Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2004. / The purpose of this study was to investigate the association between the role of Myofascial Trigger Points of the lower extremity to the clinical presentation of lIiotibialband Friction syndrome / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / Myofascial trigger points are a frequently overlooked and misunderstood phenomenon in medical curricula, yet with correct diagnosis and appropriate treatment the prognosis is usually excellent. Many effective treatments have been devised for myofascial trigger points, but the problem is that there is very little research to substantiate which of these treatments are the most effective. The aim of this randomised uncontrolled study was to justify the hypotheses which stated that both dry needling and saline injection would prove to be effective in the treatment of myofascial trigger points, with saline injection proving to be the most effective of the two. Patients were obtained for this study by convenience sampling, whereby any patients presenting to the Chiropractic clinic at Technikon Natal with neck,\xB7 upper back or shoulder pains were considered for the study. Of these patients, only those who conformed to the specified delimitations and diagnostic criteria were accepted. The sample size of thirty patients was randomly divided into two treatment groups of fifteen, one of which received saline injection and the other dry needling of active myofascial trigger points. Both groups were educated with regards to the nature and perpetuating factors of the condition, \xB7andwere instructed to follow a specific stretching programme. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic at Technikon Natal. 2001. / The purpose of this investigation was to determine the relative efficacy of Action Potential Therapy (APT) as opposed to placebo Action Potential Therapy in the treatment of myofascial pain syndrome. The study was a prospective, randomized, placebo controlled study. The study consisted of two groups of thirty subjects each, which were selected from the Durban Metropolitan area. Only subjects diagnosed as having active trigger points in either the trapezius or gluteus medius muscle were accepted into the study. Each subject received four treatments over a period of seven to ten days. Group one received an active form of Action Potential Therapy while group two received placebo Action Potential Therapy. Subjective assessment was by means of the short form McGill pain Questionnaire and the N wnerical Pain Rating Scale-l Ol. Objective assessment was by means of an algometer and the Myofascial Diagnostic Scale. Readings were taken twice for each patient. The first assessment was conducted at the initial consultation prior to the first treatment, and the second assessment was completed during the last consultation after the treatment. Intra-group comparisons were made using the parametric two-sample paired t-test and the nonparametric Wilcoxon signed rank test. For the inter-group comparison, the parametric twosample unpaired t-test and non-parametric Mann-Whitney unpaired U test were used. Statistical analysis was completed at a 5% significance level. / M

M.Tech. / The aim of this single blinded clinical trial was to determine the most effective myofascial dry needle insertion time for the relief of active trigger points in the trapezius muscle. It was hypothesised that at least one of the three time frames chosen in this study; namely 30 seconds, 1.5 minutes and until the patients pain referral ceased, would prove to be the most effective time to increase the patients pressure tolerance and decrease their subjective perception of pain. Thirty six patients who presented with bilateral active trapezius trigger points and who fell into the inclusion-exclusion criteria of this study were recruited from in and around the University of Johannesburg. Once selected for the study the patients, whose ages ranged from 18 to 40 years of age, where randomly divided into two groups of eighteen. In this study each patient served as their own control. The left and right sides where randomly assigned to either being the control side (needled for 30 seconds) or the experimental side (needled for 1.5 minutes or until the pain referral stopped). Because of this further randomisation, the two groups of eighteen were divided in to four groups of nine: Group one: Right side was the control and the left side was needled for 1.5 minutes. Group two: Right side was the control and the left side was needled until the patients pain referral ceased. Group three: Left side was the control and the right side was needled for 1.5 minutes. Group four: left side was the control and the right side was needled until the patients pain referral ceased. The patients received a once off treatment, where they were needled bilaterally with the control side being needled for 30 seconds and the experimental side being needled for either 1.5 minutes or until the pain referral stopped. The patients were required to come back for a follow-up assessment two days later. Objective measurements were obtained by using the algometer, which measured the pressure threshold of the left and right trapezius before the needling treatment, immediately after the treatment and on the two day follow-up visit. Three reading were taken at each time interval. vi Subjective measurements were obtained by using the visual analogue scale (VAS) and a subjective pain and discomfort questionnaire which patients were required to complete before the treatment, immediately after the treatment and at the two day follow-up visit. The data was statistically analysed using the Kruskal Wallis Test and the Wilcoxon Signed Ranks Test. For the inter-group analysis for average algometer readings, due to the small sample size, only group one and group four showed statistically significant changes in the average algometer readings over time. In group one the control side showed the greatest change, and in group four both the control and the experimental (which was needled until the pain referral ceased) showed a change in average algometer readings. Although the statistical evidence is inconsistent, there was a general trend of improvement seen over all four groups in terms of the average algometer readings over time. Subjectively it was seen that all four groups had a statistical decrease in the patients perceived pain with the VAS, with group four showing the most significant change over the three time variables (pre to post, post to follow-up and pre to follow-up). Group one had a statistical change from the pre reading to the post reading. Group two had a statistical change from the pre reading to the follow-up reading. Group three had a statistical change from the pre reading to the post reading. It was noted from the subjective pain and discomfort questionnaire that the patients who where needled for 30 seconds experienced a persistent stiffness and pain (although less than what they experienced before) immediately after the treatment and on their two day follow-up visit. This contrasted with the patients who were needled for 1.5 minutes and until the pain referral ceased (which averaged at 1 minute for group two and four) who experienced more relief immediately after the treatment and on the two day follow-up visit. From these results it is seen that even though objectively both the 30 second time frame and the longer time frame proved to increase pressure threshold, subjectively the patients who were needled for the longer time felt more relief than those who were needled for the shorter time frame.

