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The effectiveness of transcutaneous electrical nerve stimulation on adhesive capsulitis : a systematic review
(2025-09-29) Goorchuran, Genista; Chiliza, B.; Van der Meulen , A.
Background: Adhesive capsulitis, commonly known as frozen shoulder, is a common condition associated with pain, stiffness and reduced mobility. The pathology affects between 2 to 8% of the general population, primarily females aged 40 years and older. Patients diagnosed with diabetes mellitus, hypothyroidism and cardiovascular disease carry a higher risk of the development of adhesive capsulitis. Transcutaneous electrical stimulation (TENS) is a conservative treatment option, the evidence supporting its effectiveness remains inconsistent and varied in methodological quality. Therefore, this systematic review aimed to critically appraise the available literature and summarise the evidence to determine the level of support of the use of TENS in the management of adhesive capsulitis. Methods: The researcher searched eight electronic databases (Google Scholar, CINAHL, Cochrane databases, Cochrane review databases, PubMed, and SCOPUS). The search terms used were namely, “adhesive capsulitis”, “shoulder adhesive capsulitis”, “frozen shoulder”, “shoulder pain”, “transcutaneous electrical nerve stimulation”, “TENS” and “electrical stimulation”. The inclusion criteria included randomised controlled trials (RCTs), non-randomised controlled trials (nRCTs), and observational studies focused on adhesive capsulitis following the use of TENS as a part of the intervention. The citations and abstracts were filtered based on the relevance to keywords and the full text articles identified based on the inclusion criteria. The final list of articles was reviewed by seven reviewers using PEDro, Newcastle Ottawa and the Liddle Scales (the scales used to evaluate the articles were based on the study design), to establish the methodological rigor of the studies. Once the data collection concluded (viz., full text articles), each article was screened and reviewed by the reviewers. Therefore, the article was evaluated based on the outlined criteria, specified scales, and the limitations of the study reported. The primary outcomes were the effectiveness of TENS in the management of adhesive capsulitis either as a single treatment and/or in combination with other modalities. The data was summarised and presented in tables, illustrating the data found. Results: The initial database search yielded 4 282 studies (after 148 duplicated articles were removed), of which 23 articles fulfilled the eligibility criteria for inclusion in this systematic review. The studies provided mixed results specifically, with only one study utilized TENS as a single treatment modality, while the majority (n=22) examined TENS as part of a multimodal treatment approach. In addition, one study did not specify whether the evidence was related to TENS as the intervention was broadly described as electrical stimulation. The included studies reported improvements in pain, shoulder range of motion and functional outcomes following the interventions that incorporated TENS. However, these improvements were noted when TENS was used in combination with other treatment interventions, rather than a standalone treatment. There is limited evidence supporting the use of TENS as a single modality in the management of adhesive capsulitis, whereas the evidence supporting the use of TENS in combination therapy was deemed favourable, but the evidence was limited in respect to the contribution of TENS in the multimodal protocols. Conclusion: The evidence in support of combination therapy with the addition on TENS in the management of adhesive capsulitis was favourable as participants reported improvements in terms of pain, range of motion and in some cases functionality. Considering the current evidence, it is recommended that future studies investigate the use of TENS in combination therapy and its long-term efficacy.
Exploring the perceptions of chiropractors in the eThekwini municipality on the role of chiropractic care in the management of post-surgical lumbar pain
(2026-01-23) Fourie, Johan Carel; Abdul-Rasheed, Ashura; Padayachy , Keseri
BACKGROUND Lumbar pain is the leading cause of disability worldwide with an increasing prevalence. There are several interventions for lumbar pain, with surgery usually considered as the last resort. Chiropractic treatment is an intervention associated with management of spine pain; therefore, it stands to reason that chiropractors would encounter patients suffering from post-surgical lumbar pain in practice. The perceptions of chiropractors on the role of chiropractic management in post-surgical lumbar pain (PSLP) can therefore assist further development in this field. AIM This study aimed to explore the perceptions chiropractors in the eThekwini municipality have about their role in the management of patients who suffer from post surgical lumbar pain. METHODOLOGY A qualitative, exploratory and descriptive design, utilising the linear snowball sampling technique, was used. Individual, semi-structured interviews were conducted with 12 qualified chiropractors in the eThekwini municipality of KwaZulu-Natal in South Africa. The interviews were recorded, transcribed and then analysed. RESULTS Four main themes were extracted: informed and competent understanding of PSLP, shared recognition of the chiropractor’s role and utilisation in post-surgical lumbar spine care, shared perceptions of the therapeutic value of chiropractic treatment for managing PSLP, and uniform practice patterns and challenges in post-surgical lumbar spine management. CONCLUSION Chiropractors believe that, chiropractic care plays a role in restoring movement, improving function and reducing pain in the management of PSLP through the application of various modalities available to them within their wides scope of practice.
