A dissertation submitted in partial compliance with the Master's Diploma in Technology: Chiropractic at Technikon Natal, 1995. / The aim of this study was to determine whether the use of Interferential Current provided a non-invasive alternative to Dry Needling Agitation in the treatment of Myofascial Pain and Dysfunction Syndrome. A randomised Experimental Method of Single- Variable design was undertaken using the before-and-after-withcontrol design. / M

M.Tech. / The aim of this study was to compare the effectiveness of two different treatment methods for myofascial pain and dysfunction syndrome of the Gluteus Medius muscle. This was done in order to determine whether or not a combined treatment of the integrated neuromuscular inhibition technique (INIT) and sacroiliac joint (SIJ) adjustive therapy was more effective than the INIT applied in isolation, in the treatment of the Gluteus Medius myofascial pain and dysfunction syndrome (GMMPDS). Participants were recruited using advertisement posters placed throughout the University of Johannesburg Doornfontein Campus and were treated at the University of Johannesburg Chiropractic Day Clinic. Thirty participants, between the ages of eighteen and fifty years, who were suffering from lower back pain and presented with Gluteus Medius myofascial trigger points (TrPs) and an SIJ dysfunction were selected for the study. They were randomly assigned into one of two groups, consisting of fifteen subjects each, as they entered into the study. Group one received the INIT to the affected Gluteus Medius muscle. Group two received a combination of the INIT to the affected Gluteus Medius muscle and an SIJ adjustment. Patients attended four sessions over a period of eight days and were treated on all of these sessions. Subjective and objective data were recorded on all sessions. Subjective data was recorded using the McGill Pain Questionnaire and the Numerical Pain Rating Scale. Objective data was recorded using the Universal Goniometer, to measure hip ranges of motion of the affected Gluteus Medius muscle, and the Wagner Pressure Algometer to measure pain-pressure threshold of the affected Gluteus Medius muscle TrPs. All of the data were statistically analyzed using Repeated Measures and Independent t-Tests. P-values were calculated to determine the statistical significance of the data. The results of the study indicate that both treatment methods are effective in treating GMMPDS, however a combined treatment approach of INIT and SIJ adjustive therapy was more effective in achieving a greater therapeutic response compared to INIT alone.

M.Tech. (Chiropractic) / Purpose: The aim of this comparative study was to compare the effects of Muscle Energy Technique (MET) versus myofascial dry needling of quadratus lumborum in the treatment of myofascial trigger points (TrPs), with regards to pain, disability and lumbar spine range of motion. Method: Thirty participants, male and female between the ages of eighteen and forty-five years, with an active quadratus lumborum TrP were used in this study. The thirty participants were randomly divided into two groups consisting of fifteen individuals each, ensuring equal male to female and age ratios. Group 1 received treatment in the form of MET. Group 2 received treatment in the form of myofascial dry needling. The trial consisted of five visits over a treatment period of two weeks, of which the first four visits the participants received treatment and the fifth visit served the purpose of obtaining the final data. The data was gathered on the first, third and fifth visits. The data was gathered before the treatment was performed. Objective data consisted of measuring lumbar spine range of motion with a digital inclinometer and pain pressure threshold using an algometer. Subjective data was obtained by using the Numerical Pain Rating Scale (NPRS) and Oswestry Disablity Index for Lower Back Pain (ODI). Results: The results were interpreted by STATKON at the University of Johannesburg. Both groups improved significantly in both the objective and subjective measurements over the two week trial period. This indicted that both treatment interventions were effective in the treatment of active quadratus lumborum TrPs. The results also indicated that group 2 (myofascial dry needling) was statistically superior to group 1 (MET) with regards to the subjective and lumbar spine range of motion measurements obtained during the study. There was no statistical superiority between the two treatment interventions with regards to the pain pressure threshold values obtained. These results indicate that dry needling is more effective than MET in decreasing pain and disability, while increasing lumbar spine range motion due to active quadratus lumborum TrPs. Conclusion: It was concluded, based on the results, that myofascial dry needling was more effective than MET with regards to the subjective pain, disability and lumbar spine range of motion. However with regards to pain pressure threshold values, there was no superiority of either treatment. This study suggests that myofascial dry needling is a preferential treatment option than MET in the case of active quadratus lumborum TrPs as it is possible that dry needling alone is more effective in reducing pain, disability and increasing lumbar spine range of motion. However this does not rule out MET as treatment for active TrPs as objectively MET reduces objective pain as effectively as dry needling.

