M.Tech. (Chiropractic) / Purpose: This study aims to determine the effect of Bruegger’s exercise on chronic low back pain in association with lower crossed syndrome and compare it to spinal manipulation alone or a combination of Bruegger’s exercise and spinal manipulation with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of three different groups of ten participants each. Group one was only instructed on how to perform Bruegger’s exercise. Group two only received a spinal manipulation/s over the restricted joint/s in the lumbar spine. Group three received a spinal manipulation/s over the restricted joint/s in the lumbar spine in conjunction to being instructed on how to perform Bruegger’s exercise. All participants were assessed over a four week period. All groups attended six treatment sessions over three weeks of which Bruegger’s exercise and/or spinal manipulation were performed. The participants who needed to perform Bruegger’s exercise were also advised to continue doing the exercise out of the treatment session where applicable. In the fourth week only measurements were taken and no treatment was administered. Procedure: Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a universal goniometer for assessing passive hip flexion and extension, a digital inclinometer for assessing active lumbar range of motion and a flexible ruler for measuring the degree of lumbar lordosis. Analysis of collected data was performed by a statician. Results: Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Statistically significant changes were noted in group 1 and group 2 with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis, and in group 3 with regards to hip and lumbar range of motion as well as degree of lumbar lordosis. Conclusion: The results show that Bruegger’s exercise, spinal manipulation and the combination of Bruegger’s exercise and spinal manipulation are effective treatment protocols both clinically and significantly in decreasing pain and disability (not statistically for the combination of Bruegger’s exercise and spinal manipulation), increasing hip and lumbar range of motion as well as decreasing the degree of lumbar lordosis. However, there was no treatment protocol that proved to be preferential over the other. Because spinal manipulation alone showed the greatest overall clinical improvements, it may be suggested that spinal manipulation alone is the most effective in the treatment of chronic low back pain associated with lower crossed syndrome with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Also, the addition of Bruegger’s exercise may help in some instances to further assist in treatment once the full effects of the spinal manipulation has occurred and allowed for the muscles to be in their optimum state for exercise.

M.Tech. (Chiropractic) / Purpose: Low back pain affects the general population worldwide. Low back pain is a multi-factorial problem with debate as to the exact aetiology of low back pain. Thus, this study examines the relationship between lumbar spine lordosis, body fat percentage, physical activity level, lumbar spine range of motion and the incidence of low back pain. Method: There was a total of one hundred female participants between and including eighteen and thirty-five years of age. These females were symptomatic or asymptomatic of mechanical low back pain. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Participants were evaluated once. No treatment was administered. Procedure: Subjective responses were acquired through the Visual Analog Scale, the International Physical Activity Questionnaire and an Oswestry Low Back Pain and Disability Questionnaire. The objective evaluation included a physical examination and a lumbar spine regional examination. The participant’s height was measured using a stadiometer. The Bioelectrical Impedance Analysis (BIA) measured the participant’s weight, water content, lean tissue mass and body fat percentage. BMI was calculated from the weight and height recordings. Range of motion of the lumbar spine was measured with a Digital Inclinometer. A flexi curve ruler molded the lumbar spine lordosis of each participant, which was then traced onto a piece of paper to measure the magnitude of lumbar spine lordosis. Results: A clinical relationship did not exist between a hyperlordotic lumbar spine posture, the incidence of low back pain, body fat percentage and lumbar spine range of motion. A clinical relationship was evident between a hyperlordotic lumbar spine posture and the level of physical activity. Conclusion: Given that a clinical relationship exists between a hyperlordotic lumbar spine posture and the level of physical activity, physical activity specifically exercise to strengthen the abdominal muscles should be included in a treatment protocol to reduce the degree of lumbar spine lordosis if the degree is excessive.

