in individuals with chronic shoulder pain. For this reason, the main objective of this study is to analyze the anticipatory postural adjustments in a task of functional reach in individuals with shoulder pain compared to individuals without pain. Twenty people participated in the study, 9 in the pain group and 11 in the painless group. Electromyography data of the right trunk and lower limb muscles and force platform data were collected during a functional range task performed at different velocities (fast and normal) and heights (less than 90°, equal to 90° and greater than 90°). The pain group showed lower amplitude and pressure center displacement velocity, delayed anticipatory recruitment of the anterior tibial muscle, altered lower limb and trunk muscle synergism, delayed response time, longer execution time and less movement variability. There was no correlation between pain intensity and changes in motor behavior. The results show that individuals with shoulder pain present failure in anticipatory postural adjustment during a task of functional range when compared to individuals without pain

O objetivo do estudo foi investigar o efeito da adição de exercícios de controle motor da escápula a um programa de exercícios de fortalecimento convencional em desfechos clínicos, força muscular e amplitude de movimento em pacientes com síndrome do impacto subacromial. Métodos: Sessenta pacientes com SIS foram alocados aleatoriamente em dois grupos distintos: fortalecimento ou exercícios focalizados na escápula de controle motor. As intervenções foram realizadas três vezes por semana durante oito semanas. Função, dor, cinesiofobia, efeito percebido global, satisfação com o tratamento, força muscular, amplitude de movimento e posição da escápula foram medidos antes da intervenção (baseline), 4 semanas após o início, no final da intervenção (8 semanas após o início) e 16 semanas após a linha de base. A dor e a função do ombro foram avaliadas pela versão brasileira do Índice de Dor e Incapacidade no Ombro (SPADI-Br). Um avaliador cego para a atribuição de grupo mediu todos os resultados. Não houve diferenças entre os grupos nos desfechos primário e secundário. Em conclusão, a adição de exercícios de controle motor ao fortalecimento muscular forneceu pouco valor agregado para melhora da função e da dor em pacientes com SIS / The objective of the study was investigate the effect of adding scapula motor control exercises to a program of conventional strengthening exercises in clinical outcomes, muscle strength and range of motion in patients with subacromial impingement syndrome. Methods: Sixty patients with SIS were randomly allocated in two different groups: strengthening or motor control scapula-focused exercises. The interventions were performed three times a week for eight weeks. Function, pain, kinesiophobia, global perceived effect, satisfaction with treatment, muscle strength, range of motion and scapula position were measured before intervention (baseline), 4 weeks after baseline, at the end of intervention (8 weeks after baseline) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of Shoulder Pain and Disability Index (SPADI-Br). An assessor blinded to group assignment measured all outcomes. There were no between-group differences in primary and secondary outcomes. In conclusion, the addition of motor control exercises to strengthening treatment provides little-added value regarding improving function or pain in patients with SIS.

The supraspinatus tendon is an important structure of the rotator cuff. Subacromial impingement is a common reason for shoulder pain. Despite extensive scientific work in this field, the cause of impingement syndrome is still not fully understood. The general aim of the present thesis was to generate new knowledge with respect to pathogenesis and treatment of impingement syndrome. A combination of animal and clinical studies were performed. Different methods were used such as histology, immunohistochemistry, development and assessment of a novel measuring device and clinical and radiological assessment. Thirty rats were injected with triamcinolone or saline into the subacromial bursa. After five corticosteroid injections, we found focal inflammation, degradation and fragmentation of collagen bundles in the supraspinatus tendon, whereas the control specimens were normal (p=0.035). Subacromial bursitis was induced by injections of carrageenan into the subacromial space (n=28). Fibrocartilaginous metaplasia and bony metaplasia were found in the supraspinatus tendon. Even in specimens with no histologic changes of the collagen bundles the staining for fibronectin was significantly increased. The distance between the anterolateral acromion and the supraspinatus tendon was measured in patients with impingement syndrome intraoperatively (n=30) and in controls (instability, n=15). The mean value of the subacromial distance in controls was 16 mm, the 95% mean confidence limits between 14 and 18 mm. The mean value in the group of patients with impingement syndrome was 8 mm before and 16 mm after the decompression. Fifty patients were reviewed after arthroscopic subacromial decompression. Twenty-five showed