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

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points (MTrP). It is recognised by unique features which include a tender point in a taut band of muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the reproduction of the patient’s usual pain upon examination. A debate exists as to the precise diagnostic criteria used in identifying trigger points. This has hampered the standardized assessment and treatment of Myofascial Pain Syndrome and has led to contradictory findings being reported by various authors due to the lack of a reliable diagnostic tool. Objectives: The first objective was to determine the inter-examiner reliability of palpation of MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine whether training and standardization in palpation techniques would improve inter-examiner reliability of palpation of MTrPs. Methods: This study was designed as a quantitative pre and post intervention interexaminer reliability study. Three examiners (one qualified Chiropractor, one senior chiropractic intern from the CDC and the researcher) were used to examine sixty patients (thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two phases. During the myofascial examination of patients examiners were required to determine whether a MTrP was present or absent, differentiate whether the MTrP was active or latent and determine the presence or absence of the five characteristics of MTrP (tender point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase one the researchers were blinded to the characteristics being investigated. Subsequent to phase one, examiners had to attend two, one hour discussion sessions to reduce individual variation in the application of palpation techniques. Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage agreement and confidence intervals. The results show that three examiners are able to attain acceptable agreement in the palpation of MTrPs, since the features (described above) were shown to improve considerably in phase two after the training session in which standardization of techniques was emphasized. Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial Pain Syndrome.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / BACKGROUND: Temporomandibular disorders (TMDs) affect up to fifteen percent of adults. It produces craniofacial pain of musculoskeletal structures within the head and neck. One particular cause of TMDs is said to be myofascial pain syndrome (MFPS), which according to various research papers, if not considered and/or assessed, the general cause of a patient’s pain could be disregarded and incorrect treatment offered. Numerous studies conducted internationally on dental management of temporomandibular joint disorder (TMJD) concluded that there is a significant gap in dentists’ education and training regarding the identification and management of MFPS. Upon reviewing the current literature available in South Africa, very little research existed on dentists’ knowledge and the management strategies that they utilised regarding MFPS in TMJD patients. OBJECTIVES: To determine the dentists’ knowledge regarding MFPS of the temporomandibular joint (TMJ). What assessment and treatment/management strategies they use, and whether they make use of referral networks and if the respondents’ demographics influence their knowledge, utilisation, perception and referral patterns. METHODOLOGY: The researcher developed a research questionnaire, which was validated by both an expert and a pilot study group. This questionnaire was then used as a research tool in this cross-sectional study. General dental practitioners from the Greater eThekwini Region received an invitation to participate. The questionnaire-based survey consisted of five sections: biographical profile of respondents; topic background; perception; knowledge; utilisation and management (including referral patterns) of MFPS. RESULTS: The majority of respondents did receive basic education in MFPS, with 76.9% reporting that they received undergraduate education and 57.7% indicating that they had attended post-graduate courses/talks on MFPS. There was a 100% response from dentists indicating their willingness to attend post-graduate courses/talks on MFPS. The results indicated that the respondents, who felt that their curriculum regarding MFPS was sufficient, were more knowledgeable and more competent in diagnosing and managing MFPS. Overall, the average score for knowledge was 65.17%. Clinical features (78.85%) and the perpetuating and relieving factors (72.11%) scored the highest while causes (58.06%) and differential diagnoses (51.16%) scored the lowest knowledge levels. Respondents mostly made use of allopathic medical fields, and not of alternative medical fields, however a high number of respondents (73.1%) indicated that they would consider chiropractic co–management of patients with MFPS. CONCLUSION: This study adds new information in the South African context regarding dentists’ understanding of the myofascial component of TMDs. It also provides the dental profession with information about the knowledge and practices related to MFPS as well as information regarding the strengths and weaknesses on its educational component. It is recommended that dentists receive additional training on differential diagnoses and causes. It is also recommended that the chiropractic profession take this opportunity to offer courses/talks on MFPS and join forces with the dentistry profession on how they can assist in managing patients with MFPS. / M

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 xv, 102 leaves / The purpose of this study was to determine the relative effectiveness of TENS electrodryneedling as compared to single dry needle insertion in the treatment of Myofascial Pain Syndrome.

Thesis (M.Tech.: Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2003 1 v. (various pagings) / Headaches are one of the most common clinical problems in medicine (Edwards et al. 1995). It is estimated that one in three people suffer from headaches at some stage in their life (Kim et al. 1995). It is an extremely common complaint in the industrialized world (Nilsson, 1997) and has a significant impact on employee absenteeism, productivity and quality of life (Schwartz et al. 1997). In the United States more than 15 000 tons of Aspirin is consumed annually for the relief of headaches, and the cost of evaluation and treatment of headache patients consumes millions of dollars a year (Bernat and Vincent, 1993). Tension - type headache is the commonest form of headaches (Edwards et al. 1995). It is a highly prevalent condition experienced annually by 30 - 70% of the population, and as a chief complaint, it constitutes 5 - 8% of Chiropractic patients (Vernon and McDermaid, 1998). It is divided into an Episodic and Chronic form (IHS, 1991:29), with Episodic Tension-type headache being far more prevalent than Chronic Tension-type headache (Schwartz et al. 1998). Episodic Tension-type headache is further subdivided according to the presence or absence of a muscular factor. According to the International Headache Society (1991:29) for decades a dispute has prevailed concerning the importance of muscle contraction in the pathogenesis of the headache, but conclusive studies are still lacking (IHS, 1991:29). Based on the IHS (1991:29) classification that tension-type headache is associated with a muscular component, the purpose of this study was to investigate the effect of specific myofascial trigger point therapy in the clinical presentation of Episodic Tension-type headache.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003. xix, 199 leaves / The purpose of this study was to investigate the role of Myofascial Trigger Points of the quadriceps femoris muscle in the clinical presentation of Patellofemoral Pain syndrome. Patellofemoral Pain Syndrome according to current literature suggests an extensor mechanism dysfunction as the most probable etiology, however this syndrome has posed many unsolved mysteries and challenges to the medical community and remains a difficult condition to treat. Myofascial pain syndrome in contrast to this is a regional muscular disorder that results from myofascial trigger points within the muscle. The presence of these trigger points could result in anterior knee pain, imbalance of the extensor mechanism and instability of the patellofemoral joint, which could present as a Patellofemoral Pain Syndrome.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 / The purpose of this randomized controlled clinical trial was to investigate the relative effectiveness of proprioceptive neuromuscular facilitation (PNF) versus ultrasound therapy for the treatment of Temporomandibular joint (TMJ) dysfunction caused by masticatory myofascial trigger points, in terms of subjective and objective clinical findings.