Dissertation submitted to the faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, 2007. / The objectives of this study were: To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. Hospital nurses have a high prevalence of low back pain (LBP) (Smedley et al., 2003). It has been found that nursing personnel ranked fifth in occupations claiming worker compensation for low back injuries (Owen and Garg, 1994). A number of studies have also indicated a strong association between musculoskeletal disorders and work related factors (Maul, 2002). An epidemiological study by Smedley et al (1997) has suggested that repetitive lifting, frequent bending and twisting play a role in the development of LBP, and that heavy physical workload has played a major role in the development of LBP in nurses. LBP is therefore a serious problem in the nursing field with a relatively high prevalence worldwide. It causes increased absenteeism from work and could impact on patient care. This study was a survey, which was quantitative in nature. Data was collected by means of a questionnaire. The questionnaires were handed out in randomly selected hospitals in the Durban Metropolitan area. The names of all state and private hospitals in the Durban Metropolitan area were put into two boxes and three names were picked from each box. A letter requesting permission to carry out this research was sent out to each hospital and a positive response was received from one state hospital, R.K Khan Hospital and two private hospitals, Westville and Entabeni hospitals. Questionnaires were handed out to the nurses by the researcher, as requested by the hospitals, and collected at a later time by the researcher. Questionnaires were handed out at each ward in the hospitals to nurses who met the criteria for the study and agreed to participate in this study. Questionnaires were also handed out to nurses in the nurses lounge during lunch breaks. The questionnaire was developed as combination of; a pre-validated questionnaire made available by Yip (2001), questions on socio-demographic data, work history, patient handling activities and LBP. The compiled questionnaire was tested for face and construct validity through a focus group, and piloted before being used in the study. A total of 500 questionnaires were handed, 250 to state hospitals and 250 to private hospitals. Participants consisted of nurses (registered, enrolled and student) between the ages of 18 and 45 years, both male and female. Nurses from all hospital wards were allowed to participate in this study. A total of 124 questionnaires were received back, ( 50 from private hospitals and 74 from the state hospital), from the nurses in all the hospitals. Data was then collected from these questionnaires and was analysed using the statistical package SPSS version 13 (SPSS Inc. Chicago, Illinois, USA). A p value of <0.05 was considered as significant. The data collected from the questionnaires was analysed and the results obtained were as follows: The prevalence of work related LBP in this study was 59.7%. Of the 74 nurses with LBP, only 7 (9.5%) reported having LBP before working as a nurse. 35.1% of participants reported that they experienced pain on a daily basis while 62.2% described their LBP as moderate and 27% described their pain as severe. The median duration of LBP was 3.5hours per episode. Of all the participants in this study, 64,9% had needed bed rest due to their LBP with 43.2% having taken sick leave from work for LBP. Back pain in nurses has been found to be a major cause of days lost due to sickness (French et al., 1997). The majority of nurses (93.2%) reported lifting to be the cause of their LBP, standing and bending were also found to be important causes. Low Back injury was reported in 31.1% of participants with up to 51.4% receiving treatment for their injuries, the main choice of treatment was from a hospital or General practitioner. With regards to the frequency of manual work on LBP, there was found to be a slight tendency toward LBP with more frequent manual activity, however this was viii found to be non significant. In those respondents with LBP, the activity associated with the most intense LBP was carrying or lifting patients. Time spent; standing, holding up hands and bending were found to be higher in the group which reported LBP. Having 1-2 children was also associated with increased LBP. The prevalence of LBP was found to be higher in the state hospital (67.6%) than in the private hospitals (48%). The aim of this study was to determine the association between frequency and intensity of manual work on LBP in nurses. The results showed that frequently performed manual activities were associated with LBP but not significantly. In terms of intensity of manual work, carrying or lifting patients was found to be most associated with LBP, standing and bending were also significantly associated with LBP. This study also aimed to determine any difference in LBP between state and private hospitals and a significant difference in LBP prevalence was noted between state and private hospitals. The findings of this study suggest that LBP is a common problem among hospital nurses. The results of this study were also found to be within the same prevalence rates of international studies, which ranged from 35.9% in New Zealand to 66.8% in the Netherlands (Nelson et al., 2003). As was found in the literature (French et al., 1997 and Smedley et al., 1997), lifting was reported to be a major cause of LBP.

