The efficacy of progressive muscle relaxation in combination with spinal manipulative therapy on active trigger points of the trapezius muscle
- Authors: Brits, Michelle Charné
- Date: 2013-04-17
- Subjects: Myalgia - Chiropractic treatment , Progressive muscle relaxation therapy , Spinal adjustment , Trapezius muscle
- Type: Thesis
- Identifier: uj:7449 , http://hdl.handle.net/10210/8309
- Description: M.Tech. (Chiropractic) , Purpose: The trapezius muscle is thought to be the muscle most commonly associated with the presence of active myofascial trigger points (MFTP’s). Studies of the trapezius muscle clearly show that muscular activity significantly increases in response to psychological stress. Cervical spine manipulation has been proven to be highly effective in the treatment of active MFTP’s and muscular tension. Progressive muscle relaxation (PMR) therapy is frequently utilized as a relaxation technique in subjects complaining of increased levels of muscular tension, possibly due to an increased perception of psychological stress. Although cervical spine manipulation alone is effective in the treatment of active MFTP’s and muscular tension, chiropractors often search for adjunctive therapies to improve current treatment protocols. The purpose of this study was to determine whether the combination of cervical spine manipulation and PMR therapy is a more efficient, and possibly effective, treatment protocol for active MFTP’s of the trapezius muscle. Method: This study was a comparative study and consisted of two groups of fifteen participants each. All participants were between the ages of eighteen and thirty-five years of age, with a male to female ratio of 1:1. Potential participants were examined and accepted according to the inclusion and exclusion criteria. Group A received chiropractic spinal manipulative therapy of the cervical spine. Group B was the combination group and therefore received chiropractic spinal manipulative therapy of the cervical spine together with the application of PMR therapy. Subjective measurements consisted of a Perceived Stress Scale (PSS) Questionnaire, Visual Analog Pain Scale (VAS) and the Vernon-Mior Neck Pain and Disability Index Questionnaire. Objective measurements consisted of pressure pain threshold algometry readings taken from active trigger points one (TP1) and/or trigger point two (TP2) on the right and/or left side of the upper trapezius muscle.
- Full Text:
- Authors: Brits, Michelle Charné
- Date: 2013-04-17
- Subjects: Myalgia - Chiropractic treatment , Progressive muscle relaxation therapy , Spinal adjustment , Trapezius muscle
- Type: Thesis
- Identifier: uj:7449 , http://hdl.handle.net/10210/8309
- Description: M.Tech. (Chiropractic) , Purpose: The trapezius muscle is thought to be the muscle most commonly associated with the presence of active myofascial trigger points (MFTP’s). Studies of the trapezius muscle clearly show that muscular activity significantly increases in response to psychological stress. Cervical spine manipulation has been proven to be highly effective in the treatment of active MFTP’s and muscular tension. Progressive muscle relaxation (PMR) therapy is frequently utilized as a relaxation technique in subjects complaining of increased levels of muscular tension, possibly due to an increased perception of psychological stress. Although cervical spine manipulation alone is effective in the treatment of active MFTP’s and muscular tension, chiropractors often search for adjunctive therapies to improve current treatment protocols. The purpose of this study was to determine whether the combination of cervical spine manipulation and PMR therapy is a more efficient, and possibly effective, treatment protocol for active MFTP’s of the trapezius muscle. Method: This study was a comparative study and consisted of two groups of fifteen participants each. All participants were between the ages of eighteen and thirty-five years of age, with a male to female ratio of 1:1. Potential participants were examined and accepted according to the inclusion and exclusion criteria. Group A received chiropractic spinal manipulative therapy of the cervical spine. Group B was the combination group and therefore received chiropractic spinal manipulative therapy of the cervical spine together with the application of PMR therapy. Subjective measurements consisted of a Perceived Stress Scale (PSS) Questionnaire, Visual Analog Pain Scale (VAS) and the Vernon-Mior Neck Pain and Disability Index Questionnaire. Objective measurements consisted of pressure pain threshold algometry readings taken from active trigger points one (TP1) and/or trigger point two (TP2) on the right and/or left side of the upper trapezius muscle.
