Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: Acute ankle sprains and chronic ankle instability syndrome (CAIS) may be managed effectively through conservative management approaches such as strapping. There are two main types of strapping viz. rigid tape which is used to stabilise the joint and limit joint motion and elastic tape which permits joint motion but provides dynamic support. Kinesio™ tape is becoming increasingly popular in the management of various conditions. It is reportedly beneficial in reducing pain, improving circulation, increasing proprioception and correcting muscle function. Due to claimed benefits of Kinesio™ tape, it should, in theory, be beneficial in the management of individuals with CAIS particularly in terms of reducing pain and improving proprioception. AIM: To investigate the effect of three types of strapping applied in the method described for the application of Kinesio™ tape in the management of CAIS. METHODS This study consisted of three groups of 15 participants (recruited through convenience sampling) with each group receiving a different tape (i.e. rigid, elastic or Kinesio™ tape), all three groups, however, received the same taping method which was the Kinesio™ tape functional correction application. After obtaining informed consent each participant underwent a case history, physical examination and a foot an ankle orthopaedic examination. Thereafter, baseline measurements of subjective pain rating (NRS-101), pain threshold (analogue algometer), ankle dorsiflexion, plantarflexion and inversion (analogue goniometer) and proprioception (Biodex Biosway portable balance system) were documented. Depending on the group, the particular tape was then applied and a follow up consultation was made for two to three days later where the tape was removed, measurements were reassessed and the tape was reapplied. At the final consultation three to four days later, the tape was removed and final measurements were assessed and documented. Statistical intra- (using Wilcoxon Signed Ranks Test) and inter-group (using the Mann-Whitney U-test) analyses of the data were performed due to a skewed distribution of the variables. Data was analysed using SPSS version 21.0 with the level of significance set at 0.05. RESULTS The mean (± SD) age of the participants was 24.8 (4.7) and there were 23 male participants in total. Intra-group analyses of subjective outcome measurements showed significant increases (p < 0.05) in subjective pain rating in all three groups across all consultations. Similarly, intra-group analyses of objective outcome measurements found significant increases (p < 0.05) in pain threshold and dorsiflexion range of motion in all three groups across all consultations. Plantarflexion and inversion range of motion also showed significant increases (p < 0.05) but these were not consistent across all consultations. Intra-group analyses of the sway index showed no significant improvements (p > 0.05) in Groups Two and Three across the three consultations. Only Group One showed significant increases during the eyes open foam surface (EOFoS) (p = 0.013) and eyes closed foam surface (ECFoS) (p = 0.047) test conditions between Consultations One and Two. Inter-group analyses of subjective outcome measurements showed no significant increases (p > 0.05) in subjective pain rating across each of the three consults in all three groups. Inter-group analyses of objective outcome measurements revealed a significant increase in pain threshold (p = 0.040) between Groups Two and Three at Consultation One. There was a significant increase in plantarflexion between Groups One and Three at Consultation Two (p = 0.021) and Consultation Three (p = 0.030). There were no other significant results amongst the three groups. CONCLUSION The results suggest that pain rating, pain threshold and ankle dorsiflexion would improve if taping is applied in the manner described for Kinesio™ tape irrespective of the type of taping used in the management of CAIS. The taping method did not result in a significant difference in proprioception. Further studies, with larger sample sizes are required to confirm the findings of this study and to determine the role of taping in the management of CAIS. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / To investigate the efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and II ankle inversion sprains. The researcher hypothesised that adjusting a symptomatic ankle, in terms of the above, would result in a more significant improvement than that of a placebo treatment / M

Electrical stimulation has long been used in the treatment of a variety of ailments. Its current uses range from muscle re-education and orthotic substitute to scoliosis management and edema control. I chose to study the effect of electrode polarity in high voltage electrogalvanic stimulation in the treatment of edema for several reasons. I had access to subjects because I was the only physical therapist at the Stockton Orthopedic Medical Group. High voltage electrogalvanic stimulation is a commonly used modality in treating edema (Brown, 1981). High voltage generators have a polarity switch, and the direction manual which accompanies the Electro-Med generator used by the Stockton Orthopedic Medical Group states that the negative pole should be used for edema reduction. (Instruction manual for high voltage Electrogalvanic Stimulator, 1977). However, the effect of electrode polarity on edema reduction has not been demonstrated, nor documented in the literature.

No description available.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 121 leaves / Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points.

