M.Tech. (Chiropractic) / This study was conducted in order to compare the effectiveness of the lumbar spine manipulation versus the foot manipulation/mobilisation for people suffering with chronic low back pain. This research aims to compare the effects of lumbar spine manipulation alone, foot manipulatioil/mobilisation alone or the combination of the two in people suffering with chronic low back pain. Candidates for the study were recruited from the local surrounding area, and through information pamphlets distributed through the Technikon Witwatersrand Doornfontein. The candidates were asked to participate in the study, which was held at the Technikon Witwatersrand Chiropractic day clinic. Only -those candidates that conformed to the selection criteria were allowed to participate in the study. The candidates were assigned to one of three groups. Eac.h group had ten candidates. Group 1 received lumbar spine manipulation alone. Group 2 received foot manipulation/mobilisation alone. Group 3 candidates received lumbar spine manipulation and foot manipulatioil/mobilisation. Subjective data was collected using the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using the electronic inclinometer to measure lumbar spine range of motion in flexion, extension, right and left lateral flexion and right and left anterior rotation. The paired Hest was used for statistical analysis, where a statistically significant difference was found; the Student-Newman-Keuls test was performed to identify which statistically significant difference between the groups was found. The results of this study indicate that lumbar spine manipulation alone would appear to have responded better in terms of lumbar spine range ofmotion...

M.Tech. / OBJECTIVE: The aim of this study was to determine the extent of the benefit of combining psychological intervention, in the form of guided imagery, with spinal manipulative therapy, in the treatment of mechanical chronic lower back pain. The guided imagery functioned to address the psychosocial factors playing a role in the experience, maintenance and exacerbation of chronic pain (Turk, Swanson & Tunks, 2008), while the chiropractic spinal manipulative therapy functioned to address the dysfunctional biomechanics which cause the biological and neurological aspects of the chronic pain. DESIGN AND METHODOLOGY: 30 subjects between the ages of 18 and 40, presenting to the University of Johannesburg Chiropractic day clinic with chronic lower back pain, participated in the trail. They were randomly divided into 2 groups, which both underwent 6 treatments. During the initial consultation, both groups had their lumbar range of motion measured with the digital inclinometer, and were asked to complete the Oswestry Pain and Disability Index (Appendix G), Numerical Pain Rating Scale (Appendix H), and Perceived Stress Scale (Appendix I). This was followed for group A by spinal manipulative therapy to the restricted segments. Group B was treated with spinal manipulative therapy and a guided imagery session, performed by a registered psychologist. The participants were instructed on how to perform the guided imagery on their own, and were asked to perform it at home 3 times per week for the duration of the treatment. During the 2nd consultation, both groups received spinal manipulative therapy, and their progress was noted throughout on a SOAP note. During the 3rd consultation, both groups again had their lumbar range of motion measured, and were asked to complete the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. Treatment followed as per the initial consultation for both groups. During the 4th and 5th consultations, both groups received spinal manipulative therapy. During the final consultation, both groups were again treated with spinal manipulative therapy, followed by lumbar range of motion measurements, and final completion of the Oswestry Pain and Disability Index, Numerical Pain Rating Scale, and Perceived Stress Scale. RESULTS: There was a statistically significant improvement in overall lumbar range of motion for both groups throughout all degrees of freedom respectively. It is interesting to note that both in extension as well as rotation the inter-group measurements were statistically significantly different at treatment outset, but due to greater improvement in group B over group A, became statistically comparable on completion of the trials. There was also a significant overall improvement and decrease in subjective symptoms of perceived pain, disability and stress for both groups, and the Numerical Pain Rating Scale also demonstrated a statistically significant improvement in results, due to greater improvement of group B over group A. CONCLUSION: The subjective and objective results between participants of the same group, demonstrated that both spinal manipulative therapy alone, as well as spinal manipulative therapy in conjunction with guided imagery was effective in treating chronic mechanical lower back pain. When comparing results between the two groups, the combined protocol group showed statistically significant improvement above the purely chiropractic group in 3 out of 6 objective measures, and 1 out of 3 subjective measures. There is thus limited evidence as to the advantage of combining guided imagery with the chiropractic treatment protocol of chronic mechanical lower back pain, however unfortunately not sufficient evidence to draw a definitive conclusion.

The purpose of this study was to analyze the factor structure of items pertaining to health on the Minnesota Multiphasic Personality Inventory (MMPI2) for chronic back pain patients in comparison to a control group. The results may be used as groundwork for developing an MMPI2 subscale to describe this population. The groups differed in the sequence of the resulting factors and the percentage of variance accounted for by each factor. The factors extracted when evaluating the control group were titled in order: Poor Physical Health, Digestive Difficulties, Equilibrium, Depression/Malaise, and Multiple Somatic Complaints. Resulting factors for the pain group were: Depression/Malaise, Digestive Difficulties, Multiple Somatic Complaints, Headaches/Dizziness, and Neurological Reaction/Poor Physical Health.

