Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Modern surfing dates as far back as the 1960’s when the first amateur and professional surfing competitions were held (1). Since these humble beginnings, surfing has enjoyed a sustained growth over the last half a century, principally through increased commercialization of surfing apparel and an increased positive association with the lifestyle of surfers. Objectives: The aim of this study was to determine a retrospective cohort analysis of the injury profile of internationally competitive surfers and provide information on chronic, repetitive strain injuries suffered by them. Therefore, for the purpose of this study, the following information was gathered in order to create an injury profile: • Demographics of internationally competitive surfers competing in the Mr. Price Pro, Durban, South Africa, • Prevalence of surfing injuries, • Treatment received for injuries. Methods: This study was a retrospective, quantitative, epidemiological study (9), on the Chiropractic Student Sports Association’s (CSSA) questionnaire in order to produce a retrospective cohort analysis of the injury profile of internationally. On entry into the Chiropractic treatment facility, the surfer is requested to complete their portion of the CSSA questionnaire. Thereafter the senior intern then takes a brief case history, elaborating on the information provided by the surfer, followed by a standard clinical assessment related to the anatomical region or list of differential diagnoses based on the history. iv The study was limited to any surfer, male or female, who was competing on the World Championship Tour or the World Qualifying Series and registered to compete in the Mr. Price Pro. Results: Chronic injuries made up for 52.7% of surfing injuries, with the spine and surrounding musculature being the most commonly affected regions. Factors associated with injury were the repetitive nature of certain aspects of surfing and the age of the surfer. The findings in this study concurred with previous literature with the respect to sustaining of an injury related to surfing. However, many of the findings in this study differed to that of previous literature with respect to the common site of injury. The spine was the most common site of injury, as opposed to lower extremities as had been previously reported. The factors associated with injury also differed somewhat from previous literature. Therefore, this warrants further investigation with due consideration to the recommendations from this study.

Mini-dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is a prevalent condition and is the most common cause of lateral knee pain in long distance runners and cyclists. There are a significant number of aetiological factors related to ITBFS. As a result of this the general chiropractic approach to the treatment of ITBFS is multimodal and include interventions such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the available literature suggests that to determine its efficacy, it should be performed in isolation. The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are thought to co-exist and perpetuate one another. It is recommended that chiropractors include pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature showing its effectiveness in the treatment of this condition. There appears to be a need for further research in the form of randomized controlled clinical trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the sacroiliac joint manipulation and dry needling in the treatment of ITBFS. Objectives The study aimed to determine the comparative effectiveness of dry needling alone versus manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS. Methods This study was a randomised, open label trial. 47 participants with ITBFS were divided into three groups, each group receiving a different intervention i.e.: group one received dry needling of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac joint manipulation, group three received a combination of the two interventions. Subjective measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test as well as digital inclinometer readings of Modified Obers test, were utilised to determine the effects of the respective interventions. These measurements were recorded twice, once prior to commencing the treatment programme. These values were then evaluated to compare the efficacy of the different treatment interventions. Each participant received four treatments over a two week period. Results There were no statistically significant differences between the three treatment groups as they all seemed to parallel one another with regards to overall improvement in subjective and objective measurements (P<0.5). However on closer examination subtle differences between the groups were noted. An interesting endpoint is that the combination group did not fair the best throughout the study, which was contrary to the original hypothesis. The groups receiving only the single intervention appeared to fair marginally better over the combination group. A secondary endpoint that became evident during the study and on analysis of the data, was that hip joint instability must also be considered when treating ITBFS when there is concomitant sacroiliac joint dysfunction. Conclusion A decision needs to be made with regard to which intervention best suits the individual at the time. A combination therapy, which originally was thought to be the best treatment option, should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling should be decided upon. In totality, all intervention proved to be effective in the treatment of ITBFS.