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

M.Tech. / Problem Statement: Myofascial Pain Syndrome (MPS) is a painful and prevalent muscular condition that is characterized by the development of myofascial trigger points (TrP’s). These are locally tender when active and are able to refer pain through specific patterns to other areas of the body distal from the trigger point (Manga, 2008). Myofascial trigger points are a frequently overlooked and misunderstood source of the distressingly ever-present musculoskeletal aches and pains of mankind and many authors have found that the trapezius muscle is most often the muscle that has frequent myofascial trigger points (Travell and Simons, 1999). Much debate and discussion has arisen on the merits of the fanning dry needling technique compared to that of the static dry needling technique, but research evidence is very limited. Some practitioners prefer the static technique over the fanning technique as it reduces the presence and amount of post-needling soreness, as well as reduces the possibility of penetrating a blood vessel resulting in hemorrhaging. Other practitioners prefer the fanning technique as it increases the chances of locating the loci of the TrP, as well as increasing the chances of eliciting a local twitch response and possibly making this method more effective in deactivating a TrP than the static technique. Aim of Study: The aim of this study was to compare the effects of static myofascial dry needling to the effects of fanning myofascial dry needling of an active trigger point (TrP1) in the upper trapezius muscle in order to determine which of the two treatments is more effective with regards to decreasing neck pain and disability as well as increasing pressure pain threshold in patients with neck pain due to Trapezius Myofascial Pain Syndrome. Method: Forty participants underwent a general screening to determine whether they had active myofascial trigger points in the upper fibers of the trapezius muscle.

M.Tech. (Chiropractic) / Myofascial pain syndrome has become a significant cause of chronic pain and disability in today‟s society. Conditions causing chronic pain can not only cause disability due to pain, but can also lead to other problems such as psychological and behavioural disturbances. Physical deconditioning can also occur due to lack of exercise because of myofascial pain (Rachlin, 1994). The aim of this study was to compare dry needling therapy and ultrasound therapy in the treatment of myofascial trigger points in order to demonstrate any superiority between the two modalities. Participants for this study were recruited by word of mouth and advertisements that were placed around the University of Johannesburg Doornfontein Campus. Thirty people participated in the trial, all of whom conformed to the specific inclusion and exclusion criteria. The participants were randomly placed into two groups. Group A received dry needling therapy, namely the fanning technique, and Group B received ultrasound therapy. Participants in Group A received one treatment per week for four weeks and subjective and objective measurements were taken at each visit. Participants in Group B received two treatments per week for three weeks and measurements were taken at visits one, three, five and seven. Subjective data was obtained through the use of the Visual Analogue Pain Scale, which measured the perception of pain of the participants. Objective data was obtained from pressure algometer readings, which measured pain pressure thresholds of participants, and through the Cervical Range Of Motion (CROM) device. The results of this study indicated that dry needling therapy and ultrasound therapy both significantly benefited participants in terms of the treatment of active myofascial trigger points. Based on the final results, both dry needling therapy and ultrasound therapy are equally effective modalities in the treatment of active myofascial trigger points, with neither modality showing superiority over the other.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Dry needling (DN) fanning technique is an effective treatment for myofascial trigger points (MTP), however, it causes swelling and intramuscular haemorrhage which results in post-needling soreness (PNS). Kinesio ® taping space-correction-technique (KTSCT) is claimed to aid in reducing pain by decreasing inflammation, increasing circulation and lymphatic drainage. This in theory indicates that Kinesio ® taping could reduce/alleviate PNS pain after DN. Objective: The purpose of this study was to determine the effectiveness of KTSCT utilizing Kinesio ® Tex Gold tape in reducing the level of PNS associated with DN a trapezius muscle trigger point two. Method: Forty five patients with active trapezius muscle MTP two were randomly allocated into one of three treatment groups. All groups received a standardized DN treatment. Thereafter, group one received no further treatment and acted as the control group, group two received an application of KTSCT utilizing Kinesio ® Tex Gold tape, while group three received a non-proprioceptive hypoallergenic tape application. Assessments were made pre-, post-treatment and at a follow-up consultation on the following day once the taping application was removed. Assessments included numerical pain rating scale-101 (NRS-101), a pain diary and algometer readings. Results: Group three showed an improvement over the control group, however, it was not a statistically significant improvement in any of the assessments. Group two showed statistically significant improvement over the control in the pain diary and algometer readings overall. Results from the NRS-101, showed that group two had a statistically significant improvement when compared to the control group over the time interval when the Kinesio ® Tex Gold tape was applied to the patient. Conclusion: KTSCT utilizing Kinesio ® Tex Gold tape had a greater effect in reducing the level of PNS associated with DN a trapezius muscle trigger point two, when compared with either a non-proprioceptive hypoallergenic tape application or a control group.

