published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

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Šio tyrimo tikslas yra atskleisti pardavėjų – konsultantų ergonominės aplinkos ir nugaros skausmo sąsajas. Darbo objektas - darbuotojų nugaros skausmo priežastys. Buvo kelti šia uždaviniai: atskleisti ergonomikos sampratą ir jos įtaką nugaros skausmo atsiradimui teorinius aspektus; įvertinti pardavėjų – konsultantų nugaros skausmo paplitimą; atskleisti darbuotojų nugaros skausmų priežastis, kurios iškyla dėl ergonominių sąlygų; išsiaiškinti, kokiomis priemonėmis malšinamas patiriamas nugaros skausmas. / Aim of this research is to reveal links between ergonomic environment and backache suffered by shop-assistants/ consultats. Object of the Paper: cause of backaches suffered by employees.The foolowing tasks have been set: to reveal theoretical aspects of the conception of ergonomics and the influence thereof on occurrence of backaches; to evaluate prevalence of backaches suffered by shop-assistants/ consultants; to reveal the cause of backaches in employes occurring as a result of ergonomic conditions; to find out what were the means to relieve the suffered backache.

Thesis (M.Tech.: Environmental Health)-Dept. ofEnvironmental Health, Durban Institute of Technology, 2005 xv, 144 leaves ; 30 cm / Motivation: Lower back pain (LBP) has been found to affect workers and often result in higher costs to industry than any other musculoskeletal disorder. Traditionally, the most widely investigated risk factors for LBP have been biomechanical demands of the job. By examining LBP, both its prevalence and distribution, it becomes possible to focus on contributory risk factors that bring on its onset. Aim: To identify the selected risk factors associated with prevalence of LBP amongst refuse truck drivers in the eThekwini Municipality, and to evaluate the relationship between the selected risk factors and the prevalence of LBP.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2004. xvi, 155 leaves / The aim of this investigation was to investigate whether an immediate objective increase in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome. The actions of hip flexion, extension, abduction and adduction were assessed. The study also investigated the patients’ subjective perception of pain due to the chronic sacroiliac syndrome before and after the manipulation. The proposed increases in strength would have been as a result of a reduction in arthrogenic muscle inhibition. Stimulation of nociceptors caused by the chronic sacroiliac syndrome would have lead to the presence of the arthrogenic muscle inhibition within the joint. Arthrogenic muscle inhibition has been described as an inability of a muscle group to utilise all its muscle fibres when performing a maximum voluntary contraction of that muscle group. Arthrogenic muscle inhibition is a joints natural response to pain, damage or distension within the joint. The response is an ongoing reflex inhibition of the muscles surrounding the joint in order to protect the joint. The inhibition of the surrounding musculature clinically manifests itself as a decrease in strength of the affected muscles. The decreased strength levels hampers rehabilitation of the affected joints as active exercise forms a vital role in the rehabilitation process. Current treatment options used to reduce arthrogenic muscle inhibition include lidocaine injection into the joint, cryotherapy and transcutaneous nerve stimulation. These treatments are aimed rather at the reduction of pain, joint effusions and atrophy of the related musculature than at the reduction of arthrogenic muscle inhibition. Recent studies have proposed that manipulation reduced arthrogenic muscle inhibition by causing excitation of the joint receptors, called the Wyke receptors. Stimulation of these joint receptors is thought to cause an alteration in the afferent input to the motorneuron pool resulting in a reduction of arthrogenic muscle inhibition. This study aimed to investigate whether sacroiliac manipulation could reduce arthrogenic muscle inhibition at the hip by assessing the immediate gains in hip muscle strength. The problem statement was to evaluate if an immediate subjective or objective change in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 1 v. (various pagings) / In recent years, sacroiliac syndrome has been widely accepted by many different health professions as one of the major contributors to mechanical low back pain. Manipulation to effect the relief of the condition has thus far proven to be one of the most effective methods. However, comparatively little research has been done on the different forms of physical therapy that can be used in conjunction with a manipulation so as to maximise its effect. This study focussed on the use of ischaemic compression (a well-accepted technique for the treatment of myofascial trigger points) of the gluteus medius muscle.