Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The aim of this research was to investigate the relative effectiveness of manipulation versus core rehabilitation in the treatment of acute mechanical low back pain in sedentary patients. Recent research has found that dysfunction of the primary core stabiliser muscles is linked with an increasing number of the general population suffering from low back pain; this is thought to be due to the fact that people in general are living more sedentary lifestyles. The Aims and Objectives of this study were to determine the relative effect of manipulation and core rehabilitation in sedentary patients suffering from acute mechanical low back pain in terms of subjective findings, objective findings and to determine any correlations between these findings Thirty-two participants, with acute low back pain participated in the study. They received treatment over a period of three weeks, two treatments in the first week, two treatments in the second week and a follow up seven days later. Group A received a spinal manipulation while Group B received core rehabilitation exercises. Readings were taken at three time points, namely visit one, three and five before the treatment, they included the following readings: Numerical Pain Rating Scale, Algometer, Roland Morris Low Back Pain and Disability Questionnaire, Biofeedback Stabiliser and the Surface EMG. The results showed that there was no differential (p<0.05) treatment effect between the two Groups, and that both Groups showed a clinical improvement in their low back pain. In conclusion, it appears that even though both these treatment protocols have very different mechanisms of action, both can be effective treatment protocols and that core rehabilitation exercises when properly performed are as effective as manipulation in the treatment of acute low back pain.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Objectives: To determine the prevalence and associated risk factors of low back pain (LBP) in an automotive production company, evaluating the relationship between selected risk factors, type of occupational activity and the prevalence of LBP. Methods : This was a descriptive study at a large automotive production company entailing 200 physical production employees and 200 sedentary employees. Using a cross sectional study design, a retrospective analysis investigated the LBP prevalence, by means of a questionnaire. Individuals reported on demographics, injury location, injury aetiology, injury nature, extent of treatment rendered and time lost from work. Additionally, data was obtained regarding smoking, occupational stress and fitness.Results: A significant difference was found between sedentary and manual employees with regards to age, gender, ethnicity, marital status, education and medical aid. Similarly a significant difference between the groups was found for the point prevalence of LBP, current LBP description (sharp, shooting, dull aching, stabbing and catching pain descriptions), past LBP description (catching pain description), sidedness/ location of pain as well as associated features of the current LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends) and associated features of past LBP (viz. pins and needles, pain to the knees, numbness, bed rest, absence from work, pain at work and pain on weekends). There were no noted psychosocial factor that impacted on a difference between the groups, but there was a significant difference between the manual and sedentary employees with regards to absenteeism. Conclusion: A significant rate of LBP was reported amongst both the sedentary (59.6%) and the manual (89%) employees, implying that the costs to the company are relatively high. It is, therefore, suggested that the company looks at a variety of strategies to reduce the burden of LBP in their employees. / National Research Fund

A dissertation submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The purpose of this research is to conduct a descriptive study of cases that presented with thoracic complaints to Durban University of Technology chiropractic Day Clinic from the 13 January 1995 to 30 November 2005. This is a retrospective, quantitative, non-experimental, clinical survey. The sample size for this study included 7111 cases obtained from the Durban University of Technology chiropractic day clinic. There were no thoracic cases recorded in the random sample for the year 1995, therefore the random sample allocated for this year was subtracted from the total sample. 249 Thoracic cases were included in this research. The overall prevalence for the time period 1996 - 2005 was 3.5%. Gender: 248 of the 249 patients had recorded gender information. The majority were female 54.8% while 45.2% were male. Age: The ages ranged from 11 to 73 years. The mean age was 33.3 years. Occupation: 241 patients had a recorded occupation. 21.6% of them were classified as active or non-sedentary while the majority had sedentary jobs. The main complaint was mid-back pain which was noted in 41.4% of the population. Thoracic facet syndrome was the primary diagnosis given in 74.7% of the population; myofasciitis was the second most diagnosed condition with 8.8% of the population having this primary diagnosis. The most common treatment was joint manipulation, which was used in 82.6% of the cases, followed by soft tissue therapy (79.4%) and stretches (44.9%). The facets that were most commonly found to be fixated were in the T5 toT8 region. The investigative procedure that was used most often in the sample was x-rays. Fourteen patients were sent for x-rays (5.6%). One patient was sent for a blood test (0.4%). No other investigative procedures were used in these patients. Even though the overall prevalence of thoracic pain sufferers was only 3.5% over the ten year period, it is still an area of pain that must be investigated. The thoracic spine has been overlooked as a major region for research. This study has proved that there is need for continuing research in this area, to assist chiropractors to treat the thoracic spine more effectively. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of post-natal mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of postnatal and mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Each healing encounter, and every treatment, has specific and non-specific treatment effects. Non - specific effects, or placebo effects, are the benefits felt by the patients because of the nature of the healing encounter. Although difficult to quantify and control, a number of authors recognize that the non-specific component of management has an additive effect on the overall clinical outcome. It has been reported that due to the physical interaction and social nature of chiropractic, there is a strong non-specific component in the management process, but to what extent it facilitates in the healing encounter is unknown. It has also been shown that spinal manipulation has a clinical effect which exceeds that of placebo; therefore it is possible for its effect to be muted or amplified, depending on the presence or absence of non-specific effects. For the above reasons this study was conducted in an attempt to map the size of the nonspecific effect in the healing encounter by manipulating the practice setting in which the patients were treated. This was achieved using a prospective, randomised, comparative clinical experiment consisting of 60 individuals with Low Back Pain (LBP), selected by convenience sampling. Individuals were then divided into 2 groups of 30. The IV first group's treatment consisted of the standard diversified method of manipulation in a Clinical Research Setting, and the second group received the same treatment except the treatment took place in a Normal Practice Setting. / M

Partial Dissertation in compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Aims and Objectives: The aim of this study was to determine whether spinal manipulation affects the perceived performance of runners with low back pain. More specifically, the objective was to determine whether any relationships existed between spinal manipulation, a runner’s perceived performance and their low back pain. Method: Twenty subjects who ran thirty kilometers a week and had LBP were selected for a pre- post- cohort study according to criteria set out beforehand. The subjects received spinal manipulation applied to their lower back twice a week for a period of two weeks. At each consultation, they were requested to fill out a “Perception of Running Performance” questionnaire prior to each treatment, and one week following the final consultation. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / There are many non-surgical treatments that are available to patients with low back pain but few have been proven effective in controlled clinical trials. Arguably, the treatments with the greatest evidence for efficacy are nonsteroidal anti-inflammatory drugs (NSAIDs), some muscle relaxants and spinal manipulation (Deyo et al.(1983) and Shekelle et al.(1992). Non-steroidal antiinflammatory drugs are the most widely used agents for musculoskeletal pain and inflammation. The widespread use of NSAIDs augments the impact not only of their benefits but also the risk of their adverse effects. The effectiveness of chiropractic management is now firmly established for most patients with acute and chronic low-back pain (Koes et aI.1996). The purpose of this study was to determine the relative efficacy of combined diclofenac sodium therapy and spinal manipulation compared to combined placebo therapy and spinal manipulation in the treatment of mechanical low back pain. Sixty subjects were selected and randomly divided into two groups of thirty subjects. Subjects were treated four times over a two-week period, including a diclofenac or placebo medication course, taken three times daily for five days, starting from the first consultation. The results of the Numerical Pain Rating Scale-101, Revised Oswestry Low Back Pain Disability Questionnaire, Orthopaedic Rating Scale and Algometer readings were taken before the first, third and fourth consultations. The statistical tests used were the parametric two-sample unpaired t-tests and the paired t-tests, and the nonparametric intra-group Friedman test, multiple comparison procedure, Wilcoxon Signed Ranks test and the inter-group Mann Whitney U-test at the 95% level of significance using the SPSS statistical package. There was a statistically significant improvement in both treatment groups for both subjective and objective clinical findings, suggesting that spinal manipulation combined with either an NSAID or placebo medication will ultimately give relief to a patient suffering from lower back pain. The conclusions / M

M.Tech. (Chiropractic) / Chronic lower back pain is a very common condition affecting 60-80% of the worlds’ population at sometime in their lives. Manual therapy, including chiropractic manipulation, has been proven to be very successful in the treatment of chronic lower back pain and reduction in muscle tension. Although chiropractic treatment alone is effective in the treatment of chronic lower back pain, chiropractors often search for adjunctive modalities to enhance the positive outcomes of their treatment. Kinesio® tape application to the lumbar para-spinal muscles has been proven to be effective in increasing lumbar range of motion and in decreasing lower back pain. The purpose of this study was to determine whether the combination of Chiropractic manipulation and Kinesio® taping of the lumbar para-spinals is a more efficient, and possibly effective, treatment protocol in the treatment of chronic lower back pain. Method: This study was a comparative study and consisted of three groups of ten participants. The participants were between the ages of eighteen and forty years of age, with a male to female ration of 1:1. The potential participants were examined and accepted according to the inclusion and exclusion criteria. Group 1 received chiropractic manipulative therapy to the lumbar spine and sacroiliac joints. Group 2 only received the application of Kinesio® tape to the lumbar para-spinal muscles. Group 3 was the combination group, and received chiropractic manipulative therapy to the lumbar spine and sacroiliac joints together with the application of Kinesio® tape to the lumbar para-spinal muscles. Subjective measurements consisted of the Numerical Pain Rating Scale and the Oswestry Pain and Disability Index and objective measurements was range of motion of the lumbar spine. Procedure: Treatment consisted of seven consultations over a three week period. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations before treatment. Subjective readings were taken from the Numerical Pain Rating scale and the Oswestry Pain and Disability index.Objective Readings were taken from measurements taken from the Digital Inclinometer device measuring lumbar range of motion. At the first to sixth consultation participants each received their groups’ specific treatment protocol, the seventh consultation consisted of data collection only.

