M.Tech. / Problem Statement: Myofascial Pain Syndrome (MPS) is a painful and prevalent muscular condition that is characterized by the development of myofascial trigger points (TrP’s). These are locally tender when active and are able to refer pain through specific patterns to other areas of the body distal from the trigger point (Manga, 2008). Myofascial trigger points are a frequently overlooked and misunderstood source of the distressingly ever-present musculoskeletal aches and pains of mankind and many authors have found that the trapezius muscle is most often the muscle that has frequent myofascial trigger points (Travell and Simons, 1999). Much debate and discussion has arisen on the merits of the fanning dry needling technique compared to that of the static dry needling technique, but research evidence is very limited. Some practitioners prefer the static technique over the fanning technique as it reduces the presence and amount of post-needling soreness, as well as reduces the possibility of penetrating a blood vessel resulting in hemorrhaging. Other practitioners prefer the fanning technique as it increases the chances of locating the loci of the TrP, as well as increasing the chances of eliciting a local twitch response and possibly making this method more effective in deactivating a TrP than the static technique. Aim of Study: The aim of this study was to compare the effects of static myofascial dry needling to the effects of fanning myofascial dry needling of an active trigger point (TrP1) in the upper trapezius muscle in order to determine which of the two treatments is more effective with regards to decreasing neck pain and disability as well as increasing pressure pain threshold in patients with neck pain due to Trapezius Myofascial Pain Syndrome. Method: Forty participants underwent a general screening to determine whether they had active myofascial trigger points in the upper fibers of the trapezius muscle.

M.Tech. (Chiropractic) / Myofascial pain syndrome has become a significant cause of chronic pain and disability in today‟s society. Conditions causing chronic pain can not only cause disability due to pain, but can also lead to other problems such as psychological and behavioural disturbances. Physical deconditioning can also occur due to lack of exercise because of myofascial pain (Rachlin, 1994). The aim of this study was to compare dry needling therapy and ultrasound therapy in the treatment of myofascial trigger points in order to demonstrate any superiority between the two modalities. Participants for this study were recruited by word of mouth and advertisements that were placed around the University of Johannesburg Doornfontein Campus. Thirty people participated in the trial, all of whom conformed to the specific inclusion and exclusion criteria. The participants were randomly placed into two groups. Group A received dry needling therapy, namely the fanning technique, and Group B received ultrasound therapy. Participants in Group A received one treatment per week for four weeks and subjective and objective measurements were taken at each visit. Participants in Group B received two treatments per week for three weeks and measurements were taken at visits one, three, five and seven. Subjective data was obtained through the use of the Visual Analogue Pain Scale, which measured the perception of pain of the participants. Objective data was obtained from pressure algometer readings, which measured pain pressure thresholds of participants, and through the Cervical Range Of Motion (CROM) device. The results of this study indicated that dry needling therapy and ultrasound therapy both significantly benefited participants in terms of the treatment of active myofascial trigger points. Based on the final results, both dry needling therapy and ultrasound therapy are equally effective modalities in the treatment of active myofascial trigger points, with neither modality showing superiority over the other.