- Full Text:
A study to determine the efficacy of cervicothoracic spinal adjustment therapy in the treatment of active trapezius muscle myofascial trigger point dysfunction
- Authors: Carlyle, Nadia
- Date: 2012-08-16
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Spinal adjustment
- Type: Thesis
- Identifier: uj:9518 , http://hdl.handle.net/10210/5947
- Description: M.Tech. , This study was conducted to investigate the efficacy of Chiropractic cervicothoracic spinal adjustment therapy in the treatment of active Trapezius myofascial trigger point dysfunction. Thirty participants were recruited and placed into one of two groups. Participants were between the ages of 18 and 30 years and selected based on the inclusion criteria being met. Participants had to present with active upper Trapezius trigger points and a restriction of the cervicothoracic junction. The experimental group received a Chiropractic adjustment to the cervicothoracic junction and the control group received detuned ultrasound as their respective treatments. The participants were treated six times over a 3-week period and measurements were taken on the first, fourth and seventh visits. A case history, physical examination and cervical regional examination were conducted at the first visit. Objective measurements included pressure algometry readings of Trapezius trigger points 1 and 2 and cervical spine goniometry readings. Subjective measurements included the Vernon Mior Pain Disability Index and the Numerical Pain Rating Scale. The results were interpreted by Statcon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, the experimental group improved significantly in both the objective and subjective measurements over the seven visits. The control group showed an increase in the objective measurements and a decrease in the subjective measurements over the seven visits. This was found to be statistically insignificant. This study concluded that a Chiropractic adjustment to the cervicothoracic junction is effective in the treatment of upper Trapezius trigger points
- Full Text:
- Authors: Carlyle, Nadia
- Date: 2012-08-16
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Spinal adjustment
- Type: Thesis
- Identifier: uj:9518 , http://hdl.handle.net/10210/5947
- Description: M.Tech. , This study was conducted to investigate the efficacy of Chiropractic cervicothoracic spinal adjustment therapy in the treatment of active Trapezius myofascial trigger point dysfunction. Thirty participants were recruited and placed into one of two groups. Participants were between the ages of 18 and 30 years and selected based on the inclusion criteria being met. Participants had to present with active upper Trapezius trigger points and a restriction of the cervicothoracic junction. The experimental group received a Chiropractic adjustment to the cervicothoracic junction and the control group received detuned ultrasound as their respective treatments. The participants were treated six times over a 3-week period and measurements were taken on the first, fourth and seventh visits. A case history, physical examination and cervical regional examination were conducted at the first visit. Objective measurements included pressure algometry readings of Trapezius trigger points 1 and 2 and cervical spine goniometry readings. Subjective measurements included the Vernon Mior Pain Disability Index and the Numerical Pain Rating Scale. The results were interpreted by Statcon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, the experimental group improved significantly in both the objective and subjective measurements over the seven visits. The control group showed an increase in the objective measurements and a decrease in the subjective measurements over the seven visits. This was found to be statistically insignificant. This study concluded that a Chiropractic adjustment to the cervicothoracic junction is effective in the treatment of upper Trapezius trigger points
- Full Text:
A comparison between ultrasound therapy and dry needling in the treatment of active trapezius myofascial trigger points
- Authors: De Klerk, Anika
- Date: 2014-10-09
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Acupuncture , Ultrasonics in medicine
- Type: Thesis
- Identifier: uj:12571 , http://hdl.handle.net/10210/12362
- Description: 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.
- Full Text:
- Authors: De Klerk, Anika
- Date: 2014-10-09
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Acupuncture , Ultrasonics in medicine
- Type: Thesis
- Identifier: uj:12571 , http://hdl.handle.net/10210/12362
- Description: 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.
