A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Myofascial release (MFR) allows clinicians to directly stretch and palpate soft tissue restrictions, improving tissue elasticity, and maximizing range of motion. Research has focused on MFR following repetitive motion strain (RMS), however there is no known application of prophylactic MFR. Utilizing in vitro strain models we will investigate the role of prophylactic MFR in regulating fibroblast wound healing. We hypothesize that MFR treatments will have greater efficacy when used prior to the repetitive motion strain, increasing the rate of wound healing. Human fibroblasts were seeded onto 6-well collagen-I bioflex plates, strained with the Flexcell vacuum compression system. Sub-confluent cell constructs were wounded using sterile 1ml pipette tips to create an area devoid of cells. Spatial wound edge changes were monitored to determine closure rate at 0, 12, 24, 36 and 48 hours. Pooled data for 36 hours demonstrated that RMS closed 32% faster than the combined RMS+MFR and 30.5% faster than the non-strain control, p<0.05. This meant the data did not support the hypothesis, but prophylactic stretching has been shown to prevent and reduce injury in 5 other models. Prophylactic MFR requires additional studies to expand our model to include multiple dosed treatments with a stronger emphasis on prevention vs. healing.

Background: Massage can promote healing and recovery following exercise. (Carefelli et al. 1992). Barnes (1990) proposed that myofascial release helps to break up fibrotic fascial adhesions that may restrict joint range of motion (ROM). Self-myofascial release (SMR) is a type of massage that uses a roller and an individuals body weight to produce massage like loading over a specific anatomical area. Viscoelastic properties of muscle tissue extensibility increase during an acute bout (15 minutes) of massage-like loading (Haas et al 2012). Self-massage on the calves reduced pain and edema of the calves on nurses after an 8.5-hour work shift (Oh and Yoon 2008). Increasing blood flow through skeletal muscle will lead to increased oxygen delivery, which can increase healing and return to homeostasis post-exercise. Different shapes and densities of SMR rollers may produce different outcomes (Johansson 1962, Curran et al. 2012). Hypothesis: TP Footballer will have a greater effect on popliteal artery blood flow volume and ankle ROM vs. the SPRI® foam roller. Methods: N = 21 subjects (10 male 11 female; 18-27). No current lower extremity injury (within one year). No exercise 48 hours prior to data collection. Exercise was defined as any rigorous physical activity lasting 30 minutes or longer. Subjects rested prone 20 minutes. Resting BF and AD measurements were taken with an 8-13 MHz probe via Sonosite Micromaxx Doppler Ultrasound. Ankle ROM taken with a goniometer (mean of 3x). Statistics: Two-way repeated measure ANOVA and Bonferroni test was used to compare pre-test and post-test measures across both treatment conditions with two types of rollers. The α level was set at 0.05. Results: No significant increases found using the SPRI® foam roller on variables of BF Volume, TAP and ROM in plantar flexion. Significant increases found with arterial diameter. Significant increases using the TP Therapy Products Footballer® on variables of: ROM in plantar flexion, blood flow volume, arterial diameter Conclusion: SPRI® foam roller and TP Footballer® significantly increased popliteal arterial diameter. The TP Therapy Products Footballer® increased blood flow volume immediately following TP Therapy Soleus Protocol. TP Therapy Products Footballer® increased ankle plantar flexion immediately following TP Therapy Soleus Protocol. / text

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006. xviii, 134, 7 leaves. / Shoulder injuries, which account for 8% to 20% of volleyball injuries, are usually rotator cuff and / or biceps tendinosis caused by overuse (Briner et al.1999); in addition 38-75% of competitive swimmers have had a history of shoulder pain, while 9 - 35% of these swimmers were currently experiencing pain (McMaster and Troup, 1993). Rotator cuff tendinosis is also found in laborers involved in repeated overhead activities (i.e. among shipyard welders and steel plate workers), with a prevalence of 18, 3% and 16, 2% respectively (Herberts et al. 1984). Fricker and Hoy (1995), suggest that the principal cause of tendinosis of the rotator cuff muscles is repetitive microtrauma, due to overfatigued muscles and / or weakening of the rotator cuff and scapulothoracic muscles. The etiology of impingement syndrome is therefore multifactorial and is commonly associated with other clinical entities such as weak or dysfunctional scapular musculature, posterior glenohumeral capsule tightness, inflammation of tendons (viz. supraspinatus and long head of biceps), bursal inflammation and glenohumeral instability (Michener et al., 2003). Shoulder syndromes are often related to the development and perpetuation of myofascial trigger points (TrPs) as found by Hains (2002), who suggested that these TrPs become activated during mechanical stress and overload of the involved shoulder musculature. Hammer (1991), suggests that the most valuable modality to treat chronic overuse soft tissue syndromes (irrespective of muscular or tendinous in origin) is friction massage to both regions. Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic,Technikon Natal, 1999. / Pain arising from myofascial trigger points is common and is often so disabling that the need for fast effective treatment is urgent. Of the many documented treatments for trigger points, there is little evidence to support one treatment over another. It is thus the purpose of this study to determine the relative effectiveness of stretch and ice to stretch and spray in the treatment of myofascial trigger points found in the upper trapezius muscle. This comparative clinical study involved the participation of thirty patients presenting with myofascial trigger points of the upper trapezius muscle. By means of consecutive sampling, patients complaining of neck pain, and/or headaches, and/or shoulder pain or a combination thereof, and who were between the ages of sixteen and sixty-five, underwent a screening processes to determine if they had active myofascial trigger points in the upper trapezius. Those that were eligible for the study were randomly assigned to either the stretch and ice group or the stretch and spray group. The subjective primary data consisted of three pain questionnaires, namely the Short Form McGill Pain Questionnaire, CMCC Neck Disability Index, and Numerical Rating Scale-101. The objective data was supplied by readings taken from an algometer. The patients underwent three consultations in the first week, two consultations in the second week and a final consultation one-month after the fifth treatment. All the primary data was collected at four occasions. These were at the first, third, fifth and one month follow-up consultations. Intra-group analysis using the Wilcoxon Sign-Rank Test determined if each group improved significantly with respect to the data collected. The Mann-Whitney U test was used to determine which group was statistically better than the other. The results, including the standard deviation, standard error, mean and power / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Graston Technique Instrument-assisted Soft Tissue Mobilization (GTISTM), is a relatively new form of myofascial pain syndrome (MPS) treatment, that is thought to be an advanced form of soft tissue mobilization. The stainless steel instruments that are used are specifically designed for various parts of the body and are used to detect and release scar tissue, adhesions and fascial restrictions (Carey-Loghmani, 2003:7). It is speculated that the Graston Technique instruments may be superior to other instruments due to the uniqueness of the instrument design, instrument material (stainless steel), delivery method and technique process. The instruments have been designed to adapt to the various curves of the body allowing the clinician to detect and treat soft tissue dysfunctions in an accurate and specific manner (Carey-Loghmani, 2003;2). Other soft tissue therapeutic techniques make use of specifically designed aluminium instruments have shown to be successful in the treatment of tendonitis (Davidson et aI., 1997).Thus it was the aim of this study to determine if there was a significant clinical difference between the Graston Technique instruments and instruments of the exact design but of a constitutionally different material (i.e. aluminium). This was achieved by varying the instrument material, while maintaining all the other features of the instrument, as well as the treatment protocol in the management of myofascial trigger points (MTrPs) of the trapezius and the levator scapula muscles. III This pilot study was a comparative clinical trial conducted on a quasiexperimental basis, aimed at establishing the influence of component materials of the Graston Technique instruments in the treatment of MPS in terms of clinical outcomes. The sample size consisted of sixty patients selected from the Durban Metropolitan Area. Patients between the ages of 18 and 55 and diagnosed / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this investigation was to determine the relative effect of the four-electrode as opposed to the pen-electrode interferential current method in the treatment of myofascial pain syndromes. This was a randomised clinical trial consisting of two groups. Group A received four-electrode interferential current therapy, while Group B received pen-electrode interferential current therapy. Each group consisted of 15 subjects, between the ages of 18 and 55 years, selected from the general population. Subjects diagnosed with active myofascial trigger points in any of the following muscles: trapezius, levator scapulae, supraspinatus, infraspinatus and rhomboid major and minor, were admitted into the study. Each subject received five treatments over a period of three weeks followed by a one-month follow-up consultation. Each subject was assessed by means of the CMCC Neck Disability Index, short-form McGill Pain Questionnaire and the Numerical Pain Questionnaire; as well as pain threshold readings by means of an algometer and cervical spine ranges of motion measurements by means of a cervical goniometer. Readings were taken at the first, fifth and follow-up consultations for all subjective and objective measurements. / M

