The thesis is divided into theoretical and practical part. The theoretical part contains information about anatomy of the trapezius muscle and its myofascial pathology. Author further discusses trigger points, their histopathology and diagnostic and therapeutic capabilities. A significant section of the theoretical part explains the physical principle of ultrasound therapy and laser phototherapy, including clinical aspects and their use in the treatment of trigger points. The practical part is focused on comparing the efficacy and relative effectiveness of two methods of physical therapy - ultrasound therapy and laser phototherapy, where myofascial trigger points treatment effect can be expected. Research group is made up of 47 patients divided into two groups. These patients have a doctor confirmed trigger point in the upper portion of trapezius muscle. The first group of patients is treated by exactly parametrically defined ultrasound therapy. The second group of patients is treated by specifically defined laser phototherapy. The aim of this thesis is to compare the above mentioned physical procedures in terms of subjective and objective efficacy in the treatment of trigger points and also to compare their relative effectiveness.

<p>Det förekommer hållningsmönster som kan leda till problem från nacke och axlar. Ett hållningsmönster med hög muskelaktivitet i övre trapezius (ÖT) är ofta förknippat med nack- och skuldersmärta. Därför var det relevant att göra en experimentell hållningskorrigeringsstudie för att studera eventuella förändringar i muskelaktiviteten i ÖT. Syftet med studien var att undersöka om en korrigering av axlarnas position har betydelse för muskelaktiviteten i ÖT när armarna hålls i tre olika positioner framför kroppen, samt beskriva muskelaktiviteten i dessa positioner. Tio personer med hopsjunken hållning och nack- eller axelproblem deltog i studien. Muskelaktiviteten i ÖT mättes med elektromyografi i tre olika positioner före och efter en korrigeringsintervention. En signifikant minskning (<em>p</em><0,05) av muskelaktiviteten i ÖT registrerades för respektive position efter hållningskorrigeringen. Det fanns individuella skillnader i muskelaktiviteten i ÖT hos försökspersonerna och korrigeringseffekten för muskelaktiviteten i ÖT varierade beroende på position. Resultatet pekar på att hållningskorrigering är procentuellt sett effektivare i en armposition med låg muskelaktivitet än i en position med hög muskelaktivitet. Däremot ger en korrigering i en position med hög muskelaktivitet större reell minskning av muskelaktiviteten än i en position med låg muskelaktivitet. Vidare kunde ses att vissa individer kan vara mer mottagliga för hållningskorrigeringen än andra.</p>

Work related musculoskeletal disorders are the dominating causes of reported ill-health in industrialized countries. These chronic pain conditions are one of the most costly public health problems in Europe and North America. When work related musculoskeletal disorders are considered to be of muscular origin and the trapezius muscle is affected, the common appellation is trapezius myalgia. Since little is known about the genesis or how it is maintained, it is of great importance to better understand the pathophysiology of trapezius myalgia; doing so will better enable recommendations for prevention, treatment and rehabilitation. Several hypotheses have been presented based on biochemical alterations in the muscle, suggesting increased signaling of inflammatory substances and altered metabolism. Previous research has not been able to present the comprehensive picture of the muscle in pain. Thus there is a demand for more comprehensive research regarding the biochemical milleu of the chronic trapezius muscle. Proteomic and metabolomic methods allow non-targeted simultaneous analyses of a large number of proteins and metabolites. The main emphasis in this thesis is on a proteomic method, two-dimensional differential gel electrophoresis (2D-DIGE). The method is validated to human skeletal muscle biopsy research with laboratory specific settings. In the baseline study, there were 14 metabolic, contractile, structural and regulatory proteins that differed significantly in abundance when trapezius and vastus lateralis muscles were compared. Using the validated 2D-DIGE method and the baseline study, a comparison between healthy and myalgic muscles was made. Biopsies from female cleaners with and without myalgia were compared to obtain results from women with the same type of work exposure. In the multivariate model, 28 identified unique proteins separated healthy and myalgic muscle and were grouped according to function: metabolic (n=10), contractile (n=9), regulatory (n=3), structural (n=4), and other (n=2). Finally, a second screening method, metabolomics, was introduced to analyze differences in metabolite content as a complement to and verification of the proteomic results. Gas chromatography-mass spectrometry (GC-MS) was performed on muscle interstitial fluid samples obtained with microdialysis, and differences in the abundance of extracellular metabolites were revealed.  The 2D-DIGE method is a reliable method to analyze human skeletal muscle. The outcomes of the proteomic analyses were dependant on the statistical approach. Systematic differences in protein and metabolite content were detected using a multivariate approach. Univariate analyses were used to analyze individual proteins for their significance. The significant proteins in the baseline study were predominately related to muscle fiber type which correlated with the differences in fiber type content between trapezius and vastus lateralis. The proteomic and metabolomics studies where myalgic and healthy muscles were compared provide us with new clues and new aspects regarding the pathophysiology of the myalgic muscle. Technically advanced methods employed in the thesis enabled an explorative screening of proteins of relevance for the pathophysiology of the myalgic muscle. The results of these analyses may contribute to the formulation of future hypothesis that need to be further evaluated.