- Full Text:
Comparative study using impulse iQ® adjusting instrument versus PNF stretching of upper Trapezius muscle in treatment of chronic neck pain
- Authors: De Sousa, Raquel Freitas
- Date: 2020
- Subjects: Neck pain - Chiropractic treatment , Stretch (Physiology) , Trapezius muscle
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/457781 , uj:40634
- Description: Abstract: Background Purpose The primary aim of this research was to explore the effectiveness of Impulse iQ® Adjusting Instrument Therapy compared to PNF stretching of the upper trapezius muscle in the treatment of chronic neck pain. Method A group of 30 participants between the ages of 18 and 50 years of age, were selected to partake in this study, all of which were needed to present with chronic neck pain (neck pain for a period of 3 months or more) as well as associated active Myofascial trigger points TrP 1 or TrP 2 of the upper trapezius muscle either unilateral or bilateral. The participants were randomly allocated into two groups of 15 participants respectively. The first group was treated with Impulse iQ® Adjusting Instrument (IAI) Therapy on either TrP 1 and TrP 2 of upper trapezius muscle and the second group was treated with PNF stretching of either TrP 1 and TrP 2 of upper trapezius muscle. Each participant received 2 treatments per week during the 3 week trial period. The subjective and objective data collection was taken at the start of the trial, during the 4th visit and 7th visit. On the 7th visit only data collection was done, there were no treatments administered. The subjective measurements were performed by utilising a Numerical Rating Scale (NRS-11) to measure perceived pain. The objective measurements were performed by pressure algometer to measure pain pressure threshold (PPT) and by a easyangle goniometer to measure cervical range of motion (ROM). All the data was collected and interpreted by the researcher and the data was analysed by an assigned statistician from STATKON. Results Statistical analysis was performed using non-parametric tests including the Shapiro-Wilk test for normality. The Friedman and Wilcoxon Signed Rank tests were performed for intragroup analysis and the Mann- Whitney U test was performed for intergroup analysis. The statistical vi analysis showed a statistically significant difference for the intragroup analysis and no statistical significance for the intergroup analysis. Hence, no treatment protocol proved to be more superior to the other. Conclusion This study showed that both IAI and PNF stretching treatments were effective in treating chronic neck pain. , M.Tech. (Chiropractic)
- Full Text:
- Authors: De Sousa, Raquel Freitas
- Date: 2020
- Subjects: Neck pain - Chiropractic treatment , Stretch (Physiology) , Trapezius muscle
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/457781 , uj:40634
- Description: Abstract: Background Purpose The primary aim of this research was to explore the effectiveness of Impulse iQ® Adjusting Instrument Therapy compared to PNF stretching of the upper trapezius muscle in the treatment of chronic neck pain. Method A group of 30 participants between the ages of 18 and 50 years of age, were selected to partake in this study, all of which were needed to present with chronic neck pain (neck pain for a period of 3 months or more) as well as associated active Myofascial trigger points TrP 1 or TrP 2 of the upper trapezius muscle either unilateral or bilateral. The participants were randomly allocated into two groups of 15 participants respectively. The first group was treated with Impulse iQ® Adjusting Instrument (IAI) Therapy on either TrP 1 and TrP 2 of upper trapezius muscle and the second group was treated with PNF stretching of either TrP 1 and TrP 2 of upper trapezius muscle. Each participant received 2 treatments per week during the 3 week trial period. The subjective and objective data collection was taken at the start of the trial, during the 4th visit and 7th visit. On the 7th visit only data collection was done, there were no treatments administered. The subjective measurements were performed by utilising a Numerical Rating Scale (NRS-11) to measure perceived pain. The objective measurements were performed by pressure algometer to measure pain pressure threshold (PPT) and by a easyangle goniometer to measure cervical range of motion (ROM). All the data was collected and interpreted by the researcher and the data was analysed by an assigned statistician from STATKON. Results Statistical analysis was performed using non-parametric tests including the Shapiro-Wilk test for normality. The Friedman and Wilcoxon Signed Rank tests were performed for intragroup analysis and the Mann- Whitney U test was performed for intergroup analysis. The statistical vi analysis showed a statistically significant difference for the intragroup analysis and no statistical significance for the intergroup analysis. Hence, no treatment protocol proved to be more superior to the other. Conclusion This study showed that both IAI and PNF stretching treatments were effective in treating chronic neck pain. , M.Tech. (Chiropractic)
- Full Text:
The efficacy of chiropractic adjustments and PAIN®GONE therapy in the treatment of trapezius myofascial pain syndrome
- Authors: Edwards, Nicole Lauren
- Date: 2014-10-09
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Electric stimulation
- Type: Thesis
- Identifier: uj:12573 , http://hdl.handle.net/10210/12364
- Description: M.Tech. (Chiropractic) , Myofascial trigger points are very common and can become a painful part of most people’s life at one time or another. According to Travell and Simons (1999), active upper trapezius myofascial trigger points are common in patients presenting with neck pain. Myofascial pain syndrome is a regional muscle disorder that is one of the most common causes of persistent pain in the head, face and neck regions (Rachlin, 2002). The PAIN®GONE pen is a device that produces a high voltage, low frequency pulse for only a brief period of time. The electrical stimulation activates endorphins in the hypothalamus which plays a role in pain relief (Puskas, 2004). The technical system of the device is clinically proven and uses Transcutaneous Electric Nerve Stimulation (TENS), based on the pain gate control theory of Melzack and Wall (1965). The purpose of this study was to determine the efficacy of treating active upper trapezius trigger points with PAIN®GONE therapy combined with cervical spine chiropractic adjustments.This study consisted of two groups, the PAIN®GONE therapy group (Group 1) with fifteen participants and the placebo PAIN®GONE therapy group (Group 2) with fifteen participants. The participants were between the ages of 18 and 40 years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a case history, physical examination, cervical regional examination and upper trapezius muscle palpation to assess for upper trapezius myofascial trigger points. Treatment was applied to the cervical spine by Chiropractic adjustments, and to the upper active trapezius myofascial trigger points via PAIN®GONE therapy or placebo PAIN®GONE therapy, from which the subjective and objective data were based.Each participant was treated six times over a period of three weeks. Prior to the initiation of treatment, each participant was requested to complete a Vernon-Mior Neck Pain and Disability Index questionnaire and Numerical Pain Rating Scale. Algometer readings were obtained for the active upper trapezius myofascial trigger points. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion in flexion, extension, lateral flexion androtation. Both groups, received treatment to the active upper trapezius trigger points and Chiropractic adjustments to the cervical spine for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th and 7th final consultation...
