Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Background: Myofascial pain is the most common cause of persistent regional pain such as back pain, shoulder pain, tension-type headaches and facial pain. A variety of therapeutic modalities are proposed in the treatment of myofascial pain including massage. A variety of massage oils are available on the market, each claiming therapeutic efficacy. Most of these claims, however, have not been verified through clinical trials. Methods: A double-blinded placebo controlled study in which 80 subjects were randomly divided into 4 groups of twenty. Subjects in Group 1 received unscented mineral oil, those in Group 2 received scented mineral oil. Subjects in Group 4 received Arnica Massage oil while those in Group 4 received Blue Steel Arnica Massage oil. Results and Conclusions: The use of Arnica Massage oil or Blue Steel Arnica Massage oil resulted in almost 50 % pain reduction in the subjects after five days of self-administered treatment. Both these products can be recommended for the treatment of myofascial pain syndromes but one cannot be placed in preference to the other, as the results were similar with regards to their effectiveness.

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.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xv, 81 leaves ; 30 cm / The purpose of this study was to investigate the association between active Myofascial Trigger Points in the dominant shoulder external rotator muscle group in overhead throwing athletes and an altered internal/external rotation peak torque and single repetition work ratio of the involved shoulder. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Myofascial pain syndrome is the second most common reason patients seek the help of health care workers. It costs billions of dollars each year in lost revenue due to loss of productivity and other costs. The treatment of myofascial pain syndrome has been extensively researched and it appears that dry needling and medicinal injections of trigger points are some of the most effective modalities. However, an unwanted side effect common to both these therapies is post-needling soreness. Despite being mentioned in passing by many authors, very little detail is available regarding post-needling soreness. It is unclear whether post-needling soreness arises from the trigger point itself, or whether the tissue damage caused by the needle insertion is responsible. Therefore, this study was aimed at investigating whether dry needling muscle tissue in asymptomatic subjects (i.e. subjects not suffering from myofascial pain syndrome) resulted in post-needling soreness. Two different dry needling techniques were also compared with a placebo group in order to determine which technique resulted in the least post-needling soreness. This study was designed as a prospective, randomised, placebo controlled experimental investigation. Sixty subjects were randomly allocated into three equal groups. Group one received the single needle insertion technique and the second group received the fanning dry needling technique. The last group formed the control group and the subjects were treated using the Park Sham Device (placebo needles). All the subjects were between the ages of 18 and 50 and were required to be asymptomatic in the low back region. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / According to Wood (1998), patellofemoral pain syndrome (PFPS) refers to a syndrome that comprises of the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof. Prevailing literature suggests that the presence of myofascial trigger points (MFTP’s) in quadriceps femoris (QF) muscle could result in a combination of the following signs and symptoms: - Retro- or peripatella pain, - Weakness of the quadriceps muscle (Chaitow and DeLany, 2002) - Loss of full lengthening (Travell and Simons, 1983:248-250) The aetiology of PFPS is poorly understood (Kannus et al. 1999). The current trend in literature suggests an extensor mechanism dysfunction as the most probable aetiology (Galantly et al., 1994; Juhn, 1999). There appears to be a clinical overlap between the two syndromes, in terms of an extensor mechanism dysfunction and of signs and symptoms. The aim of this investigation was to evaluate the role of active myofascial trigger points in the vastus lateralis (VL) muscle as perpetuating, causative or concomitant factors in the alteration of VL/VM Total Work (TW) in PFPS in distance runners.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, 2005. / To document the relationship between total work and myofascial trigger points in the vastus lateralis and vastus medialis portion of the quadriceps femoris muscle, whilst providing baseline graphs of these muscles with the use of a Cybex 700 Isokinetic Dynanometer in long distance runners both with and without patellofemoral pain syndrome. Methods: A quantitative, non-intervention clinical exploratory study. Fifty participants were divided into two groups, Group A (40 symptomatics) and Group B (10 asymptomatics). Both groups were screened for vastus lateralis and vastus medialis trigger points. Subjective data was obtained from Group A only, using the Numerical Pain Rating Scale and the Patient Specific Functional Scale. Objective data was obtained from both groups using the algometer, Myofascial Diagnostic Scale, and the Cybex 700 Isokinetic Dynanometer. For descriptive analysis frequency tabulations, box and whisker plots were used to display distributions graphically. Comparisons of categorical and quantitative variables between independent groups were run using chi square and Mann-Whitney testing consecutively. Finally Spearman’s correlation, multivariate generalized linear modelling and repeated measures ANOVA were also used. All statistical analysis was completed at the 95% (p<0.05) level of confidence. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / 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. / M

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