Indiana University-Purdue University Indianapolis (IUPUI) / Ligament injury is one of the most prevalent musculoskeletal disorders that may lead to disability or disease, such as osteoarthritis. Conservative interventions which accelerate or augment ligament healing are needed to enhance therapeutic outcomes. The purpose of this research agenda was to investigate the tissue level effects of a type of manual therapy, cross fiber massage (CFM), in particular instrument-assisted CFM (IACFM), on ligament healing. Bilateral knee medial collateral ligament (MCL) injuries were created using an established rodent model where one MCL received IACFM treatment and the other untreated MCL served as a within subjects control. The short and long term effects of IACFM on the biomechanical and histological properties of repairing ligaments were investigated. Tensile mechanical testing was performed to determine ligament mechanical properties. Ligament histology was examined under light microscopy and scanning electron microscopy. IACFM was found to accelerate early ligament healing (4 weeks post-injury), possibly via favorable effects on collagen formation and organization, but minimal improvement was demonstrated in later healing (12 weeks post-injury). Regional blood flow and angiogenesis were investigated as possible mechanisms underlying the accelerated healing found in IACFM-treated ligaments. Laser Doppler perfusion imaging was used to investigate vascular function. Micro-computed tomography was used to determine vascular structural parameters. Compared to untreated contralateral injured controls, IACFM-treated injured knees demonstrated a delayed increase in blood flow and altered microvascular structure, possibly suggesting angiogenesis. Mechanotransduction is discussed as a mechanism for the beneficial effects of CFM in that application of a mechanical force was found to enhance biomechanical and histological properties as well as vascular function and structure acutely in healing ligaments. Although this thesis focused on IACFM treatment of injured knee ligaments, it is plausible for concepts to apply to other manual modalities that offer conservative alternatives to invasive procedures or pharmaceuticals in the treatment of soft tissue injuries.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / There are mechanical loads applied to the patella tendon in almost all sporting activities and as a result is commonly injured (Peterson and Renström, 2003:321). Patellar tendinopathy is a common chronic tendinopathy (Hamilton and Purdman, 2004) and occurs commonly in athletes who impose rapid eccentric loading of the knee extensor mechanism (Norris, 2004:246). Deep Transverse Friction Massage (DTFM) and soft tissue mobilization are the two most common forms of manual therapy used to treat patellar tendinopathy (Rees et al., 2006). DTFM is considered the most effective treatment for patellar tendinopathy (Brunker and Khan, 2002:487). It is theorised that DTFM causes the softening of scar tissue and the breakdown of adhesions, promoting the realignment of disrupted connective tissue fibrils within the affected tendon (Stasinopoulos and Johnson, 2007). Graston Instrument Assisted Soft Tissue Mobilization (GIASTM) consists of a set of stainless steel instruments (Carey 2003:2) and is an advanced form of soft tissue mobilization used in detecting and releasing scar tissue, adhesions and fascial restrictions (Carey, 2003:7). The controlled microtrauma created by these instruments is hypothesised to create a localised inflammatory response (Hammer, 2004) in a similar mechanism to that of DTFM. The aim of this study was to determine the relative effectiveness of GIASTM versus DTFM in treating patellar tendinopathy. The study included a total of twenty-six knees among twenty-one patients. Patients were placed randomly into either the GIASTM group or the DTFM group. Each patient received a total of twelve treatments over a three month period. Algometer and inclinometer readings were recorded at set intervals and compromised objective measures. Two questionnaires and a numerical pain rating scale (NRS) were administered at set intervals and compromised subjective measures. SPSS version 13.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data. Repeated measures ANOVA was used to examine changes in quantitative outcomes over the time points (intragroup analysis) and a treatment effect (intergroup analysis). To control for the partial pairing in the intergroup analysis, a variable which classified each subject as paired (both left and right knee used in study) or non-paired (only used once in study) was used as a factor in the model. Correlations between the intragroup changes in the various outcome variables were assessed using Pearson’s correlation coefficients. Statistical analysis of both objective and subjective data revealed significant improvements for most outcome measures in the study. Findings imply that GIASTM is as effective as DTFM in treating patellar tendinopathy.

The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques. / School of Physical Education