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.

published_or_final_version / Community Medicine / Master / Master of Public Health

<p>Nursing is a high-risk profession for the development of musculoskeletal problems and low back pain (LBP) in particular. Currently there is limited information available for the prevalence of LBP among the South African nursing population and no evidence on knowledge, attitudes and beliefs about the prevention and self-treatment principles for LBP among this group. The aim of this study was to evaluate the knowledge, attitudes and beliefs about the prevention and self-treatment principles for LBP among nursing staff in Cecilia Makiwane Hospital, East London Hospital Complex. The study found that the majority of the participants experienced LBP on a regular basis.</p>

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / To compare the relative activation and endurance of core stability muscles in 2 different populations i.e. elite athletes and non-athletes, and establish whether these findings correspond to episodes of mechanical lower back pain. / M

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

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

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology. Thesis, 2005. / In symptomatic sacroiliac syndrome, nociceptors located within the capsule and ligaments of the sacroiliac joint are said to be activated which in turn act on inhibitory interneurons that synapse with the motor neuron pool of the muscles of that joint (muscles responsible for hip flexion, extension, abduction and adduction fall within the sacroiliac motor neuron pool). These inhibitory interneurons relay information that decreases the recruitment ability of that motor neuron pool. This is termed Arthrogenic muscle inhibition (AMI) and it has been stated that the number of motor units innervating a muscle relates positively to the strength of that muscle and hence may have an effect on the functional ability of that muscle. However, it has been proposed that spinal manipulation activates mechanoreceptors (Wyke receptors) from structures in and around the manipulated joint causing changes in motor neuron excitability through the altered afferent input and thereby causing an increase in motor neuron recruitment and a decrease in AMI. Furthermore, it has been found that sacroiliac joint problems have often been related to reduced or asymmetric range of motion (ROM) of the hip and / or lack of proprioceptive ability in the ipsilateral limb. In light of the above, manipulation has been found to cause a re-establishment of normal muscle tone and joint kinematics, therefore relaxing the muscles in that area and restoring normal ROM of the involved joint. This study presents the results of sacroiliac manipulation on objective hip measures (including peak torques, ROM and proprioception). / M

A dissertation presented in partial compliance with the requirements for the Master's Degree technology: Chiropractic, Durban Institute of Technology, 2002. / Low back pain is estimated to effect 60-90% of the world's population sometime during their lives while 20-30% of people suffer from low back pain at any given time (Cassidy and Burton, 1992:3). Locally, epidemiological studies into low back pain have revealed incidence rates of 57.6% amongst black South Africans (Van der Meulen, 1997) and between 70 and 80% amongst Indians and Coloureds (Docrat, 1999). The use of spinal manipulation with the emphasis on restoring joint mobility, has been proven to be one of the most effective and cost effective approaches in the management low back pain of a mechanical origin (Di Fabio, 1992). McMorland (2000), showed in a study of 199 patients, that spinal manipulation resulted in an average of 52.5% and 52.9% reduction in low back pain and disability respectively. Panjabi (1992:1) has postulated a theory of a 'neutral zone' around which the passive lumbar spine operates. He describes the neutral zone as a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. It is, according to Panjabi (1992:1), possible for this neutral zone to increase with injury to the spinal column or with weakness of stabilising muscles, which could result in low back pain. The trunk muscles therefore have to be able to co-contract isometrically to control the neutral zone and protect the spinal tissue from excessive motion (Richardson et aI.1990). The transversus abdominis muscle and multifidus muscle have been identified as playing an important role in the complex synergistic interaction of the trunk (Norris, 1995). The above concept involving muscles attempting to maintain a neutral zone is commonly referred to as 'core stabilisation' (Norris, 1995). / M