Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Health care practitioners have known for some time that patients benefit from specific manual intervention effects, but also from the manner in which these are presented. The latter at times having as much impact on patient health as the former. Thus the purpose of this study was to determine the effect of the clinical ritual during instrument assisted adjusting whilst managing mechanical lower back pain. The study was a randomized prospective study comprising of sixty participants aged 18-59. These individuals were randomly allocated into two groups of thirty and then further stratified to control for gender. Both Groups were diagnosed according to the Activator Methods Chiropractic Technique (AMCT), however the tension was set at maximum for group A, whilst the device was set to the minimum tension for group B. Each patient received three treatments and one follow up visit over a two-week period. Subjective data was collected at the first, third and follow up visit. Subjective data was recorded using the Visual Analogue Scale, the Numerical Pain Rating Scale, the Roland Morris Questionnaire and the Short-form McGill Pain Questionnaire. Outcomes were analysed through with the SPSS statistical package at a 95% level of confidence. After analysis of the collected data it was found that there was no statistical difference between the groups, but there was a non-specific trend suggesting a better outcome in the full tension activator group (Group A). Thus, the research indicated that patients perceptions, the patient-practitioner relationship, and the assumption of an outcome of success as well as the power of placebo or non-specific effects play a large role in the managing of lower back pain in a chiropractic environment. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / This study was done in order to compare the effectiveness of chiropractic treatment in association with a wellness approach, to chiropractic treatment without a wellness approach in the management of Mechanical Low Back Pain. Low back pain is an enormous problem in today's society. Vast amounts of money are spent annually on the investigation into and treatment of low back pain, and numerous work days are lost due to absenteeism. Chronic low back pain also affects the individual's life\xB7style, and can lead to psychological problems. Thousands of low back operations are done yearly, with a significantly high failure rate. (Frymoyer et al. 1980.) In this study factors such as cost, recovery tine and incidence of reoccurrence were used as criteria to determine the effectiveness of chiropractic treatment applied to the two groups of patients. The concept of holise was applied to one group, whereas the other group was treated without this approach. The study was conducted as a clinical trial, with two experimental groups. Thirty patients who had responded to an advertiselOent were selected and randomly divided into two groups. The patients were selected fro~ the general population on the grounds of their signs and sylllptoos. Group A received chiropractic treatment in association with the wellness approach. This comprised patient education in the form of guidance towards life-style changes and exercises. Patients were also given a detailed explanation of their problems, leading to an understanding of their conditions. Group B received chiropractic treatment only. Their condition was not explained, and they did not receive any of the holistic aspectts mentioned for group A. / M

Mini-dissertation in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, in the Department of Chiropractic at the Durban University of Technology, 2009 / The aim of this study was to investigate the relative effectiveness of Transeva and spinal manipulative therapy for mechanical low back pain. The objectives evaluated the effectiveness of only administering Transeva therapy alone, or Spinal manipulative therapy alone as well as Transeva therapy with Spinal manipulative therapy on mechanical low back pain with respect to the patients’ subjective and objective responses to the respective treatment group. The final objective was to correlate the subjective and objective data collected to determine the effectiveness of each of the therapies in comparison with another. Design: A sample of thirty patients diagnosed with mechanical low back pain were accepted into the study. These patients were randomly divided into three groups of 10, which received different treatment protocols for mechanical low back pain. Outcome Measure: The following outcomes were measured; a decrease in pain (measured with the Numerical Pain Rating Scale (NRS), a decrease in disability (measured with the Roland-Morris Questionnaire), a decrease in local tenderness (measured with the pressure Algometer) and an increase in lumbar range of motion (measured with the Inclinometer). The data was collected prior to treatment one, prior to treatment four and at the sixth follow-up visit. Results and Conclusion: All groups improved with the treatments they received; however, no single treatment was statistically better than any other treatment intervention tested. However, the Spinal manipulative therapy group had a statistically significant faster reduction in pain on the NRS readings with p=0.048.

