Faculty of Health Sciences
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Item 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, GrantBackground: 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.Item A study of the efficacy of manipulation as opposed to cryotherapy and manipulation in the treatment of tension-type headache(1997) Angus, Antony Keith; Parkin-Smith, G. F.The purpose of this investigation, was to determine what role cryotherapy plays in conjunction with manipulation headaches.Item 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 andItem The effect of a cooling cuff and moist ice pack on radial artery blood flow and lumen diameter(2014) Gernetzky, Joshua; O'Connor, Laura; Varatharajullu, DesireeBackground: When a soft tissue injury occurs the blood vessels and surrounding tissue are damaged leading to haemorrhaging and inflammation. Cryotherapy (cold therapy) is generally acknowledged as the preferable treatment by manual therapists during this immediate post-traumatic period of an injury. Cryotherapy has been shown to result in vasoconstriction decreasing the rate of blood flow which has a favourable effect on inflammation and pain. The commercially available cooling cuff is a relatively new cryotherapy modality offering a mechanism of cooling that does not require freezing and is easy to use. The polymer granules within the cooling cuff are activated by emersion in water therefore freezing is not required making the cooling cuff readily available compared to more traditional forms of cryotherapy. Aim: The aim of this study was to determine the effect of a moist ice pack and a commercially available cooling cuff radial artery blood flow (cm.s-1) and radial artery lumen diameter (mm) after 15 minutes of application. Method: This study was a pre-test post-test design utilising 43 asymptomatic participants that were randomly allocated to one of two groups. Each group either received a standard moist ice pack or a commercially available cooling cuff, placed on the ventral surface of the participants forearm, over the radial artery, for a duration of 15 minutes. Measurements were taken with a Doppler ultrasound to determine radial artery blood flow and lumen diameter, prior to the intervention and 15 minutes after the cryotherapy application. Data analysis was performed using IBM SPSS VERSION 20 (IBM Corp. Released 2010.IBM SPSS Statistics for Windows, Version 19.0. Armonk, New York: IBM Corp.). Statistical significance was set at a p< 0.05 level. Intra-group and inter-group comparisons were measured using repeated measures ANOVA testing. Results: Both the moist ice pack and commercially available cooling cuff resulted in a significant decrease in radial artery blood flow (p< 0.001) after 15 minutes of application with no significant changes being observed in radial artery diameter Conclusions: The commercially available cooling cuff resulted in a similar effect on radial artery blood flow and lumen diameter as moist ice, indicating that the commercially available cooling cuff may be utilised in the acute phase of an injury to alter blood flow.Item The effect of three different cooling gels on acute non-specific low back pain(2015) Prince, Cleo Kirsty; O'Connor, Laura; Gerber, DavidBackground: Cryotherapy is often the first option in treating acute conditions and can be applied in various forms including ice packs and cooling gels. Cooling gels are easy to use and readily available making them popular with consumers. They can also contain additional ingredients which can assist with inflammation, making them ideal for musculoskeletal disorders. A cooling gel containing menthol and anti-inflammatory herbs is available in pharmacies nationwide in South Africa, but has not been clinically investigated. This gel is often used in the treatment of acute injuries such as low back pain but its effectiveness in treating this condition has not yet been verified. Objectives: To determine the effectiveness of a menthol cooling gel combined with anti-inflammatory herbs compared to a menthol gel and a placebo gel in the treatment of acute non-specific low back pain. Method: A double-blinded placebo controlled clinical trial (n = 60) was conducted. Each participant was randomly allocated into one of three treatment groups consisting of a minimum of 20 participants between the ages of 18 and 40 who met the study criteria. Informed consent was obtained from the participants prior to their participation in the study. At the initial consultation baseline measurements (pain rating, disability and pressure pain threshold) were taken and the respective treatments (menthol with anti-inflammatory herb, menthol or placebo gel) were administered. Participants were instructed on how to apply the gel at home and were requested to apply it three times a day for one week. Statistical analysis was performed using repeated measures ANOVA for inter- and intra-group analysis with one way ANOVA and chi square tests being used to compare baseline values. A p-value < 0.05 was considered to be statistically significant. The study received ethical clearance from the Durban University of Technology Institutional Research Ethics Committee (REC 81/13). Results: No significant differences were observed between the groups at baseline assessment, indicating that the groups were comparable. Participants were instructed on how to apply the gel at home and were requested to apply it three times a day for one week. Follow up appointments for data collection was scheduled at days three or four and six. No statistically significant differences were observed between the three groups over time for pain (p = 0.95), disability (p = 0.903) or pressure-pain threshold (p = 0.824), with all groups showing improvement. All three groups showed clinically significant changes in pain from moderate to mild over the duration of the study but no clinically significant changes were noted in terms of pressure-pain threshold and disability. Conclusion: The results indicate that irrespective of whether or not the gel contains active ingredients there was an improvement in acute low back pain. Further research needs to be conducted to determine if tissue depth and the concentration of the active ingredients such as menthol are factors affecting the efficacy of this gel.Item The effectiveness of an ice pack, a menthol based cooling gel, a menthol based cooling gel with extracts and a placebo gel in the treatment of acute ankle sprain(2010) Harper, Shaun Michael; Wilson, Laura Maie; Gerber, DavidCryotherapy is commonly used to decrease pain, swelling and disability in acute injury. The most common form traditionally used is ice packs, with menthol based cooling gels being increasingly used by physicians in place of ice. More recently companies are experimenting with adding herbs containing anti-inflammatory properties to these menthol based gels to enhance their effectiveness. There is a paucity of literature comparing different forms of cryotherapy to one another, and more experiments are necessary to determine if cooling gels containing menthol and cooling gels with menthol and anti-inflammatory herbs are comparable to that of conventional ice pack cryotherapy. Objectives To determine the relative effectiveness of an ice pack, a menthol based gel, a menthol based gel with herbal extracts (combination gel) and placebo gel in the treatment of an acute grade 1 or 2 inversion ankle sprains, in terms of subjective and objective measurements. Any adverse reactions were also noted. Method A placebo controlled randomised, single blinded clinical trial (n=48) was conducted. Participants were randomly allocated into one of the four groups. Each group consisted of 12 people between the ages of 18 and 45. Each participant had a case history, physical and ankle examination prior to being accepted to ensure that they met the inclusion and exclusion criteria. On the initial consultation the respective treatments were administered and participants were instructed on how to apply the gel or ice pack, which they were required to utilise at home three times per day for 3 days. Those receiving the gels were blinded as to which gel they were receiving, all gels looked and smelt the same. On the 4th day the participants returned for data collection and were instructed to stop using the treatment and return 7 days later for further data collection. Statistical analysis consisted of repeated measures of ANOVA and Bonferroni post hoc tests, with a p-value of <0.05 considered statistically significant. Results Intra-group and inter-group analysis showed that all four groups had statistically significant improvements in terms of subjective and objective measurements. The results of the study demonstrated that the effects produced by the two cooling gels containing menthol, are comparable with those of conventional/traditional ice pack cryotherapy in the treatment of acute grade 1 or 2 inversion ankle sprains. No adverse reactions were reported. Conclusion This study found that all four treatment interventions were effective and safe in treating acute grade 1 and 2 inversion ankle sprains, however the ice pack and both cooling gel groups appear to statistically significantly improve treatment outcomes at a similarly higher rate when compared to the placebo gel group.Item The effect of cryotherapy on post dry needling soreness(2008) Chonan, Dheshini; Kretzmann, HeidiDry 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.Item 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 MariaDue 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.