M.Tech. (Chiropractic) / Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.

M.Tech. (Chiropractic) / Objective: The purpose of this study was to compare dry needling with cervical spine manipulation combined with dry needling, in the treatment of infraspinatus muscle myofascial trigger points. Study Design: This was a randomized experimental study Setting: The participants were treated at the University of Johannesburg chiropractic day clinic Subjects: 30 participants volunteered for the study. The participants were divided into groups by randomly drawing thirty numbers from a hat, and placing them into two groups: either dry needling combined with spinal manipulation (group 1) or dry needling only (group 2). Participants had to be between eighteen and fifty years old and they could have been male or female. Participants had to present with active infraspinatus muscle myofascial trigger points and also had to present with shoulder or lateral arm pain reproduced by infraspinatus trigger point palpation. Method: Participants were either treated using dry needling only or dry needling combined with spinal manipulation. There were seven consultations. The first six consultations were treatment consultations. Measurements were taken at consultations one, four and seven. Results: The results indicate statistically that participants who had dry needling on its own had a faster increased pressure pain tolerance and a faster decrease in resting electrical activity of the muscle over the treatment period than those that recieved dry needling in combination with spinal manipulation. We must emphasize however that this did not show in the numerical pain rating scale. Participants felt a relatively even relief of their pain in both groups. These overall results might have been skewed by outliers in groups and a small demographic study size. The rest of the results were statistically insignificant, however there was a clinically desired therapeutic effect noted in both groups throughout the study. Conclusion: Dry needling only and dry needling combined with spinal manipulation, individually have desired therapeutic effects in the treatment of infraspinatus myofascial trigger points. There is however no conclusive statistical results in this study that shows one treatment protocol to have a greater therapeutic effect when compared to the other. However this study size was small and therefore the results may have been coincidental.

M.Tech. (Chiropractic) / Purpose: Patients presenting with mechanical cervical spine pain demonstrate myofascial trigger points of the surrounding cervical spine musculature (De Las Penas, Alonso-Blanco, Alguacil-Diego and Miangolarra-Page, 2006). Myofascial trigger points, from specifically the cervical spine musculature, have been seen to be involved to a large extent with not only the local mechanical cervical spine pain but also the accompanying referred pain patterns and symptoms (De Las Penas, Alonso-Blanco and Miangolarra-Page, 2007). The purpose of this study is to compare the efficacy of ischaemic compression and laser therapy respectively, applied to an active myofascial trigger point in participants with acute mechanical cervical spine pain associated with an active trapezius myofascial trigger point TP1, with regards to pain, activities of daily living, pressure pain threshold and cervical spine range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and the laser group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1. Treatment was applied to the active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each participant was treated six times over a period of two consecutive weeks. Prior to initiation of the treatment, each participant was requested to complete the Vernon-Mior Neck Pain and Disability Index questionnaire and the Visual Analogue Scale. Algometer readings were obtained over the trapezius myofascial trigger point 1, bilaterally. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion: flexion, extension, lateral flexion, and rotation. Ischaemic compression and laser therapy, group 1 and group 2 respectively, then each received treatment of the active trapezius myofascial trigger point 1, for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th, and at the 7th final consultation.