Thesis (M.Tech.:Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2005 xvii, 58 leaves, Annexures A-J / It has generally been accepted that 60 to 80% of the general population will suffer from low back pain at some point in their life. (Kirkaldy - Willis, 1992). The use of manipulation for the treatment of low back pain is well documented but lumbar mobilization has undergone comparatively little investigation (Goodsell et al., 2000). Furthermore, there remains little evidence to advocate the use of Muscle Energy Technique (MET) in the form of a randomized clinical trial (Wilson, 2003). The purpose of this study was to determine whether patients with acute and sub-acute low back pain would demonstrate a reduction in disability after being treated with MET or specific passive mobilization. Both interventions are joint mobilization techniques the only difference being that one is passive and the other (MET), is an active technique

M.Tech. (Chiropractic) / Chronic lower back pain (LBP) is considered as one of the most prevalent conditions in our society with 70-85% of the population experiencing pain at some point in their lives and 80% having recurrent episodes. The majority of chronic LBP is treated with conservative care, with spinal manipulation being a treatment modality shown to be beneficial resulting in restoration of normal ranges of movement, decrease of muscle spasm and there is an overall biomechanical change. One of the more modern trends is combining manipulation with taping. It has been shown that with the application of Kinesio tape to the lumbar para-spinal muscles effectively increases lumbar range of motion and decreases pain with the relaxation of tense muscles as well as increase in proprioception as the tape increasingly stimulates cutaneous mechanoreceptors. Elastic bandage has been shown to improve proprioceptive acuity as it stimulates cutaneous mechanoreceptors, as well as providing support to joint structure. The purpose of this study was to determine the superiority of one tape versus the other as well as the efficacy of the individual tape and whether the combination treatment of spinal manipulative therapy and taping of the lumbar paraspinal muscles are possibly a more effective treatment protocol in the treatment of chronic lower back pain. Method: This clinical study was a comparative study and consisted of two groups of fifteen participants who met the inclusion and exclusion criteria. The participants were between the ages of eighteen and forty-five years of age. Group 1 was treated with lumbar spine and sacroiliac joint adjustments and the application of Kinesio tape􀂥. Group 2 was treated with lumbar spine and sacroiliac joint adjustments and the application of elastic bandage. Treatment took place over a period of three weeks and participants were treated six times out of a total of seven consultations. Procedure: Subjective data was recorded at the first and fourth consultation prior to treatment and on the seventh consultation by means of a Numerical Pain Rating Scale and an Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was recorded at the first and fourth consultation prior to treatment and on the seventh consultation by means of a digital inclinometer for assessing lumbar spine range of motion. Data recorded was analyzed by a statistician. Results: Clinically and statistically significant improvements were noted in both groups over the course of the study with regards to pain, disability and lumbar spine range of motion. Conclusion: The results show that both combination treatments of spinal manipulative therapy and the application of Kinesio™ tape or elastic adhesive bandage are effective treatment protocols, both clinical and statistical in decreasing pain, disability and improving lumbar range of motion in patients with chronic lower back pain. However neither treatment protocols proved to be superior over the other.

M.Tech. (Chiropractic) / This study was undertaken to evaluate the effectiveness of chiropractic treatment of chronic lower back pain in conjunction with the use of the Cory knee cushion during sleep as compared with chiropractic treatment alone. The cushion is used in an attempt to improve sleeping posture. It was proposed that both treatment protocols would be effective, but that the combined therapy would show better results. An unblinded, controlled pilot study was conducted. Patients responding to advertisements were recruited from the general population. Thirty patients who conformed to the specified criteria and delimitations were accepted into the study and placed randomly in one of two possible treatment groups. One group received chiropractic adjustments in conjunction with the use of the Cory knee cushion during sleep, the other received chiropractic adjustments alone. Comparisons were performed by means of objective (lumbar spine range of motion) and subjective (Oswestry Pain and Disability Questionnaire, MCGiIl Pain Questionnaire and Visual Analogue Scale) assessments over the eight-week treatment period, with comparisons made at treatments one, four, seven, nine and ten. The results were recorded and the data was statistically analysed using two-sample ttests, paired t-tests, sign rank tests and Mann-Whitney tests. The results indicated that there was a generalised improvement in both of the treatment groups in terms of lumbar spine range of motion and pain relief. While group one attained a better range for rotation after the month break, this was an isolated improvement. Under the circumstances of the research, neither group showed considerably superior results over the other, as there was no statistically significant difference between the groups. Thus, the full benefit of sleeping with a cushion between the knees in an attempt to improve sleeping posture will need additional investigation in order to be of-use as an adjunct to chiropractic treatment.

