M.Tech. (Chiropractic) / There is research to show that ischaemic compression is very effective in the treatment of myofascial trigger points (MFTP’s). It is less invasive when compared to other treatment methods such as dry needling however; according to Gulick (2010) there is a lack of randomised controlled studies with regard to standard ischaemic compression treatment protocols. This includes the appropriate amount of pressure, duration of compression or frequency of treatment (Gulick, 2010). This study was conducted in order to determine whether ischaemic compression that is applied at pain threshold would have a similar effect when compared to ischaemic compression at pain tolerance in the treatment of active rhomboid major and minor myofascial trigger points, using a hand held algometer. This study was specifically undertaken to provide more information regarding the most effective method of ischaemic compression with regard to the amount of pressure that is most suitable during treatment. The results of this study could potentially improve patient comfort and reduce pain during treatment by showing that treatment at pain threshold may be as effective as conventional ischaemic compression at pain tolerance. It was hypothesized that ischaemic compression applied at pain threshold may have a similar effect as application at pain tolerance by having a positive outcome on the subjective and objective findings in patients with active myofascial trigger points of the rhomboid major and minor muscles. Participants were recruited into the study by word of mouth as well as with the use of advertisements that were placed around the University of Johannesburg Doornfontein campus and clinic. Thirty participants that conformed to the specified limitations and diagnostic criteria were accepted to partake in this study. The participants were then placed in a random and stratified manner into two groups of 15, based on age and gender. Group A received ischaemic compression of the rhomboid major and minor muscles at pain threshold while Group B received ischaemic compression of the same muscles at pain tolerance. Ischaemic compression was administered over a 30 second duration. Each participant received 2 treatments a week for 3 weeks while a 7th and final visit served only for measurement taking.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1998. / Myofascial syndrome is a very common condition which is frequently encountered at Chiropractic clinics. It is also a very complex condition and as such is a very frustrating one to treat effectively. Tens is resegnised as a clinically effective modality in the treatment of Myofascial syndrome, however guidelines with respect to the most effective electrode placements are lacking. / M

M.Tech.

Purpose: Trigger points may occur when muscle is subject to direct trauma, sustained tension, fatigue, radiculopathy, joint dysfunction and emotional stress, which may cause aberrant nerve conduction and dysfunction of the motor neurons. Any of these factors may increase the possibility of overload stress to a muscle and may convert a latent trigger point to an active one. In humans, due to muscle attachments, spinal manipulation causes reflex relaxation of associated and distal musculature. The purpose of this study was to assess the effects of upper cervical spine manipulation, specifically C1, on pain tolerance of trigger points over the erector spinae muscles in show-jumping horses. Method: This study consisted of two groups, the experimental and the control group, each consisting of ten horses. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. The only method of treatment that was administered to each horse was chiropractic manipulation to the most restricted side of the UPPER CERVICAL SPINE joint complex, from which the objective findings were based. Procedure: Both groups were examined for trigger points within the Erector Spinae muscles and these trigger points were assessed, via an algometer, for spot tenderness. All horses were then examined for a cervical restriction of the upper cervical spine. Only the experiment group had the restriction corrected by a chiropractic manipulation and thereafter both groups were reassessed two minutes later, and then again two weeks later, via an algometer, for spot tenderness within the same trigger points. Results: Statistically significant changes were found when comparing the algometer readings before the adjustment with the algometer readings after the adjustment on the right. Otherwise no statistically significant differences were found when comparing algometer readings before the adjustment with the algometer readings after the adjustment on the left, or when comparing the algometer readings before the adjustment with the algometer reading two weeks later bilaterally. Conclusion: The results were inconclusive with regards to immediate and prolonged effects of upper cervical spine manipulation, specifically C1, on pain tolerances over the erector spinae muscle. As this study was directed to a small group of subjects, accurate conclusions cannot be formulated due to the insignificant findings obtained from the study and further research needs to be performed on the effects of upper cervical spine manipulation on trigger points in horses. / Dr. Ashleigh Deall Dr. Alex Niven Dr. Chris Yelverton