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of Myofascial Adhesion Manipulation (grip and rip) in the treatment of Myofascial Pain Syndrome. The study was a prospective, unblinded, randomized, placebo-controlled, clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients diagnosed with active trigger points in either the Trapezius and/or the Levator Scapulae muscles were accepted into the study. The sample was divided into two groups of 30 patients each. One group received Myofascial Adhesion Manipulation, whilst the other group received placebo ultrasound. Each patient received four treatments over a maximum period of 3 weeks. Data was obtained from the patients at the first and second consultations, prior to treatments, and at the fourth consultation, immediately following the treatment. Subjective data was obtained with the Numerical Pain Rating Scale (NRS 101) and the Short-Form McGill Pain Questionnaire (S-FMPQ). Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale (MDS) / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the efficacy of dry needling latent myofascial trigger points, in the treatment of Myofascial Pain Syndrome. The study was a prospective, randomized placebo controlled study. Sixty patients, between the ages of 18-60, from the greater Durban area participated in the study. They underwent a case history, relevant physical examination and a cervical spine examination. The sixty subjects were randomly allocated into two groups of thirty. Group one received sham/ placebo needling while group two received dry needling, after being diagnosed systematically as suffering from latent myofascial trigger points of the trapezius and/or the levator scapulae muscle/muscles. Each patient received two treatments within a week with a one-week follow-up. Subjective and objective measures were taken at all three visits. Subjective data was obtained from the Numerical Pain Rating Scale 101 and objective data was obtained from the use of the algometer. This data was used to perform statistical analysis using parametric unpaired and paired t-tests to compare inter- and intra-group data respectively, at a 95% level of confidence. / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. xii, 62, [18] leaves / The purpose of this study was to determine the comparative effectiveness of cryo-ischaemic compression, using the Cold Tennis-ball Technique, and ischaemic compression, using normal tennis balls, in the treatment of Myofascial Pain Syndrome The study was a randomised, controlled, comparative clinical trial. The samlpe population comprised of sixty patients between the ages of 18-35 years. Patients were screened according to the inclusion and exclusion criteria, were selected and randomly divided into two groups. One group, of thirty patients, received ischaemic compression using normal tennis balls, whilst the second group, of thirty patients, received ischaemic compression using the Cold Tennis-ball Technique. Patients received four treatments over a period of two weeks. Data was obtained from each patient prior to and immediately after each treatment. Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale. Subjective data was obtained from the Numerical Pain Rating Scale (NRS) and patients were required to give a sensory description of their pain at two-minute intervals during the course of the treatment. Statistical analysis of the data was performed using the SPSS version 11.5 and Stata version 9.0 software. Treatment effects for quantitative outcomes were analysed using repeated measures ANOVA. Profile plots were examined in order to assess in which direction the significance lay. Ordinal outcomes were examined for a treatment effect using ordinal logistic regression modelling. These models also examined a time by group interaction. Nonparametric Spearman’s correlation coefficients were used to examine intra-group relationships. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the immediate and short term effectiveness of dry needling the primary, active Biceps TrP on the pain experienced during shoulder flexion and abduction range of motion, as well as on an associated bicipital tendonitis and satellite TrP's. The study was a prospective, controlled, pilot study that included 30 patients from the greater Durban area. All patients were between the ages of 20 and 45 years and all were diagnosed with an active trigger point (TrP) in the Biceps muscle. Each patient was required to attend three visits on three consecutive days. The treatment intervention was dry needling of the active Biceps TrP. Subjective and objective data was obtained from the patients before and after the first consultation. At the second consultation, if the Biceps TrP was still present andactive, the subjective and objective data was obtained before and after the treatment again (Group lA). If, however, at this consultation, the TrP had resolved,no treatment intervention wasgivenand both types of data were obtained only once (Group lB). The third consultation was reserved for data collection only, no treatment intervention wasgiven to the patients. / M