Sammanfattning För den dubbelstakande längdåkaren är överansträngda muskler ett pågående problem. På uppdrag av Johnny Nilsson – lektor vid Gymnastik och Idrottshögskolan (GIH) i Stockholm – har en prototyp tagits fram för att övervaka överansträngning hos musculus trapezius (m. trapezius) med hjälp av elektromyografi (EMG). Prototypen kravspecificerades och projektgruppen fick uppdraget att med fria händer utveckla en rörelsereferens med mål att validera var i rörelsen som längdåkaren överanstränger muskeln. För att bygga elektromyografen användes den öppna hårdvaran Arduino som med EMG-modul kunde samla in data genom ytelektroder fästa på m. trapezius. För att uppfylla de funktionskrav som ställdes på rörelsereferensen byggdes en elektrogoniometer där en vridpotentiometer fästes på armbågsleden och mätte dess flexions- och extensionsvinkel. Arduinon programmerades genom dess egen programmeringsmiljö och ett SD-kort installerades på mikrokontrollerkortet för insamling av rådata; efterbehandlingen och presentation av data skedde sedan i Matlab. Med hjälp av Peter Arfert vid medicinsk bildteknik KTH designades ett 3D-utskrivet hölje till EMG-prototypen. Slutligen fick projektgruppen möjlighet att besöka LIVI-laboratoriet i Falun där längdåkning utövades på rullband. Studiebesöket gjorde det möjligt att praktiskt utföra testförsök av prototypen i dess tilltänkta testmiljö och samla in rådata. / Overwork of muscle can be a problem for the double poling cross country skier potentially resultingin lower efficiency. An assignment was established – on behalf of Johnny Nilsson at Gymnastik- ochIdrottshögskolan (GIH) in Stockholm – in order to build a prototype able to monitor and record datafrom musculus trapezius (m. trapezius) through the use of electromyography (EMG). The EMG wasmade using the open source hardware Arduino. The prototype was able to record bilateralmeasurements with the use of EMG-shields, where surface-electrodes were attached to m. trapezius.By creating a prototype based on a rotary potentiometer attached to the elbow joint a reference ofmovement was established by measuring the extension and flexion angle of the elbow. Arduino’s ownIDE was used to program the hardware of the prototype and data was post-processed and presented inMatlab. Data was transferred with the use of an SD-card reader installed on the microcontroller. Withthe help of Peter Arfert at KTH, a 3D-printed model was made for the prototype. The final prototypewas attached to an elite level cross-country skier and tested on a professional treadmill at the LIVIlaboratory in Falun, Sweden. Raw-data was successfully recorded during these trials.

Title: Evaluation of EMG Activity of the Shoulder Girdle Muscles during Exercises with Thera-Band in Aquatic Environment and on Land. Objective: The main goal of this thesis is to determine a degree of muscle activity of upper trapezius muscle and other selected muscles in the aquatic environment and on land and to compare the values. Furthermore, to determine whether the upper trapezius muscle activates in the aquatic environment later than on land, compared to other selected muscles. Methods: This is the case of study, where the degree of muscle activity and the onset of activation of the upper trapezius muscle and other selected muscle is analyzed and then evaluated during shoulder abduction in two different environments using elastic resistance strength (yellow Thera-Band). As an objectification method surface electromyography had been chosen. To ensure the same set of initial conditions the abduction was performed in sitting position. The same chair was used in water and on land. Four female participants part in the experiment. Findings: The degree of muscle activity of upper trapezius muscle in the aquatic environment significantly decreased. It wasn't confirmed, that the upper trapezius muscle has been activated later in water than on land. Timing of selected muscles in aquatic environment...

Einleitung Funktionsstörungen der Schulter treten mit unterschiedlicher Häufigkeit nach Neck dissection auf. Die durchgeführten Studien untersuchten den Einfluss einer Trapeziusparese und einer Schädigung des Plexus cervicalis auf die Entstehung einer Schulterfunktionsstörung. Hierzu sollten neue Methoden zur Bewertung der Aktivität des Musculus trapezius entwickelt werden. Die genauen Auswirkungen auf die Lebenssituation des Patienten waren bisher unklar. Methode Zur Bewertung der Trapeziusfunktion wurde eine simultane Oberflächenlelektromyographie und Schulterhebekraftmessung durchgeführt. In Vorversuchen erfolgte die Entwicklung des Versuchsaufbaus. Wir verwendeten eine bipolare Ableitung des oberen und unteren Trapeziusanteils und eine isometrische Schulterhebekraftmessung bei 90° Abduktion. Es wurden frequenz- und amplitudenabhängige Merkmale bei rampenförmig ansteigender Schulterhebekraft berechnet (Root Mean Square, Mean Frequency, Mean Power Frequency, Frequenzverhältnis und Turnanalyse nach Willison). Die Datenanalyse erfolgte unter LabVIEW(r). Die Funktion des Plexus cervicalis wurde anhand einer semiquantitativen Erfassung der Oberflächensensibilität festgestellt. Die Auswirkung der Schulterfunktionsstörung auf die Lebenssituation des Patienten wurde mittels des Constant Murley Scores eingeschätzt. Ergebnisse Die erste Studie beinhaltete 90 Probanden und zeigte einen statistisch signifikanten Anstieg (p / Introduction Functional shoulder disorders after neck dissection have different incidences. The following studies investigated the influence of a trapezius muscle palsy and a damage of the cervical plexus on the frequency of painful shoulder complaints. The consequences for shoulder function and for daily life activities were not yet clear. Methods For assessment of the trapezius function a simultaneous surface electromyography and force measurement were performed. We used a bipolar electrode configuration and an increasing isometric contraction in 90° arm abduction. Frequency and amplitude based parameters (Root Mean Square, Mean Frequency, Mean Power Frequency, Frequency Ratio, Turn Analysis of Willison) were computed and analysed in LabVIEW(r). The cervical plexus function was determined by semiquantitative measurement of the cutaneous sensibility. Shoulder function and restriction in daily life activities were assessed by the Constant Murley Score. Results The first group included 90 probands and showed a statistical significant (p

