A dissertation proposal presented in partial fulfilment of the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / Lateral epicondylitis is a relatively common disorder affecting approximately one third of the nearly thirty-two million tennis players worldwide. It usually presents as a chronic disorder that follows a remitting relapsing course, and as such represents a challenge to manage. At present the scientific literature does not favour any particular treatment modality and as such well designed placebo studies are required to assess the efficacy of the various modalities of treatment, with a long term view of establishing an effective treatment protocol to manage lateral epicondylitis. The purpose of this study was to determine the efficacy of dry needling the posterior distal muscles of the upper extremity as a treatment for lateral epicondylitis. Sixty patients were included in the study. They all under went a case history, physical examination and an elbow regional examination. They were then randomly allocated into the experimental or control groups. The thirty patients in the experimental group received dry needling while the thirty included in the control group received placebo or 'sham' needling. All participants in the study received three treatments over a nine-day period with subjective and objective measurements being taken before the 1st. 2nd, and 3rd treatments, with a 4th being taken after the third treatment. Examination of the statistical data revealed that a significant improvement in the experimental group versus the control group in terms of both subjective / M

M.Tech. / Purpose: Lateral epicondylitis has been identified as one of the most common conditions affecting the upper limb. The exact pathophysiology of this condition is still under investigation; however it is believed to be an overuse injury which affects the common extensor tendon at the tenoperiosteal and/or the musculotendonous junctions. Despite the frequent occurrence of lateral epicondylitis and its considerable symptoms there is little scientific evidence to support the effectiveness of any treatment methods. As yet one treatment method has not been proved more effective than the other. The purpose of this comparative study was to determine whether manipulation combined with dry needling of the common extensor tendon and extensor muscle belly of the forearm, was more effective than cross friction of the common extensor tendon combined with manipulation with regards to a decrease in pain and an increase in pressure pain threshold. Method: This study consisted of 32 participants between the ages of 18 – 40. Possible participants were examined and accepted according to the inclusion and exclusion criteria. Once accepted the participants were assigned into two groups each consisting of equal amounts of males and females. The first group received manipulation of their elbow combined with dry needling of their common extensor tendon and extensor muscle belly of their forearm. The second group also received manipulation of their elbow but this was combined with cross friction of their common extensor tendon. Procedure: Each participant received six treatment sessions and one follow up session. Objective data and subjective data was taken at the beginning of the first, fourth and seventh session. Objective data consisted of algometer readings that were taken on the common extensor tendon, the lateral epicondyle of the humerus and the extensor muscle belly. The subjective data collected was in the form of the Numerical Pain Rating Scale and the short form of the McGill Pain Questionnaire. The manipulation of the elbow was then administered based on the restrictions identified during motion palpation. This was followed by either dry needling of the common extensor tendon and the extensor muscle belly of the forearm or cross v friction of the common extensor tendon. The information collected was analysed by means of Friedman and Wilcoxon Signed Rank tests.Results: Statistically significant improvements in all measurements were noted over the course of the treatments for all participants in both groups. However there was no statistically significant difference between the improvements of the dry needling group compared to that of the cross friction group. Conclusion: The results illustrate the effectiveness of the individual treatments over the treatment period. However it is still inconclusive whether one treatment method is more effective than the other. As this study was directed to a small group of participants, accurate conclusions could not be formulated to prove the effectiveness of one treatment method over that of another. Due to the insignificant findings obtained in this study, further studies need to be performed to determine which method of treatment is most effective when treating lateral epicondylitis.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Lateral epicondylalgia (L.E) is a common diagnosis in elbow pathology. The aetiology is poorly understood but it is generally accepted to be as a result of repetitive microtrauma, affecting the proximal end of the extensor carpi radialis brevis tendon. Elbow bracing and exercise modification are often utilised by sufferers in order to reduce symptoms. In addition, there have been multiple treatment regimes used in practice to treat L.E, but none has stood out as being more effective than another. Thus, the aim of this study was to investigate the relative clinical effectiveness of therapeutic exercises alone and in combination with orthotic bracing, in terms of subjective and objective clinical findings. Methods This stratified, quantitative, prospective clinical trial consisted of two equal groups (n=15) diagnosed with L.E. Group One consisted of a strengthening and stretching programme alone, and Group Two consisted of a combination of the same programme and an orthotic brace. The participants performed the programme daily at home for six weeks, and the brace was worn throughout the day for six weeks. Each participant was assessed before, during and after the programme, in terms of subjective and objective clinical data which was then statistically analysed using SPSS version 18. Repeated measures ANOVA testing was also used to compare the outcomes between the groups over the time points. Results Both groups showed significant statistical improvement in terms of all the outcome measures. The groups also showed a clinically significant improvement for all the outcome measures except pressure pain threshold where Group Two showed clinically significant improvement over Group One. v Conclusion The results show that there was negligible benefit when combining an orthotic brace with therapeutic exercises as opposed to performing the therapeutic exercises alone.