Dissertation completed in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background:Myofascial Pain Syndrome is characterized by localized muscle pain, in which affected muscles are in a chronically-shortened state and contain trigger points.It is the single most common source of musculoskeletal pain that is encountered in clinical practice. Modalities such as electrotherapy, cryotherapy, thermal therapy, dry-needling and ultrasound are used in its management. The use of phonophoresis has generated much interest; and literature around this modality continues to accumulate. Numerous studies have demonstrated the efficacy of phonophoresis with an anti-inflammatory in the treatment of musculoskeletal disorders, attributing the efficacy to the penetration of the coupling medium by means of the ultrasonic waves. Traumeel®S, is a homeopathic anti-inflammatory, that has successfully been used in the treatment of musculoskeletal injuries.It has anti-oedematous, anti-exudative, anti-inflammatory and analgesic properties. Its efficacy as a coupling agent in phonophoresis has not been tested for myofascial pain syndrome. Methodology:This study was designed as a prospective, double-blinded, randomized, and controlled experimental investigation. Sixty subjects were randomly allocated to three groups of 20 subjects each. Group Areceived active phonophoresis with Traumeel® S gel;Group B received sham phonophoresis with Traumeel® S gel; Group C received an application of Traumeel® S gel only.Algometer and Numerical Pain Rating Scale 101 (NRS) readings were taken immediately before treatment at visit one and thereafter at visits three and four. Results:Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS and algometer readings. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. It was noted that there was a higher rate of improvement in Group A over time; however, this difference was not statistically significant. Conclusion:The results from this study revealed that all three treatment groups responded favorably to the alleviation of pain. It was concluded that phonophoresis with Traumeel® gel had no significant additional beneficial effects.

Completed in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Background: Dry needling is known to be effective and efficient in the treatment of myofascial pain syndrome; pragmatically however, patients utilise Flurbiprofen LAT patches as home therapy anticipating similar results. This may not be true and thus, this study aimed to investigate the effectiveness of dry needling versus Flurbiprofen LAT patches in the treatment of myofascial pain syndrome of the upper Trapezius muscle. Methods: This ethics approved, prospective, randomized, single blinded (blinded assessor), comparative clinical trial required sixty participants, randomly (randomisation table) allocated to two groups. After the completion of informed consent participants received treatment over three consultations with a follow up a week later. Baseline and repeated outcome measures included Numerical Pain Rating Scale, Neck Disability Index Questionnaire, Myofascial Diagnostic Scale, Algometer and Cervical Range of Motion device. The data was analysed using ANOVA tests with the p-value set at 0.05. Results: Baseline demographics and outcome measures showed that only age was significantly different between the groups. This difference was controlled for in the statistical analysis. Dry needling resulted in better treatment outcomes than the Flurbiprofen LAT patches in terms of function (cervical range of motion) (right lateral flexion p=0.043) and Myofascial Diagnostic Scale scores (p<0.001), whereas the Algometer measures and remaining cervical ranges of motion improved significantly over time in both groups, but not between the groups. Tthe Flurbiprofen LAT patches fared better in terms of the subjective reporting (Numerical Pain Rating Scale), this was not significant. Conclusion: The interventions were both effective over time, however, the needle group achieved improved functional ability and the Flurbiprofen LAT patches improved the pain outcomes with limited functional ability. Therefore the use of these modalities requires clinical judgement to appropriately administer the treatment option that the patient would best benefit from.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Aim: This study aimed to compare the effectiveness of the Impulse iQ® Adjusting Instrument and ischaemic compression on trigger points in pain relief and quality of life in adults presenting with non-specific neck pain. Methodology: This study was a randomised single-blinded clinical trial which consisted of 40 participants residing in the eThekwini municipality, divided into two groups of 20 each. The participants were randomly assigned using concealed allocation to one of two treatment groups of 20 viz. Impulse iQ® Adjusting Instrument (IAI) trigger point therapy group and ischaemic compression (IC) group. Neck pain level was determined using a numerical pain rating scale (NRS). Degree of lateral flexion (LF) was determined by a cervical range of motion (CROM) goniometer. Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of neck pain on participants’ activities of daily living was assessed using the Canadian Memorial Chiropractic College (CMCC) Neck Disability Index (NDI). The participants’ overall perception of improvement since the initiation of treatment was assessed using the Patients Global Impression of Change (PGIC). The participants received three treatments over a two and half week period with the fourth consultation being used for the final subjective and objective measurements. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS, algometer readings and CROM goniometer measurements. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. It was noted that there was a higher rate of improvement in IAI Group with respect to algometer readings over time; however, this difference was not statistically significant. Conclusion: This study concluded that neither IAI nor IC is more effective than the other with respect to participants’ pain perception and CROM. However, the IAI was more effective on pain pressure threshold. Based on the results collected from this study, both therapies can used in the treatment protocols of neck pain associated with MFTPs. / M