M.Tech. / Objective: Translation and validation of the Afrikaans version of the Roland Morris Disability Questionnaire and the Oswestry Disability Index. Methods: The English questionnaires were translated into Afrikaans. The translations were then scrutinized by a focus group in order to determine its face validity. After face validity was established, the content validity was determined by two subject experts. Both the original and the translated versions of the questionnaires were given to a study group to complete on two separate occasions. The results from the study group were then put through various psychometric evaluations in order to determine its concurrent validity and reliability. Results: Results indicated that the Oswestry Disability Index had a significant level of reliability (α=0.830) and although the reliability of the Roland Morris Disability Questionnaire was below a significant level (α<0.7) it was still deemed reliable as it corresponded with its English counterpart. Both the Roland Morris Disability Questionnaire and Oswestry Disability Index indicated significant levels of concurrent validity; however the Roland Morris Disability Questionnaire seemed to have a higher level of concurrent validity. Conclusion: Both the Roland Morris Disability Questionnaire and the Oswestry Disability Index were translated successfully and can now be used within the Afrikaans population as an alternative to the English versions. Low back pain is a very common medical problem with a great impact on a patient’s health and quality of life. According to a review conducted by Papageorgiou et al. (1995), 60-80% of the general world population will suffer from low back pain in some stage of their life. In South Africa, De Wet, Losco and Moodley (2003) conducted a study on the incidence and prevalence of low back pain on 355 ABSA Bank and Unibank employees. The results of the study showed that the lifetime incidence of low back pain was 63%, the 6 month prevalence of LBP was 41% and the point prevalence of LBP was 9.6%. Treatment was sought by 46.94% of the sample population primarily from pharmacies, chiropractors, medical doctors, and physiotherapists. In addition, the study also showed that this condition is costing the South African economy millions each year due to lost working days as a result of absenteeism. As a result, disability questionnaires are increasingly used for clinical assessment, outcome measurement of treatment of low back pain. However, the use in different cultural groups has led to the need for the translation and the cross-cultural adaptation of these questionnaires to aid practitioners in the accurate assessment of low back pain.

M.Tech. (Chiropractic) / Purpose: This study aims to determine the effect of Bruegger’s exercise on chronic low back pain in association with lower crossed syndrome and compare it to spinal manipulation alone or a combination of Bruegger’s exercise and spinal manipulation with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of three different groups of ten participants each. Group one was only instructed on how to perform Bruegger’s exercise. Group two only received a spinal manipulation/s over the restricted joint/s in the lumbar spine. Group three received a spinal manipulation/s over the restricted joint/s in the lumbar spine in conjunction to being instructed on how to perform Bruegger’s exercise. All participants were assessed over a four week period. All groups attended six treatment sessions over three weeks of which Bruegger’s exercise and/or spinal manipulation were performed. The participants who needed to perform Bruegger’s exercise were also advised to continue doing the exercise out of the treatment session where applicable. In the fourth week only measurements were taken and no treatment was administered. Procedure: Subjective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a Numerical Pain Rating Scale and Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was collected at the first and fourth consultations prior to treatment, as well as on the seventh consultation by means of a universal goniometer for assessing passive hip flexion and extension, a digital inclinometer for assessing active lumbar range of motion and a flexible ruler for measuring the degree of lumbar lordosis. Analysis of collected data was performed by a statician. Results: Clinically significant improvements in group 1, group 2 and group 3 were noted over the duration of the study with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Statistically significant changes were noted in group 1 and group 2 with regards to pain, disability, hip and lumbar range of motion as well as degree of lumbar lordosis, and in group 3 with regards to hip and lumbar range of motion as well as degree of lumbar lordosis. Conclusion: The results show that Bruegger’s exercise, spinal manipulation and the combination of Bruegger’s exercise and spinal manipulation are effective treatment protocols both clinically and significantly in decreasing pain and disability (not statistically for the combination of Bruegger’s exercise and spinal manipulation), increasing hip and lumbar range of motion as well as decreasing the degree of lumbar lordosis. However, there was no treatment protocol that proved to be preferential over the other. Because spinal manipulation alone showed the greatest overall clinical improvements, it may be suggested that spinal manipulation alone is the most effective in the treatment of chronic low back pain associated with lower crossed syndrome with regards to pain and disability, hip and lumbar range of motion as well as degree of lumbar lordosis. Also, the addition of Bruegger’s exercise may help in some instances to further assist in treatment once the full effects of the spinal manipulation has occurred and allowed for the muscles to be in their optimum state for exercise.