Neck-shoulder pain (NSP) is a highly prevalent musculoskeletal disorder with unclear causes, and effective prevention and treatment require a further understanding of the underlying mechanisms. Aberrant autonomic nervous system (ANS) regulation is a hypothesized causal element in the development and maintenance of chronic muscle pain. The overall aim of this thesis was to investigate possible differences in ANS regulation between chronic NSP and healthy control (CON) groups using both laboratory assessment and ambulatory monitoring in daily life. Four papers are included in this thesis, based on data from three groups with chronic NSP. Autonomic responses to laboratory stressors were assessed using heart rate variability (HRV), blood pressure, trapezius muscle activity and blood flow measurements (Study І) in NSP and CON. Long-term ambulatory monitoring of HRV, physical activity and perceived symptoms were assessed in Studies ІІ and IV to investigate group differences in real-life conditions. Finally, the effects of a ten-week intervention (using individually adjusted HRV biofeedback) to reinstating ANS balance in subjects with chronic NSP were evaluated using self-reported symptoms and health ratings, as well as autonomic regulation testing (i.e., evaluating HRV at rest and in response to stress) (Study ІІІ). The main findings from the four studies demonstrated aberrant ANS regulation in the NSP group compared to CON, which was predominantly characterized by diminished parasympathetic cardiac activity during rest and sleep, and altered sympathetic reactivity to laboratory stressors (Studies І, ІІ and IV). Different patterns in physical activity were observed between the NSP and CON groups, with reduced physical activity during leisure time in the NSP group (Studies ІІ and IV). Physical activity was found to be positively associated with HRV. Positive effects of HRV-biofeedback were found on perceived health, including social function, vitality and bodily pain, and improved HRV (Study ІІІ). In conclusion, imbalanced ANS regulation was demonstrated among persons with chronic NSP at both the systemic and local levels. Diminished parasympathetic activity in NSP was modulated by lower levels of physical activity in leisure time. Interventions targeting ANS functions might benefit persons with chronic NSP.

Det förekommer hållningsmönster som kan leda till problem från nacke och axlar. Ett hållningsmönster med hög muskelaktivitet i övre trapezius (ÖT) är ofta förknippat med nack- och skuldersmärta. Därför var det relevant att göra en experimentell hållningskorrigeringsstudie för att studera eventuella förändringar i muskelaktiviteten i ÖT. Syftet med studien var att undersöka om en korrigering av axlarnas position har betydelse för muskelaktiviteten i ÖT när armarna hålls i tre olika positioner framför kroppen, samt beskriva muskelaktiviteten i dessa positioner. Tio personer med hopsjunken hållning och nack- eller axelproblem deltog i studien. Muskelaktiviteten i ÖT mättes med elektromyografi i tre olika positioner före och efter en korrigeringsintervention. En signifikant minskning (p&lt;0,05) av muskelaktiviteten i ÖT registrerades för respektive position efter hållningskorrigeringen. Det fanns individuella skillnader i muskelaktiviteten i ÖT hos försökspersonerna och korrigeringseffekten för muskelaktiviteten i ÖT varierade beroende på position. Resultatet pekar på att hållningskorrigering är procentuellt sett effektivare i en armposition med låg muskelaktivitet än i en position med hög muskelaktivitet. Däremot ger en korrigering i en position med hög muskelaktivitet större reell minskning av muskelaktiviteten än i en position med låg muskelaktivitet. Vidare kunde ses att vissa individer kan vara mer mottagliga för hållningskorrigeringen än andra.