Blocking the contents of the pterygopalatine fossa (PPF) is a highly effective method in alleviating pain in trigeminal neuralgia (TN) and other facial pain syndromes. This, however, is not a widely used technique, due to the difficulty in locating the PPF which is obscured by bony and soft tissue structures. Despite the various unspecific techniques that have been attempted, in many cases radiography still seems to be used as it is the most effective method in locating the PPF. The aim of this study was therefore to achieve a safe and alternative method of locating the PPF including its contents without the aid of radiography. A total of 160 skulls from the Pretoria Bone Collection at the University of Pretoria were used. Distinct anatomical landmarks and the use of existing and new anthropometric measurements were used to define the location of the PPF in any individual. Regression analysis provided the strength of influence each measurement had on the location of the PPF. From the results, two mathematical formulae were devised (one for each side). These formulae were tested on 47 cadavers by substituting the measurements of each individual into the created formulas. A needle was then inserted at the calculated points, and the area around the needle dissected to determine whether or not it was in the PPF. Our results showed an accuracy of 65.22% on the right and 54.35% on the left. It is hoped that this new technique will aid researchers and clinicians alike in the management of various pain disorders as well as pain management during surgery. AFRIKAANS : Daar is bevind dat ‘n lokale verdowingsblok van die inhoud van die pterygopalatine fossa (PPF) die pyn effektief verlig vir trigeminale senuweepyn, sowel as ander pyn sindrome. Die tegniek word egter nie gereeld gebruik nie as gevolg daarvan dat dit moeilik is om die PPF te betree deurdat dit deur verskeie benige en sagte weefsels verberg word. Die literatuur beskryf verskeie onspesifieke metodes om die prosedure uit te voer, maar in die meeste gevalle moes radiografie gebruik word om sukses te behaal. Die doel van hierdie projek was om ’n alternatiewe metode te ontwikkel wat veilige en effektiewe toegang tot die PPF bied, sonder om radiografie te gebruik. ’n Totaal van 160 skedels was gebruik om anatomies landmerke en bestaande sowel as nuwe antropologiese metings te maak. Regresie analise het die sterkte van die invloed van die onderskeie metings met die pterygopalatine fossa gemeet. Vanuit die resultate van die statistiese analise is twee formules ontwerp (een vir elke kant van die gesig). Die formules was getoets op 47 kadavers deur die metings vir elke individu in die formules te plaas. ‘n Naald is dan geplaas in die uitgewerkte punt, die area om die naald was gedisekteer om te sien of die naald in die fossa en dus by die ganglion was of nie. Die resultate toon ‘n akkuraatheid van 65.22% aan die regterkant en 54.35% aan die linkerkant. Daar word gehoop dat hierdie nuwe tegniek ‘n effektiewe manier van pyn behandeling word in verskeie pyn sindrome sowel as gedurende chirurgie vir beide navorsers en chirurge. / Dissertation (MSc)--University of Pretoria, 2011. / Anatomy / unrestricted

Submitted in partial fulfillment of the requirements for Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: Ankle sprains are a frequently occurring injury sustained by sports individuals accounting for approximately 20% to 40% of all sports injuries (DiStefano et al. 2008; LeBrun and Krause, 2005). Ankle sprains are mainly caused by excessive inversion (Takao et al., 2005; Andersen et al., 2004), when the foot is twisted inwards and lands at a high velocity damaging the lateral capsule-ligamentous complex (Beynnon et al., 2005). According to Naqvi, Cunningham and Lynch (2012) untreated or inappropriately managed ankle sprains can lead to a cascade of negative alteration to both the joint structures and the individual’s lifestyle. According to Hale, Hertel and Olmsted-Kramer (2007) 30% of ankle sprains result in chronic ankle instability (CAI) and 78% of the CAI cases develop into post-traumatic ankle osteoarthritis. This poses a negative impact on an individual’s athletic performance. Ankle sprains can be managed conservatively with the utilization of the PRICE protocol during the acute stage, cross friction massage or instrument assisted soft tissue mobilization techniques (for example Graston®, FAKTR© Concept) for both acute and subacute ankle sprains (Bleakley, 2010). Aim: The purpose of this study was to determine the effectiveness of a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy compared to cryotherapy and sham laser in the treatment of sub-acute and acute ankle inversion sprains. Objectives: 1. To determine the effectiveness of a myofascial treatment protocol combined with cryotherapy in terms of subjective (numerical pain rating scale [NRS] and foot function index [FFI]) and objective (oedema measurements [EDM], digital inclinometer readings [DIR], algometer readings [AR] and stork balance stand test score [STR]) measurements in the treatment of acute and sub-acute ankle sprains. 2. To determine the effectiveness of sham laser combined with cryotherapy in terms of subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements in the treatment of acute and sub-acute ankle sprains. 