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Cryotherapy 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.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / BACKGROUND: Plain film radiography is the most common imaging technique requested by chiropractors to assist in the management of patients with musculoskeletal complaints. There is a paucity literature indicating that chiropractors’ interpretive radiographic skills are consistently able to achieve the same outcome given a particular set of radiographs. An important indication for the use of radiography in chiropractic is to exclude any possible contraindications to spinal manipulative therapy (SMT) that could cause serious injury to a patient if it is left unmodified or excluded as a treatment option. OBJECTIVES: The study aimed to investigate the inter- and intra-examiner reliability of chiropractor’s diagnosis on cervical spine radiographs. Additionally, the effect of clinical history added to the radiographs was assessed. METHODS: Inter- and intra-examiner evaluations occurred on two consecutive readings of 30 radiographs by six qualified chiropractors. No clinical history was given during Round One, but was available during Round Two. RESULTS: The inter-observer agreement for categorisation and management went from “poor agreement” in Round One (Κ=0.1962 and Κ=0.1996 respectively) to “fair agreement” (Κ= 0.2041 and Κ=0.2036 respectively) beyond that expected by chance in Round Two. Identification remained “fair agreement” beyond that expected by chance over both rounds (Κ=0.3113 and Κ=0.2159). Sensitivity at Round One was 94.4% and the specificity was 61.1%. At Round Two the sensitivity had decreased to 93.8% and the specificity had decreased to 50%. There was no significant difference between the accuracy of the Round One and Round Two results for categorisation (p=0.243) and management (p=0.220), but there was a clinical difference for identification (p=0.014). iii CONCLUSION: Differences in the result were small indicating clinical relevance with regards to inter-examiner reliability was fair in most instances. Although clinical history did not influence categorisation or management, it did improve accuracy of identification of pathology. Chiropractors successfully identified between 93.8% and 94.4% of abnormal radiographic findings demonstrating that chiropractors use of radiographs as a diagnostic tool when looking for contraindications to spinal manipulative therapy was sensitive. This demonstrates that its use as a diagnostic tool for contraindications to spinal manipulative therapy (SMT) is sensitive.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Attempts to determine the association between the radiographic and clinical findings of knee pathology have produced conflicting results. It is also not yet known how knee radiographs influence the conservative management of patients with knee pain. Objectives: 1. To determine the association between the clinical and radiographic diagnoses of knee pain. 2. To record the consultation at which a radiograph of the knee was requested by the student or clinician and the reasons thereof. 3. To record the suspected clinical diagnoses and management of the patients prior to referral for radiographs of the knee. 4. To determine the number of incidental radiographic findings in the selected radiographs. 5. To determine any change in the clinical diagnoses and management following radiographic reporting of the selected radiographs. Method: Radiographic and clinical data from 1 January 1997 to 31 December 2010 were retrospectively collected from knee radiographs and corresponding patient files from the archives of the Chiropractic Day Clinic (CDC). Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. Diagnoses were categorized into specific groups and to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine the association indicator variables were used. Results: The overall agreement between the clinical and radiographic diagnoses was 85.5%. For degenerative joint disease there was a 97.8% agreement while in Osgood Schlatter’s disease the agreement was 100%, and in chondromalacia patella the agreement was 50%. However, there was no agreement between the clinical and radiographic diagnoses for each of the other specific conditions. Degenerative changes were the most common radiographic findings. The iv majority of the knee radiographs were requested at the initial consultation and as the length of treatment increased, the frequency of radiograph requests decreased. The most common reasons for referral for radiographs were to identify degenerative changes (47.5%) and to assess for unspecified pathology (37.4%). Of the 146 patients in this study, 125 patients did not have a change in diagnosis after radiographs were obtained which means that 85.6% of the diagnoses remained the same after radiographic examination. There was a wide range of treatment modalities utilized in the management of patients with knee pain, including soft tissue therapy, electrotherapeutic modalities and manual therapy (manipulation and mobilization). The use of manual therapy increased from 67.8% prior to radiographs being taken to 82.9% after radiographs were obtained. Conclusion: Knee radiographs were over-utilized at the CDC and the findings on radiography did not have much influence on the diagnosis and the management of the patient presenting with knee pain. The majority of the clinical diagnoses were degenerative causes of knee pain. / Durban University of Technology Research Fund

No description available.

Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Ankle sprains are reportedly the most common lower limb injury amongst active individuals. Aim: The aim of this study was to investigate whether treatment interventions employed by physiotherapists during the first week of functional rehabilitation of an ankle sprain, at primary care level, were aligned with evidence-based guidelines for acute ankle sprains. Design: A descriptive cross-sectional study was conducted. Participants: A total of 91 physiotherapists from the Western Cape Metropole (WCM) completed questionnaires. Method: Physiotherapists' treatment interventions were recorded based on a case study of a typical moderately sprained ankle. According to classification of the West Point Ankle Grading System, a moderate sprain is a partial macroscopic tear of the ligaments with moderate pain, swelling and tenderness with some loss of motion and mild to moderate instability of the joint. Anticipated return to sport is two to six weeks. Relative occurrence of selected interventions during the first week of rehabilitation was calculated. Chi-square tests were used to compare differences between physiotherapists' responses and the recommendations of the practice guidelines. Results: Physiotherapists' overall selections of treatment interventions were in alignment with the "Koninklijk Nederlands Genootschap voor Fysiotherapie" (KNGF) guidelines and correlated positively to the recommendations stipulated by KNGF therein. Physiotherapists indicated many interventions for which good evidence exists: compression, cryotherapy, early mobilisation, and neuromuscular exercises. It is of concern that 49% – 91% (n = 91) physiotherapists indicated some form of manual mobilisations for which there is a lack of evidence, and more than two-thirds indicated the application of an electrotherapy intervention, which is not recommended in the guidelines. Conclusion: Physiotherapists should reconsider interventions for which there is no evidence as this may reduce cost of care, without compromising patient outcomes. / AFRIKAANSE OPSOMMING: Verslae dui daarop dat verstuite enkels die mees algemene besering van die onderste ledemaat van aktiewe persone is. Doelwit: Die doel van hierdie ondersoek was om vas te stel of fisioterapeute in primere gesondheidsorg se keuse van rehabilitasie tegnieke gedurende die eerste week van funksionele rehabilitasie na 'n enkel besering, op koers is met bewysgebaseerde kliniese riglyne in die hantering van akute enkel beserings. Ontwerp: 'n Beskrywende deursnit ondersoek is geloods. Deelnemers: 'n Vooraf opgestelde vraelys is deur 91 fisioterapeute in die Weskaapse metropool voltooi. Metodiek: 'n Gevalle studie is aangebied van 'n tipiese matige verstuite enkel. Die respondent moes hulle tegnieke in die hantering van die geval aandui. Volgens die klassifikasie van die “West Point Grading System” word so 'n verstuiting gekenmerk deur makroskopiese gedeeltelike skeur van die enkel ligamente, matige pyn, swelsel en tasteerheid van die area. Dit gaan gepaard met 'n effense verlies van beweging en stabiliteit van die gewrig. Die prognose vir so 'n besering om na sport terug te keer is om en by twee tot ses weke. Die insidensie van aanwending van geselekteerde metodes van behandeling gedurende die eerste week en die verhouding met die vooraf geselekteerde behandelings riglyne opgestel deur die “Koninklijk Nederlands Genootschap voor Fysiotherapie” (KNGF) is bereken en ontleed. Die “Chi-square” toets is gebruik om die verskil te bereken tussen die respons van die Fisioterapeute en die aanbevelings van die kliniese riglyne. Resultate: Oorkoepelend is die keuses van behandelings tegnieke deur die fisioterapeute in lyn met die riglyne van die 'Koninklijk Nederlands Genootschap voor Fysiotherapie' (KNGF). Verskeie sinvolle behandelings is gekies waarvoor daar positiewe aanduidings was, byvoorbeeld: lokale kompressie, ys terapie, en oefeninge. Dit is egter kommerwekkend dat 49 – 91% (n=91) van die deelnemers 'n manuele tegniek ingesluit het waar daar tans gebrekkige aanduidings voor bestaan. Verder, het meer as twee derdes van die fisioterapeute aangedui dat hulle elektroterapie sou gebruik wat nie in riglyne aanbeveel word nie. Gevolgtrekking: Fisioterapeute moet die gebruik van tegnieke waarvoor daar nie duidelike bewyse in die literatuur bestaan nie, heroorweeg, want dit mag die koste van behandeling verminder, sonder om die positiewe resultate van herstel, negatief te beinvloed.

published_or_final_version / Pharmacology / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Anatomy / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / Anatomy / Doctoral / Doctor of Philosophy