Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / Epidemiological studies on low back pain (LBP), conducted in a number of countries, strongly suggest that LBP is internationally a very common condition, imposing a significant social and economic burden on society. It however appeared that the epidemiology of LBP among the black population of South Africa had not yet been investigated. The purpose of this study was to determine the prevalence of LBP in the formal black South African township of Chesterville, and to assess the extent to which LBP adversely affects the lives of the residents, in order to establish the need for specialized low back care in this community. A further aim of the study was to assess the associations between certain individual factors and the prevalence ofLBP. A population-based epidemiological survey on LBP was conducted on a sample of 1 000 residents of the township of Chesterville. After a pilot survey of 25 households suggested that the characteristics of the households in Chesterville were fairly similar with respect to the objective of the study, a clustered sample of 300 lots was selected from a layout map of Chesterville. All residents, aged 13 or older, living on these lots were interviewed by the researcher until a sample of 1 000 subjects had been achieved. The total population of Chesterville is approximately 20 000; hence the sample size covers 5% of the population of study. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / There have been few studies conducted to determine the effects of stretching as a therapy on its own in the treatment of low back pain. In response to this, the objective of this study was to evaluate the relative effectiveness of stretching the hamstring muscles on low back pain experienced by cyclists. Thirty two cyclists with low back pain were screened for lumbar facet syndrome, sacroiliac syndrome and myofascial pain syndrome of the quadratus Iumborum, gluteus medius and gluteus maximus muscles and randomly divided into two groups of sixteen. Detuned ultrasound was applied to the hamstring muscles of the patients in the placebo group twice a week for three weeks. Patients in the experimental group were involved in a stretching program whereby the hamstring muscles were passively stretched for three sets of thirty seconds duration, two days a week for three weeks. Both groups were evaluated in terms of subjective clinical findings by utilising the Oswestry Low Back Pain Disability Questionnaire, the Numerical Pain Rating Scale-101, and theti / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / 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

M.Tech. / This research study was conducted as an unblinded controlled pilot study. The aim of this research was to investigate the effects of spinal manipulation in conjunction with proprioceptive rehabilitation on proprioceptive ability with regards to balance in patients with mechanical low back pain. Candidates for the research were recruited through advertisements in the local newspapers, posters put up at the Technikon Witwatersrand Doornfontein Campus as well as at the Technikon Witwatersrand Day Clinic. Candidates that fitted the selection criteria were selected to participate and were randomly divided into three groups. Each group consisted of 10 patients. Group A received chiropractic manipulation of the lumbar spine and sacroiliac joints ...

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2007. / Objectives The objectives were to compare the relative effect of manipulation and core rehabilitation in the treatment of acute mechanical lower back pain in athletes. Project Design: The study design was a randomized controlled parallel group trial. A quantitative study was performed, by making use of a pre à à à ¢ and post experimental investigation (Nansel et al. 1993 and Naidoo, 2002). Setting: Participants presenting with acute low back pain with an onset of 7 days or less, to the Chiropractic Day Clinic at the Durban University of Technology. Subjects: Thirty athletic participants, either male or female, between the ages of 18 and 45 years presented at the initial consultation which included participant screening and establishment of their suitability for the study. These were then divided into either group A (which received a manipulation) or group B (which received core exercises). Outcome measure: A correct contraction of the core stability muscles was maintained, with a decrease in pressure (in mm Hg) on a Pressure Biofeedback Unit, and an increase in length of time (in seconds). Results: It was found that there was no significant difference between the manipulation and the core rehabilitation groups. Although both groups showed v improvement with regards to their acute mechanical low back pain, the core rehabilitation group improved at a significantly faster rate than the manipulation group with regards to endurance on the stabilizer. Conclusions: Both treatments were equally beneficial for most of the quantitative outcomes measured in this study. However, for the outcome of time on the stabilizer, the core rehabilitation group improved at a significantly faster rate than the manipulation group (p=0.006).

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2007. / Objectives The objectives were to compare the relative effect of manipulation and core rehabilitation in the treatment of acute mechanical lower back pain in athletes. Project Design: The study design was a randomized controlled parallel group trial. A quantitative study was performed, by making use of a pre à à à ¢ and post experimental investigation (Nansel et al. 1993 and Naidoo, 2002). Setting: Participants presenting with acute low back pain with an onset of 7 days or less, to the Chiropractic Day Clinic at the Durban University of Technology. Subjects: Thirty athletic participants, either male or female, between the ages of 18 and 45 years presented at the initial consultation which included participant screening and establishment of their suitability for the study. These were then divided into either group A (which received a manipulation) or group B (which received core exercises). Outcome measure: A correct contraction of the core stability muscles was maintained, with a decrease in pressure (in mm Hg) on a Pressure Biofeedback Unit, and an increase in length of time (in seconds). Results: It was found that there was no significant difference between the manipulation and the core rehabilitation groups. Although both groups showed v improvement with regards to their acute mechanical low back pain, the core rehabilitation group improved at a significantly faster rate than the manipulation group with regards to endurance on the stabilizer. Conclusions: Both treatments were equally beneficial for most of the quantitative outcomes measured in this study. However, for the outcome of time on the stabilizer, the core rehabilitation group improved at a significantly faster rate than the manipulation group (p=0.006).