3. To compare the relative improvement between the two groups in terms of subjective (NRS and FFI) and objective measurement (EDM, DIR, AR and STR). Study design: This was a quantitative randomised controlled clinical trial. Methods: Forty participants with sub-acute or acute ankle sprains of not more than three weeks were recruited into the study. All participants had a full case history, physical, and foot and ankle regional examination to assess for their eligibility for entry into the study in terms of inclusion and exclusion criteria. These participants were randomly allocated using the hat method into one of two study groups, Group A (treatment group) or Group B. Participants in Group A received a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy and Group B received cryotherapy and sham laser. These participants had four treatments in two weeks where the appropriate treatment was administered. Pre-treatment subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements were taken at each consultation. This data was analysed using SPSS software version 24.0. Results: The General Linear Model for repeated measures was used for the intra- group and inter-group analysis of the data. Intra-group analysis of the FAKTR© treatment group showed that the group had statistically significant improvements in terms of the subjective and objective measurements of the study with the p-value < 0.05 between all treatment periods. Intra-group analysis of the control group showed no statistically significant improvements in terms of subjective and objective measurements of the study. Inter-group analysis showed no statistically significant difference in terms of the DIR and EDM. The NRS, AR, STR and FFI readings showed statistically significant differences between the two groups with a p-value of < 0.05 mainly on the last two consultations. Conclusion: This study concluded that the myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy was more effective than cryotherapy and sham laser in the treatment of sub-acute and acute inversion ankle sprains. The FAKTR© Concept treatment group appeared to show statistically significant improvements compared to the control group.

M.Tech. / This study aimed to determine the difference between the standard dry needling technique versus the rapid dry needling technique with regards to which technique would provide quicker relief of symptoms, as measured by an increase in participant’s pressure tolerance and range of motion and a decrease in subjective pain. Subjectively it was seen that both groups had a statistical decrease in the participants perceived pain with the Oswestry Disability Index, the McGill’s Pain Questionnaire and the Numeral Pain Rating Scale. Both groups showed significant changes over the two time variables (pre-Treatment one and post-Treatment four) with regards to all the questionnaires. Group 2 showed the most significant change when comparing the two groups with regards to the Oswestry Disability Index and the Numeral Pain Rating Scale. From these results it is seen that subjectively all the participants felt relief with respect to their perceived pain. However, objectively the rapid dry needling technique proved to improve pain faster and more consistently throughout the treatment period over the standard intra-muscular dry needling technique. Therefore the rapid dry needling technique is more effective in treating active Gluteus medius muscle trigger points.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic Durban University of Technology, 2013. / Objectives: Myofascial pain dysfunction is a common musculoskeletal disorder, known to affect athletes. This research aimed to create a map of myofascial trigger points (MFTPs), to ascertain sport specific combinations. Design and Setting: This IRB approved study was a cross-sectional, observational study. Participants: Forty swimmers and forty non-swimmers (soccer players). Measurements : All participants underwent one assessment, non-intervention session where primary measures included: shoulder disability index (SDI), myofascial diagnostic scale (MDS), algometer and numerical pain rating scale (NRS). Manual palpation, the MDS and an algometer assessed MFTPs and the SDI overall function. SPSS version 20 (IBM) using Pearson’s chi square tests / Fisher’s exact tests compared MFTP locations between the groups, and non-parametric Mann-Whitney tests compared continuous measures (due to significant non-normal distribution), with a p-value <0.05 level of significance. Results: MFTP presence is very uncommon in swimmers, with associated pain and loss of function being very low on average. No evidence was found that swimmers were affected more than non swimmers by MFTPs related pain or loss of function, but has indicated that algometer measurements for infraspinatus MFTP 1, were significantly higher (p<0.027) (showing decreased tenderness) than the values in non swimmers. Conclusions: These results contradict the literature which suggests that unique activity specific patterns of MFTPs exist. This may be as a result of underlying systemic causes of MFTPs that obscured the pattern in this study. It is therefore suggested that larger trials with more participants per group be done in order to verify the results of this study.

