M.Tech. / Purpose: To determine what effects flexion distraction will have on males with chronic lumbar facet syndrome, in reference to intersegmental range of motion and pain. Method: Thirty male participants with chronic lumbar facet syndrome received flexion distraction technique. The trail consisted of seven visits over two to three weeks. Treatment was performed on the first to sixth visit, readings and questionnaires were completed on the first, fourth and seventh visits. Data collection was concluded before treatment on the mentioned visits. Subjective data consisted of the Oswestry Disability Index (ODI) and the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2). Objective data included global lumbar range of motion measurements using the Baseline Digital Inclinometer, and segmental lumbar range of motion by means of the Radiographical Midplane Angle method. Results: Objectively, clinical significance of the intersegmental lumbar range of motion increased from the L1/L2 to the L4/L5 level (2.2% - 17.7%), but showed no statistical significance. In relation to the maximal motion possible at these levels, the increase in motion escalated from 0.8% at the L1/L2 segment to 9.2% at the L4/L5 segment. The global lumbar range of motion showed clinical significant increase in all of the ranges except for extension, however statistical significance was found in right lateral flexion only (p = 0.045). The greatest increase in motion was observed in left lateral flexion (15.72%) and a decrease in extension (3.72%) was illustrated. Subjectively, the group showed statistical significant improvement in both the SF-MPQ-2 (p = 0.000) and ODI (p = 0.000). Clinical meaningful change was noted throughout the subjective data, which resultantly showed a 66% and a 67% change in pain respectively. Conclusion: Flexion distraction has shown to have clinical significant effects on segmental and thus global range of motion, and great clinical meaningful change in pain levels and pain perception. Thus specific segmental mobilisation does affect the segmental motion.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xviii, 140 leaves / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non – specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the non-specific effect in the healing encounter by manipulating the practice setting in which the patients were treated.

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2008 / Core strengthening has become a major trend in the rehabilitation of patients suffering with acute low back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus, lessen mechanical stress to the spine. Literature suggests that vibration/acceleration training may be a more effective and sufficient method of core stability exercises, with regards to core muscle endurance and activation in treatment of acute low back pain. This may have more advantages than using traditional core stability exercises in the treatment of acute low back pain. However, vibration/acceleration training as core stability exercises has yet to be investigated. In order to choose the most appropriate treatment protocol for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the acute period. Therefore, this study was designed to establish the effectiveness of vibration/acceleration training as a core stability exercise in the treatment of acute low back pain and to establish whether this protocol should be utilized routinely in the management of this condition.