M.Tech. (Chiropractic) / OBJECTIVE: The aim of this study was to determine the effectiveness of a single treatment approach of flexion distraction or diversified lumbar adjustments, compared to the combined treatment of flexion distraction in conjunction with diversified lumbar adjustments. STUDY DESIGN: A total of 30 participants were used, they all presented with chronic low back pain (LBP) of mechanical origin. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: The participants were divided randomly into one of 3 groups: Group 1 was treated with diversified lumbar adjustments. Group 2 was treated with flexion distraction directed at the lumbar spine. Group 3 was treated with a combination of diversified lumbar adjustments and flexion distraction. Each participant was treated 6 times over a 3 week period, with a 7th consultation where subjective and objective measurements were taken with no treatment. METHODS: Group 1 was adjusted on a chiropractic table in a seated or side lying posture. Group 2 was treated lying prone on the Cox Flexion Distraction Table. Group 3 was treated with a combination of the above treatments. Flexion distraction was applied to all participants in group 2. It was applied over the segments that were found to be restricted during motion palpation. One set of 10 repetitions was performed under distraction in each range of motion (ROM). Mobilisation of the restricted joints was executed until full and complete ROM was detected. To ensure that the participant was comfortable and received the best treatment possible Velcro straps were used to secure them onto the flexion distraction table. Diversified chiropractic adjustments were done on the flexion distraction bed or the chiropractic tables in the University of Johannesburg Chiropractic Day Clinic. Spinous Hook (Pull), Thigh-Transverso-Deltoid, Transverso-Deltoid and Push-Pull Technique were the names of the adjustments used to treat participants in group 1 or group 3. PROCEDURE: Subjective data was collected using the Oswestry Low Back Pain and Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS), which were completed by the participants prior to the 1st and 4th consultations and then again on the 7th consultation. Objective data was collected using the Digital Inclinometer. The ROMs measured were forward flexion, extension, left lateral flexion, right lateral flexion left rotation and right rotation of the lumbar spine. This data was collected by the researcher prior to the 1st and 4th consultations and then again on the 7th consultation. RESULTS: This study was done to try and establish the most effective approach in the management of chronic mechanical LBP using the different treatment approaches. When comparing the results obtained from the study it can be seen that all 3 groups were effective at reducing pain levels using the NPRS. There was a significant change that occurred on the 7th consultation when looking at the NPRS values. The statistics were then further analysed and a statistically significant difference was shown to have occurred between groups 1 and 3. This indicates that the chiropractic adjustment used alone, was the best treatment protocol compared to groups 2 and 3. The ODQ values showed that the treatments for all 3 groups were effective at getting the participants back to normal activities of daily living over the treatment protocol, with no preference between any of the treatment protocols. Statistically significant changes were found to have occurred in only some ranges of motion of the lumbar spine within certain groups. Clinical improvements regarding ROM were evident in group 1 concerning flexion, left rotation and right rotation. A clinical decrease was found in extension, left and right lateral flexion with group 1. Clinical improvements concerning group 2 were found in extension, left rotation and right rotation. Flexion showed a clinical decrease in ROM values of group 2. Statistically significant improvements were found with left and right lateral flexion in group 2. Group 3 showed positive clinical results with left and right rotation. Flexion and left and right lateral flexion ROM showed decreased values clinically in group in group 3. Extension showed a statistically significant decrease in group 3. These results indicate that chiropractic adjustments used alone, were the best treatment protocol compared to group 2 and 3 when using the NPRS. The ODQ values showed that there was no preference between either of the treatment protocols with regards to normal activities of daily living.