M.Tech. / According to the “Lovett Reactor” as explained by Walther (2000), the Atlas and the 5th lumbar vertebrae rotate in the same direction when a person walks. This relationship continues throughout the spinal column as 3rd cervical vertebrae (C3) rotates in the same direction as 3rd lumbar vertebrae (L3). From this point the movement changes to counter-rotation as 4th cervical vertebrae (C4) counter-rotates to 2nd lumbar vertebrae (L2) and 5th cervical vertebrae (C5) to 1st lumbar vertebrae (L1). According to Inman, Ralston and Todd (1981) this correlation extends as the Sacrum reacts with the Occiput. Thus, there is clinical verification demonstrating that the Lovett Reactor vertebrae are often interrelated to primary and compensatory subluxations. The aim of this study was to determine the effect of Chiropractic Occipital adjustments versus Chiropractic Sacroiliac adjustments in the treatment of chronic Lumbar Sacral pain.

M.Tech. / Purpose: Chiropractic adjustment has been shown to be an effective treatment for low back pain (Cox, 1999 and Lawrence et al, 2008). The role that the transverse abdominus plays in low back pain is not clear. Sacroiliac adjustment changes the activation speed (Marshall and Murphy, 2006) and the strength of contraction of transverse abdominus. This study aims to determine the short-term effects of chiropractic manipulative treatment on the feed-forward activation of the deep abdominal muscles in patients with chronic low back pain. Method: Forty five participants with chronic mechanical low back pain were used in this study. The primary cause of their back pain was mechanical. The study consisted of three randomly selected groups of participants. Group one was treated using abdominal exercise only. Group two was treated using both chiropractic manipulation and abdominal exercise. Group three was treated using chiropractic manipulation only. Procedure: The effect on the feed-forward activation of transverse abdominus and internal oblique was measured and recorded using surface electromyography in each group. The participants also completed an Oswestry Low Back Pain and Disability Questionnaire and a Numerical Pain Rating Scale in order to record any change in back pain. Participants were seen seven times over a maximum four week period. Readings were taken on the first, third and fifth and seventh visits. Results: Statistically significant (p<0.05) results were seen in all three groups for the Oswestry Pain and Disability Questionnaire and Numerical Pain Rating Scale. Minimum EMG results were not statistically significant, however group three showed improvement clinically. Maximum EMG results were also did not show a statistically significant change. Feed-forward activation of the transverse abdominus muscle showed no statistically significant change. Conclusion: Favourable results were obtained clinically for all three groups. Group three (chiropractic manipulation only) was shown to be the most effective in terms of patient perception of pain and disability. Objectively, the results were less definitive. Chiropractic manipulation alone had the most favourable effect on the resting surface EMG readings of the transverse abdominus, while chiropractic manipulation combined with abdominal exercises and abdominal exercises alone did not show this change. This too was seen in the results for the maximum EMG readings. Onset times of the transverse abdominus muscle showed no improvement.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 60 leaves, Annexures 1-9 / The Transversus Abdominis (TrA) muscle is recognised in the literature as playing a vital and protective role in maintaining a healthy core and aiding lumbar biomechanics in the dampening of external forces applied to the lumbar spine. Pilates purports to employ the principles of core training yet there remains a deficit in the literature despite its popularity in rehabilitation and fitness industries. This study aimed to evaluate the efficacy of Pilates method in training the TrA in comparison to a moderately active population that regularly exercises in a gym environment, as well as a sedentary control.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Musculoskeletal disorders (MSDs) are a significant and common occupational health concern, consequently impacting work attendance and performance. High prevalence rates of MSDs have been reported amongst school teachers. Studies have linked these higher prevalence rates to typical daily teaching activities including prolonged standing, awkward postures, heavy lifting, bending and repetitive movements. Objectives: To determine the prevalence of neck, shoulder and low back pain among primary school teachers in the Central Durban area; to identify any risk factors associated with neck, shoulder and low back pain; and to establish the relationship, if any, between the prevalence and risk factors of neck, shoulder and low back pain among primary school teachers. Methods: This was