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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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    The relative effectiveness of cryotherapy and moist heat in the treatment of myofascial pain syndromes
    (1998) Andersen, Martin Steenfeldt; Smith-Parkin, G.
    Myofasciitis IS a very common yet misunderstood problem. There are many treatments available yet there is no research to substantiate which of the many treatments available is the most effective (Travell and Simons 1983:6). The purpose of this study was to investigate the relative effectiveness of Cryotherapy versus moist heat in the treatment of myofasciitis of the shoulder girdle muscles. Patients for this comparative, randomized clinical trial were obtained by consecutive sampling. Any patient between eighteen and fifty-five presenting to the Chiropractic Clinic at Technikon Natal with neck pain, upper back pain or shoulder paIn was considered a potential candidate. Thirty patients underwent a screening process to assess their viability for the study. This screening procedure consisted of questions regarding the pattern of pain referral and of palpation of the relevant zones for muscle spasm, twitch responses, patient jump sign and/or referred palll. The thirty patients were randomly divided into two groups of fifteen. One group received cold and passive stretching and the other group received moist heat and passive stretching. Each patient was treated five times within a three week period. Thereafter a follow-up appointment was scheduled one month after the final treatment to assess the long term effects of the treatments . The subjective information was questionnaires: (1) the CMCC Neck Numerical Pain Rating Scale-l0l assessed us Ing three Disability Index, (2) the and (3) the Short Form McGill Pain Questionnaire. These three forms were used to subjectively assess vanaus aspects of the patient's pain. Patients were required to fill these forms out at the first and
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    The effect of heat therapy on post-dry needling soreness in the deltoid muscle of asymptomatic subjects
    (2011) Govender, Merissa; Docrat, Aadil
    Background: Myofascial Pain Syndrome is a condition characterized by the development of hyperirritable foci in muscle. Treatments include modalities such as cryotherapy, electrotherapy, ultrasound, ischeamic compression and dry-needling, the latter of which is reported to be the most effective. A side-effect of dry-needling is post-needling soreness which results from bleeding in the area of needle insertion. The application of heat as a therapy to an injured area has been reported to decrease pain by blocking nociceptors, decreasing muscle spasm, and increasing connective tissue extensibility. Objectives: To determine the relative effectiveness of heat therapy immediately after dry-needling versus dry-needling alone on post-needling soreness in the deltoid muscle of asymptomatic subjects. This was done in terms of subjective and objective clinical findings. Methodology: This study was designed as a randomised, parallel-controlled clinicaltrial. Thirty asymptomatic subjects were used. Each subject acted as their own control in that both the left and right arms of each subject were dry-needled. One of the arms received heat therapy after the dry-needling procedure while the other arm acted as a control. Algometer readings, a Numerical Pain Rating Scale-101 (NRS- 101) and a 24 Hour Pain Diary were used as assessment tools. Algometer and NRS-101 readings were taken before and after the dry-needling procedure and during the 24 hour follow up visit. Subjects used a 24 hour pain diary which was filled out at 3 hour intervals, to record the development of post-needling soreness. Independent samples t-test and Pearson’s chi square test were used to compare age and gender between the treatment groups. Repeated measures ANOVA testing was used to compare the effect of heat treatment with no heat treatment in the 60 arms over the three time periods of assessment for the outcomes which were 4 5 measured as continuous variables (NRS-101 and algometer). For binary outcomes such as the presence or absence of pain at any time point, Fisher’s exact tests were used to compare the heat treated with the control arms in the left and right arms separately. A p value of less than 0.05 was considered as statistically significant. Results: Both the objective and subjective measurements from the heat intervention and control groups revealed the development of post-needling soreness. There was a slight trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings which was however, not found to be statistically significant. Conclusion: Although the results of the study revealed no statistical evidence of a beneficial effect of heat therapy on objective or subjective findings clinical significance could not be excluded due to the observed trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings. Further investigation is recommended.