Thesis (M.Tech.: Chiropractic)-Dept of Chiropractic, Durban Institute of Technology, 2005 x, 58, Annextures A-L, 20 leaves / An inversion ankle sprain can be defined as an injury caused by landing forcefully on an inverted, plantarflexed and internally rotated foot. This results in the fibres of the surrounding ligaments to become ruptured without disturbing the continuity of the ligament. Chronic stable ankle sprains was defined as the recurrent giving way of the ankle and there may be residual pain and swelling with no mechanical instability. According to literature, mechanisms involved in the development of chronic ankle sprains are: the lack of appropriate and early immobilization in severe cases, the development of scar tissue, lack of strengthening exercises or the development of hypermobility. Many treatments have been suggested to address these factors and would include: peripheral manipulation of the ankle joint, Muscle Energy Technique, muscle strengthening and stretching, proprioceptive training and deep transverse friction massage. Of the above mentioned treatments, Muscle Energy Technique has not been researched in a clinical setting for the treatment of chronic stable ankle inversion sprains. Therefore the purpose of this study was to investigate the relative effectiveness of Muscle Energy Technique compared to Manipulation in the treatment of chronic stable ankle inversion sprains.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / An inversion ankle sprain can be defined as an injury caused by landing forcefully on an inverted, plantarflexed and internally rotated foot. This results in the fibres of the surrounding ligaments to become ruptured without disturbing the continuity of the ligament. Chronic stable ankle sprains was defined as the recurrent giving way of the ankle and there may be residual pain and swelling with no mechanical instability. According to literature, mechanisms involved in the development of chronic ankle sprains are: the lack of appropriate and early immobilization in severe cases, the development of scar tissue, lack of strengthening exercises or the development of hypermobility. Many treatments have been suggested to address these factors and would include: peripheral manipulation of the ankle joint, Muscle Energy Technique, muscle strengthening and stretching, proprioceptive training and deep transverse friction massage. Of the above mentioned treatments, Muscle Energy Technique has not been researched in a clinical setting for the treatment of chronic stable ankle inversion sprains. Therefore the purpose of this study was to investigate the relative effectiveness of Muscle Energy Technique compared to Manipulation in the treatment of chronic stable ankle inversion sprains. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Purpose: Ankle sprains are amongst the most common injury sustained by athletes and the general public. When an ankle is repeatedly sprained it results in chronic ankle instability syndrome (CAIS). This repeated trauma results in disruption of the afferent nerve supply from the injured joint, which affects the motor neuron pool excitability of the peroneal and soleus muscles resulting in arthogenic muscle inhibition (AMI). Traditional treatment for CAIS focuses on rehabilitation of the affected muscles via strength and proprioceptive training. Recent literature has shown that the addition of ankle joint manipulation resulted in improved clinical outcomes in the treatment of CAIS. The mechanism on how joint manipulation affects AMI is under-investigated especially in extremity joints. Thus this study aimed to determine the immediate effect of ankle joint manipulation on peroneal and soleus muscle activity, by assessing surface electromyography (sEMG) H/M ratio to detect a change in the proportion of the total motor neuron pool being recruited, in participants with CAIS. Methods: The study utilised a quantitative, experimental, pre-test post-test study design. Forty two participants with grade I and II CAIS, aged 18-45 years, were randomly allocated into one of three groups. Group one received a single talocrural joint long axis distraction manipulation, group two received a sham manipulation and group three was the control receiving no intervention. sEMG H/M ratio measurements were taken before and immediately after the intervention using a Biopac wireless emg system. Results: The groups were comparable at baseline for age, gender, body mass index and H/M ratio measurements for the soleus and peroneal muscles (p < 0.050). Intra-group analysis of the soleus muscle H/M ratio showed no statistically significant change over time for the manipulation (p = 0.975) and sham (p = 0.056) groups, with the control group showing a statistically significant (p = 0.019) decrease in the H/M ratio. For the peroneal muscle no statistically significant (p > 0.050) differences were observed in any of the three groups. Inter-group analysis of the soleus muscle H/M ratio measurements showed no statistically significant differences between the three groups (p = 0.470; F = 1.010) over time, with Tukey’s HSD post-hoc test revealing a statistically significant (p = 0.028) difference being observed between the sham and control groups in terms of post soleus muscle H/M ratio measurements. Conclusion: This study failed to show that ankle joint manipulation affects the soleus and peroneal muscles in terms of H/M ratio measurements in participants with CAIS. There may have been a trend of an effect of the sham and manipulation interventions counteracting the muscle fatigue experienced in the control group, however further investigation is required. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points. / M