Dissertation completed in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / Background: Mechanical neck pain is a common complaint characterized by pain, limited range of motion and myofascial trigger points. The most common treatments for it are manual therapy and drug therapy. The former includes massage and exercise therapy and more specific to this study spinal manipulation and dry needling. The latter includes non-steroidal anti-inflammatories (NSAIDs) and analgesics. Manipulation assists in increasing range of movement and reduces muscle spasm, while dry-needling inactivates trigger points and decreases local and referred pain. NSAIDs reduce pain and muscle spasm by inhibiting inflammatory pathways. Traumeel®S is a commonly used, safe and well tolerated homoeopathic anti-inflammatory with similar efficacy as NSAIDs but without the adverse gastrointestinal effects. It has also been shown to be highly effective in the treatment of myofascial pain. Methodology: This study was designed as a randomized comparative clinical trial. Fourty participants between ages 18-55 years of age were randomly allocated to two groups of twenty participants each. Group A received spinal manipulation and dry needling in trapezius trigger point two; while Group B received spinal manipulation and Traumeel®S solution injection in trapezius trigger point two. The study took place over a period of two weeks and involved four consultations. Subjective and objective readings were taken at every consultation. Subjective tools included the Numerical pain rating scale (NRS) and Canadian Memorial Chiropractic College (CMCC) neck disability index. Objective tools included the pressure algometer and cervical range of motion (CROM-II) goniometer. SPSS version 20.0 was used in the data analysis. A p-value of <0.05 was considered as statistically significant. Results: The results showed that no statistically significant differences were observed between the two groups in terms of subjective and objective measurements. However, there were statistically significant improvements seen in both groups equally in terms of subjective and objective measurements i.e. both groups showed improvement. Conclusion: The results of this study concluded that the effectiveness of spinal manipulation and dry needling versus spinal manipulation and Traumeel®S Injectable solution in the treatment of mechanical neck pain associated with trapezius myofascial trigger points is equivalent to each other. No statistically or clinically significant changes were noticed between the groups.

Síndrome do Desfiladeiro Torácico (SDT) abrange manifestações nervosas e/ou vasculares. Pode haver dor e/ou parestesia em braço, antebraço e mão mesmo em repouso, assim como sensação de dormência, força diminuída ou dificuldades durante atividades com elevação dos braços mesmo com exame eletrofisiológico negativo, forma neurológica não verdadeira. Na intenção do aprimoramento da técnica, tem se usado ultrassom na infiltração muscular. Objetivo: avaliar a eficácia da injeção de ropivacaína 0,375% nas doses de 2,5ml em cada ventre dos músculos escalenos anterior e médio, guiado por ultrassonografia, no tratamento da Síndrome do desfiladeiro torácico neurogênico inespecífico através dos protocolo de funcionalidade DASH - DISABILITIES OF THE ARM, SHOULDER, AND HAND e EVA ou VAS - escala visual analógica comparado com o toque cutâneo com mesmo conjunto seringa-agulha nos mesmos pontos de acesso de onde seria a injeção. Método: ensaio clínico, controlado por placebo, aleatorizado, duplo cego, com dois braços paralelos. Os dados clínicos foram coletados por meio de um protocolo padronizado. Foram incluídos nesse estudo sujeitos com diagnóstico de Síndrome do Desfiladeiro Torácico Neurogênico inespecífico, que contemplaram os critérios de inclusão com dor em membros superiores e/ou cervicalgia sem radiculopatia ou comprometimento neurológico do membro em questão por causas radiculares compressivas ou encefálicas. O desfecho primário foi a funcionalidade avaliada pela escala Disabilitie of the Arm, Shoulder and Hand - DASH validada no