Sammanfattning Titel: Finns det ett samband mellan bullernivå och spänning i m. trapezius? Bakgrund: Företaget Saint-Gobain Sekurit Scandinavia AB tillverkar bilglas. I deras arbetsmiljöarbete ingår konceptet Smart Workplace. En del av det arbetet behandlar belastningsergonomi och bullerexponering. Syfte: Syftet med examensarbetet var att se om det fanns en korrelation mellan minskat buller och minskad muskelspänning. Målet var att kunna påvisa om operatörer i det aktuella fallet ute i produktion fick minskad muskelaktivitet i m. trapezius eller inte, när bullernivån minskar. Dessutom undersöktes vilka åtgärdsmöjligheter som fanns, kopplat till Smart Workplace, för att minska bullerexponeringen. Teori: Sambandet mellan bullerexponering och spända muskler är relativt outforskat och få forskningsstudier har gjorts. Det finns dock visade samband mellan bullerexponering och hormoner, blodtryck samt hjärtfrekvens. Metod: Tretton operatörer som arbetade vid linje 5230 mättes med EMG-mätare på en nackmuskel på höger sida medan de drog höger hand längs övre kanten på ett bilglas. Arbetsplatsen valdes ut i samråd med företaget. Arbetsmomentet var likadant som operatörer normalt utförde på arbetsplatsen. Mätning utfördes i sex minuter, halva tiden utan hörselkåpor och halva tiden med hörselkåpor. I samband med EMG-mätningarna utfördes även ljudnivåmätning för att säkerställa att ljudnivån var densamma vid alla mätningar. Resultat: Resultatet visade att det inte gick att påvisa att minskad ljudtrycksnivå ger minskad muskeltonus. Däremot visade resultatet på de lägsta 10 % av RVE-värdena att det blev en skillnad om operatörerna hade hörselkåpor eller inte vilket betyder att det inte går att utesluta att det kan finnas ett samband mellan minskat buller och minskad muskeltonus. Den dagliga bullerexponeringsnivån på linje 5230 var 84,7 (± 4,2) dB(A). Kåporna dämpade mer än nödvändigt jämfört med den bullerexponering som operatörerna utsattes för. Diskussion: Felkällor som noterades var författarnas inverkan på operatören vid mätningen, svårigheter med EMG-utrustning, felaktig kalibrering, placering av EMG-elektroderna, underhudsfett och hudmotstånd samt avläsning av diagram. Vidare studier bör utforska området ytterligare då inte så många studier finns inom området. Intressant fokus hade varit mätning av muskelspänning under längre tid samt med högre bullerexponering. Slutsats: Denna studie kan inte påvisa att minskad ljudtrycksnivå ger minskad muskeltonus. Området kring linje 5230 hade en daglig bullerexponeringsnivå på 84,7 (± 4,2) dB(A) vilket innebär att åtgärder måste sättas in för att minska bullernivån både för att klara lagkraven men också för att nå målen med Smart Workplace. För framtida arbetsplatser på SG Sekurit Scandinavia är det avgörande att kraven på maximala bullernivåer finns med som ett kriterium vid upphandling. Om man inte klarar nivåerna för bullerexponeringen är det viktigt att beräkning enligt HML-metoden genomförs för att kunna välja rätt hörselskydd som ger korrekt dämpning. / Abstract Title: Is there a correlation between noise level and tension in m. trapezius? Background: The company Saint-Gobain Sekurit Scandinavia AB manufactures car glass. Their work environment improvement includes a concept called Smart Workplace. A part of that work contains ergonomics and noise exposure. Aim: The aim of this master thesis was to see if there was a correlation between reduced noise level and reduced muscle tension. The goal was to demonstrate if the operators in the studied environment in production got reduced muscle tension in m. trapezius or not, when the noise level was reduced. It was also investigated which possibilities for actions there was, according to Smart Workplace, to reduce noise exposure. Theory: The correlation between noise exposure and muscle tension is relatively unexplored. Few research studies have been done on this topic. However research has shown correlation between noise exposure and hormones, blood pressure and heart rate. Method: Thirteen operators who worked on the line 5230 were measured with EMG-equipment on a neck muscle on their right side while they moved the right hand over the upper side of a car glass. The workstation