Most activities of daily living and numerous modes of physical activity incorporate some form of ambulation, of which the foot and ankle constitute the first link in the kinetic chain. A change in foot or ankle structure may therefore have subsequent effects on the superincumbent joints of the human body such as the knee, hip and lower back. Plantar pressure and impulse measurements can therefore provide greater insight into the mechanics of the foot under load-bearing conditions with regards to the areas and regions of the foot that exhibit the largest pressure values and impulse figures. Hence, it is of importance to establish normative data so as to obtain a frame of reference to identify those individuals that fall outside these norms and may exhibit a larger probability of injury. Aim and Objectives: The primary aim was to identify and compare the plantar pressure distribution patterns and impulse values of students of a South African university of different gender and race groups. To realise this aim two specific objectives were set. The first was to determine whether height, weight, body mass index (BMI), gender, race, and the level of physical activity were related to the pressure and impulse values obtained, and the second was to generate reference tables from the normative data gathered. Method: The RS Footscan system was used to measure the pressure and impulse values of the foot. The characteristics that were analysed were height, weight, body mass index and the level of physical activity of the participant and their respective association with plantar pressure and impulse values obtained. This information was then used to establish normative data. A quasi-experimental study design utilising convenience sampling was implemented as the intention was to investigate as single instance in as natural a manner as possible. Convenience sampling was used with predefined inclusion and exclusion criteria. A total of 180 participants were utilised in this study and were subdivided as follows: Gender: Males (n = 90); Females (n = 90); Race: African black (n = 60); white (n = 60) and coloured (n = 60). Each race group therefore comprised of 30 males and 30 females respectively. The anthropometric profile of participants was as follows: Age (S.D.) = 22.21 (S.D. ± 2.93) years; Height (S.D.) = 169.69 (S.D. ± 8.91) cm; Weight (S.D.) = 66.97 (S.D. ± 12.01) kg; BMI (S.D.) = 23.16 (S.D. ± 3.15) kg/m2. Participants were asked to complete a questionnaire prior to testing that would identify all exclusion criteria consisting of: the presence of foot pain or deformity, acute lower extremity trauma, lower extremity surgery, exhibited problems of performance including eye, ear or cognitive impairment, diabetes mellitus or other neurological neuropathy, or the use of walking aids. Anthropometric measurements were then taken for those participants that qualified for the study. Participants were required to perform approximately five warm-up trials to familiarise themselves with the testing equipment before testing commenced. A total of ten successful trails were subsequently recorded for each participant, with three footprints being recorded per trial on the pressure platform, thereby comprising 30 footprints (15 left foot and 15 right foot) per participant that were analysed regarding pressure and impulse values. The two-step gait initiation protocol was implemented which was proven to be a valid and reliable means of assessing gait. Participants were instructed to walk at a comfortable walking speed between 1.19 – 1.60 m/s to ensure conformity between all participants as between-trial gait velocities were proven to be significantly variable. The foot was subdivided into ten anatomical areas focusing on the great toe, lesser toes, metatarsal 1, metatarsal 2, metatarsal 3, metatarsal 4, metatarsal 5, midfoot, medial heel and lateral heel. These ten areas were then grouped into one of three regions, namely the forefoot region (great toe, lesser toes, and all five metatarsal head areas), midfoot region (midfoot area), and rearfoot/heel region (medial and lateral heel areas). Once all relevant data was gathered, corrected and analysed it was used to establish normative data tables pertaining to the various gender and race groups. Results: Of the ten individual pressure and impulse areas, the second and third metatarsal heads demonstrated the highest mean peak pressure and impulse values. Once grouped into one of the three regions, the heel region was ascribed with the largest impulse and pressure values. It was established that statistically and practically significant racial pressure differences were apparent in the left and right forefoot and midfoot regions, with black and coloured individuals yielding the highest values, whereas white participants yielded the lowest. The same was true with regards to impulse