Submitted in partial compliance for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2009. / The aim of this study was to investigate patient management protocols of low back pain (LBP) by chiropractors in the greater Durban metropolitan area. In this investigation a more generalized approach was chosen to investigate trends within the field of patient management and education for LBP. The study population of 80 chiropractors in the greater Durban metropolitan area, required a minimum response rate of 70% to obtain statistical significance (Esterhuizen, 2008), which was achieved. This study involved a quantitative descriptive design utilizing a questionnaire developed and validated by the researcher and focus group. The questionnaire was comprised of three sections, including personal information, treatment protocols and patient management with advice and education. Statistical analysis involved the use of SPSS version 15.0 (SPSS Inc., Chicago, Illinois, USA), a data analysis tool. Descriptive objectives were analysed with frequency tables and cross-tabulation tables (Esterhuizen, 2008). Demographic variables and practice variables were assessed for association with responses to the questionnaire using Pearson’s Chi square test in the case of categorical demographics and responses (Esterhuizen, 2008). Bar graphs were included to reflect the treatments that were always or frequently used by respondents (Esterhuizen, 2008). There appeared to be a wide range of influences on practice philosophy and methods, independent of demographics and training institute. A chiropractor’s age was regarded as significant with regard to philosophical orientation. However, the majority of these chiropractors obtained their qualifications from international colleges. vi Spinal manipulations directed at quadratus lumborum myofascial trigger points were strongly advocated by respondents. Specific short lever manipulations were the preferred manipulation technique for treatment of LBP. Sacroiliac joint manipulation was also considered important by a significant proportion of respondents. Respondents most commonly recommended the use of mobilizations and cryotherapy when contra-indications to manipulation were evident. There was consensus in the number of days before the first follow-up after an initial treatment for a presentation of acute LBP, where 96.42% of respondents recommended follow-up at day 1 or 2. In chronic LBP first follow-up after initial treatment was recommended by 41.1% of respondents on day 2; 28.6% day 3 and 8.9% on day 1. Management protocols for acute LBP appeared to be more uniform when compared to management of chronic LBP. Despite the variances in philosophy and management protocols amongst respondents, there remains consensus that manual articular manipulation remains the mainstay in chiropractic treatment protocols for both acute and chronic LBP.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Through the literature review it has become apparent that low back pain is a very real problem in most societies. It has been suggested that there is enough evidence to prove the relationship between low back pain and local muscle dysfunction and that focus in management of these patients should be the rehabilitation of these muscles by exercise. Literature suggests that optimal core muscle strength, control and endurance working synergistically with the rest of the neuromusculoskeletal system is necessary for lumbar spine stability . Arthrogenic Muscle Inhibition is caused by distension and/or damage of a joint and is thought to disable the muscle from contracting all its muscle fibres. When a joint is injured it is thought that AMI causes muscle weakness, which in turn hampers the rehabilitation process of that joint despite complete muscle integrity. Spinal manipulative therapy has been shown to alter the excitability of spinal muscle motor neurons due to the stimulation of mechanoreceptors in the joint capsules suggesting that SMT could be a means to remove this inhibitory action. The literature supports the hypothesis that a decrease in the neurological deficit caused by AMI may result in a faster recovery rate. Aims The aim of this study is to determine the immediate effect of thoraco-lumbar spinal manipulation compared to lower lumbar spinal manipulation on core muscle endurance and activity in patients with mechanical low back pain by assessing the correlation between the objective and subjective measures. Method A prospective, convenience sample with purpose allocation (pre /post) clinical trial was used as the sampling method. Thirty participants where placed in two groups, group one and group two, of fifteen people each. Group one underwent spinal v manipulative therapy between L4 and S1 spinal levels. Group two underwent spinal manipulative therapy in between T8 and L1 spinal levels. The objective and subjective testing was done pre- and post-intervention. The objective data was that of a surface EMG attached bilaterally over the internal oblique as well as a prone abdominal draw in biofeedback test. The subjective data included a pain numerical rating scale (0-100). Results The results showed to partially favour group two (thoraco-lumbar), in both increased endurance time that would prove that AMI does in fact inhibit the transversus abdominis and obliques internus, thus it would hinder the rehabilitative process. Some of the statistics where not in favour of the aims, as there was no difference in the effect of group one or two on the NRS, as both improved consistently. It would be recommended that use be made of fine-wire EMG for testing the activity in both the obliques internus and the transversus abdominis, which would allow for more consistent readings, thus adding strength to the research.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, at echnikon Natal, 1999. / In order to investigate low back pain in an Indian and a Coloured community in South Africa, a population-based epidemiological survey was carried out in which 1 000 subjects were interviewed (500 Indians and 500 Coloureds). Subjects were selected using the Systematic Random Sampling method. A pre-tested questionnaire, designed by the researcher, was used to elicit information about the subjects' demography, general characteristics and details regarding low back pain (incidence, prevalence, severity, disability, treatment). Only subjects 18 years or older who were permanent residents of the 2 suburbs were included in the study. The author carried out the interviews personally / M