- Full Text:
- Authors: Edwards, Nicole Lauren
- Date: 2014-10-09
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Electric stimulation
- Type: Thesis
- Identifier: uj:12573 , http://hdl.handle.net/10210/12364
- Description: M.Tech. (Chiropractic) , Myofascial trigger points are very common and can become a painful part of most people’s life at one time or another. According to Travell and Simons (1999), active upper trapezius myofascial trigger points are common in patients presenting with neck pain. Myofascial pain syndrome is a regional muscle disorder that is one of the most common causes of persistent pain in the head, face and neck regions (Rachlin, 2002). The PAIN®GONE pen is a device that produces a high voltage, low frequency pulse for only a brief period of time. The electrical stimulation activates endorphins in the hypothalamus which plays a role in pain relief (Puskas, 2004). The technical system of the device is clinically proven and uses Transcutaneous Electric Nerve Stimulation (TENS), based on the pain gate control theory of Melzack and Wall (1965). The purpose of this study was to determine the efficacy of treating active upper trapezius trigger points with PAIN®GONE therapy combined with cervical spine chiropractic adjustments.This study consisted of two groups, the PAIN®GONE therapy group (Group 1) with fifteen participants and the placebo PAIN®GONE therapy group (Group 2) with fifteen participants. The participants were between the ages of 18 and 40 years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a case history, physical examination, cervical regional examination and upper trapezius muscle palpation to assess for upper trapezius myofascial trigger points. Treatment was applied to the cervical spine by Chiropractic adjustments, and to the upper active trapezius myofascial trigger points via PAIN®GONE therapy or placebo PAIN®GONE therapy, from which the subjective and objective data were based.Each participant was treated six times over a period of three weeks. Prior to the initiation of treatment, each participant was requested to complete a Vernon-Mior Neck Pain and Disability Index questionnaire and Numerical Pain Rating Scale. Algometer readings were obtained for the active upper trapezius myofascial trigger points. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion in flexion, extension, lateral flexion androtation. Both groups, received treatment to the active upper trapezius trigger points and Chiropractic adjustments to the cervical spine for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th and 7th final consultation...
- Full Text:
Ischaemic compression versus laser therapy of an active upper trapezius myofascial trigger point in the management of acute mechanical cervical spine pain
- Authors: Fensham, Jessica Jane
- Date: 2013-04-17
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Lasers - Therapeutic use , Ischaemic compression , Trapezius muscle , Neck pain - Chiropractic treatment
- Type: Thesis
- Identifier: uj:7452 , http://hdl.handle.net/10210/8312
- Description: M.Tech. (Chiropractic) , Purpose: Patients presenting with mechanical cervical spine pain demonstrate myofascial trigger points of the surrounding cervical spine musculature (De Las Penas, Alonso-Blanco, Alguacil-Diego and Miangolarra-Page, 2006). Myofascial trigger points, from specifically the cervical spine musculature, have been seen to be involved to a large extent with not only the local mechanical cervical spine pain but also the accompanying referred pain patterns and symptoms (De Las Penas, Alonso-Blanco and Miangolarra-Page, 2007). The purpose of this study is to compare the efficacy of ischaemic compression and laser therapy respectively, applied to an active myofascial trigger point in participants with acute mechanical cervical spine pain associated with an active trapezius myofascial trigger point TP1, with regards to pain, activities of daily living, pressure pain threshold and cervical spine range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and the laser group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1. Treatment was applied to the active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each participant was treated six times over a period of two consecutive weeks. Prior to initiation of the treatment, each participant was requested to complete the Vernon-Mior Neck Pain and Disability Index questionnaire and the Visual Analogue Scale. Algometer readings were obtained over the trapezius myofascial trigger point 1, bilaterally. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion: flexion, extension, lateral flexion, and rotation. Ischaemic compression and laser therapy, group 1 and group 2 respectively, then each received treatment of the active trapezius myofascial trigger point 1, for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th, and at the 7th final consultation.
