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    An analysis of the combined effects of swimming and overhead throwing on the shoulder complexes of male first division waterpolo players
    (2021-05-10) Gibb, Conor Beckett; Matkovich, Grant
    Background Abstract Waterpolo is often compared to other sports, mainly swimming and overhead throwing sports. Swimming favours a posture of glenohumeral internal rotation and horizontal adduction. Overhead throwing sports can characteristically cause posterior shoulder immobility with a loss in glenohumeral internal rotation and horizontal adduction. Based on the fact that waterpolo players combine both swimming and overhead throwing whilst playing and training, it is the purpose of this study to investigate the sport-specific characteristics of the shoulder complexes of waterpolo players in an effort to determine how these unique characteristics may relate to the development of overuse injuries. Aim The aim of this study is to compare the dominant and non-dominant shoulder complexes of male water polo players in terms of posture, range of motion and sport- specific overuse injuries in order to develop an understanding of the combined effects of swimming and overhead throwing on the shoulders of water polo players. Methods The study used an observational based research design and consisted of 33 male waterpolo players currently competing in the Kwa-Zulu Natal mens 1st division waterpolo league. Participants underwent a shoulder digital posture examination as well as a shoulder-complex physical examination consisting of range of motion and orthopaedic testing which was then compared between the dominant and non- dominant shoulders. Participants were assessed for the presence of rotator cuff injury, glenoid labrum and LHBT injury, and anterior glenohumeral instability using the following physical tests: Empty can test, painful arc test, external rotation resistance, Hawkins-Kennedy test, Neer test, Yergassons test, Biceps Load test II, and the apprehension-relocation-surprise test. Glenohumeral range of motion was assessed using manual goniometry to measure passive internal and external rotation and horizontal adduction. Statistical analysis was performed using IBM SPSS version 27 statistical analysis software. Paired tests were used to compare outcomes from the dominant and non-dominant shoulders of the participants. To compare the posture measurements, as well as injuries present between the dominant and non-dominant shoulders, McNemar’s chi square tests were used. To compare the Range of motion measurements between the dominant and non-dominant shoulders, paired t-tests were used. A p value < 0.05 was considered statistically significant. Results Forward head posture with rounded shoulders was extremely common, with 73% of the participants in this study displaying a bilateral forward shoulder position ranging from moderate to severe, and 45% of participants displaying a bilateral forward head posture ranging from mild to severe. Glenohumeral internal and external rotation ROM measurements showed no difference between sides. There was a borderline significant difference (p=0.05) in the horizontal adduction measurements, with the non- dominant side showing greater values. The only injury test that yielded significant results was the empty can test for supraspinatus injury that had a higher prevalence for being positive on the dominant side. Conclusion The results of this study suggest that water polo players are prone to the development of a bilaterally equal forward head posture with rounded shoulders and are susceptible to similar mechanisms of bilateral overuse injury as swimmers. In addition, the dominant shoulders of these athletes are susceptible to damage caused by the repetitive, traumatic forces experienced by the posterior cuff musculature and posterior glenohumeral joint capsuloligamentous structures during the follow-through and deceleration phases of overhead throwing, resulting in an increased risk of supraspinatus-specific rotator cuff injury and a loss of glenohumeral horizontal adduction that potentially increases the risk of glenoid labrum and LHBT injury.