a quantitative, descriptive and cross-sectional study, conducted in 12 selected public primary schools within the Central Durban area. Volunteers who met the inclusion criteria (n = 97) were invited to complete self-administered questionnaires. Results: Of the 97 completed questionnaires 83.1 percent (%) reported neck and shoulder pain and 71.0% low back pain. Neck and shoulder pain were significantly associated with a forward-bent head posture (p = 0.001), ethnicity (p = 0.001), and history of a severe trauma/injury (p = 0.006). Similarly, significant associations were noted with regards to medical conditions (p = 0.006), a backward-bent head posture (p = 0.016), lifting of heavy loads (p = 0.045) and treatment for severe injury (p = 0.047). Associations were also noted between low back pain and prolonged standing (p = 0.000), ethnicity (p = 0.008), transportation methods (p = 0.023), medical conditions (p = 0.031) and a history of a severe trauma/injury (p = 0.049). Conclusion: This is a first South African study, to our knowledge that highlights increased prevalence rates for both neck and shoulder pain and low back pain amongst teachers, with a variety of associated risk factors. This draws attention to the urgent need for intervention programs to be implemented to prevent/reduce the development of musculoskeletal pain amongst teachers. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2017. / Title: A profile of patients presenting with spinal pain at Mahalapye and Shoshong World Spine Care clinics in Botswana Background: Spinal pain such as low back and neck pain, are common and can cause severe long term pain which results in a major burden on individuals and health care systems (Woolf and Pfledger, 2003; Hondras et al., 2015a). Low-income countries often have few resources for adequately addressing musculoskeletal (MSK) pain (Louw et al., 2007). Thus, World Spine Care (WSC), a non-governmental organization, opened two clinics in Botswana to help improve spinal health care by providing access to MSK specialists (Haldeman et al., 2015). These clinics have been functional since 2012, and to date the profile of patients attending these clinics has not been investigated. Studies on patients attending chiropractic clinics have been carried out internationally (Hartvigsen et al., 2002; Giles et al., 2002; Coulter and Shekelle, 2005; Holt and Beck, 2005; Mootz et al., 2005; Sorensen et al., 2006; Garner et al., 2007; Stevens, 2007; Rubinstein et al., 2008; Martinez et al., 2009; Ailliet et al., 2010; Lischyna and Mior, 2012) and locally (Benjamin, 2007; Jaman, 2007; Mohamed, 2007; Venketsamy, 2007; Higgs, 2009; McDonald, 2012; Hitge, 2014), and yet very little information exists on the patients presenting to clinics in the public sector of Botswana. Demographic and disease profiles of patients vary by clinical setting, from country to country, and within regions of the same country (Hoy et al., 2010a). Thus, this study aimed to determine the demographic and disease profile of spinal pain patients attending the WSC clinics in Mahalapye and Shoshong in Botswana. Method: A retrospective, descriptive study design was used to extract data from the WSC patient files at the Mahalapye and Shoshong WSC clinics from 1 November 2012 to 31 March 2016. The research proposal was approved by the Institutional Research Ethics Committee (IREC); REC 53/16 (Appendix A), WSC (Appendix B) and Botswana MoH (Appendix C). Patient files included had provided consent for their files to be used for research purposes (Appendix F). Data recorded included demographic characteristics, factors related to spinal pain, the presenting complaint and the presence of co-morbid conditions. The data was analysed using Statistical Package for the Social Science (SPSS) version 24.0. Descriptive statistics in the form of graphs and cross tabulations were used to describe the demographic and disease profile of the spinal pain patients. Inferential statistics like chi-square, Fischer’s exact test for categorical variables and Independent student’s t tests for numerical variables were used to determine differences between the two clinics. A p-value of less than 0.05 was used to indicate statistical significance (Singh, 2016). Results: The sample size was 65% (n=714). There was a female preponderance (75.2%, n=537), a mean age of 50.6 years (±SD 16.13). Most patients were married (38%) and the most common occupations were either farmers (18.2%, n=129) or unemployed (16.3%, n=115). The majority of patients suffered from chronic (88%), idiopathic (59.5%), low back pain (69.9%), followed by upper/mid back (19.1%), with the least visits occurring for neck pain (8%). The most frequent diagnosis was joint dysfunction with associated soft tissue disorders. The patients reported mild disability with moderate pain intensity and most patients had not experienced previous spinal pain (60%). The patients did not report a secondary area of MSK pain (28.6%) and 73.9% of patients