M.Tech. (Chiropractic) / Purpose: Low back pain affects the general population worldwide. Low back pain is a multi-factorial problem with debate as to the exact aetiology of low back pain. Thus, this study examines the relationship between lumbar spine lordosis, body fat percentage, physical activity level, lumbar spine range of motion and the incidence of low back pain. Method: There was a total of one hundred female participants between and including eighteen and thirty-five years of age. These females were symptomatic or asymptomatic of mechanical low back pain. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Participants were evaluated once. No treatment was administered. Procedure: Subjective responses were acquired through the Visual Analog Scale, the International Physical Activity Questionnaire and an Oswestry Low Back Pain and Disability Questionnaire. The objective evaluation included a physical examination and a lumbar spine regional examination. The participant’s height was measured using a stadiometer. The Bioelectrical Impedance Analysis (BIA) measured the participant’s weight, water content, lean tissue mass and body fat percentage. BMI was calculated from the weight and height recordings. Range of motion of the lumbar spine was measured with a Digital Inclinometer. A flexi curve ruler molded the lumbar spine lordosis of each participant, which was then traced onto a piece of paper to measure the magnitude of lumbar spine lordosis. Results: A clinical relationship did not exist between a hyperlordotic lumbar spine posture, the incidence of low back pain, body fat percentage and lumbar spine range of motion. A clinical relationship was evident between a hyperlordotic lumbar spine posture and the level of physical activity. Conclusion: Given that a clinical relationship exists between a hyperlordotic lumbar spine posture and the level of physical activity, physical activity specifically exercise to strengthen the abdominal muscles should be included in a treatment protocol to reduce the degree of lumbar spine lordosis if the degree is excessive.

No description available.

Magister Scientiae - MSc / Clinical research has shown that patients experience difficulty in adjusting to their pre-morbid worker roles after they have been through a back rehabilitation programme. The pressure and competitiveness of modern day society to achieve competence and to survive has proven to be stressful, both for the injured and uninjured, the unemployed and employed. Back rehabilitation and the successful return of the injured worker to the workplace have been of great interest to industry for the last decade, due to the ever-increasing support of legislature for the injured. There is a range of medical interventions available but few of these achieve successful outcomes due in part to the fact that many intervention strategies do not take the patients perspectives into consideration. Therefore, the purpose of the study was to explore back rehabilitated clients perceptions and experiences of the challenges they face in adapting to their worker roles. / South Africa

M.Tech. / According to the “Lovett Reactor” as explained by Walther (2000), the Atlas and the 5th lumbar vertebrae rotate in the same direction when a person walks. This relationship continues throughout the spinal column as 3rd cervical vertebrae (C3) rotates in the same direction as 3rd lumbar vertebrae (L3). From this point the movement changes to counter-rotation as 4th cervical vertebrae (C4) counter-rotates to 2nd lumbar vertebrae (L2) and 5th cervical vertebrae (C5) to 1st lumbar vertebrae (L1). According to Inman, Ralston and Todd (1981) this correlation extends as the Sacrum reacts with the Occiput. Thus, there is clinical verification demonstrating that the Lovett Reactor vertebrae are often interrelated to primary and compensatory subluxations. The aim of this study was to determine the effect of Chiropractic Occipital adjustments versus Chiropractic Sacroiliac adjustments in the treatment of chronic Lumbar Sacral pain.

M.Tech. / Purpose: Chiropractic adjustment has been shown to be an effective treatment for low back pain (Cox, 1999 and Lawrence et al, 2008). The role that the transverse abdominus plays in low back pain is not clear. Sacroiliac adjustment changes the activation speed (Marshall and Murphy, 2006) and the strength of contraction of transverse abdominus. This study aims to determine the short-term effects of chiropractic manipulative treatment on the feed-forward activation of the deep abdominal muscles in patients with chronic low back pain. Method: Forty five participants with chronic mechanical low back pain were used in this study. The primary cause of their back pain was mechanical. The study consisted of three randomly selected groups of participants. Group one was treated using abdominal exercise only. Group two was treated using both chiropractic manipulation and abdominal exercise. Group three was treated using chiropractic manipulation only. Procedure: The effect on the feed-forward activation of transverse abdominus and internal oblique was measured and recorded using surface electromyography in each group. The participants also completed an Oswestry Low Back Pain and Disability Questionnaire and a Numerical Pain Rating Scale in order to record any change in back pain. Participants were seen seven times over a maximum four week period. Readings were taken on the first, third and fifth and seventh visits. Results: Statistically significant (p<0.05) results were seen in all three groups for the Oswestry Pain and Disability Questionnaire and Numerical Pain Rating Scale. Minimum EMG results were not statistically significant, however group three showed improvement clinically. Maximum EMG results were also did not show a statistically significant change. Feed-forward activation of the transverse abdominus muscle showed no statistically significant change. Conclusion: Favourable results were obtained clinically for all three groups. Group three (chiropractic manipulation only) was shown to be the most effective in terms of patient perception of pain and disability. Objectively, the results were less definitive. Chiropractic manipulation alone had the most favourable effect on the resting surface EMG readings of the transverse abdominus, while chiropractic manipulation combined with abdominal exercises and abdominal exercises alone did not show this change. This too was seen in the results for the maximum EMG readings. Onset times of the transverse abdominus muscle showed no improvement.