calcific deposits in the rotator cuff on radiographs preoperatively. In 13 patients the calcific deposits totally disappeared postoperatively. In another six patients the calcifications had decreased in size. Four patients still showed calcifications, which were 5 mm or greater in size. The postoperative results measured by the Constant score were almost identical in the calcific and the non-calcific groups. Tillander 010916 8 Human surgical supraspinatus tendon specimens were studied from patients with impingement (n=16), ruptured supraspinatus tendons (n=7) and controls (n=10). Degradation of tendinous tissue and fibrin were found only in some specimens from ruptures. The difference in fibronectin staining was significant between controls and patients with a rupture (p=0.002). Fibrosis and thinning of fascicles seemed to be a more non-specific finding, appearing in control, impingement and rupture specimens. In conclusion, subacromial corticosteroid injections may cause rupture of the supraspinatus tendon. Metaplasia of the supraspinatus tendon may play a role in the pathogenesis of impingement and rupture of the supraspinatus tendon. The subacromial distance can be measured intraoperatively and was shown to be lower in patients with impingement than in patients with instability. Calcifications disappear or decrease in size after arthroscopic subacromial decompression and do not seem to influence the postoperative outcome in patients with impingement. Degradation of tendon tissue, fibrin and fibronectin appear to be signs of tendon degeneration, whereas fibrosis and thinning of fascicles were found also in controls.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic,Durban Institute of Technology, 2005 xxi, 132, 34 leaves ; ill. ; 30 cm / To assess and quantify the number, severity and specific location of myofascial trigger points within the shoulder rotator muscle group. To assess the internal/external ratio of the dominant shoulder in throwing athletes using a Cybex 700 dynamometer, after intervention and to establish a comparable clinical profile of the participants.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban Institute of Technology, 2008. / Purpose Cricket fast bowlers are prone to the development of Myofascial pain syndrome and in particular active myofascial trigger points in their rotator cuff muscles of the shoulder joint (Scott, et al. 2001). This is due to the severe stresses placed upon the muscles, bones and joints of the shoulder as a result of the high velocity throwing action (Bartlett, et al.1996). In muscles containing active myofascial trigger points a decrease in the stretch range of motion as well as the maximal contractile force is noted, these two factors may negatively affect the speed at which a fast bowler deliver the ball (Travell, Simons and Simons, 1999). Dry needling is viewed as the most effective means of deactivating myofascial trigger points leading to in increase in both the contractile force and range of motion of the affected muscle, which could increase the speed at which the bowler delivers the ball (Wilks, 2003). The aim of the study was to determine the immediate effect of dry needling active myofascial trigger points of the rotator cuff on bowling speed in action cricket fast bowlers. Method The study consisted of 40 participants (randomly split into two equal groups of 20) each with shoulder pain of a myofascial origin. Group A (intervention group) received the dry needling intervention in their most tender active myofascial trigger point. While participants in Group B (control group) received no treatment. Bowling speeds were measured both before and after the intervention, to determine its effect on bowling speed. IV Data was entered into MS Exel spreadsheet and imported into SPSS version 15 (SPSS Inc.,Chicago, Iiiinois, USA), which was used for data analysis. Paticipants were evaluated on bowling speed, Algometer readings and Numerical pain rating Scale (NRS) both pre and post intervention. Participants were also asked if they believed the intervention increased, decreased or had no effect on their bowling speeds. Two sample t-test was used to compare baseline values between the groups. A repeated measure ANOVA was used to compare the rate of change of each outcome over time in the two groups. Pearson’s correlation analysis (intra-group) was used to assess the strength and magnitude of correlations of the changes in the outcomes. The McNemar – Bowker test and Weighted Cohen’s kappa statistics were calculated to assess agreement between perceived and actual levels of change. Results A significant treatment effect was observed in the intervention group were an increase in bowling speed, algometer readings as well a decrease in Numerical pain rating scale(NRS) scores was observed. There was also a perceived increase in the speed the participants delivered the ball in the intervention group. No significant changes were observed in the control group. The findings of this study indicate that dry needling as a treatment modality would be beneficial to fast bowlers in not only increasing their speeds but also the pain experienced as a result of active myofascial trigger points.