presented with at least one comorbid condition. Patients attending the rural clinic were older on average (52.7 years, ±SD 16.92) than those at the urban clinic (48.9 years, ±15.29) (p = 0.002). There were more women attending the urban clinic when compared to the rural clinic (p = 0.009), with those attending the rural clinic most often reporting a primary school level of education in contrast to those in the urban clinic having most likely obtained a more than secondary school education (p < 0.001). More patients in the urban clinic had “other mechanical” e.g. joint dysfunction as an aetiology for their spinal pain when compared to the rural clinic (p = 0.039). In terms of pain duration, the rural clinic patients were more likely to present with acute and subacute pain than at the urban clinic (p = 0.001). The rural clinic patients also reported more previous episodes of spinal pain in contrast to those from the urban clinic (p <0.001). Conclusion: The spinal pain patients attending the WSC clinics had many similarities to spinal pain patients internationally and in SA, however unique differences were found specifically when the urban and rural clinic patients were compared. The findings of this study can assist WSC to provide more targeted healthcare at each clinic and within this region. / National Research Fund / M

Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Mid-back pain (mbp) is defined as pain occurring within the limits of the third thoracic (T3) and ninth thoracic (T9) vertebrae, caused by the dysfunction of the musculoskeletal structures in the thoracic spine. It can present as pain and/ burning between the shoulder blades with reduced thoracic spine mobility and increased muscle tension. Congenital disorders such as scoliosis and Scheuermann’s disease, or acquired disorders such as thoracic facet and costovertebral joint dysfunction may cause mbp. The thoracic facet and costovertebral joints are similar in anatomy and share a mutually dependent biomechanical relationship. There were a handful of controlled studies that highlighted the effectiveness of thoracic facet manipulation on mbp, but there were none on the effects of costovertebral manipulation on mbp. Objectives The aim of this study was to investigate the immediate effects of the combination of thoracic facet and costovertebral joint manipulation on mbp in terms of pain perception, pressure pain thresholds (PPT) and thoracic spine range of motion (ROM). Design A prospective single-blind randomised comparative clinical trial. Setting This study was conducted in a university setting at the Durban University of Technology Chiropractic Day Clinic Participants Fifty participants were recruited via responses to advertisements placed around the Durban University of Technology (DUT) campuses and individuals presenting at the Chiropractic Day Clinic (CDC). Intervention The participants were divided into two groups of twenty-five. Group A received the thoracic facet joint manipulations and Group B received a combination of the thoracic facet and costovertebral joint manipulations. Outcome measures All subjective and objective measurements were taken before and after the application of the manipulations. Pain perception i.e. subjective measurement) was measured by the Numerical Pain Rating Scale (NPRS), pressure pain thresholds (PPT) (i.e. objective measurement) were measured by the Wagner’s FDK Force Gage Algometer and thoracic spine range of motion (ROM) i.e. objective measurement was measured by the Saunders Digital Inclinometer. Results The data was analyzed using the latest version of SPSS and a p-value = 0.05 was used to determine statistical significance. Descriptive statistics in the form of univariate analysis described the data in terms of measures of central tendency and measures of dispersion. Data that was distributed normally was analyzed using the t-test and ANOVA. Data that was distributed abnormally was analyzed using the non-parametric Wilcoxon ranked and Mann Whitney tests. Nominal and ordinal data was analyzed using the Chi squared test. The results of the intra-group analysis indicated a statistically significant decrease in pain perception (p ≤ 0.000), increase in PPT (p ≤ 0.05) and decrease in thoracic spine ROM (p ≤ 0.000). However, the results for the inter-group analysis indicate there was no statistically significant difference in pain perception (p = 0.386), PPT (p > 0.05) and thoracic spine ROM (p >0.05) between Group A and Group B. Conclusions These results showed that the combination of thoracic facet and costovertebral joint manipulation was as effective as thoracic facet joint manipulation alone, in the treatment of mbp. These findings suggested that manipulation of the costovertebral joints may not be necessary for the effective treatment of mbp. / M

Thesis (M.Tech.:Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006 22, xii, 44 leaves, Appendices 1-10 / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis.