"A dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Chiropractic, Technikon Natal, 1995. / Mechanical lower back pain is a common clinical entity which encompasses a spectrum of disorders. studies show that spinal manipulative therapy is of value in the treatment of mechanical lower back pain, while some chiropractors are of the opinion that McManis traction offers an effective adjunct to spinal manipulative therapy in the treatment of such conditions / M

M.Tech. (Chiropractic) / This study was undertaken to evaluate the effectiveness of chiropractic treatment of chronic lower back pain in conjunction with the use of the Cory knee cushion during sleep as compared with chiropractic treatment alone. The cushion is used in an attempt to improve sleeping posture. It was proposed that both treatment protocols would be effective, but that the combined therapy would show better results. An unblinded, controlled pilot study was conducted. Patients responding to advertisements were recruited from the general population. Thirty patients who conformed to the specified criteria and delimitations were accepted into the study and placed randomly in one of two possible treatment groups. One group received chiropractic adjustments in conjunction with the use of the Cory knee cushion during sleep, the other received chiropractic adjustments alone. Comparisons were performed by means of objective (lumbar spine range of motion) and subjective (Oswestry Pain and Disability Questionnaire, MCGiIl Pain Questionnaire and Visual Analogue Scale) assessments over the eight-week treatment period, with comparisons made at treatments one, four, seven, nine and ten. The results were recorded and the data was statistically analysed using two-sample ttests, paired t-tests, sign rank tests and Mann-Whitney tests. The results indicated that there was a generalised improvement in both of the treatment groups in terms of lumbar spine range of motion and pain relief. While group one attained a better range for rotation after the month break, this was an isolated improvement. Under the circumstances of the research, neither group showed considerably superior results over the other, as there was no statistically significant difference between the groups. Thus, the full benefit of sleeping with a cushion between the knees in an attempt to improve sleeping posture will need additional investigation in order to be of-use as an adjunct to chiropractic treatment.

M.Tech. (Chiropractic) / OBJECTIVE: The aim of this study was to determine the effectiveness of a single treatment approach of flexion distraction or diversified lumbar adjustments, compared to the combined treatment of flexion distraction in conjunction with diversified lumbar adjustments. STUDY DESIGN: A total of 30 participants were used, they all presented with chronic low back pain (LBP) of mechanical origin. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: The participants were divided randomly into one of 3 groups: Group 1 was treated with diversified lumbar adjustments. Group 2 was treated with flexion distraction directed at the lumbar spine. Group 3 was treated with a combination of diversified lumbar adjustments and flexion distraction. Each participant was treated 6 times over a 3 week period, with a 7th consultation where subjective and objective measurements were taken with no treatment. METHODS: Group 1 was adjusted on a chiropractic table in a seated or side lying posture. Group 2 was treated lying prone on the Cox Flexion Distraction Table. Group 3 was treated with a combination of the above treatments. Flexion distraction was applied to all participants in group 2. It was applied over the segments that were found to be restricted during motion palpation. One set of 10 repetitions was performed under distraction in each range of motion (ROM). Mobilisation of the restricted joints was executed until full and complete ROM was detected. To ensure that the participant was comfortable and received the best treatment possible Velcro straps were used to secure them onto the flexion distraction table. Diversified chiropractic adjustments were done on the flexion distraction bed or the chiropractic tables in the University of Johannesburg Chiropractic Day Clinic. Spinous Hook (Pull), Thigh-Transverso-Deltoid, Transverso-Deltoid and Push-Pull Technique were the names of the adjustments used to treat participants in group 1 or group 3. PROCEDURE: Subjective data was collected using the Oswestry Low Back Pain and Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS), which were completed by the participants prior to the 1st and 4th consultations and then again on the 7th consultation. Objective data was collected using the Digital Inclinometer. The ROMs measured were forward flexion, extension, left lateral flexion, right lateral flexion left rotation and right rotation of the lumbar spine. This data was collected by the researcher prior to the 1st and 4th consultations and then again on the 7th consultation. RESULTS: This study was done to try and establish the most effective approach in the management of chronic mechanical LBP using the different treatment approaches. When comparing the results obtained from the study it can be seen that all 3 groups were effective at reducing pain levels using the NPRS. There was a significant change that occurred on the 7th consultation when looking at the NPRS values. The statistics were then further analysed and a statistically significant difference was shown to have occurred between groups 1 and 3. This indicates that the chiropractic adjustment used alone, was the best treatment protocol compared to groups 2 and 3. The ODQ values showed that the treatments for all 3 groups were effective at getting the participants back to normal activities of daily living over the treatment protocol, with no preference between any of the treatment protocols. Statistically significant changes were found to have occurred in only some ranges of motion of the lumbar spine within certain groups. Clinical improvements regarding ROM were evident in group 1 concerning flexion, left rotation and right rotation. A clinical decrease was found in extension, left and right lateral flexion with group 1. Clinical improvements concerning group 2 were found in extension, left rotation and right rotation. Flexion showed a clinical decrease in ROM values of group 2. Statistically significant improvements were found with left and right lateral flexion in group 2. Group 3 showed positive clinical results with left and right rotation. Flexion and left and right lateral flexion ROM showed decreased values clinically in group in group 3. Extension showed a statistically significant decrease in group 3. These results indicate that chiropractic adjustments used alone, were the best treatment protocol compared to group 2 and 3 when using the NPRS. The ODQ values showed that there was no preference between either of the treatment protocols with regards to normal activities of daily living.