Thesis (M.Tech.:Chiropractic)-Dept. of 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

Thesis (M.Tech.: Chiropractic)- Dept.of Chiropractic, Durban Institute of Technology, 2006 xxiv, 139, [17] leaves / This pilot study was a pre-post clinical investigation assessing the influence of component materials on the effectiveness of GTISTM in the treatment of MPS, in terms of clinical outcomes.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 1 v. (various pagings) / 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.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Technikon Natal, 2002 1 v. (various pagings) / The purpose of this clinical trial was to evaluate the efficacy of Magnesium phosphate, as an adjunct to dry needling, in the treatment of Myofascial Pain Syndrome (MPS), in terms of objective and subjective clinical findings. MPS is a frequently encountered condition. If not treated adequately, this condition can lead to long term, recurrent pain, as well as patient and physician frustration. Many treatment protocols have been examined with contradictory results and research into epidemiological studies and combinations of various treatment protocols are lacking.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2003 103 leaves / The purpose of this study was to investigate the efficacy of dry needling latent myofascial trigger points, in the treatment of Myofascial Pain Syndrome.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / The purpose of this study was to determine the efficacy of Therapeutic Faradic Stimulation in patients with Myofascial Pain Syndrome of theTrapezius and Levator Scapula musculature. This study was a quantitative pilot placebo controlled clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients between the ages of 30 and 50, who were office workers and were diagnosed with active trigger points in either the Trapezius and/or the Levator Scapula muscles were accepted into this study. The sample was divided into 3 groups of 20. One group received Faradic Stimulation in the form of the Transeva, another group received Placebo Transeva and the third group received Pulsed Ultrasound. Each patient received 2 research treatments with a maximum of 72 hours between treatment 1 and 2, and the third free Chiropractic treatment being a week later. Data (both subjective and objective) were obtained from the patients at the first and second consultations, prior to treatments and at the third follow up before treatment. Subjective data were obtained with the Short form McGill pain questionnaire, the Numerical Pain Rating Scale and the CMCC Neck Disability Index. Objective data were obtained from the Pressure Algometer and the CROM Cervical Range of Motion Instrument. Statistical Analysis of the data was conducted using the SPSS (version 9) software suite. This Statistical software program was manufactured by SPSS Inc, 444N. Michigan Avenue, Chicago, Illinois, USA. Various Descriptive and Inferential Statistical techniques were used. The Descriptive procedures used were various tables and graphs and a few summary statistics including but not limited to means, proportions and percentages. Inferential Statistics included iv various Hypothesis testing techniques. Due to the size of our samples, namely 20 in each group, non-parametric Statistical Tests were used. All the tests were set at type 1 error at 5%, or mentioned differently = 0.05. If our p value as reported was less than 0.05 we declared a significant result and our Null Hypothesis was rejected. Evaluation of the statistical analyses revealed significant improvements with regards to subjective and objective data for mostly the Attenuated Faradic Treatment (Transeva) group. Although significant Placebo and Ultrasound effects were obtained initially after the first treatment, the Transeva group showed more favourable results between consultations two and three, giving a good indication of the progression of the treatment regimen. Comparison between groups showed a significant difference with regards to CMCC Neck Disability Index scores, NPRS 101 questionnaires, CROM extension and right lateral flexion readings and Algometer readings. It was concluded that the Transeva is an effective form of treatment for the active trigger points of Myofascial Pain Syndrome of the Trapezius and Levator Scapula musculature in terms of both subjective and objective clinical findings. Suggestions were made to double-blind further studies as this will aid in reducing researcher bias toward a favoured treatment protocol. This study and observations made by the author with respect to Myofascial Transeva treatment are hoped to contribute to the limited literature available on this modality.