M.Tech. (Chiropractic) / PURPOSE: The aim of the study was to compare the effectiveness of treating inter-scapular pain with either chiropractic adjustments delivered to the costovertebral joints, with ischaemic compression of the myofascial trigger points of the rhomboid muscles, or using a combination treatment protocol in order to determine which of the three treatment protocols was superior. DESIGN: This study was a comparative study consisting of three groups of ten participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. A McGill Pain Questionnaire, numerical pain rating scale, a clinical case history, full physical examination, a cervical regional examination were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received chiropractic adjustments to the costovertebral joints, Group 2 received ischaemic compression to the myofascial trigger points of the rhomboid muscles. Group 3 received a combination treatment involving both chiropractic adjustments to the costovertebral joints together with ischaemic compression of the rhomboid trigger points. Subjective and objective readings were based on the above treatment protocols. All participants received a total of six treatments over a three week period. MEASUREMENTS: Subjective measurements were obtained by the Numerical Pain Rating Scale and the McGill Pain Questionnaire. Objective measurements were obtained using the hand-held pressure algometer. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the McGill Pain Questionnaire for the intragroup analysis indicated that the ischaemic compression group showed the greatest improvement over time (84.06%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the adjustment group showed the greatest improvement over time (78.70%). The intergroup analysis indicated that there were no statistically significant differences. With regards to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the ischaemic compression group showed the greatest improvement over time (35.44%). Once again, there were no statistically significant differences with the intergroup analysis. CONCLUSION: Based on the results of this study, it showed that all three treatment groups were effective in decreasing inter-scapular pain and disability. Although all three treatment protocols have shown to be effective, and have shown similar improvement, intergroup analysis indicates that statistically there is no treatment protocol that is seen to be more superior or more effective in treating inter-scapular pain.

M.Tech. (Chiropractic) / The aim of this study is to compare Chiropractic Manipulative Therapy of the lumbar spine combined with Therapeutic Ultrasound Therapy over the adjacent lumbar paraspinal muscles to ascertain the most effective protocol in the treatment of Chronic Mechanical Lower Back Pain. Thirty participants with Chronic Mechanical Lower Back Pain between the ages of 18 and 35 years were recruited. Successful participants were randomly placed in two groups, of fifteen participants each, which would receive different treatment protocols according to their group allocation. Group One received Chiropractic Manipulative Therapy to lumbar spine restrictions. Group Two received Chiropractic Manipulative Therapy to the lumbar spine restrictions as well as Therapeutic Ultrasound Therapy to the adjacent paraspinal muscles. The participants completed a total of seven visits, including 6 treatments over 3 weeks. Subjective and Objective readings were taken on the first, fourth and seventh visits. Subjective readings from each participant were recorded using the Oswestry Disability Iindex and Numerical Pain Rating Scale. Objective readings were taken and recorded three times consecutively using a Pressure Algometer over the adjacent lumbar paraspinal muscles and a Digital Inclinometer to measure lumbar spine range of motions. The statistical data was analysed using the Friedman test, Mann-Whitney test and the Bonferroni test. The results demonstrated overall that both groups responded favourably to their specific treatment protocols, however no significant differences between groups was noted, highlighting the positive effects of the manipulation alone.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007. xii, 72, 12 leaves / Aims and Objectives: The aim of this study was to determine whether spinal manipulation affects the perceived performance of runners with low back pain. More specifically, the objective was to determine whether any relationships existed between spinal manipulation, a runner’s perceived performance and their low back pain. Method: Twenty subjects who ran thirty kilometers a week and had LBP were selected for a pre- post- cohort study according to criteria set out beforehand. The subjects received spinal manipulation applied to their lower back twice a week for a period of two weeks. At each consultation, they were requested to fill out a “Perception of Running Performance” questionnaire prior to each treatment, and one week following the final consultation.