M.Tech. (Chiropractic) / Purpose: The purpose of this study was to determine if inversion therapy is beneficial for participants with lower back pain and if there is an additive effect when combining it with manipulation. Three treatment approaches were utilized: inversion therapy, lumbar spine manipulations and a combination of inversion therapy with lumbar spine manipulations. Method: Thirty participants who qualified for the study were randomly divided into three equal groups consisting of ten participants each. Depending in which group the participant was allocated, determined if they received lumbar spine manipulation (Group 1), inversion therapy (Group 2), or a combination of inversion therapy performed after the lumbar spine manipulation (Group 3). Procedure: Each participant was treated a total of six times over a course of three weeks, furthermore there was a seventh day of final data collection. The measurements were taken on the first, fourth and seventh visit. Subjective measurements consisted of the numerical pain rating scale (NPRS) and the Oswestry Low Back Pain Disability Index. Objective measurements were done with the inclinometer (lumbar range of motion) and the flexicurve (lumbar lordosis measurement). Results: It is clear that there were statistically significant improvements in all three of the groups in both the NPRS and the Oswestry disability index. The inversion therapy group performed the best with the NPRS and the Oswestry disability index, with the spinal manipulation and combination group following narrowly. However, there were no statistically significant differences on the intergroup analysis with regards to the subjective results. The results of the subjective measurements indicated that there was a relative decrease in lumbar spine lordosis measurements, over the trial period, but with no statistical significance. With the lumbar range of motion-flexion measurements it was clear that the spinal manipulation group and the inversion therapy group had superior results compared to the combination group, with both indicating statistical significance over the trial period. Extension, lateral flexion and rotation did not show any statistical significance over the trial period. Conclusion: There were statistically significant improvements within each of the three groups on intragroup analysis, but no statistically significant differences were found on intergroup analysis. Therefore, none of the groups could be singled out as being the superior treatment for mechanical lower back pain. All three groups’ demonstrated improvement. There was no significant additive effect by combining the two treatments. Therefore there is no benefit to adding inversion therapy to the treatment protocol. Manipulation alone demonstrated to have similar effects. However, should a patient not be able to see a chiropractor for treatment, home based inversion therapy can be beneficial. A concern that should be addressed is that home based treatment wouldn’t be supervised and as such it is not advised to do without some form of professional management. Inversion therapy can definitely be utilized as a home based treatment option for a patient with LBP, patients that can’t make use of regular chiropractic care due too logistical or financial restraints will benefit from inversion therapy home usage. Home usage will provide the patient with regular general traction therapy and can result in patient pain relief, increase overall functioning of the patient and the patient compliance may improve.

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.

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.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Low back pain is a common condition and affects most people at least once in their lives. The causes of low back pain (LBP) are numerous and may include non-specific mechanical causes, or specific causes which may be of a more serious nature. Researchers have tried to link specific history and physical examination findings with certain disorders, but as of yet, have been unsuccessful. Research has shown that x-rays may be over utilized and the guidelines for referral are not always adhered to. Furthermore, there is a paucity of literature on the role of x-rays in influencing the management of patients with low back pain. Objectives: The objectives of this retrospective study were: 1) to determine the relationship between the clinical and the radiographic diagnoses of patients with LBP, 2) to record the consultation at which a lumbar spine x-ray was requested by the student or clinician and the reasons thereof, 3) to record the suspected clinical diagnoses and management of the selected patients prior to referral for lumbar spine x-rays, 4) to determine the number of incidental radiographic findings in the selected patients’ x-rays, and 5) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patients’ x-rays. Method: The Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) archives were searched for lumbar spine radiographs and the corresponding patient files of patients who presented with LBP from 1 January 1997 to 31 July 2010. Data collection was in a stepwise process with the anteroposterior and lateral lumbar spine x-rays being read first, without any knowledge of the patient’s main complaint and then the corresponding patient files were evaluated and selected clinical variables were recorded. Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Diagnoses were categorized into specific groups and indicator variables were used to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine any possible associations. Results: The mean age of the patients was 43.9 (± 16.9) years and the number of male and female patients were 40 and 34 respectively. It was not possible to correlate the clinical and radiographic diagnoses because the categories were too different for any statistical test to be performed. Spondylosis was the most common radiographic finding. The majority of the lumbar spine x-rays were requested at the first consultation. No suitable reason for obtaining the x-ray was provided in 14.6% of the x-rays requested and 20.7% were requested to examine for an unspecified pathology. Of the 74 patients in this study, 44 patients did not have a change in diagnosis, which means that 59.5% of the diagnoses stayed the same after x-ray examination. However, in 30 (40.5%) of cases the clinical diagnosis was changed following x-ray examination. This may indicate an overuse of x-rays at the CDC. Most patients were diagnosed with the non specific mechanical causes of low back pain. A wide range of treatment modalities were utilized both before and after x-rays were taken, including soft tissue therapies, electrotherapies and spinal manipulation. Following x-ray imaging there was a greater use of spinal manipulation ie. 62% versus only 39% of cases prior to imaging. Conclusion: Lumbar spine x-rays may be over utilised at the CDC but their findings were influential in the diagnosis and management in 30 (40.5%) of the patients. The majority of the clinical diagnoses were of the mechanical or non-specific causes of low back pain. / Durban University of Technology.