M.Tech. / OBJECTIVE: An association between cervicogenic headache, cervical joint dysfunction and the presence of myofascial trigger points in the sternocleidomastoid muscle exists. This study is aimed at determining the most effective Chiropractic treatment protocol in the management of cervicogenic headache by comparing the objective and subjective measurements gained in delivering Chiropractic spinal manipulative therapy to the upper cervical spine, myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle and/or a combination of both therapies. DESIGN: Forty-eight participants suffering from cervicogenic headache were allocated into one of three groups of equal male to female ratio. Each patient was examined and cleared for participation in a clinical trial in which Diversified Chiropractic techniques and/or myofascial dry needling therapy were delivered. Group 1 received Chiropractic spinal manipulative therapy to the upper cervical spine. Group 2 received myofascial dry needling therapy to myofascial trigger points in the sternocleidomastoid muscle. Group 3 received a combination of the mentioned therapies. DURATION AND MEASUREMENTS: Participants were consulted seven times in a four week period. They were treated twice per week for three weeks and a final, follow-up assessment was performed at the start of the fourth week. Subjective and objective measurements were taken and recorded on the first, fourth and seventh consultations. Subjective measurements were taken via the Vernon-Mior Neck Pain and Disability Questionnaire, Triple Visual Analogue Scale and the Headache Disability Index. Objective measurements included cervical spine ranges of motion which were measured using the Cervical Range of Motion Instrument (CROM). The data was statistically analysed using the Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney, Friedman and Wilcoxon Signed Ranks tests. RESULTS: Clinically and statistically significant improvements in all three groups were noted over the course of the study, with regards to perception of pain, disability and cervical spine range of motion. Statistically significant changes in ranges of motion were demonstrated in Group 1 for flexion, extension, lateral flexion (right and left) and right rotation; in Group 2 for right lateral flexion and left rotation and in Group 3 for all cervical ranges of motion. The comparison between the groups (intergroup analysis) showed no statistically significant changes except for right lateral flexion at the first consultation (pre-treatment). CONCLUSION: The results show that Chiropractic spinal manipulative therapy and dry needling are both effective treatment protocols in decreasing pain and dysfunction and increasing cervical range of motion in patients suffering from cervicogenic headache. This was demonstrated clinically, and to a lesser degree, statistically. The results carry a possible suggestion that although the different treatment options are effective individually, no treatment option proves to be statistically superior.

Background: Biomechanical stiffness has been linked to risk of injury and found to be a measureable characteristic in musculoskeletal disorders. Specific identification of stiffness may clarify who is most likely to benefit from the trigger point dry needling (TDN). The purpose of this study is to investigate the reliability and concurrent validity of the MyotonPRO® to the criterion of shear wave ultrasound elastography for the measurement of biomechanical stiffness in the infraspinatus, erector spinae, and gastrocnemius of healthy subjects over increasing muscle contraction. Second purpose is to investigate the biomechanical effects of TDN to latent myofascial trigger points (MTrPs) in the infraspinatus, erector spinae, or gastrocnemius. Research Design and Method: The first phase of the study investigated 30 subjects who completed three levels of muscle contraction in standardized test positions for the infraspinatus, erector spinae and gastrocnemius. Biomechanical stiffness measures were collected using shear wave elastography and MyotonPRO®. The second phase of the study investigated 60 new subjects who were categorized into infraspinatus, erector spinae, or gastrocnemius group based on an identified latent MTrP. These subjects underwent TDN while monitoring biomechanical stiffness at baseline, immediately post TDN, and 24 hours later. Analysis: Discriminate ability, reliability, and correlations were calculated for measured stiffness variable across the three conditions of contraction in the first phase of the study. Differences between stiffness at baseline and after TDN were calculated in the second phase of the study. Results: Correlation of the two measurement methods in the three muscle regions was significant and strongest in the gastrocnemius. MyotonPRO reliability was excellent, and demonstrated ability to discriminate between the three levels of muscle contraction. In the second phase, immediate decreased stiffness was observed in the MTrP following TDN treatment. Significant decreased stiffness was found in in the erector spinae and gastrocnemius group who also demonstrated a localized twitch response during TDN. Stiffness returned to near baseline values after 24 hours. Discussion: The MyotonPRO® stiffness measurement was found to be reliable and discriminate across predefined muscle contraction intensities. TDN may cause an immediate change in stiffness but this change was not observed at 24 hours. It is not known whether these effects are present in a symptomatic population or related to improvements in other clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is an indication of patient improvement in pain and function.

Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group included TDN to MTPs in the gastrocnemius, soleus or tibialis posterior each session while the same soft tissue mobilization and exercise program was conducted in both groups. Results: Within group analysis was performed for each group at 4 week and 90 day follow up. Significant improvement (p < .05) was achieved for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 90 days. The GROC was significant for MT + Ex at 90 days. The MCID for the FAAM, GROC were surpassed in both groups at 4 weeks and 90 days. NPRS surpassed the MCID for the MT + Ex group at 4 weeks. Conclusion: A large RCT to investigate the effects of TDN on MTP in Achilles tendinopathy is feasible with modifications. Recommendations: Special considerations for data collection sites should be given to the health care system, insurance payor, and financial burden to subjects.

Abstract Aim: The aim of this study was to investigate if treatment with “dry needling” in myofascial triggerpoints (MTrPs) in the rotatorcuff muscles may affect impingement symptoms such as pain during provocative tests, shoulder mobility, and function. The research questions were: Does the value of pain change on the Visual Analog Pain Scale (VAS) between before and after treatment? Do the positive provocative tests for impingement change between before and after treatment? Does the active shoulder mobility change between before and after treatment? Does the self-rated function change between before and after treatment? Method: The study was a prospective randomized intervention study and 19 persons with impingement symptoms (mean ± standard deviation; 58 ± 18 years, and shoulder pain duration 3.9 ± 1.6 months) were randomized into two groups. The groups were tested before, directly after and 3 weeks after treatment. The intervention group was treated twice, with a week in between, with “dry needling” in MTrPs. The control group was also treated on two occasions but was instead given a superficial needle in the infraspinatus muscle. All subjects were treated by the same physiotherapist. Pain was evaluated on the VAS when subjects performed active shoulder flexion before and after treatment. Provocative tests for shoulder impingement (Neer sign, Hawkins-Kennedy test and Jobe test) as well as range of motion tests were performed before, after and three weeks after treatment. The frequencies of positive/negative provocative tests were presented. Shoulder function was evaluated with the QuickDASH questionnaire. Significance level p≤0.05 was used in the study and a tendency was identified between 0.05 ≤ p &lt; 0.1. Results: There was a tendency (p=0.086) with decreased pain (VAS) in the intervention group after the treatment. Among the impingement tests only significant improved results was observed for Neer sign test three weeks after the treatment (p=0.025) No significant difference could be seen on the active shoulder mobility between before and after the treatment. The perceived function in the intervention group, measured with the Quick DASH questionnaire, showed a tendency (p=0.086) towards a better function. Conclusions: The study showed a tendency towards that”dry needling”  in MTrPs may affect impingement symptoms such as pain and function. The provocative tests for shoulder impingement, Neer sign, showed a significant decrease in pain after treatment. More studies with larger population is needed to make a statement about the effect of “dry needling” in MTrPs as a treatment for shoulder impingement symptoms. / Sammanfattning Syfte och frågeställningar: Syftet med studien var att undersöka om behandling med ”dry needling” (intramuskulär nålstimulering) i myofasciella triggerpunkter (MTrPs) i rotatorcuffmuskulaturen kan påverka impingementsymptom såsom smärta vid provokationstester, axelledsrörlighet och funktion. Frågeställningarna var: Förändras smärtskattning på visuell analog skala(VAS) vid aktiv axelflexion efter jämfört med före behandling? Förändras de positiva provokationstesterna för impingement efter jämfört med före behandling? Förändras den aktiva axelledsrörligheten efter jämfört med före behandling? Förändras den självskattade funktionen efter jämfört med före behandling? Metod: Studien var en prospektiv