- Full Text:
- Authors: Fensham, Jessica Jane
- Date: 2013-04-17
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Lasers - Therapeutic use , Ischaemic compression , Trapezius muscle , Neck pain - Chiropractic treatment
- Type: Thesis
- Identifier: uj:7452 , http://hdl.handle.net/10210/8312
- Description: M.Tech. (Chiropractic) , Purpose: Patients presenting with mechanical cervical spine pain demonstrate myofascial trigger points of the surrounding cervical spine musculature (De Las Penas, Alonso-Blanco, Alguacil-Diego and Miangolarra-Page, 2006). Myofascial trigger points, from specifically the cervical spine musculature, have been seen to be involved to a large extent with not only the local mechanical cervical spine pain but also the accompanying referred pain patterns and symptoms (De Las Penas, Alonso-Blanco and Miangolarra-Page, 2007). The purpose of this study is to compare the efficacy of ischaemic compression and laser therapy respectively, applied to an active myofascial trigger point in participants with acute mechanical cervical spine pain associated with an active trapezius myofascial trigger point TP1, with regards to pain, activities of daily living, pressure pain threshold and cervical spine range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and the laser group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1. Treatment was applied to the active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each participant was treated six times over a period of two consecutive weeks. Prior to initiation of the treatment, each participant was requested to complete the Vernon-Mior Neck Pain and Disability Index questionnaire and the Visual Analogue Scale. Algometer readings were obtained over the trapezius myofascial trigger point 1, bilaterally. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion: flexion, extension, lateral flexion, and rotation. Ischaemic compression and laser therapy, group 1 and group 2 respectively, then each received treatment of the active trapezius myofascial trigger point 1, for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th, and at the 7th final consultation.
- Full Text:
Cervical spine manipulation and muscle energy technique in the treatment of upper trapezius myofascial pain
- Authors: Ferreira, Vicki
- Date: 2017
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Stretch (Physiology) , Spinal adjustment , Trapezius muscle
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/231366 , uj:23571
- Description: M.Tech. (Chiropractic) , Abstract: Purpose: The aim of this study was to compare the effects of muscle energy technique (MET) to chiropractic manipulations and a combination thereof with regards to pain, disability and range of motion of the cervical spine in the treatment of upper trapezius myofascial and associated neck pain. This was done by comparing MET, chiropractic manipulation and combination treatment groups. Short term and long term effects were measured to determine an appropriate treatment protocol for upper trapezius and associated neck pain. Method: Forty five (45) participants, between the ages of 18 and 55, with non-specific neck and muscle pain were invited to participate in the study. Once the cervical spine examination was performed and all the inclusion criteria were met with none of the exclusion criteria present, they were included in the study and randomly allocated into 3 groups. Group A received a chiropractic manipulation to the cervical spine, Group B received MET to the upper trapezius muscle and Group C received a combination treatment. Each participant was treated a total of six times over a two week period. The seventh visit served the purpose of obtaining the final measurements. The data was always collected before the treatment was administered. The objective data consisted of measuring the range of motion of the cervical spine with a CROM instrument as well as measuring the pain pressure threshold with a pressure algometer. The subjective data was collected using the Vernon-Mior neck pain and disability index. The objective data was gathered on the first, fourth and seventh visits and the subjective data on the first and seventh visits. Results: The results were interpreted by STATKON at the University of Johannesburg. All three groups improved significantly in the subjective and objective measurements over the two week trial period with regards to pain, disability and cervical range of motion. This indicated that all three treatment interventions were effective in the treatment of upper trapezius myofascial pain. These results also indicated that Group C (combination treatment of MET and chiropractic manipulation) was statistically superior to Group A (chiropractic manipulation) and Group B (MET) when cervical range of motion was considered as a whole. There was no statistical superiority between the three treatment groups with regards to pain pressure threshold values obtained, even though Group B reported a greater improvement over time. With regards to the subjective measurements, all three groups were equally effective in reducing the patient’s perceived pain and disability. Conclusion: The results of this study show that chiropractic manipulation, MET and a combination of chiropractic manipulation and MET are effective treatments in reducing pain and disability and have the ability to restore proper mechanical function by increasing cervical spine range of motion. There was no treatment protocol that was proven to be more effective than the other. Since a combination treatment of...