Dissertation submitted to the faculty of health in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, at the Durban University of Technology, 2008 / Introduction: Myofascial Pain Syndrome (MPS) is a painful and prevalent muscular condition. It is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active and which can refer pain through specific patterns to other areas of the body distal from the trigger point. There exist many types of treatments for MPS of which dry needling is one of the most effective forms. However, a very common side-effect experienced is postneedling soreness, which when compared to trigger point injections are more painful, with respect to both intensity and duration. Studies have shown that the exact cause of post-needling soreness has not been clearly documented. Action Potential Simulation (APS) Therapy operates using a direct electric current (DC) on muscles. It stimulates action potentials that are stronger than the natural nerve impulses. It operates on a similar principle to the gate control theory of Melzack and Wall (1988) which results in the inhibition of nociceptive signals. Stimulation by the APS unit creates a normal action potential that restores the inherent biochemical processes in the region. This low to medium frequency current (below 150 Hz) has been reported to alleviate pain, decrease inflammation, enhance blood circulation and aid in wound and bone fracture healing. Methodology: This study was designed as a prospective, randomised, controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups of 20 subjects each. Group One received the fanning dry needling technique; Group Two received a combination of fanning dry needling plus APS Therapy. Group Three was the control group in which the subjects were treated with fanning dry needling with „Sham‟ APS Therapy. Algometer and Numerical Pain Rating Scale 101 (NRS 101) readings were taken immediately before and after the dry needling procedure and again at the follow-up visit 24 hours later. Subjects used a 24-hour pain diary and the NRS 101 scale which was filled out at 3 hour intervals, to record any post-needling soreness. Results: An intra-group analysis revealed that, objectively and subjectively, all groups experienced some degree of post-needling soreness, which deceased significantly over time. This decrease of pain was not significantly related to the treatment group, and there is no evidence of the differential time effect with the treatment. An inter-group analysis yielded no statistically significant results regarding the effectiveness of the treatments received by the patients. This could be because of the small sample size or because „„Sham‟‟ APS is not a useful intervention. Conclusion: The results from this study revealed that all three treatment groups responded equally in the alleviation of pain. However, the dry-needling treatment group alone (Group One) revealed a much more significant decrease in pain compared to the other two. It can thus be concluded that APS Therapy had no significant beneficial effects on post-needling soreness.

The role rehabilitation plays in the management of patients with lateral epicondylalgia (LE) remains elusive secondary to high recurrence rates. Addressing scapular muscle deficits may be important in the rehabilitation of patients with LE. However, it is unknown if scapular muscle impairments exist in a working population of patients with LE. The purpose of this dissertation was to assess scapular muscle strength and endurance in a working population of patients with LE. Clinical scapular muscle assessment tools are limited in their ability to isolate specific muscles. Rehabilitative ultrasound imaging (RUSI) is a potentially useful tool but few studies have investigated its utility. Absolute muscle thickness measurements were obtained on healthy individuals for the lower trapezius (LT) and serratus anterior (SA) under three conditions (arm at rest, arm elevated with a low load, arm elevated with a high load). For both the LT and SA, a significant distinction could be made in muscle thickness between rest and a loaded condition but not between the two load conditions. Furthermore, excellent reliability was demonstrated for both muscles. It is unknown whether arm dominance plays a role in scapular muscle assessments. Therefore, healthy individuals between the ages of 30 and 65 were recruited to compare the effect of arm dominance on scapular muscle strength, endurance, and change in thickness measured by RUSI. Results indicate that arm dominance does significantly affect some measures of scapular muscle strength and endurance. However, the differences between the dominant and non-dominant limbs were not beyond measurement error. Scapular muscle strength, endurance, and change in muscle thickness of the LT and SA were assessed in 28 patients presenting with signs and symptoms consistent with LE. LT strength, SA strength, middle trapezius strength, endurance, and change in SA thickness were significantly less in patients with LE compared to matched controls. SA and LT strength were significantly less in the involved limb compared to the uninvolved limb in patients with LE. The results suggest that assessing scapular muscle endurance as well as LT and SA strength is indicated when evaluating patients with LE, and the results should be compared to normative data.