randomiserad interventionsstudie, 19 forskningspersoner (fp) med impingementsymptom, (medelålder 58 ± 18 år, besvärsdurationens medeltid 3.9 ± 1.6 mån), randomiserades till två grupper. Grupperna undersöktes före, direkt efter och tre veckor efter avslutad behandling. Interventionsgruppen behandlades vid två tillfällen, med en veckas mellanrum, med ”dry needling” i MTrPs medan kontrollgruppen vid två tillfällen istället fick en ytlig akupunkturnål i m infraspinatus. Behandlingen av alla fp utfördes av en och samma fysioterapeut. Smärta utvärderades med (VAS) vid aktiv axelflexion direkt före och efter behandling. Provokationstester (Neer sign, Hawkins-Kennedy test och Jobe test) samt rörlighetsmätning utfördes före, efter och tre veckor efter avslutad behandling. Frekvensen positiva/negativa provokationstesttest summerades. Funktionen utvärderades med frågeformuläret QuickDASH. Signifikansnivå p&lt; 0.05 används i studien och en tendens identifierades mellan 0.05 ≤ p &lt; 0.1. Resultat: Det fanns en tendens (p=0.086) till minskad smärta (VAS) i interventionsgruppen efter jämfört med före behandling. Bland impingementtesterna sågs enbart ett signifikant förbättrat resultat för Neers sign tre veckor efter avslutad behandling jämfört med före behandling (p=0.025). Ingen signifikant skillnad kunde ses gällande rörligheten före och efter behandling. Den upplevda funktionsförmågan mätt med frågeformuläret QuickDASH visade en tendens (p=0.086) mot bättre funktion i interventionsgruppen. Slutsats: Studien har visat tendenser på att ”dry needling” i MTrPs kan påverka impingementsymptom såsom minskad smärta och bättre självskattad funktion efter behandling jämfört med före. Impingementtestet Neer sign visade en signifikant minskad smärta efter behandling. Fler studier med större grupper, större ålderspann och längre behandlingstid behövs för att kunna uttala sig om effekten av ”dry needling” i MTrPs som behandlingsmetod vid impingementsymptom i axeln. / <p>Fristående kurs i Idrottsvetenskap inriktning idrottsmedicin 2013-2015</p>

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Cette thèse a été réalisée au sein du LERMAB et du CETELOR et se consacre à la mise au point de matériaux composites biosourcés à plus de 98%. Des fibres libériennes de type lin, chanvre, kénaf et jute ont ainsi été sélectionnées, caractérisées chimiquement et physiquement. Les renforts en nontissés sont définis ici comme une superposition de voiles (ou nappes de fibres) cohésifs produits par cardage pneumatique et dont la consolidation est réalisée par aiguilletage. Les voies que nous avons choisies au cours de ce travail nous ont permis d'appréhender et de mettre en évidence l'importance de la qualité des fibres sur les propriétés mécaniques et structurales des matériaux développés. Les renforts réalisés dans un premier temps dans une gamme de poids de 200 à 800 g/m² en simple, double ou triple épaisseurs ont ensuite été optimisés dans le but de préserver les propriétés mécaniques des fibres et de permettre une bonne accessibilité de la résine d'imprégnation. Pour limiter les facteurs de complications, les paramètres process ont été limités pour toutes les fibres et composites. Les fibres ont été mises en oeuvre seules ou en mélanges, et imprégnées de matrice à base de résine naturelle tannin de mimosa et d'hexamine (comme durcisseur) ou de résine synthétique de type époxy. Des biocomposites à taux de fibres en masse de plus de 50% et de densité entre 0,9 et 1,2 ont été obtenus. Les modules d'élasticité atteignent 6 GPa en flexion et en traction. Pour les contraintes, les moyennes atteignent 42 MPa et 75MPa respectivement en traction et en flexion / This thesis was carried out within the LERMAB and the CETELOR and about the development of more than 98% biobased composites materials. Bast fibre type flax, hemp, kenaf and jute were selected, characterized chemically and physically. Nonwovens reinforcements are defined here as a superposition of cohesive webs products by pneumatic carding and consolidation by needling. The process we have chosen during this work allowed us to understand and to highlight the importance of the quality of the fibers on the mechanical and structural properties of the materials developed. Reinforcements made initially