- Full Text:
- Authors: Ferreira, Vicki
- Date: 2017
- Subjects: Myofascial pain syndromes - Chiropractic treatment , Stretch (Physiology) , Spinal adjustment , Trapezius muscle
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/231366 , uj:23571
- Description: M.Tech. (Chiropractic) , Abstract: Purpose: The aim of this study was to compare the effects of muscle energy technique (MET) to chiropractic manipulations and a combination thereof with regards to pain, disability and range of motion of the cervical spine in the treatment of upper trapezius myofascial and associated neck pain. This was done by comparing MET, chiropractic manipulation and combination treatment groups. Short term and long term effects were measured to determine an appropriate treatment protocol for upper trapezius and associated neck pain. Method: Forty five (45) participants, between the ages of 18 and 55, with non-specific neck and muscle pain were invited to participate in the study. Once the cervical spine examination was performed and all the inclusion criteria were met with none of the exclusion criteria present, they were included in the study and randomly allocated into 3 groups. Group A received a chiropractic manipulation to the cervical spine, Group B received MET to the upper trapezius muscle and Group C received a combination treatment. Each participant was treated a total of six times over a two week period. The seventh visit served the purpose of obtaining the final measurements. The data was always collected before the treatment was administered. The objective data consisted of measuring the range of motion of the cervical spine with a CROM instrument as well as measuring the pain pressure threshold with a pressure algometer. The subjective data was collected using the Vernon-Mior neck pain and disability index. The objective data was gathered on the first, fourth and seventh visits and the subjective data on the first and seventh visits. Results: The results were interpreted by STATKON at the University of Johannesburg. All three groups improved significantly in the subjective and objective measurements over the two week trial period with regards to pain, disability and cervical range of motion. This indicated that all three treatment interventions were effective in the treatment of upper trapezius myofascial pain. These results also indicated that Group C (combination treatment of MET and chiropractic manipulation) was statistically superior to Group A (chiropractic manipulation) and Group B (MET) when cervical range of motion was considered as a whole. There was no statistical superiority between the three treatment groups with regards to pain pressure threshold values obtained, even though Group B reported a greater improvement over time. With regards to the subjective measurements, all three groups were equally effective in reducing the patient’s perceived pain and disability. Conclusion: The results of this study show that chiropractic manipulation, MET and a combination of chiropractic manipulation and MET are effective treatments in reducing pain and disability and have the ability to restore proper mechanical function by increasing cervical spine range of motion. There was no treatment protocol that was proven to be more effective than the other. Since a combination treatment of...
- Full Text:
Ischaemic compression compared to dry needling of trapezius myofascial trigger point 1
- Authors: Khorasani, Fatemeh
- Date: 2019
- Subjects: Ischemia , Trapezius muscle , Myofascial pain syndromes - Chiropractic treatment
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/292948 , uj:31844
- Description: Abstract: Purpose: Myofascial pain syndrome is one of the leading causes of chronic pain and imposes large financial costs to society. Myofascial trigger points are closely associated with the clinical manifestation of myofascial pain syndrome. Myofascial trigger points may be active or latent in presentation and may produce characteristic symptoms in terms of pain presentation. The constant use of computers to perform daily tasks has contributed to the development of musculoskeletal disorders. Bad posture while working with a computer leads to rounded shoulders and forward head position which potentially leads to the formation of the spasm-pain-spasm cycle, which, due to the decreased blood and oxygen supply and nutrients to the muscle, eventually leads to the formation of myofascial trigger points. The aim of this study is to compare the efficacy of ischaemic compression and dry needling applied individually to an active myofascial trigger point of the upper trapezius muscle (TP1) with regards to pain, disability, and cervical spinal range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and dry needling group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each group‟s participants were treated six times over a period of three weeks. The participants were measured using pressure algometer and cervical range of motion devices (CROM) for objective measurements and they completed Vernon-Mior Neck pain and disability index (VMNPDI) and a Numerical Pain Rating Scale (NPRS) for subjective measurements. Ischaemic compression and dry needling, group 1 and group 2 respectively, then each received treatment of active trapezius myofacial trigger point 1, for... , M.Tech. (Chiropractic)
- Full Text:
- Authors: Khorasani, Fatemeh
- Date: 2019
- Subjects: Ischemia , Trapezius muscle , Myofascial pain syndromes - Chiropractic treatment
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/292948 , uj:31844
- Description: Abstract: Purpose: Myofascial pain syndrome is one of the leading causes of chronic pain and imposes large financial costs to society. Myofascial trigger points are closely associated with the clinical manifestation of myofascial pain syndrome. Myofascial trigger points may be active or latent in presentation and may produce characteristic symptoms in terms of pain presentation. The constant use of computers to perform daily tasks has contributed to the development of musculoskeletal disorders. Bad posture while working with a computer leads to rounded shoulders and forward head position which potentially leads to the formation of the spasm-pain-spasm cycle, which, due to the decreased blood and oxygen supply and nutrients to the muscle, eventually leads to the formation of myofascial trigger points. The aim of this study is to compare the efficacy of ischaemic compression and dry needling applied individually to an active myofascial trigger point of the upper trapezius muscle (TP1) with regards to pain, disability, and cervical spinal range of motion. Method: This study consisted of two groups, the ischaemic compression group with fifteen participants and dry needling group with fifteen participants. The participants were between the ages of eighteen and forty-five years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a clinical case history, physical examination, cervical spine regional examination and upper trapezius muscle palpation to assess for an active trapezius myofascial trigger point 1 only, from which the subjective and objective results were based. Procedure: Each group‟s participants were treated six times over a period of three weeks. The participants were measured using pressure algometer and cervical range of motion devices (CROM) for objective measurements and they completed Vernon-Mior Neck pain and disability index (VMNPDI) and a Numerical Pain Rating Scale (NPRS) for subjective measurements. Ischaemic compression and dry needling, group 1 and group 2 respectively, then each received treatment of active trapezius myofacial trigger point 1, for... , M.Tech. (Chiropractic)
- Full Text:
The effect of Kinesio tape® on post dry needling soreness in the treatment of trapezius trigger point one
- Authors: Maruggi, Marco
- Date: 2014-04-23
- Subjects: Kinesio® taping , Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Acupuncture , Pain - Treatment , Bandages and bandaging
- Type: Thesis
- Identifier: uj:10842 , http://hdl.handle.net/10210/10349
- Description: M.Tech. (Chiropractic) , Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.
- Full Text:
- Authors: Maruggi, Marco
- Date: 2014-04-23
- Subjects: Kinesio® taping , Myofascial pain syndromes - Chiropractic treatment , Trapezius muscle , Acupuncture , Pain - Treatment , Bandages and bandaging
- Type: Thesis
- Identifier: uj:10842 , http://hdl.handle.net/10210/10349
- Description: M.Tech. (Chiropractic) , Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.
- Full Text:
Comparing the effectiveness of static myofascial dry needling versus fanning dry needling in the treatment of trapezius myofascial pain syndrome
- Authors: Palm, Bryan
- Date: 2012-10-16
- Subjects: Myofascial pain syndrome - Chiropractic treatment , Acupuncture , Trapezius muscle
- Type: Thesis
- Identifier: uj:10396 , http://hdl.handle.net/10210/7854
- Description: 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.
- Full Text:
- Authors: Palm, Bryan
- Date: 2012-10-16
- Subjects: Myofascial pain syndrome - Chiropractic treatment , Acupuncture , Trapezius muscle
- Type: Thesis
- Identifier: uj:10396 , http://hdl.handle.net/10210/7854
- Description: 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.
- Full Text:
Activator instrument versus dry needling of active upper trapezius myofascial trigger points in those with neck pain
- Authors: Siphuma, Winnie Mulalo
- Date: 2013-04-17
- Subjects: Myofascial pain syndromes- Chiropractic treatment , Dry needling therapy , Neck pain - Chiropractic treatment , Acupuncture , Trapezius muscle
- Type: Thesis
- Identifier: uj:7456 , http://hdl.handle.net/10210/8316
- Description: M.Tech. (Chiropractic) , Neck pain is a common and costly complaint in society and many are made to believe that their neck pain is caused by pinched nerve, compressed disk, arthritis or displaced cervical vertebrae, when in reality the pain may be solely due to referral from myofascial trigger points in overworked or traumatized muscles of their upper back and shoulders. Travel and Simons (1999) demonstrated trapezius muscle of the neck, back and shoulder as the main cause of mechanical neck pain and stiffness. The aim of this study was to compare the effects of trigger point therapy using an activator instrument versus myofascial dry needling in combination with cervical spine adjustment in the treatment of those with acute or chronic neck pain associated with active trigger point 1 (TrP 1) or trigger point 2 (TrP 2) of upper trapezius muscle, with regards to pain and disability, pressure pain threshold and cervical spine range of motion. The clinical study consisted of forty participants, from the ages of 18 and 45, randomly allocated into two groups of twenty individuals each. Potential participants were examined and accepted based on inclusion and exclusion criteria. Group 1 received activator trigger point therapy to upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine, and group 2 received myofascial dry needling of upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine. Participants were treated four times over a period of two weeks. Subjective data was collected using the Vernon-Mior Neck Pain and Disability Index and a Visual Analog Scale. Objective data was collected using an algometer to measure pressure pain threshold of trapezius TrPs muscles, and a goniometer to measure cervical spine range of motion. All data was collected at the first and third visits prior to treatment, and at the fifth visit. The statistical analysis was conducted using nonparametric tests. Friedman’s test was used to assess whether neck pain, disability, cervical spine range of motion and pressure pain threshold varied over the three time intervals. Wilcoxon Signed Ranks Pair test was used for assessment of comparability of the results in each group separately, and the Mann-Whitney U test was used for comparison of the accumulated data in the two groups.
- Full Text:
- Authors: Siphuma, Winnie Mulalo
- Date: 2013-04-17
- Subjects: Myofascial pain syndromes- Chiropractic treatment , Dry needling therapy , Neck pain - Chiropractic treatment , Acupuncture , Trapezius muscle
- Type: Thesis
- Identifier: uj:7456 , http://hdl.handle.net/10210/8316
- Description: M.Tech. (Chiropractic) , Neck pain is a common and costly complaint in society and many are made to believe that their neck pain is caused by pinched nerve, compressed disk, arthritis or displaced cervical vertebrae, when in reality the pain may be solely due to referral from myofascial trigger points in overworked or traumatized muscles of their upper back and shoulders. Travel and Simons (1999) demonstrated trapezius muscle of the neck, back and shoulder as the main cause of mechanical neck pain and stiffness. The aim of this study was to compare the effects of trigger point therapy using an activator instrument versus myofascial dry needling in combination with cervical spine adjustment in the treatment of those with acute or chronic neck pain associated with active trigger point 1 (TrP 1) or trigger point 2 (TrP 2) of upper trapezius muscle, with regards to pain and disability, pressure pain threshold and cervical spine range of motion. The clinical study consisted of forty participants, from the ages of 18 and 45, randomly allocated into two groups of twenty individuals each. Potential participants were examined and accepted based on inclusion and exclusion criteria. Group 1 received activator trigger point therapy to upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine, and group 2 received myofascial dry needling of upper trapezius TrP 1 or 2 with chiropractic adjustment to restricted segments of the cervical spine. Participants were treated four times over a period of two weeks. Subjective data was collected using the Vernon-Mior Neck Pain and Disability Index and a Visual Analog Scale. Objective data was collected using an algometer to measure pressure pain threshold of trapezius TrPs muscles, and a goniometer to measure cervical spine range of motion. All data was collected at the first and third visits prior to treatment, and at the fifth visit. The statistical analysis was conducted using nonparametric tests. Friedman’s test was used to assess whether neck pain, disability, cervical spine range of motion and pressure pain threshold varied over the three time intervals. Wilcoxon Signed Ranks Pair test was used for assessment of comparability of the results in each group separately, and the Mann-Whitney U test was used for comparison of the accumulated data in the two groups.
- Full Text:
The effect of cervical spine adjustment applied with ischaemic compression or low level laser therapy on an upper trapezius myofascial trigger point
- Authors: Van Wyngaardt, Louise
- Date: 2015
- Subjects: Trapezius muscle , Myofascial pain syndrome - Chiropractic treatment , Lasers - Therapeutic use , Neck pain - Chiropractic treatment
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/58203 , uj:16429
- Description: Abstract: Please refer to full text to view abstract , M.Tech. (Chiropractic)
- Full Text:
- Authors: Van Wyngaardt, Louise
- Date: 2015
- Subjects: Trapezius muscle , Myofascial pain syndrome - Chiropractic treatment , Lasers - Therapeutic use , Neck pain - Chiropractic treatment
- Language: English
- Type: Masters (Thesis)
- Identifier: http://hdl.handle.net/10210/58203 , uj:16429
- Description: Abstract: Please refer to full text to view abstract , M.Tech. (Chiropractic)
- Full Text:
- «
- ‹
- 1
- ›
- »