Brasil e a melhora da dor, mensurada através da Escala Visual Analógica - EVA. O tempo das avaliações foram T0= antes da intervenção; T1= imediatamente após, T2= 1 semana, T3=4 semanas e T4= 12 semanas, sendo que para o T1 não foi aplicado o DASH. Resultados: o total de pacientes foram 38, sendo 19 no grupo controle (CT) e 19 no grupo intervenção (INT). Os pacientes e os controles foram comparáveis com relação as variáveis idade, gênero, escolaridade, índice de massa corporal (IMC), atividade física, tabagismo, doenças crônicas associadas (p > 0,05). Com relação ao DASH, de forma estatisticamente significante (p > 0,05), é possível afirmar que o grupo intervenção apresentou melhora da funcionalidade a partir de 4 semanas e essa melhora se manteve, até a décima segunda semana. Não houve diferença estatisticamente significante entre os grupos CT e INT, quanto a escala VAS nos 5 momentos avaliados (VAS inicial grupo total p < 0,001). Conclusão: Em termos práticos conclui-se que injeção de ropivacaína 0,375% nas doses de 2,5ml em cada ventre dos músculos escalenos anterior e médio, guiado por ultrassonografia, no tratamento da Síndrome do desfiladeiro torácico neurogênico inespecífico auxilia na melhora da função entretanto, em relação a melhora da dor não há diferença entre os grupos / Thoracic Outlet Syndrome (TOS) encompasses nerve and/or vascular manifestations. There may be pain and/or paresthesia in the arm, forearm and hand even at rest, as well as numbness, decreased strength or difficulties during activities with elevation of the arms even with negative electrophysiological examination, non-true neurological form. In order to improve the technique, ultrasound has been used in muscle infiltration. Objective: to evaluate the efficacy of 0.375% ropivacaine injection in the doses of 2.5 ml in each muscular belly of the anterior and middle scolenes muscles, guided by ultrasonography, in the treatment of nonspecific Thoracic Outlet Syndrome through DASH - DISABILITIES OF THE ARM, SHOULDER, AND HAND and VAS - visual analogue scale compared to the skin touch with the same syringe-needle set at the same access points from where the injection would be. Method: A randomized, double-blind, placebo-controlled clinical trial with two parallel arms. Clinical data were collected through a standardized protocol. Included in this study were subjects with a diagnosis of nonspecific, Thoracic Outlet Syndrome who included criteria for inclusion with pain in upper limbs and / or neck pain without radiculopathy or neurological impairment of the limb in question due to compressive or encephalic root causes. The primary endpoint was the functionality evaluated by the Disabilitie of the Arm, Shoulder and Hand - DASH scale validated in Brazil and the improvement of pain, measured by the Visual Analogue Scale - VAS. The time of the evaluations were T0 = before the intervention; T1 = immediately after, T2 = 1 week, T3 = 4 weeks and T4 = 12 weeks, and for T1 the DASH was not applied. Results: the total number of patients was 38, 19 in the control group (CT) and 19 in the intervention group (INT). Patients and controls were comparable in relation to the variables age, gender, schooling, body mass index (BMI), physical activity, smoking, and associated chronic diseases (p > 0.05). With regard to DASH, statistically significant (p > 0.05), it is possible to state that the intervention group showed improvement of the functionality after 4 weeks and this improvement was maintained until the twelfth week. There was no statistically significant difference significant difference between the groups CT and INT, and the VAS scale in the 5 moments evaluated (initial ARV total group p < 0.001). Conclusion: In practical terms, it is concluded that ropivacaine injection 0.375% in doses of 2.5 ml in each anterior and middle scalene muscles, guided by ultrasonography, in the treatment of nonspecific neurogenic thoracic defibrillary syndrome helps to improve function, however, in relation to pain improvement there is no difference between the groups

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.