Submitted in partial compliance with the requirements for the Doctoral Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Introduction: Myofascial pain syndrome is a condition of collective sensory, motor and autonomic symptoms caused by myofascial trigger points, which are hyper-irritable foci in a muscle and palpated as a taut, tender, ropey band. There are many types of treatment for myofascial pain syndrome; dry needling is one of the most effective forms. Dry needling involves the insertion of a needle into the myofascial trigger points in order to break up the contractile elements and any somatic components that may contribute to trigger point hyperactivity, and to stimulate sensitive nerve ending in the area. Although therapeutic, an unpleasant side effect of dry needling is the post-needling soreness. Various modalities have been utilised to decrease post-needling soreness, such as ice, heat and action potential simulation, to mention a few, however no study has been conducted to date that documents low intensity laser therapy and its effect on post-needling soreness. This study therefore aimed to evaluate the effect of low intensity laser therapy on post-needling soreness in trigger point 2 of the upper trapezius muscle. Methodology: This study was designed as a randomised, controlled pre-test and post-test experimental trial. Forty participants were randomly allocated into two equal groups of 20 participants each. Group 1 received the needling and laser therapy; Group 2 received needling and placebo laser. Algometer and Numerical Pain Rating Scale 11 (NRS 11) readings were taken immediately before the dry needling procedure; after the laser or placebo laser therapy; and again, at the follow-up visit 24 hours later. Subjects used a 24- hour pain diary which was completed at three-hour intervals, to record any post-needling soreness. The NRS 11 scale was used immediately before the needling and again at the follow-up visit 24 hours later. Results: Statistical analysis was done using SPSS version 24.0 to conduct inferential and deductive statistics. A significance of p=0.05 was set. Baseline demographics and outcome measurements were compared between the two groups using t-tests or ANOVA where appropriate. An inter-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 low intensity laser therapy is not a useful intervention. Conclusion: The results from this study revealed that both treatment groups responded equally in the alleviation of pain. It can thus be concluded that low intensity laser therapy had no significant beneficial effects on post-needling soreness. / M

M.Tech. / Purpose: The purpose of this study is to investigate whether needling active trigger points in the upper fibres of the trapezius muscle, using myofascial deep dry needling versus superficial dry needling is effective in the treatment of Trapezius Myofascial Pain Syndrome. Method: Forty participants underwent a general screening to determine whether they have active myofascial trigger points in the upper fibres of the Trapezius muscle. The general screening was done by using a pincer grip technique to find the active trigger point within the trapezius. If the pincer grip revealed that there were active trigger points, the participant was suitable for this study. Each filled in a neck disability index and a pain rating scale, with algometer readings taken Pre and Post-treatment on visit 1 to visit 4. Algometer readings were taken at the active trigger point Pre and Post-treatment (subjective data). Each participant received either myofascial deep dry needling or superficial dry needling to the active trigger point. After the two week trial, the participants had to fill out a neck disability index and a pain rating scale for a second time in order to objectively measure the participants pain. Results: The results were interpreted by Statkon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, both groups improved significantly in both the objective and subjective measurements over the four visits. Overall, the mean values for both the myofascial deep dry needling group and the superficial dry needling group were P = 0.001. The superficial dry needling group showed a further increase over a short term period in the objective and subjective measurements over each visit. Conclusion: Based on the results of this study, it can be concluded that both myofascial deep dry needling and superficial dry needling is effective and can be used in the treatment of Trapezius Myofascial Pain Syndrome. This study further indicated that superficial dry needling was shown to be a significantly effective treatment short term when compared to that of myofascial deep dry needling of active trigger points in the upper fibres of the Trapezius muscle