figures in that both statistical and practical significant levels were established in the forefoot and midfoot regions. Black and coloured participants exhibited larger impulse values than the white participants. The level of physical activity was found to be associated with both pressure and impulse values over the various regions of the foot. Black individuals that were largely inactive as well as moderately active coloured participants yielded the highest pressure and impulse values, which were found to be statistically and practically significant over the forefoot regions. Conversely, white participants of all physical activity levels as well as coloured participants of both low and high physical activity levels exhibited the lowest pressure values over the forefoot region, which were also found to be statistically and practically significant. The anthropometric variables of height, weight and BMI were found to relate statistically to pressure and impulse values under the various regions of the foot, but none were found to be of any practical significance (r < .30). Conclusion: It was clearly established that both gender and race specific differences existed regarding plantar pressure and impulse values of the normal foot. Plantar pressure and impulse values were also associated with the level of physical activity of the individual, thereby indicating that the level of physical activity could be a contributing factor to altered pressure and impulse values. Anthropometric variables such as height, weight and BMI could not solely account for the variances observed in pressure and impulse. Further research is required to determine whether pressure or impulse values above or below those obtained predispose an individual to injury and to contrast between various activity or sporting codes and the effect of these on plantar pressure and impulse figures. Finally, from the collected data one was able to establish reference tables for the specific gender and race groups for both plantar pressure and impulse values. This enables one to classify individuals based on the pressure and impulse values generated.

La manipulation vertébrale (MV) est l'une des options dans le traitement des douleurs d'origine neuromusculosquelettique. Ses indications ont été identifiées à partir de l'expérience des professionnels qui l'utilisent, ainsi que des études épidémiologiques autour de ses résultats cliniques. Cependant, son mécanisme d'action précis demeure à ce jour inexpliqué.La littérature scientifique sur ce sujet est incomplète, éparse et confuse. Certains auteurs et professionnels proposent des hypothèses des mécanismes d'action neurobiologiques et d'autres biomécaniques. De plus, l'étude de la douleur rend la situation difficile en raison de la complexité des situations cliniques et des traitements associés dont les patients bénéficient. C'est la raison pour laquelle l'objectif de cette thèse est d'étudier si la MV a un effet sur la douleur provoquée de manière expérimentale. Si tel est le cas, il importe de savoir s'il est systémique ou locorégional et dans cette dernière hypothèse, si ce résultat est le produit d'une action directe de la MV sur la douleur ou secondaire à une amélioration du mouvement. N'ayant pas trouvé d'étude englobant la problématique mixte des effets de la MV sur la douleur et le mouvement, nous avons procédé à deux revues systématiques et critiques de la littérature scientifique ; l'une a porté sur son effet sur la douleur et l'autre sur l'amplitude du mouvement des segments vertébraux. Dans la première, nous avons rassemblé 22 articles décrivant 43 essais cliniques montrant un effet hypoalgésique de la MV au niveau locorégional, mais les résultats diffèrent selon la manière dont la douleur a été provoquée. Nous n’avons pas pu tirer de conclusion sur l'action systémique de la MV du fait de la qualité des articles sur ce sujet. Quant à la revue de la littérature réalisée sur l'effet de la MV sur l'amplitude du mouvement, l'étude de 15 articles ne nous a pas permis de prouver l'efficacité de cette technique pour augmenter l'amplitude des mouvements segmentaires, malgré des limitations à prendre en considération, notamment le fait que ces études ont été réalisées sur des volontaires sains et non sur des patients avec une mobilité réduite. A partir de là, nous concluons que l'effet de la MV sur la douleur est plutôt direct, et défendons la thèse que l'hypoalgésie induite par la MV permet l'amélioration et la récupération de la fonction de mouvement, et non l'inverse.Cependant, même si nous répondons à nos questions de recherche, ces réponses demeurent partielles et le sujet reste à approfondir. Nos deux revues indiquent qu’il reste à clarifier : les mécanismes exacts des effets de la MV sur la douleur, la durée des effets, les rapports "dose/effet", l'identification des techniques les plus