Thesis (MAppSci in Physiotherapy) -- University of South Australia, 1994

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / The purpose of this study was to determine the efficacy of Therapeutic Faradic Stimulation in patients with Myofascial Pain Syndrome of theTrapezius and Levator Scapula musculature. This study was a quantitative pilot placebo controlled clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients between the ages of 30 and 50, who were office workers and were diagnosed with active trigger points in either the Trapezius and/or the Levator Scapula muscles were accepted into this study. The sample was divided into 3 groups of 20. One group received Faradic Stimulation in the form of the Transeva, another group received Placebo Transeva and the third group received Pulsed Ultrasound. Each patient received 2 research treatments with a maximum of 72 hours between treatment 1 and 2, and the third free Chiropractic treatment being a week later. Data (both subjective and objective) were obtained from the patients at the first and second consultations, prior to treatments and at the third follow up before treatment. Subjective data were obtained with the Short form McGill pain questionnaire, the Numerical Pain Rating Scale and the CMCC Neck Disability Index. Objective data were obtained from the Pressure Algometer and the CROM Cervical Range of Motion Instrument. Statistical Analysis of the data was conducted using the SPSS (version 9) software suite. This Statistical software program was manufactured by SPSS Inc, 444N. Michigan Avenue, Chicago, Illinois, USA. Various Descriptive and Inferential Statistical techniques were used. The Descriptive procedures used were various tables and graphs and a few summary statistics including but not limited to means, proportions and percentages. Inferential Statistics included iv various Hypothesis testing techniques. Due to the size of our samples, namely 20 in each group, non-parametric Statistical Tests were used. All the tests were set at type 1 error at 5%, or mentioned differently = 0.05. If our p value as reported was less than 0.05 we declared a significant result and our Null Hypothesis was rejected. Evaluation of the statistical analyses revealed significant improvements with regards to subjective and objective data for mostly the Attenuated Faradic Treatment (Transeva) group. Although significant Placebo and Ultrasound effects were obtained initially after the first treatment, the Transeva group showed more favourable results between consultations two and three, giving a good indication of the progression of the treatment regimen. Comparison between groups showed a significant difference with regards to CMCC Neck Disability Index scores, NPRS 101 questionnaires, CROM extension and right lateral flexion readings and Algometer readings. It was concluded that the Transeva is an effective form of treatment for the active trigger points of Myofascial Pain Syndrome of the Trapezius and Levator Scapula musculature in terms of both subjective and objective clinical findings. Suggestions were made to double-blind further studies as this will aid in reducing researcher bias toward a favoured treatment protocol. This study and observations made by the author with respect to Myofascial Transeva treatment are hoped to contribute to the limited literature available on this modality.

A dissertation submitted in partial compliance with the requirements for Master's Degree in Technology: Durban institute of Technologies, 2003. / The purpose of this study was to determine the relative effectiveness of TENS electrodryneedling as compared to single dry needle insertion in the treatment of Myofascial Pain Syndrome . This study was a prospective, unblinded, randomized, placebo-controlled clinical trial. A sample size of 60 patients from the Durban Metropolitan area was used. Only patients diagnosed with active trigger points in the Trapezius muscle were accepted into the study. The sample was divided into two groups of 30 patients each. Group A received single dry needle insertion and Group B received electrodryneedling. Each patient received two treatments over a period of one week. The short term effects of both treatments were noted. Data was obtained from the patients before and immediately after each consultation. Subjective data was obtained with the Numerical Pain Rating Scale (NRS 101) and the objective data was obtained from pressure threshold algometry. Statistical analysis of the data involved parametric testing. Intra-group comparisons were made using the paired t-test for NRS 101 and algometer scores. Inter-group comparisons were made using the unpaired t-test for NRS / M

Thesis (M App Sci in Physiotherapy) --University of South Australia, 1992

Thesis (MAppSc in Physiotherapy) -- University of South Australia

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 xv, 102 leaves / The purpose of this study was to determine the relative effectiveness of TENS electrodryneedling as compared to single dry needle insertion in the treatment of Myofascial Pain Syndrome.

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.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Therapeutic dry needling is an established modality for the treatment of myofascial pain, whereas limited research on Kinesiotape® exists. Kinesiotaping® is becoming popular, with the main benefit of being non-invasive and long wearing, thereby extending the treatment to the patient. This study aimed to determine the relative effectiveness of these two treatment modalities in patients with myofascial pain syndrome of the Trapezius muscle. Methods: The study design was a quantitative prospective randomised clinical trial. Fifty patients were equally and randomly allocated into either the dry needling or Kinesiotape® groups. Each patient received two treatments on separate visits to the upper trapezius muscle. Follow-ups were scheduled two to four days after the previous visit. Subjective measures were the Visual Analog Scale (VAS) and the Neck Disability Index (NDI), whilst objective measures were pain pressure threshold (PPT) and cervical range of motion (CROM). Results: Kinesiotape® demonstrated statistical significant treatments with the VAS (p < 0.001), NDI (p < 0.001) and PPT (p= 0.022) (95% CI). Dry needling showed statistical improvements in VAS (p= 0.001) and NDI (p < 0.001) only. Also, Kinesiotape® demonstrated a clinically significant improvement with the VAS when compared to the minimal clinically important differences (MCIDs). Trends of a superior treatment effect of Kinesiotape® over dry needling was observed in the VAS and PPT groups (p= 0.155; p= 0.428). Future studies could repeat the study with larger sample sizes to determine if these trends can be validated. Conclusion: This study demonstrated that Kinesiotape® was at least as effective as dry needling in the treatment of Myofascial Pain Syndrome. Therefore, Kinesiotaping® is a non-invasive alternative to dry needling. Kinesiotape® therapy resulted in a greater change in pain and disability scores than did dry-needling trigger point therapy, implying that Kinesiotape® may be a noninvasive alternative to dry needling.

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.

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...