M.Tech.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xviii, 140 leaves / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non – specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the non-specific effect in the healing encounter by manipulating the practice setting in which the patients were treated.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 144 leaves / Objective: The aim of this study was to investigate the relative effectiveness of TENS, versus, needling, versus Electro-needling in the treatment of MTSS. First objective The first objective was to evaluate the effectiveness of TENS therapy on MTSS with respect to the patients subjective and objective responses to the treatment. Second Objective The second objective was to evaluate the effectiveness of needling therapy on MTSS, with respect to the patient’s subjective and objective responses to the treatment. Third Objective The third objective was to evaluate the effects of electro-needling on MTSS, with respect to the patients’ subjective and objective responses to the treatment. Fourth Objective The fourth objective was to integrate the subjective and objective data collected in order to determine the viability of each of the therapies in comparison to one another as treatment options of MTSS.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 xvii, 148 leaves, Annexures A-L / Brunarski (1984) says that philosophically and historically, chiropractic has been uniquely orientated toward an emphasis on preventative care and health maintenance with a mechanistic and hands-on model for treatment. Instead of reductionism, chiropractors focus on holism, non-invasiveness and the sharing of the responsibilities for healing between doctor and patient. As stated in a Canadian report by Manga et al. (1993), lower back pain is a ubiquitous problem and there are many epidemiological and statistical studies documenting the high incidence and prevalence of lower back pain (Manga et al., 1993). Evans and Oldreive (2000) revealed in a study of the transversus abdominis that low back pain patients had reduced endurance of the transverses abdominis and that its protective ability was decreased. In addition, it was noted that wasting and inhibition of the other core stabiliser and co-contractor, multifidus, was present (Hides et al.,1994), both of which have been linked to the presence of low back pain (Evans and Oldreive, 2000 and Hides et al., 1994). Thus, it stands to reason that manipulation, as an effective treatment for low back pain (Di Fabio, 1992), could be effective in restoring the strength and endurance of the core stability muscles. This is theoretically supported by the fact that a restriction in motion and pain due to mechanical derangement in the low back can be effectively treated by manipulation (Sandoz, 1976; Korr (Leach, 1994); Herzog et al., 1999; Homewood, 1979; Vernon and Mrozek, 2005 and Wyke (Leach, 1994)). Homewood (1979) described that a subluxation may interfere with the nerve supply and result in a decrease in muscular activity. He hypothesized that removal of the subluxation could restore: normal physiological processes, increase muscle activity and; improve functional ability and normalize the torque ratios (Herzog et al., 1999; Korr (Leach, 1994); Nansel et al., 1993 and Rebechini-Zasadny et al., 1981). In terms of an intervention, Rebechini-Zasadny et al. (1981) and Naidoo (2002) demonstrated and inferred that manipulation to the cervical spine could affect the muscular activity supplied by those levels. They, however, suggested further studies of manipulation-induced peripheral changes in the muscles are needed, due to unaccounted for variables and small sample sizes in their respective studies This research aims to address the questions posed by the above literature, hence by investigating a high velocity low amplitude manipulation as a possible added intervention for improving local core stabilizer muscle strength, a management protocol for the chronic mechanical lower back pain could be developed.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 121 leaves / Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Through the literature review it has become apparent that low back pain is a very real problem in most societies. It has been suggested that there is enough evidence to prove the relationship between low back pain and local muscle dysfunction and that focus in management of these patients should be the rehabilitation of these muscles by exercise. Literature suggests that optimal core muscle strength, control and endurance working synergistically with the rest of the neuromusculoskeletal system is necessary for lumbar spine stability . Arthrogenic Muscle Inhibition is caused by distension and/or damage of a joint and is thought to disable the muscle from contracting all its muscle fibres. When a joint is injured it is thought that AMI causes muscle weakness, which in turn hampers the rehabilitation process of that joint despite complete muscle integrity. Spinal manipulative therapy has been shown to alter the excitability of spinal muscle motor neurons due to the stimulation of mechanoreceptors in the joint capsules suggesting that SMT could be a means to remove this inhibitory action. The literature supports the hypothesis that a decrease in the neurological deficit caused by AMI may result in a faster recovery rate. Aims The aim of this study is to determine the immediate effect of thoraco-lumbar spinal manipulation compared to lower lumbar spinal manipulation on core muscle endurance and activity in patients with mechanical low back pain by assessing the correlation between the objective and subjective measures. Method A prospective, convenience sample with purpose allocation (pre /post) clinical trial was used as the sampling method. Thirty participants where placed in two groups, group one and group two, of fifteen people each. Group one underwent spinal v manipulative therapy between L4 and S1 spinal levels. Group two underwent spinal manipulative therapy in between T8 and L1 spinal levels. The objective and subjective testing was done pre- and post-intervention. The objective data was that of a surface EMG attached bilaterally over the internal oblique as well as a prone abdominal draw in biofeedback test. The subjective data included a pain numerical rating scale (0-100). Results The results showed to partially favour group two (thoraco-lumbar), in both increased endurance time that would prove that AMI does in fact inhibit the transversus abdominis and obliques internus, thus it would hinder the rehabilitative process. Some of the statistics where not in favour of the aims, as there was no difference in the effect of group one or two on the NRS, as both improved consistently. It would be recommended that use be made of fine-wire EMG for testing the activity in both the obliques internus and the transversus abdominis, which would allow for more consistent readings, thus adding strength to the research.