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    The effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on shoulder impingement syndrome: a systematic review
    (2021-03-23) Maharaj, Shrishti; Korporaal, Charmaine Maria
    Background Shoulder impingement syndrome (SIS) is a common condition that causes pain and functional impairment in the shoulder. There have been various studies assessing methods of pain management in SIS, however, the knowledge around the association between transcutaneous electrical nerve stimulation (TENS) and SIS management has been found to be limited. A systematic review of the literature will provide healthcare providers and the public with an evidence-based summary of evidence regarding the effectiveness of TENS in treating SIS pain. Objective To systematically assess and review the methodological rigour of all available studies that have used TENS to treat SIS in order to provide evidence-based knowledge to either support or refute its use in clinical practice. Methods A literature search was conducted on electronic databases Google, Google scholar and DUT Summons (Pubmed, MEDLine, Mantis, ScienceDirect). The relevant key search words used at this stage of the study included the term “TENS” and each of the following: shoulder pain, frozen shoulder, calcific tendonitis, shoulder impingement syndrome, shoulder myofascial pain syndrome, brachial dysfunction, shoulder dysfunction and shoulder bursitis. It was identified that SIS would be the focus of this study and therefore, full-text articles relevant to SIS and TENS were included, based on the inclusion and exclusion criteria outlined in the study design. The final list of included articles was reviewed by a total of seven reviewers using either the PEDro and/or Newcastle-Ottawa scale, in order to establish the methodological rigour of the studies. Results During the data collection process that took place between August 2019 to January 2020, 106 articles were screened for eligibility. Patients included in these studies were adults who were required to have been diagnosed with SIS. These articles included randomized controlled trials (RCTs), non-RCT’s, case studies and case reports. The 106 articles were reduced to 20 articles meeting the inclusion criteria, consisting of 19 RCTs and 1 non-RCT. Following the conclusion of the data collection process, the articles collectively were divided into three groups. Screening and review of the articles were conducted by the three reviewers allocated to each group. Each article was then ranked according to the criteria outlined in the PEDro and/or Newcastle-Ottawa scale, and the limitations of each article were stated. Following this process, the findings of all articles were collated, with the results indicating that there is limited evidence to support the use of TENS in the management of SIS. Conclusion Even though TENS has been found to be effective in inducing pain relief in a variety of conditions, clinicians should use TENS with caution as the limited and conflicting evidence available does not advocate for its use (alone or in combination with other therapies) in treating SIS. Thus, there is a demand for more high-quality studies pertaining to TENS and SIS clinical subcategories. It is however recognised that the findings of this study may be limited to a specific time period and could be influenced by more recently published studies not included. Key words Shoulder pain, Frozen shoulder, Calcific tendonitis, Shoulder impingement syndrome, shoulder myofascial pain syndrome, Brachial dysfunction, shoulder dysfunction, shoulder bursitis, transcutaneous electrical nerve stimulation
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    The effect of low intensity laser therapy on post needling soreness in trigger point 2 of the upper trapezius muscle
    (2018) Dhai, Mishka; Docrat, Aadil; Ally, Fazila
    Introduction: Myofascial pain syndrome is a condition of collective sensory, motor and autonomic symptoms caused by myofascial trigger points, which are hyper-irritable foci in a muscle and palpated as a taut, tender, ropey band. There are many types of treatment for myofascial pain syndrome; dry needling is one of the most effective forms. Dry needling involves the insertion of a needle into the myofascial trigger points in order to break up the contractile elements and any somatic components that may contribute to trigger point hyperactivity, and to stimulate sensitive nerve ending in the area. Although therapeutic, an unpleasant side effect of dry needling is the post-needling soreness. Various modalities have been utilised to decrease post-needling soreness, such as ice, heat and action potential simulation, to mention a few, however no study has been conducted to date that documents low intensity laser therapy and its effect on post-needling soreness. This study therefore aimed to evaluate the effect of low intensity laser therapy on post-needling soreness in trigger point 2 of the upper trapezius muscle. Methodology: This study was designed as a randomised, controlled pre-test and post-test experimental trial. Forty participants were randomly allocated into two equal groups of 20 participants each. Group 1 received the needling and laser therapy; Group 2 received needling and placebo laser. Algometer and Numerical Pain Rating Scale 11 (NRS 11) readings were taken immediately before the dry needling procedure; after the laser or placebo laser therapy; and again, at the follow-up visit 24 hours later. Subjects used a 24- hour pain diary which was completed at three-hour intervals, to record any post-needling soreness. The NRS 11 scale was used immediately before the needling and again at the follow-up visit 24 hours later. Results: Statistical analysis was done using SPSS version 24.0 to conduct inferential and deductive statistics. A significance of p=0.05 was set. Baseline demographics and outcome measurements were compared between the two groups using t-tests or ANOVA where appropriate. An inter-group analysis revealed that objectively and subjectively all groups experienced some degree of post-needling soreness, which deceased significantly over time. This decrease of pain was not significantly related to the treatment group, and there is no evidence of the differential time effect with the treatment. An inter-group analysis yielded no statistically significant results regarding the effectiveness of the treatments received by the patients. This could be because of the small sample size or because low intensity laser therapy is not a useful intervention. Conclusion: The results from this study revealed that both treatment groups responded equally in the alleviation of pain. It can thus be concluded that low intensity laser therapy had no significant beneficial effects on post-needling soreness.