M.Tech. (Chiropractic) / Please refer to full text to view abstract

M.Tech. (Chiropractic) / PURPOSE: The aim of the study was to compare the effectiveness of treating inter-scapular pain with either chiropractic adjustments delivered to the costovertebral joints, with ischaemic compression of the myofascial trigger points of the rhomboid muscles, or using a combination treatment protocol in order to determine which of the three treatment protocols was superior. DESIGN: This study was a comparative study consisting of three groups of ten participants each. Participants were between the ages of eighteen and forty-five and there was an equal male to female ratio. Prior to becoming a participant in this study individuals were assessed according to the inclusion and exclusion criteria. A McGill Pain Questionnaire, numerical pain rating scale, a clinical case history, full physical examination, a cervical regional examination were completed. The method of treatment for each participant was determined by random group allocation. Group 1 received chiropractic adjustments to the costovertebral joints, Group 2 received ischaemic compression to the myofascial trigger points of the rhomboid muscles. Group 3 received a combination treatment involving both chiropractic adjustments to the costovertebral joints together with ischaemic compression of the rhomboid trigger points. Subjective and objective readings were based on the above treatment protocols. All participants received a total of six treatments over a three week period. MEASUREMENTS: Subjective measurements were obtained by the Numerical Pain Rating Scale and the McGill Pain Questionnaire. Objective measurements were obtained using the hand-held pressure algometer. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the McGill Pain Questionnaire for the intragroup analysis indicated that the ischaemic compression group showed the greatest improvement over time (84.06%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the adjustment group showed the greatest improvement over time (78.70%). The intergroup analysis indicated that there were no statistically significant differences. With regards to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the ischaemic compression group showed the greatest improvement over time (35.44%). Once again, there were no statistically significant differences with the intergroup analysis. CONCLUSION: Based on the results of this study, it showed that all three treatment groups were effective in decreasing inter-scapular pain and disability. Although all three treatment protocols have shown to be effective, and have shown similar improvement, intergroup analysis indicates that statistically there is no treatment protocol that is seen to be more superior or more effective in treating inter-scapular pain.

M.Tech. (Chiropractic) / The aim of this study is to compare Chiropractic Manipulative Therapy of the lumbar spine combined with Therapeutic Ultrasound Therapy over the adjacent lumbar paraspinal muscles to ascertain the most effective protocol in the treatment of Chronic Mechanical Lower Back Pain. Thirty participants with Chronic Mechanical Lower Back Pain between the ages of 18 and 35 years were recruited. Successful participants were randomly placed in two groups, of fifteen participants each, which would receive different treatment protocols according to their group allocation. Group One received Chiropractic Manipulative Therapy to lumbar spine restrictions. Group Two received Chiropractic Manipulative Therapy to the lumbar spine restrictions as well as Therapeutic Ultrasound Therapy to the adjacent paraspinal muscles. The participants completed a total of seven visits, including 6 treatments over 3 weeks. Subjective and Objective readings were taken on the first, fourth and seventh visits. Subjective readings from each participant were recorded using the Oswestry Disability Iindex and Numerical Pain Rating Scale. Objective readings were taken and recorded three times consecutively using a Pressure Algometer over the adjacent lumbar paraspinal muscles and a Digital Inclinometer to measure lumbar spine range of motions. The statistical data was analysed using the Friedman test, Mann-Whitney test and the Bonferroni test. The results demonstrated overall that both groups responded favourably to their specific treatment protocols, however no significant differences between groups was noted, highlighting the positive effects of the manipulation alone.

Magister Public Health - MPH / 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. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / The aim of the current study was to determine the relationship between low back pain and physical activity levels among nurses in Kanombe Military Hospital (KMH), as well as other confounding factors leading to low back pain. A quantitative, cross-sectional and descriptive design was used to conduct the study. The study population and sample included all clinical nurses in all the departments/wards at KMH (excluding three nurses doing administrative work only and the four who participated in the pilot study). A total of 133 nurses participated in the study and data was collected using three self administered questionnaires. The first one requested socio-demographic data, followed by the International Physical Activity Questionnaire (IPAQ) which examined the physical activity levels of nurses, and lastly the Nordic Musculoskeletal Disorder Questionnaire which examined low back pain prevalence. A response rate of 122 (92%) was obtained. / South Africa

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / The absence of tested theory has resulted in a continued variation in protocols for the treatment of mechanical low back pain. This study was designed in order to determine the relative effectiveness of spinal manipulation versus spinal manipulation in conjunction with a low back strapping in the treatment of mechanical low back pain in the phase of dysfunction. / M

Dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Chiropractic, Natal Technikon, 1997. / The purpose of this study is to evaluate the usefulness of the Gonstead Listing System as a reliable indicator of the direction in which to adjust the sacroiliac joint in subjects with sacroiliac joint dysfunction, in terms of their subjective and objective clinical findings. The hypothesis is that the direction of manipulation is clinically insignificant in causing a decrease in the subject's clinical findings. This information is necessary in order for chiropractors to formulate a more cost-effective treatment protocol for their patients. / M