was chosen in consultation with the company and the work situation was the same as the one the operators performed in their normal work. The EMG-measurements took place during six minutes, half the time without earmuffs and half the time with earmuffs. In connection with the EMG-measurements the noise level was measured to ensure that the noise level was the same. Results: The results showed that there is no correlation between reduced noise level and decreased muscle tonus. However the result from the lowest 10 percent of the RVE-measurements showed a difference if the operators had earmuffs or not, which means that a correlation between reduced noise and reduced muscle tonus can`t be excluded. The daily noise exposure level at line 5230 was 84,7 (± 4,2) dB(A). The attenuation of the earmuffs was too high compared to the noise level the operators were exposed to. Discussion: Error sources was the writers influence on the operators during the measurements, difficulties with the equipment during the EMG-measurement, wrong calibration, the location for the EMG-electrodes, fat under the skin and resistance on the skin and reading of the diagram. Further studies should be done to investigate this topic more since there are few studies in this field. An interesting focus would be to measure during a longer period of time or with higher noise levels. Conclusion: This study cannot show that reduced noise level gives reduced muscle tension. The area around line 5230 had a daily noise exposure level of 84,7 (± 4,2) dB(A) which means that action must be taken to reduce the noise level both in order to fulfill legal requirements and also to reach the goals for Smart Workplace. For future workplaces at SG Sekurit Scandinavia it is crucial that the requirement for maximum noise level is a criteria from the start. If the company cannot meet the requirements on noise levels it is important that calculations are done according to the HML-method to be able to choose the right hearing protectors.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Dry needling (DN) fanning technique is an effective treatment for myofascial trigger points (MTP), however, it causes swelling and intramuscular haemorrhage which results in post-needling soreness (PNS). Kinesio ® taping space-correction-technique (KTSCT) is claimed to aid in reducing pain by decreasing inflammation, increasing circulation and lymphatic drainage. This in theory indicates that Kinesio ® taping could reduce/alleviate PNS pain after DN. Objective: The purpose of this study was to determine the effectiveness of KTSCT utilizing Kinesio ® Tex Gold tape in reducing the level of PNS associated with DN a trapezius muscle trigger point two. Method: Forty five patients with active trapezius muscle MTP two were randomly allocated into one of three treatment groups. All groups received a standardized DN treatment. Thereafter, group one received no further treatment and acted as the control group, group two received an application of KTSCT utilizing Kinesio ® Tex Gold tape, while group three received a non-proprioceptive hypoallergenic tape application. Assessments were made pre-, post-treatment and at a follow-up consultation on the following day once the taping application was removed. Assessments included numerical pain rating scale-101 (NRS-101), a pain diary and algometer readings. Results: Group three showed an improvement over the control group, however, it was not a statistically significant improvement in any of the assessments. Group two showed statistically significant improvement over the control in the pain diary and algometer readings overall. Results from the NRS-101, showed that group two had a statistically significant improvement when compared to the control group over the time interval when the Kinesio ® Tex Gold tape was applied to the patient. Conclusion: KTSCT utilizing Kinesio ® Tex Gold tape had a greater effect in reducing the level of PNS associated with DN a trapezius muscle trigger point two, when compared with either a non-proprioceptive hypoallergenic tape application or a control group.

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.

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