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    Knowledge and practices of myofascial pain syndrome of the temporomandibular joint by dentists in the Greater eThekwini region
    (2018) Van der Colff, Hyla; Pillay, Julian David; Docrat, Aadil
    BACKGROUND: Temporomandibular disorders (TMDs) affect up to fifteen percent of adults. It produces craniofacial pain of musculoskeletal structures within the head and neck. One particular cause of TMDs is said to be myofascial pain syndrome (MFPS), which according to various research papers, if not considered and/or assessed, the general cause of a patient’s pain could be disregarded and incorrect treatment offered. Numerous studies conducted internationally on dental management of temporomandibular joint disorder (TMJD) concluded that there is a significant gap in dentists’ education and training regarding the identification and management of MFPS. Upon reviewing the current literature available in South Africa, very little research existed on dentists’ knowledge and the management strategies that they utilised regarding MFPS in TMJD patients. OBJECTIVES: To determine the dentists’ knowledge regarding MFPS of the temporomandibular joint (TMJ). What assessment and treatment/management strategies they use, and whether they make use of referral networks and if the respondents’ demographics influence their knowledge, utilisation, perception and referral patterns. METHODOLOGY: The researcher developed a research questionnaire, which was validated by both an expert and a pilot study group. This questionnaire was then used as a research tool in this cross-sectional study. General dental practitioners from the Greater eThekwini Region received an invitation to participate. The questionnaire-based survey consisted of five sections: biographical profile of respondents; topic background; perception; knowledge; utilisation and management (including referral patterns) of MFPS. RESULTS: The majority of respondents did receive basic education in MFPS, with 76.9% reporting that they received undergraduate education and 57.7% indicating that they had attended post-graduate courses/talks on MFPS. There was a 100% response from dentists indicating their willingness to attend post-graduate courses/talks on MFPS. The results indicated that the respondents, who felt that their curriculum regarding MFPS was sufficient, were more knowledgeable and more competent in diagnosing and managing MFPS. Overall, the average score for knowledge was 65.17%. Clinical features (78.85%) and the perpetuating and relieving factors (72.11%) scored the highest while causes (58.06%) and differential diagnoses (51.16%) scored the lowest knowledge levels. Respondents mostly made use of allopathic medical fields, and not of alternative medical fields, however a high number of respondents (73.1%) indicated that they would consider chiropractic co–management of patients with MFPS. CONCLUSION: This study adds new information in the South African context regarding dentists’ understanding of the myofascial component of TMDs. It also provides the dental profession with information about the knowledge and practices related to MFPS as well as information regarding the strengths and weaknesses on its educational component. It is recommended that dentists receive additional training on differential diagnoses and causes. It is also recommended that the chiropractic profession take this opportunity to offer courses/talks on MFPS and join forces with the dentistry profession on how they can assist in managing patients with MFPS.
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    The effectiveness of a myofascial treatment protocol combined with cryotherapy compared to cryotherapy alone in the treatment of acute and subacute ankle sprains
    (2017) Kahere, Morris; Matkovich, Grant
    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.
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    The treatment of myofascial syndrome using transcutaneous electrical nerve stimulation (TENS) : a comparison between two types of electrode placements
    (1998) Hutchings, Tracey Ann; Mathews, Robert
    Myofascial syndrome is a very common condition which is frequently encountered at Chiropractic clinics. It is also a very complex condition and as such is a very frustrating one to treat effectively. Tens is resegnised as a clinically effective modality in the treatment of Myofascial syndrome, however guidelines with respect to the most effective electrode placements are lacking.
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    The relative effectiveness of chiropractic manipulation to the level of main segmental nerve supply as opposed to dry needling in the treatment of muscles with myofascial trigger points
    (2000) Pooke, Hayden Clyde; Jones, Andrew D.
    Myofascial trigger points are a common problem for patients as weJl as physicians. According to some authors Myofascial Pain Syndromes encompass the largest group of unrecognised and under-treated medical disorders. At present, needling techniques seem to be most effective in treating myofascial trigger points, however, many chiropractors claim that manipulation alone is sufficient for trigger point amelioration. The aim of this study was to determine the effectiveness of chiropractic manipulation to the level of main segmental nerve supply versus dry needling in the treatment of selected muscles with myofascial trigger points.
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    The relative effectiveness of laser versus dry needling in the treatment of myofasciitis
    (2000) Miller, Karen Janette; Kretzmann, Heidi
    This study compared the relative effectiveness of low intensity laser therapy as opposed to dry needling in the treatment of active myofascial trigger points. The purpose of this study was to determine the more effective method of treating active myofascial trigger points, in terms of subjective and objective clinical findings. This study was a comparative, uncontrolled, unblinded pilot study. It was also intended to expand upon the little understood pathophysiology and treatment of muscular pain, in both chiropractic and medical curricula (Gatterman 1990: 285).
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    The relative effectiveness of a home programme of ischaemic compression, sustained stretch and a combination of both for the treatment of myofascial trigger points in the upper trapezius musculature
    (2003) Thoresson, Marlon; Kruger, Brian
    The purpose of this study was to determine the relative effectiveness of a home programme of ischaemie compression, sustained stretch and a combination of the two, in terms of subjective and objective clinical findings for the treatment of Myofascial Pain Syndrome.
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    The relative effectiveness of proprioceptive neuromuscular facilitative stretching as compared to static stretching in the treatment of active myofascial trigger points
    (1999) MacDougall, Tarryn Clair; Nook, B. C.
    The purpose of this study is to determine the relative effectiveness of (Contract-Relax- Agonist-Contract) CRAC stretching, a component of Proprioceptive Neuromuscular facilitated (PNF) stretching, as opposed to static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. This was a randomised clinical trial consisting of two groups. Group A received static stretching as their treatment protocol and Group B received PNF (CRAC) as their treatment protocol. Each group consisted of fifteen people between the ages of 18 and 55 who were randomly allocated to their respective groups. It is hypothesised that PNF (CRAC) stretching would be relatively more effective than Static stretching in the treatment of active myofascial trigger points of the shoulder girdle and neck muscles. Subjects diagnosed with active myofascial trigger points in the Trapezius, Infraspinatus and Rhomboid muscles were included in the study. The treatment regime consisted of a course of five treatments spread over a period of two weeks and then a one - month follow up consultation. Subjective and objective measurements were taken at the first, fifth and follow up consultations. Subjective data consisted of the Short Form McGill Pain Questionnaire, the CMCC Neck Disability Index and the Numerical Pain Rating Scale -101. The objective data was collected by means of algometer and goniometer measurements. This data was used to perform statistical analysis using the non-parametric Wilcoxin signed-rank test and the Mann Whitney unpaired test to compare intra-group and intergroup data respectively, at a 95% confidence level. This study suggests that both static and PNF (CRAC) stretching are effective in the treatment of active myofascial trigger points. However there is no clinical statistical difference between these two treatments. Further studies with a larger sample size are needed to clearly evaluate the use of stretching in the treatment of active myofascial trigger points.