M.Tech. (Chiropractic) / Myofascial trigger points are very common and can become a painful part of most people’s life at one time or another. According to Travell and Simons (1999), active upper trapezius myofascial trigger points are common in patients presenting with neck pain. Myofascial pain syndrome is a regional muscle disorder that is one of the most common causes of persistent pain in the head, face and neck regions (Rachlin, 2002). The PAIN®GONE pen is a device that produces a high voltage, low frequency pulse for only a brief period of time. The electrical stimulation activates endorphins in the hypothalamus which plays a role in pain relief (Puskas, 2004). The technical system of the device is clinically proven and uses Transcutaneous Electric Nerve Stimulation (TENS), based on the pain gate control theory of Melzack and Wall (1965). The purpose of this study was to determine the efficacy of treating active upper trapezius trigger points with PAIN®GONE therapy combined with cervical spine chiropractic adjustments.This study consisted of two groups, the PAIN®GONE therapy group (Group 1) with fifteen participants and the placebo PAIN®GONE therapy group (Group 2) with fifteen participants. The participants were between the ages of 18 and 40 years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a case history, physical examination, cervical regional examination and upper trapezius muscle palpation to assess for upper trapezius myofascial trigger points. Treatment was applied to the cervical spine by Chiropractic adjustments, and to the upper active trapezius myofascial trigger points via PAIN®GONE therapy or placebo PAIN®GONE therapy, from which the subjective and objective data were based.Each participant was treated six times over a period of three weeks. Prior to the initiation of treatment, each participant was requested to complete a Vernon-Mior Neck Pain and Disability Index questionnaire and Numerical Pain Rating Scale. Algometer readings were obtained for the active upper trapezius myofascial trigger points. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion in flexion, extension, lateral flexion androtation. Both groups, received treatment to the active upper trapezius trigger points and Chiropractic adjustments to the cervical spine for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th and 7th final consultation...

M.Tech. / This study was conducted to investigate the efficacy of Chiropractic cervicothoracic spinal adjustment therapy in the treatment of active Trapezius myofascial trigger point dysfunction. Thirty participants were recruited and placed into one of two groups. Participants were between the ages of 18 and 30 years and selected based on the inclusion criteria being met. Participants had to present with active upper Trapezius trigger points and a restriction of the cervicothoracic junction. The experimental group received a Chiropractic adjustment to the cervicothoracic junction and the control group received detuned ultrasound as their respective treatments. The participants were treated six times over a 3-week period and measurements were taken on the first, fourth and seventh visits. A case history, physical examination and cervical regional examination were conducted at the first visit. Objective measurements included pressure algometry readings of Trapezius trigger points 1 and 2 and cervical spine goniometry readings. Subjective measurements included the Vernon Mior Pain Disability Index and the Numerical Pain Rating Scale. The results were interpreted by Statcon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, the experimental group improved significantly in both the objective and subjective measurements over the seven visits. The control group showed an increase in the objective measurements and a decrease in the subjective measurements over the seven visits. This was found to be statistically insignificant. This study concluded that a Chiropractic adjustment to the cervicothoracic junction is effective in the treatment of upper Trapezius trigger points

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to determine the relative effectiveness of a home programme of ischaemie compression, sustained stretch and a combination of the two, in terms of subjective and objective clinical findings for the treatment of Myofascial Pain Syndrome. / M