Lower back pain is the leading cause of disability and is thought to be driven primarily by intervertebral disc degeneration (DD) [1]. Studies suggest DD is associated with increases in inflammatory and catabolic signaling and is characterized by a loss of structural integrity [2, 3]. These degenerative changes ultimately compromise disc mechanics and produce a loss of pressurization. Prior studies have identified increases in pro-inflammatory signaling molecules (IL1β, TNFα, HMGB1) during DD [4-6]. Furthermore, the presence of infiltrating immune cells, such as monocyte/macrophages have also been observed in injured and degenerated discs [7, 8]. Though an increased inflammatory signaling microenvironment is thought to be a hallmark of DD, studies have yet to identify if inflammatory signaling alone is capable of driving degeneration. Further complicating this, the complex mechanical environment and the immune privileged nature of the IVD has left unanswered questions regarding the role that innate immune response plays in propagating disease pathology. In following studies, we evaluated the inflammatory signaling milieu produced by needle puncture injury. Within this study we utilized a connective tissue specific genetic knockout model of a primary inflammatory candidate following injury, the potent damage associated molecular pattern, HMGB1. We identified regional activation of HMGB1 to have roles in tissue structure homeostatic changes and recruiting innate immune cells to the disc following tissue damage. To next answer whether inflammatory biological factors alone are capable of initiating DD, we utilized a connective tissue specific genetic mouse model. In this broad approach of producing an inflammatory microenvironment we identified how prolonged activation of NF-κB, a master transcription factor regulator of inflammatory responses and immune cell recruitment, affects disc integrity. In vivo analyses of the inflammatory disc microenvironment revealed that NF-κB over-activation within IVD cells produced severe degeneration, possibly initiated by an increase in chemotactic proteins and recruitment of inflammatory macrophages. Lastly, directed by findings of significant monocyte/macrophage infiltration following NF-κB over-activation and tissue damage, we examined the response of macrophages to the mechanical hydrostatic pressure (HP) loading present in the IVD microenvironment [9]. Using a novel bioreactor system, we observed macrophages to be mechanoresponsive to physiologically relevant HP loading magnitudes via activation of an inflammatory resolving functional state. We characterized this HP activated macrophage by distinct transcriptome profile changes, increased anti-inflammatory cytokine release, and phagocytic activity. These findings reveal IVD homeostatic and inflammatory functions primarily mediated by HMGB1, both basally and following injury. Further, findings provide evidence that NF-κB signaling is capable of producing severe DD in the absence of a physical injurious initiating event. Within inflammatory over-activation and puncture injury models, we have identified multiple avenues, dictated by inflammatory signaling or tissue damage, in which innate immune cells are recruited to the IVD. Lastly, using a novel HP bioreactor system we have characterized an inflammatory resolving functional macrophage activated via healthy HP loading magnitudes. These findings suggest that a loss of pressurization within the disc may contribute to a lack of inflammatory resolution and frustrated healing.

The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the

The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the

Magister Scientiae (Physiotherapy) - MSc(Physio) / The aim of this study was to determine assessment and treatment choices of physiotherapists treating non-specific low back pain in Rwanda. The main objectives were to identify the common types of low back pain treated by physiotherapists, to determine the / South Africa

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Thesis (M.Tech-: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 x, 57 leaves, Annexures 1-10 / To determine if serum cortisol levels are increased following Spinal Manipulation Therapy (SMT) to the low back region and to determine the effect of a short rest interval on the cortisol levels

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2004. 1 v. (various pagings) / Background: Back pain among the golfing population is considered endemic as it has been recommended to golfers that they should attempt to use a state of maximal spinal rotation in their golf swing in order to achieve maximum ball distance. Evidence suggests that maximum spinal rotation range of motion will be more restricted in the golfers with low back pain, even though this maximum rotated position has been considered ideal for developing optimal Club Head Velocity (CHV). Research has demonstrated an approximate 1:3 relation between CHV and air travel (i.e. distance) of the golf ball. An increase in 1mph in CHV would increase air travel of the golf ball by approximately 3 yards. If one considers that CHV is primarily influenced by the strength and power of the torso (low back and abdominal muscles), muscle balance and flexibility, which are responsible for the static and dynamic postural stability of the golf swing, it stands to reason that low back pain, which has been identified as the most common problem affecting amateur golfers, will affect CHV. Objective: The purpose of this investigation was to evaluate the immediate effect of spinal manipulative therapy on club head velocity in amateur golfers suffering from mechanical low back pain in terms of subjective and objective measures.

Thesis (M.Tech.: Chiropractic)- Dept of Chiropractic, Durban Institute of Technology, 2005. xiii, 129 leaves :|bill. (some col.) ;|c30 cm / Research indicates the sacroiliac joint (prevalence of sacroiliac syndrome ranges from 19.3% and 47.9% (Toussaint et al., 1999)) as being the primary source of low-back pain in 22.5% of patients with back pain (Bernard et al., 1987:2107-2130). Treatment options that are available for the treatment of low-back pain include allopathic (Hellman and Stone, 2000), and manual therapies such as hydrotherapy and traction (Cull and Will, 1995). It has been found that allopathic interventions have been less effective than spinal manipulative therapy, even with spinal manipulative therapy having various modes of application (e.g. side posture and drop piece manipulations) (Gatterman et al., 2001). Drop table thrusting techniques were found to be effective for patients with neuromuskuloskeletal problems such as facet syndrome (Haldeman et al., 1993), however, it is still not known which specific drop piece technique is the most appropriate for sacroiliac syndrome. Thus it is important to ascertain the clinical effectiveness of the technique as certain conditions prevent the patient from being positioned in the conventional side posture for treatment of sacroiliac syndrome (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Therefore this study aims at determining the efficacy of a maintained contact drop piece manipulation technique.

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2008 / The core stability, club head velocity and ball carry in golfers with and without low back pain – a comparative study. Objective: The aims of this study was to establish whether an observable difference exists in the abdominal core stability of two comparable groups of golfers: one asymptomatic and the other suffering from low back pain, and whether an observable reduction of performance, expressed as club head velocity and ball carry can be observed in those with low back pain. First Objective was to differentiate the groups at baseline with respect to core stability strength between asymptomatic golfers and golfers suffering from low back pain. Whereas the Second Objective was to establish whether a relationship exists between abdominal core stability, CHV and ball carry in the two population groups under study. Following the above the Third Objective was to establish which other factors besides core stability strength have an effect on CHV and ball carry. And lastly the Fourth Objective was to establish the correlation between CHV and ball carry. Design: A comparative study was carried out between the two sample groups. A sample of forty patients were selected for this study, where twenty patients were asymptomatic and had no current episode of low back pain and were able to maintain a core contraction; and the other twenty patients low back pain and could not maintain a core contraction. Because the patients presented in a random manner, the patients were matched as close as possible according to age, so as to have better comparative value between the groups (the maximum age difference of a year was instituted). This allowed for comparisons among similar ages, with the difference being their low back pain and core contraction status. Outcome Measure: Each golfer was required to hit 5 balls using a standard club (in this study, a standard driver was used), after which an average value v was calculated for CHV and ball carry. All measurements were carried out using the Flightscope Pro machine at the Durban Pro Shop. Results: Core stability and low back pain did not influence CHV. However there was a non significant trend which indicated higher ball carry in the group with better core stability and no low back pain than in the group with low back pain and poor core stability. Increasing age and handicap reduced the CHV and ball carry values significantly. Ball carry and CHV were positively correlated together in both groups.

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.