An epidemiological study of Medial Tibial Stress Syndrome Type II in club hockey players in the eThekwini Municipality
(2026-01-26) Blackburn, Jonathan; Pillay , Julian David; Ally, Fazila
Background: Field hockey is a high intensity sport that exposes players to intrinsic, extrinsic, and overuse injuries. An overuse injury that appears to be neglected in field hockey epidemiological research is Medial Tibial Stress Syndrome (MTSS TII). Objectives: This study aimed to determine the self-reported prevalence of MTSS TII in club hockey players within the eThekwini Municipality, any potential contributing possible risk factors that may contribute to its development, and identify the treatment-seeking strategies employed by these players. Methods: A quantitative, cross-sectional study was conducted to determine the prevalence and potential risk factors of MTSS TII among club hockey players in the eThekwini Municipality, KwaZulu-Natal, South Africa. An online self-administered questionnaire was distributed via the Durban Hockey Association to registered adult players (older than 18 years old) competing for clubs within the municipality. The questionnaire explored the demographics, potential risk factors contributing to MTSS TII, a MTSS TII assessment tool, MTSS TII history and education, and management of the condition. Results: Among the 137 participants, 10.9% (n=15) were self-diagnosed with MTSS TII. A higher prevalence of MTSS TII was found in women (60%) compared to men. A significant association was found between MTSS TII and duration of shoe use (Fisher’s exact test = 12.328, p=0.007), with 40% of those with MTSS TII used their hockey shoes for less than six months compared to 9% of those without MTSS TII. A total of 55 participants (40.1%) had a history of MTSS TII or had been diagnosed by a licenced practitioner. Physiotherapy was the most frequently consulted medical service (85%), with stretching (88.9%), massage (88.9%), and strapping (74.1%) reported as the most frequently used treatments. Notably, only 13.1% of participants reported receiving any education about MTSS TII from coaches or team staff (p<0.01). Discussion and conclusions: MTSS TII is a relatively common occurrence in field hockey players, particularly among women. This study clarifies the prevalence, potential risk factors, education, and management of MTSS TII in field hockey players. The results of this study, particularly the high percentage of players with a history of shin splints, indicate the need for injury prevention strategies.
The immediate effect of long-axis talocrural manipulation and sham laser on sagittal motion of the ankle joint and bowling speed of club cricket pace bowlers in the eThekwini Municipality
(2025-12-15) Vermaak, Jason; Currie, Shereen; Shaik, Junaid
Purpose: The purpose of this study was to determine the immediate effect of talocrural long-axis manipulation and sham laser on sagittal ankle motion and bowling speed in club cricket pace bowlers in the eThekwini Municipality. Method: Fifty-four club-level pace bowlers were randomly assigned into two equal groups, Groups A and B (n = 27 each). Participants in Group A received a talocrural long-axis manipulation (TLAM) intervention, while participants in Group B received a sham laser intervention (placebo). All participants bowled six maximum-effort deliveries both before and after the intervention. Bowling speed (km·h⁻¹) was measured using a SpeedTrac X Radar Gun (EMG Companies Inc., Prescott, USA). Both front and back foot ankle sagittal range of motion (ROM) (°), namely, dorsiflexion and plantarflexion, were assessed using an analogue goniometer (Hitech Therapy, Durban, South Africa). For each participant, the mean of the three fastest deliveries was recorded for the pre- and post-intervention. Data were analysed using SPSS version 31. Paired sample t-tests were used to compare pre- and post-intervention means for ankle sagittal motion and bowling speed to determine statistical significance. To evaluate the collective influence of the intervention type (Group A: talocrural manipulation; Group B: sham laser) on changes in ankle joint ROM and bowling speed, with age as a covariate, a GLM multivariate analysis was conducted. A follow-up univariate ANOVA test was performed to determine which individual variables contributed to the overall intervention effect. The correlation between the ankle sagittal ROM and bowling speed was assessed using Spearman’s correlation. An alpha level of 0.05 was set to determine statistical significance; therefore, a p-value of <0.05 was considered statistically significant. Results: The mean ± standard deviation (SD) of the age of participants was 31.7 ± 8.0 years in Group A (intervention) and 32.8 ± 7.4 years in Group B (control). In the intervention group, front foot dorsiflexion improved significantly from 110.9° ± 5.7 to 101.9° ± 7.7 (-9.0°, 95% CI: −11.6 to −6.4, p < 0.001), and plantarflexion improved significantly from 152.9° ± 9.1 to 160.0° ± 7.3 (+7.1°, 95% CI: 4.5 to 9.9, p = 0.001). A smaller but significant improvement was also observed in back foot plantarflexion from 154.1° ± 8.2 to 155.8° ± 7 (+1.7°, 95% CI: 0.2 to 3.1, p = 0.025), with an insignificant improvement in back foot dorsiflexion (-1.3°, 95% CI: −3.3 to 0.6, p = 0.173). In contrast, no significant changes in front foot or back foot ROM were observed in the control group. Bowling speed in Group A increased significantly from 112.8 ± 12.5km·h⁻¹ to 118 ± 11.3km·h⁻¹ (+5.4km·h⁻¹, 95% CI: 2.6 to 8.3, p < 0.001). In contrast, no significant change in bowling speed was observed in Group B. A multivariate analysis confirmed that the intervention had a significant collective effect on ankle sagittal ROM and bowling speed (Pillai’s Trace = 0.488, F (5,47) = 9.0, p < 0.001, partial η² = 0.50), independent of age. A statistically significant, moderate negative correlation (r = -0.484, p = 0.049) was observed between increases in ankle dorsiflexion ROM and bowling speed in the intervention group. Conclusion: TLAM of the front foot resulted in a significant increase in ankle sagittal ROM and bowling speed in club-level cricket pace bowlers, with no adverse effects reported. This provides the first evidence that front foot ankle manipulation can improve a key performance metric in pace bowling, reinforcing the ankle’s crucial biomechanical role in generating bowling speed. These findings suggest that TLAM could support the performance enhancement of pace bowlers, offering a safe and non-invasive intervention that manual therapists can use within a cricket team. While improvements in ankle sagittal motion and bowling speed were observed, the effect of TLAM on other pace bowling performance metrics, such as accuracy and bounce, remains unexplored. Future research should explore these performance metrics, assess the combined impact of TLAM with upper body manipulation, and investigate the effect of TLAM in different population groups, such as female pace bowlers.
Evaluating the ratio of mature oocytes to immature oocytes in oocyte cohorts aspirated from HIV seropositive and HIV seronegative females post-controlled ovarian hyperstimulation
(2024-08) Ndlela, Nombuso Felicia; Prakaschandra, D. R.; Gabriel, E.
A woman’s reproductive potential can be threatened by disrupting normal oocyte development, often associated with advancing maternal age, chronic viral infections, medical conditions/interventions, pharmaceutical and recreational drugs, and an individual’s Body Mass Index (BMI). Often, these factors affect the outcomes of assisted reproductive techniques (ART); however, they are not always addressed well, especially in developing countries such as South Africa. Research Aim and Objectives: This study aimed to provide a comparative analysis of the mature and immature oocyte yields in oocyte cohorts obtained from HIV-infected females against HIV-uninfected women of reproductive age, post-controlled ovarian hyperstimulation (COH). Additionally, the study examined the potential influence of factors associated with HIV infection, infertility, and ART, such as age, BMI, viral load, CD4+ lymphocyte counts, antiretroviral medication intake, ovarian stimulation protocols, and ovulation trigger injections on oocyte maturation outcomes. Methodology: This study evaluated n=80 women aged between 18-39 years attending ART between 2021 and 2023. GnRH-Antagonist protocol (Cetrotide® antagonist) for COH was used on all patients, and the exogenous gonadotropins for follicular stimulation were initiated on day 2/3 of the menstrual cycle. Ovitrelle® at 250mcg or Lucrin® at 40IU or 80IU were the ovulation triggers used. The oocytes were aspirated 36 hours after administration of the ovulation trigger. Oocyte denudation and assessment were done 2 hours after the TVOA, after which insemination using the ICSI technique was conducted 2 hours after incubation. Only the mature (MII) oocytes were inseminated at Day 0/Day 1, the appearance of 2 pronuclei (PN) and 2-Polar bodies (PB) at 16-18hours signified successful fertilisation, and single embryo culture in one-step media (under oil) was carried out for the next 3-5 days in a benchtop incubator. Results: The means for MII oocytes (p-value= 0,264), MI oocytes (p-value= 0,352), and GV oocytes (p-value= 0,258) between the HIV-infected population and HIV uninfected controls showed no statistical differences (all p-values> 0.05). Furthermore, when the total population was matched by age, BMI, ovarian stimulation protocol, ovulation trigger injection, and serum AMH, outcomes (follicle number, oocyte retrieval rates, and MII oocyte number) were comparable (all p-values> 0.05). Age was, however, positively associated with the relationship between AMH, follicle number, and MII oocyte number in the entire population. In this study, the quantities of mature (MII) oocytes in oocyte cohorts from the HIV positive females against the HIV negative females were similar. Furthermore, there were no significant differences in ART outcomes between the two groups after matching patients by age, BMI, ovarian stimulation protocol, and ovulation trigger.