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

Introdução: a relação entre zumbido e pontos-gatilho miofasciais têm sido debatida, mas poucas são as condutas terapêuticas propostas. Este estudo teve os objetivos de verificar: (1) a eficácia da desativação dos pontos-gatilho miofasciais para o alívio do zumbido em pacientes com síndrome dolorosa miofascial, (2) a correlação de lateralidade entre zumbido e dor e a associação entre a melhora de ambos e (3) se o fenômeno da modulação do zumbido durante a palpação dos pontos-gatilho apresenta bom prognóstico para este tratamento. Métodos: um ensaio clínico randomizado duplo-cego e placebo controlado foi desenvolvido para verificar a eficácia de 10 sessões de desativação dos pontos-gatilho em uma população com zumbido e síndrome dolorosa miofascial. Os critérios de inclusão eram: presença de zumbido e pelo menos um ponto-gatilho ativo em oito possíveis músculos da região da cabeça, pescoço ou cintura escapular, excluindo-se aqueles com dor generalizada ou tratamento recente para ambos os sintomas. Depois de triados por um otorrinolaringologista e avaliados por uma \"pesquisadora cega\" no início e após a quinta e décima sessões de tratamento, os indivíduos foram encaminhados para uma fisioterapeuta, que realizou a randomização em dois grupos e o tratamento de ambos. O grupo experimental foi submetido à desativação dos pontos-gatilho por digito-pressão e a orientações de condutas domiciliares e o grupo controle, a uma leve pressão em pontos adjacentes aos pontos-gatilho existentes. Resultados: o tratamento do grupo experimental foi mais eficaz em relação à intensidade do zumbido, número de sons, valor total do questionário de gravidade do zumbido e intensidade da modulação (p< 0,001). Houve associação entre a melhora da dor e a melhora do zumbido (p= 0,013; correlação de Spearman= 0,426) e o tratamento foi eficaz em todas as variáveis relacionadas à dor (p< 0,001) como: a intensidade da dor, valor do algômetro e número de pontos-gatilho ativos e latentes totais. Houve correlação de lateralidade entre os lados de pior zumbido e de dor em 54,4% dos casos (Kappa= 0,32; p< 0,001). A modulação do zumbido foi bastante freqüente no grupo experimental e controle (75,7% e 83,3% respectivamente), porém este fenômeno não influencia o prognóstico deste tratamento. No entanto, diminuir a intensidade do zumbido na modulação foi uma condição importante para um bom resultado de alívio do zumbido (p= 0,002). Conclusões: o grupo experimental foi mais eficaz em todas as variáveis analisadas após o tratamento de desativação dos pontos-gatilho miofasciais. Também foi observada uma correlação de lateralidade de ambos os sintomas e a existência de uma relação direta entre a melhora da dor e a melhora do zumbido. Modular o zumbido na avaliação dos pontos-gatilho não influencia o prognóstico do tratamento, porém, diminuir a intensidade durante a modulação promove uma resposta maior de alívio do zumbido do que aqueles que aumentam a intensidade ou modificam o tipo de som. / Introduction: the relationship between tinnitus and myofascial trigger points has been subject to debate but few therapeutic guidelines have been proposed. This study aims at analyzing (1) efficacy of myofascial trigger point deactivation for the relief of tinnitus in patients with myofascial pain syndrome; (2) correlation of laterality between tinnitus and pain - and the relief of both of them - as well as (3) whether the presence of tinnitus modulation upon trigger point palpation represents good prognosis for the treatment. Methods: a double-blind randomized placebo controlled clinical trial was developed in order to ascertain efficacy of 10 sessions of myofascial trigger point deactivation in a population suffering from both tinnitus and myofascial pain syndrome. Inclusion criteria were: presence of tinnitus and at least one active trigger point in eight possible muscles of the head, neck or shoulder girdle, excluding patients with generalized pain or undergoing recent treatment for both symptoms. After having been selected by an otologist and evaluated by a \"blind researcher\" in the beginning and after the fifth and tenth session, subjects were directed to a physiotherapist, who randomized them in two groups and treated both. The experimental group was subject to myofascial trigger point deactivation by means of digital pressure and guidance related to procedures to be followed at home, whereas the control group was subject to light pressure in spots adjacent to the existing trigger points. Results: treatment of the experimental group was more effective in relation to tinnitus loudness, number of sounds, total value of the Tinnitus Handicap Inventory as well as modulation intensity (p< 0,001). There was an association between pain relief and tinnitus relief (p= 0,013; Spearman correlation = 0,426) and treatment was effective in all pain-related variables (p< 0,001) such as: pain intensity, algometer value and amount of active and latent trigger points. Laterality correlation was also observed between the side with the worst tinnitus and the side with pain in 54.4% of the cases (Kappa= 0,32; p< 0,001). Tinnitus modulation was frequent in both experimental and control groups (75.7% e 83.3% respectively), even though such phenomenon does not influence the prognosis of the treatment. Nevertheless, diminishing tinnitus intensity was an important condition for tinnitus relief (p= 0,002). Conclusions: the experimental group was more effective in all variables subject to evaluation after treatment with myofascial trigger point deactivation. Laterality correlation of both symptoms was also observed as well as the existence of a direct link between pain relief and tinnitus relief. Modulation of tinnitus during trigger point evaluation does not influence the treatment prognosis, even though diminishing intensity during modulation allows more tinnitus relief than raising intensity or modifying the type of sound.