efficaces, ou encore, sur le ciblage plus fin des patients à traiter. Il en est de même en ce qui concerne l'étude de l'effet de la MV sur l'amplitude du mouvement, où il manque notamment des études réalisées sur des patients et des personnes présentant des mouvements limités. Des améliorations sont également à prévoir dans la coordination des chercheurs les rassemblant autour d'une politique de recherche partagée sur le long/moyen terme, et à partir d'un consensus méthodologique, particulièrement en termes de suivi des essais, d'unités de mesures, de précision des critères de qualité des essais, de promotion de méta-analyses, etc. Au total, si la MV semble avoir un effet direct sur la douleur, il n’en demeure pas moins que la connaissance détaillée de ses mécanismes et des modalités d'application dans la pratique clinique reste à approfondir, ce qui pourrait devenir un véritable enjeu pour la communauté des chercheurs, des enseignants et des cliniciens. / Spinal manipulative therapy (SMT) is one of the treatments used to reduce musculoskeletal pain. Some clinical studies have shown that it really has a pain reducing effect but the indications for when it should be used is mainly based on clinical experience and logic. Further, although SMT is widely used, the precise mechanisms of action that can explain how it works, are unknown.We noticed that the scientific literature on this subject is incomplete, scattered and confused. In relation to the mechanisms, some authors propose a number of neurobiological mechanisms (such as a direct reduction of pain) whereas others are convinced that the mode of action is biomechanical (such as improved range of motion). For this reason, when trying to find out if SMT has a pain reducing effect, a better alternative is to start with healthy people, provoke a pain experimentally, perform the SMT, and measure their pain, to see if it has improved with the “treatment”. If it would be possible to see if SMT does have a pure pain reducing effect, then it would be important to find out if this effect is only regional, in the area of the manipulation, or if this effect is systemic. Also, none of the authors who proposed the biomechanical theory offered any evidence that improved movement results in less pain, but then, the opposite pathway (reduce pain first, better movement after) has not been shown either, by these proponents of theories. For this reason we decided to study the already existing scientific literature in a critical and systematic fashion.Unfortunately, we did not find any study including the mixed problem of the effects of SMT on pain and movement, we therefore performed two systematic reviews of the scientific literature: one focused on its effect on experimental pain and the other on its effect on the range of motion (ROM) of the vertebral segments. In the first one, we collected 22 articles describing 43 trials showing an hypoalgesic effect of the locoregional level. Interestingly, the results differ depending on how the pain was provoked. We were not been able to reach a conclusion on the systemic action of the SMT because of the lack of quality of articles on this topic. Concerning the literature review on the effect of SMT on ROM, the review of 15 research articles did not allow us to « prove » the effectiveness of this technique to increase the range of segmental motion. There were some limitations with these studies, such as the fact that they had been performed in healthy volunteers and not in people with reduced mobility. In sum, we could conclude that the effect of SMT on pain has been clearly shown, which supports the hypothesis that the hypoalgesia induced by SMT allows the improvement and recovery of function of movement, and not the inverse. These results have been reported in our two scientific articles.However, even if we were able to obtain answers to our research questions, these answers are incomplete and the subject remains to be further explored. There are still questions that remain to be clarified, such as: What are the exact effects of SMT on pain mechanisms? How long does the effect remain ? Is there a " dose / effect "? Which are the most effective SMT techniques? and How should patients be best targeted for this treatment ? Does SMT have an effect on ROM on people with limited movement?Finally, a coordination of research is necessary to move forward more effectively. Researchers would need to gather around a shared policy in relation to the medium / long term research, and from a methodological consensus. In conclusion, SMT does seem to have a direct effect on pain. However, we need some more and detailed knowledge of the mechanisms and procedures before we can really apply this knowledge efficiently in clinical practice. No doubt, this could become an important issue for the community of researchers, teachers and clinicians.