M.Tech. / Dancing, over the years has become a highly competitive sport with demanding levels of fitness and flexibility needed in order to progress to a professional level (DeMann, 1997). With lower back pain becoming a common occurrence in dancers, both physical as well as emotional stress is placed on the dancer and their lower back (DeMann, 1997). The aim of this study was to compare the effectiveness of Chiropractic adjustments on the lumbar spine and Sacroiliac joints, stretching certain muscle groups or the combination of the two treatment protocols on Freestyle dancers with chronic lower back pain with regards to pain, disability and lumbar spine and pelvis range of motion. Thirty female participants between the ages of thirteen and twenty five years were recruited to participate in this study. Successful participants were then randomly placed into one of three groups, of ten participants each, which would receive different treatment protocols according to their group allocation. Group 1 underwent Chiropractic adjustments to the lumbar spine and Sacroiliac joints, Group 2 received stretching exercises to the Quadratus lumborum muscle; gluteal muscles consisting of Gluteus maximus, medius and minimus; Piriformis; Psoas; Hamstring and Multifidus muscles only and Group 3 received a combination of the treatment protocols. Participants in all three groups were assessed using the Numerical Pain Rating Scale and the Roland-Morris Disability Questionnaire for subjective readings; the Digital Inclinometer was used for objective readings of ROM. All treatments were performed at the Riviere Academy of Dance under the supervision of a qualified Chiropractor. The results concluded that the benefits of an adjustment alone, stretching alone as well as the two treatments combined showed a reduction of pain and increase of ROM, when managing a dancer with lower back pain. Not one treatment was shown to be more beneficial than the other.

M.Tech. (Chiropractic) / This study was conducted in order to compare the effectiveness of the lumbar spine manipulation versus the foot manipulation/mobilisation for people suffering with chronic low back pain. This research aims to compare the effects of lumbar spine manipulation alone, foot manipulatioil/mobilisation alone or the combination of the two in people suffering with chronic low back pain. Candidates for the study were recruited from the local surrounding area, and through information pamphlets distributed through the Technikon Witwatersrand Doornfontein. The candidates were asked to participate in the study, which was held at the Technikon Witwatersrand Chiropractic day clinic. Only -those candidates that conformed to the selection criteria were allowed to participate in the study. The candidates were assigned to one of three groups. Eac.h group had ten candidates. Group 1 received lumbar spine manipulation alone. Group 2 received foot manipulation/mobilisation alone. Group 3 candidates received lumbar spine manipulation and foot manipulatioil/mobilisation. Subjective data was collected using the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using the electronic inclinometer to measure lumbar spine range of motion in flexion, extension, right and left lateral flexion and right and left anterior rotation. The paired Hest was used for statistical analysis, where a statistically significant difference was found; the Student-Newman-Keuls test was performed to identify which statistically significant difference between the groups was found. The results of this study indicate that lumbar spine manipulation alone would appear to have responded better in terms of lumbar spine range ofmotion...

M.Tech. / OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain. DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment. During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy. During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials. There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A. CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain. When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures. There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.

M.Tech. / Purpose: This study aims to compare the effects of lumbar spine and/or pelvic manipulation, and lumbar spine and/or pelvic manipulation in conjunction with the application of subcutaneous parenteral Traumeel® in the treatment of chronic mechanical low back pain with regards to pain, disability and lumbar spine range of motion. These effects were evaluated using a questionnaire consisting of a Numerical Pain Rating Scale, and an Oswestry Low Back Pain and Disability Questionnaire, and by measuring lumbar spine range of motion using a digital inclinometer. The questionnaire was completed and the range of motion readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were stratified in number and gender between two groups of equal size (15 participants each). Group one received spinal manipulation to restricted lumbar spine and/or sacroiliac joints followed by the administration of subcutaneous parenteral Traumeel®. The second group received spinal manipulation to restricted lumbar spine and/or sacroiliac joints. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a Numerical Pain Rating Scale (NPRS) and an Oswestry Low Back Pain Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a digital inclinometer in order to assess lumbar spine range of motion. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and lumbar spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 with reference to lumbar spine range of motion. vi Conclusion: The results show that both spinal manipulation, as well as spinal manipulation in conjunction with subcutaneous parenteral Traumeel® are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing lumbar spine range of motion in patients with mechanical low back pain. However, neither treatment protocol proved to be preferential. The results carry a possible suggestion that chiropractic manipulation (common to both groups) is effective in ameliorating participant-rated pain and disability, and increasing lumbar spine range of motion in the case of chronic mechanical low back pain.