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic at the Durban University of Technology, 2009 / Objectives: When we consider the body position of a field hockey player, the lumbar spine is always in a flexed position, which combined with rotational movements during various hitting and pushing techniques, increases the strain upon the spine and surrounding muscles, thus leading to low back pain. To determine the relationship between core strength and trunk extensor endurance relating to the incidence of acute low back pain in field hockey players. Project Design: The research project was in the form of a quantitative cross-sectional study, using human subjects. Setting: The research project occurred during the field hockey season (2008) with players who had acute low back pain. The players were clinically assessed and subdivided into necessary groups at the Chiropractic Day Clinic at the Durban Institute of Technology. Subjects: Adult, male patients, aged between 18 and 30 years of age, playing premier field hockey. Out of the thirty players, 12 players have played in the National u/21 squad, 7 players have played in a Junior National team and 11 players have played senior provincial field hockey. Outcome measure: This included three tests. Firstly, the absolute difference of pressure from the reference value of 70mmHg (prone) and 40mmHg (supine) was used as the outcome measure on a Pressure Biofeedback Unit and length of time (in seconds), a correct contraction of the core stability muscles was maintained. Secondly, the length of time (in seconds) for Trunk Extensor Endurance. Thirdly, repeated measures for NRS-101 and Quebec Back Pain Disability Scale for the duration of the research period. v Results: It was found that there was no statistical evidence or convincing trend to show that the training programmes (core stability and trunk extensor endurance) increased the subjects’ core strength or trunk extensor endurance in the time allocated, although there seemed to be a placebo effect in the Trunk Extensor Group, which showed improvement in some of the core stability outcomes. There was statistical evidence that the intervention (training programmes) reduced pain, according to the Quebec Back Pain Disability Scale (Quebec) score over time, and a non-significant trend suggested this according to the Numerical Rating Scale-101 (NRS). Since both groups’ NRS and Quebec scores were not significantly different at baseline, the difference can be attributed to the effect of the intervention. Conclusions: The results of this study found that the Trunk Extensor Endurance Group, that performed the trunk extensor endurance training programme, yielded better results in core stability and trunk extensor endurance. However, the Core Stability Group, that performed the core stability training programme, showed a quicker reduction in pain levels during the three week intervention period. Therefore, by combining both training programmes, future rehabilitation of athletes suffering from acute low back pain will be more successful. Sport performance of the athletes (field hockey players), through the proponents of swiss ball training, will also improve.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban University of Technology, 2009. / The low back and the lower limb are generally viewed as two isolated regions, however, there are many authors who believe that these two regions are functionally related. This is due to the two regions being connected to each other through the kinematic chain of the lower extremity. The lumbar spine is the link between the lower extremities and the trunk, and plays a significant role in the transfer of forces through the body via the kinematic chain. The physical link between the low back and the lower limb is supplied by the thoracolumbar fascia, which plays an important role in the transfer of forces between the spine, pelvis and legs. Although a relationship between the lower extremity and low back pain is often assumed, little research has been published to demonstrate the association. Most of the evidence so far has been anecdotal, without scientific research to support it. This study was designed to compare the relative effectiveness of lumbar spine manipulation, compared to combined lumbar spine and subtalar manipulation for the treatment of chronic mechanical low back pain, using subjective and objective measures, for the management of chronic mechanical low back pain. The study design was a quantitative clinical trial, using purposive sampling. It consisted of forty voluntary participants with chronic mechanical low back pain. There were two groups of twenty participants each, each of whom received six treatments within a three week period. Group A received manipulation of the lumbar spine only, whilst Group B received manipulation of both the lumbar spine and subtalar joint. The outcome measures included the response of the participants to the Numerical Pain Rating Scale-101 and the Quebec Low Back Pain and Disability Questionnaire. Objective data was obtained from three digital Algometer measures. Data was collected prior to the initial, third and sixth treatment. iv Statistically both groups showed improvements, subjectively and objectively, with regards to chronic mechanical low back pain. Inter-group testing for NRS over time showed no significant effect for both treatment groups. There was a significant treatment effect for Algometer Average TP1 while the treatment effect for Algometer Average TP2 was not significant. However, inter-group testing for the Quebec LBP over time showed no significant effect for both treatment groups. Inter-group analysis demonstrated no statistical significance between the two groups for subjective and objective measurements, thus suggesting that there is no additional benefit in treating the subtalar joint in the management of mechanical low back pain. Further studies will also benefit greatly from the use of larger sample sizes to improve statistical relevance of data.

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.

Thesis advisor: Elizabeth Altmaier. Includes bibliographic references (p. 122-128).