in a weight range from 200 to 800 g/m² in single, double or triple thicknesses have then been optimized to preserve the mechanical properties of the fibers and allow good accessibility of the impregnating resin. To limit the factors of complications, the process parameters have been limited for all fibers and composites. Fibers have been used singly or in mixtures, and impregnated by a matrix of natural tannin from mimosa and hexamine (as a hardener) or by synthetic resin of epoxy. Biocomposites with a rate of fibre mass over 50%, and density between 0.9 and 1.2 were obtained. Elasticity Modulus reach 6 GPa flexural and tensile. For strenght, averages reach 42 MPa and 75MPa respectively in tensile and bending

The temporomandibular myofascial pain presents a major challenge in the diagnosis of temporomandibular disorders. Due to the characteristics of this condition, intramuscular injection procedures are often needed for adequate control of symptoms and treatment. Thus, the aim of this study was to evaluate the effectiveness of injection with different substances or dry needling in temporomandibular myofascial pain. The study design consisted of a systematic review of randomized clinical trials and research databases consulted were: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus and Web of Science until October 2014. The selection of studies was carried out by two independent reviewers, who applied eligibility criteria to obtain the final sample of primary studies. After application of the inclusion criteria were selected fifteen studies. Due to the heterogeneity of the primary studies it was not possible to perform a meta-analysis. The narrative analysis of the results showed that most of the studies had methodological limitations and biases that have compromised the quality of its findings. Thus, there is a need of conducting further randomized clinical trials, with follow-up and larger samples, to evaluate the real effectiveness of the technique and evaluated substances. / A dor miofascial temporomandibular apresenta um grande desafio diagnóstico dentro das Disfunções Temporomandibulares. Devido às características dessa condição, procedimentos de infiltração intramuscular muitas vezes são necessários para o adequado controle e tratamento dos sintomas. Assim, o objetivo desse estudo é avaliar a efetividade de infiltrações com diferentes substâncias ou agulhamento à seco em dor miofascial temporomandibular. O delineamento do estudo consistiu em uma revisão sistemática de ensaios clínicos randomizados e as bases de pesquisa consultadas foram: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus e Web of Science no período até outubro de 2014. A seleção dos estudos foi realizada por dois avaliadores independentes, que aplicaram critérios de elegibilidade para a obtenção da amostra final de estudos primários. Após a aplicação dos critérios de inclusão quinze estudos foram selecionados. Devido à heterogeneidade dos estudos primários não foi possível realizar uma meta-análise. A análise narrativa dos resultados mostrou que a maioria dos estudos apresentava limitações metodológicas e vieses que comprometeram a qualidade de seus achados. Assim, existe a necessidade da condução de novos ensaios clínicos randomizados, com tempo de acompanhamento e amostras maiores, para avaliar a real efetividade da técnica e das substâncias avaliadas.

My thesis is focused on process preparation and building construction technology of primary lining road tunnel, implemented in city part of Troja in the capital city Prague. Specifically it is a part of tunnel complex Blanka. The name of this part is Kralovská obora. If the all tunnel parts are built this tunnel complex Blanka can be complemented to already opened tunnels Zlíchovský, Mrázovka and Strahovský which are the part of city traffic circle. This technology preparation includes schedules and financial plans of the building, technological prescription for the primary tunnel lining, safety plan, control and trial/test plans, environmental plan, project of construction site, design of the main working machines, items budget of the north tunnel tube, coordination situation plan with wider relationships transport routes and technical report of building technological project.