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-08-18T13:46:45Z No. of bitstreams: 1 MARCELO WATANABE DE MATOS.pdf: 908435 bytes, checksum: fc89cc18e73bc7e996153afa23e2e3c0 (MD5) / Made available in DSpace on 2016-08-18T13:46:45Z (GMT). No. of bitstreams: 1 MARCELO WATANABE DE MATOS.pdf: 908435 bytes, checksum: fc89cc18e73bc7e996153afa23e2e3c0 (MD5) Previous issue date: 2012-08-01 / Fibromyalgia can be defined as a syndrome of chronic and diffuse musculoskeletal pain, with non-inflammatory characteristics. With the etiological processes still unclear, this disease has assumed an increasingly important role worldwide, with a prevalence of 2% estimated in the world population. Currently, the most discussed pathological mechanism for the disease is a change in pain perception mediated by excitatory and inhibitory neurotransmitters in the central nervous system. In this context are very relevant targets the endogenous opioids and their correlated receptors. The OPRM1 gene encoding the major opioid receptor called mu-opioid receptor, presents a single nucleotide polymorphism (SNP) at position 118 (A118G) that significantly affects the response to endogenous and synthetic opioids. Objectives: The objectives of this study were to compare the frequency of A118G polymorphism in the OPRM1 gene in two groups of women, including 50 women affected by fibromyalgia and 50 unaffected, as well as to investigate the possible associations between the A118G polymorphism with clinical and functional symptoms of the disease. Methodology: Patient´s clinical and functional pain symptoms were assessed by using the Fibromyalgia Impact Questionnaire (FIQ). The A118G polymorphism of the OPRM1 gene was analyzed by polymerase chain reaction followed by analysis of restriction fragment length polymorphism DNA was extracted from peripheral blood samples obtained from the two groups of women. Descriptive and comparative statistical analysis were performed and the results obtained. Results: The results of clinical and functional pain symptoms from fibromyalgia patients, obtained by the FIQ, confirmed the clinical severity of the patients selected in this study. The allele frequencies obtained for the two groups were: A (86,0%) and G (14,0%) for patients with fibromyalgia and A (87,8%) and G (12,2%) for controls. The AA genotype frequencies were found (74,0%) and AG (24,0%) and GG (2,0%) for patients with fibromyalgia and AA (77.6%) and AG (20.4%) and GG (2,0%) for the controls. Conclusions: No statistically significant difference was detected between the group of patients with fibromyalgia and control patients. The A118G polymorphism of the OPRM1 gene was not associated with clinical and functional pain symptoms of the patients analyzed in this study. / A fibromialgia pode ser definida como uma síndrome de dor músculoesquelética difusa e crônica, de caráter não inflamatório. Com processos etiológicos ainda não elucidados, esta patologia tem assumido um papel cada vez mais importante no cenário mundial, com uma prevalência estimada de 2% da população. Atualmente, o possível mecanismo patológico mais discutido é o de uma alteração na percepção da dor, mediada por neurotransmissores excitatórios e inibitórios no Sistema Nervoso Central. Neste contexto, inserem-se os opióides endógenos e seus receptores correlatos. O gene OPRM1 codifica o principal receptor opióide, denominado receptor mu-opióide, cujo polimorfismo de nucleotídeo único (SNP) na posição 118 (A118G) afeta significativamente a resposta aos opióides endógenos e sintéticos. Objetivos: Os objetivos deste estudo foram comparar a frequência do polimorfismo A118G no gene OPRM1 em dois grupos de mulheres, incluindo 50 afetadas pela fibromialgia e 49 não afetadas, bem como investigar as possíveis associações entre o polimorfismo A118G e os sintomas clínicos e funcionais da doença. Metodologia: Os sintomas clínicos e funcionais do quadro álgico das pacientes foram avaliados por meio do Questionário de Impacto da Fibromialgia (do Inglês: Fibromyalgia Impact Questionnaire – FIQ). O polimorfismo A118G do gene OPRM1 foi analisado por meio da reação em cadeia de polimerase seguida de análise de polimorfismos de comprimento de fragmentos de restrição, a partir de DNA extraído de amostras de sangue periférico obtidas dos dois grupos de mulheres. Análise estatística descritiva e comparativa foi realizada a partir dos resultados obtidos. Resultados: A análise dos resultados dos sintomas clínicos e funcionais do quadro álgico das pacientes com fibromialgia, obtidos por meio do FIQ, comprovaram a gravidade do quadro clínico das pacientes selecionadas neste estudo. As frequências alélicas obtidas para os dois grupos foram: A (86,0%) e G (14,0%) para as pacientes com fibromialgia e A (87,8%) e G (12,2%) para os controles. As frequências genotípicas encontradas foram AA (74,0%); AG (24,0%) e GG (2,0%) para pacientes com fibromialgia e AA (77,6%); AG (20,4%) e GG (2,0%) para os controles. Conclusões: Nenhuma diferença estatisticamente significativa foi detectada entre o grupo de pacientes com fibromialgia e as pacientes do grupo controle. O polimorfismo A118G do gene OPRM1 não esteve associado com os sintomas clínicos e funcionais do quadro álgico das pacientes analizadas neste estudo.