Background: In the clinical examination of patients with low back pain (LBP), musculoskeletal physiotherapists routinely assess lumbar spinal segmental motion by performing physical examination procedures such as observation of active range of motion and palpation of intervertebral motion. The validity of manual assessment of segmental motion, however, has not been adequately investigated. Methods: In this pragmatic, multi-centre, criterion-related validity study, 138 consecutive patients with LBP were recruited and examined by physiotherapists with postgraduate training in musculoskeletal manual therapy. Clinicians examined each patient�s spine for the presence of segmental motion abnormalities, described as lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI), then referred the patients for flexion-extension (FE) radiographs. The physical examination procedures of interest were: 1) assessment of forward-bending (FB) active range of motion (AROM); 2) FB and backward-bending (BB) passive physiological intervertebral motion testing (PPIVMs) in the sagittal plane; and 3) central postero-anterior passive accessory intervertebral motion testing (PAIVMs). Sagittal displacement kinematics of the lumbar spinal segments were measured from the FE radiographs, and served as the criterion standard against which the clinical assessment results were compared. The kinematic parameters measured were sagittal rotation, sagittal translation, ratio of translation per degree of rotation (TRR), instantaneous axis of rotation (IAR), and centre of reaction (CR). Reference ranges for normal motion were calculated from the analysis of FE radiographs of 30 asymptomatic volunteers. The accuracy and validity of the clinical examination procedures were then calculated, and reported as sensitivity, specificity, and likelihood ratios for a positive test (LR+) and a negative test (LR-). Results: In patients with LBP, sagittal rotation LSR and sagittal translation LSR had a prevalence of approximately 5.7% (p <0.0005) in this cohort. Sagittal rotation LSI was not found in statistically significant numbers. Sagittal translation LSI was found at a prevalence of 3.6% (p <0.05). Abnormal TRR (23.3%), IAR (17.7%), and CR (16.5%) were more prevalent findings (all p <0.0005). Observation of the quantity of AROM, during FB, is not valid for the assessment of either total lumbar segmental sagittal rotation, or detection of individual segments with abnormal segmental motion. PPIVMs and PAIVMs are specific, but not sensitive, for the detection of rotation LSI and translation LSI. A positive test (grade 4 on a scale from 0 to 4) with BB PPIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 8.4 and 7.1 respectively (and 95% CIs from around 1.7 to 38). Likelihood ratio statistics for FB PPIVMs were not statistically significant. A positive test (grade 2 on a scale from 0 to 2) with PAIVMs may have some utility for the diagnosis of rotation LSI or translation LSI, with LR+ of 2.7 and 2.5 respectively (and 95% CIs from around 1.01 to 7.5). Neither PPIVMs nor PAIVMs were useful for the detection of LSR, or abnormal quality of motion as measured by TRR, CR, and IAR. Conclusions: Abnormal spinal segmental motion is associated with the symptom of LBP, in patients presenting to physiotherapists with a new episode of recurrent or chronic LBP, however prevalence is low due to highly variable lumbar segmental motion among asymptomatic individuals. Manual physical examination has moderate validity, but limited utility on its own, for the detection of translation LSI. Further research should investigate the utility of other clinical examination findings for the detection of lumbar segmental mobility disorders.