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    The effect of cryotherapy on post dry needling soreness
    (2008) Chonan, Dheshini; Kretzmann, Heidi
    Dry needling is the most effective way of treating Myofascial Pain Syndrome and appears to be as effective as an injection of an anaesthetic into myofascial trigger points. However the side effect common to both dry needling and the injection of an anaesthetic, is the development of post-needling soreness. Post-needling soreness results from bleeding at the area of needle insertion. The immediate application of cold to a needled area may decrease the severity of the cellular damage by restricting local bleeding. Cryotherapy can also decrease both nerve excitability and histamine release, which may result in decreased pain experienced by patients. The purpose of this study was to determine the effectiveness of cryotherapy on post dry needling soreness. Therefore a randomised, 2 group parallel controlled clinical trial was proposed to test this hypothesis. Sixty asymptomatic volunteer participants between 18 and 50 were randomly divided into two equal groups - group A (combination group) received dry needling in conjunction with a cold gel pack, and group B received dry needling only. Algometer readings, a Numerical Pain Rating Scale (NRS 101) and a 24 Hour Pain Diary were used as assessment tools. SPSS version 15 was used for data analysis (SPSS Inc. Chicago, Ill, USA). Baseline demographics and outcome measurements (NRS 101, Algometer readings and 24 Hour Pain Diaries) were compared between the two groups using Pearson’s chi square tests or Independent Samples t-tests as appropriate For the evaluation of the treatment effect for the NRS 101 and Algometer outcomes, repeated measures ANOVA procedure was used. Twenty four hour Pain Diaries by group interactions were reported for comparison of the treatment effect in the two treatment groups. The number of participants reporting pain at various time points post treatment were compared cross-sectionally by group with Pearson’s chi square tests. A Mann-Whitney U test was used to compare time points post treatment at which the worst pain was experienced between groups. The change in the presence of pain over time was recorded as either no change, an increase (from no pain to pain) or a decrease (from pain to no pain). This wascompared between treatment groups using the Pearson’s chi square test. Intragroup correlations between changes in outcome variables were achieved with Pearson’s correlation. P values of <0.05 were considered as statistically significant. The results of the study showed no evidence of a beneficial effect of cryotherapy on objective or subjective findings. Thus it can be concluded that cryotherapy as used in this study had no significant effect on reducing post dry needling soreness.
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    To investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles
    (2005) Francis, Romona; Korporaal, Charmaine Maria
    Due to sustained partial neck flexion when operating a computer terminal for prolonged periods and by holding a stooped posture being proposed aetiologies for hypertonic posterior cervical muscles and subsequent mechanical neck pain, subjects for this research study were chosen according to their occupation and had to sit at a desk for more the three hours and less than eight hours a day. The purpose of this study was to investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation combined with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles. This was a comparative, randomised, clinical trial consisting of two groups. Group A received proprioceptive neuromuscular facilitation (PNF) combined with heat therapy as their treatment protocol. Group B received proprioceptive neuromuscular facilitation combined with cryotherapy as their treatment protocol. Each group consisted of thirty people between the ages of 25 and 50 who were randomly allocated to their respective groups. It was hypothesized that the analgesic properties related to cryotherapy would result in the treatment group that received PNF stretching combined with cryotherapy yielding better results in terms of objective clinical findings. It was also hypothesized that the therapeutic effects of heat therapy would result in the treatment group receiving PNF stretching combined with heat therapy would yield better results in terms of subjective clinical findings and it is hypothesized that there is an association between the subjective and objective clinical findings between the cryotherapy and the heat therapy groups. The treatment regimen consisted of each participant receiving three treatments over a period of one week and then a one-week follow-up consultation. Subjective data monitored consisted of the Numerical Pain Rating Scale –101 (NRS-101) and the CMCC Neck Disability index. Objective data was collected using the Cervical Range of Motion goniometer (CROM) and the Algometer. At the end of all treatment protocols, statistical (quantitative) analysis was performed to determine whether one treatment protocol was more effective than the other. The analysis of the data collected showed that for all outcomes measured, either of the two treatments was effective overall. Trends suggested optimum treatments were dependent on the age of the patient. Age groups of 46-50 years old, 41-45 years old and the 31-35 years old responded best and improved the most with heat intervention, while age group of 36-40 years old responded best to the cryotherapy intervention. For the youngest age group of 25-30 years old, it did not make a difference whether they received heat therapy or cryotherapy as an intervention. It would seem that the older the patient the more effective the application of heat therapy as a result of the effect of heat therapy on the collagen and elastin fibers within the muscle and its fascia which allowed for increased and sustained improvement of the majority of the age groups represented in this study. Conversely it would seem that the cryotherapy group had only immediate and unsustained effects in the long term, which suggests that the cryotherapy had only a pain relieving function that allowed for the improvement of patients in the study, which when removed resulted in regression to the initial clinical syndrome severity. Most of the outcomes did not show a statistically significant interaction between time, age group and treatment group. The study was underpowered at the age group level, with only 12 subjects per age group. Further studies with a larger sample size in each of the age groups are needed in order to determine whether age is a definitive factor in one treatment being preferred over the other.