published_or_final_version / Orthopaedics and Traumatology / Master / Master of Philosophy

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / Epidemiological studies on low back pain (LBP), conducted in a number of countries, strongly suggest that LBP is internationally a very common condition, imposing a significant social and economic burden on society. It however appeared that the epidemiology of LBP among the black population of South Africa had not yet been investigated. The purpose of this study was to determine the prevalence of LBP in the formal black South African township of Chesterville, and to assess the extent to which LBP adversely affects the lives of the residents, in order to establish the need for specialized low back care in this community. A further aim of the study was to assess the associations between certain individual factors and the prevalence ofLBP. A population-based epidemiological survey on LBP was conducted on a sample of 1 000 residents of the township of Chesterville. After a pilot survey of 25 households suggested that the characteristics of the households in Chesterville were fairly similar with respect to the objective of the study, a clustered sample of 300 lots was selected from a layout map of Chesterville. All residents, aged 13 or older, living on these lots were interviewed by the researcher until a sample of 1 000 subjects had been achieved. The total population of Chesterville is approximately 20 000; hence the sample size covers 5% of the population of study. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / There have been few studies conducted to determine the effects of stretching as a therapy on its own in the treatment of low back pain. In response to this, the objective of this study was to evaluate the relative effectiveness of stretching the hamstring muscles on low back pain experienced by cyclists. Thirty two cyclists with low back pain were screened for lumbar facet syndrome, sacroiliac syndrome and myofascial pain syndrome of the quadratus Iumborum, gluteus medius and gluteus maximus muscles and randomly divided into two groups of sixteen. Detuned ultrasound was applied to the hamstring muscles of the patients in the placebo group twice a week for three weeks. Patients in the experimental group were involved in a stretching program whereby the hamstring muscles were passively stretched for three sets of thirty seconds duration, two days a week for three weeks. Both groups were evaluated in terms of subjective clinical findings by utilising the Oswestry Low Back Pain Disability Questionnaire, the Numerical Pain Rating Scale-101, and theti / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this study was to evaluate thoracic spine manipulation in comparison to interferential current therapy in order to determine the relative effectiveness of each treatment protocol in the management of mechanical thoracic back pain. The design was that of a single blind, randomized, comparative pilot study. Sixty patients were selected from the general population, of which 30 patients made up group one and the other 30 patients made up group two. After an extensive case history and physical examination the patients were diagnosed with mechanical thoracic spinal pain and then randomly divided into the two groups. The first group received spinal manipulative therapy and the second group received interferential current therapy. All sixty patients received a minimum of three or up to a maximum of six treatments. The treatments were given two to three times a week. Objective and subjective data was collected before the first, second and final treatment in order to assess the effectiveness of each treatment protocol. The objective data consisted of thoracic range of motion using the BROM II goniometer and pain threshold using an algometer. The subjective data was collected using the Short-form Pain Questionnaire, Numerical Pain Rating Scale -101 and the Oswestry Back Pain Disability Index Questionnaire. The data gathered at the relevant appointments was then statistically analyzed, using a 95% (a = 0.05) confidence level. Inter-group analysis was performed using the Unpaired T- test and the Mann- Whitney U - test for the continuous and categorical variables respectively. The Oswestry Back Pain Disability Index Questionnaire showed a statistical difference at the final visit when compared between the two groups. / M

A dissertation in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Low back pain (LBP) is a significant public health problem that has had a marked impact on quality of life and on health care costs (Weiner, et al. 2000:450). Toussaint, et al. (1999:134) established that the prevalence of sacroiliac joint dysfunction in the population has been noted in the medical literature to be between 19.3% and 47.9%. There is a lack of consensus among medical practitioners, chiropractors, osteopaths, physiotherapists and others as to the most appropriate therapy or management for sacroiliac syndrome. This study was designed to determine the effectiveness of manipulation of the symptomatic sacroiliac joint compared to manipulation of both the symptomatic and the asymptomatic sacroiliac joints in the treatment of unilateral sacroiliac syndrome. Anecdotal evidence would seem to indicate that the direction of the chiropractic manipulation is immaterial to clinical improvement (Till, 1994). Bilateral manipulation of the symptomatic and asymptomatic joints has been used in clinical practice in an attempt to increase the efficacy of chiropractic management for unilateral sacroiliac joint syndrome (Till, 1994, Lewis, 2001 and Nook, 2000). Walker (1992:914) was of the opinion that 'Unless reliability and validity of assessments and effectiveness of treatment procedures can be demonstrated, clinicians should temper their claims of measurement of, and direct effects on, the sacroiliac joint.' This randomized, comparative clinical trial consisted of sixty voluntary subjects each suffering from sacroiliac joint syndrome. There were two groups of thirty subjects, each of whom received five treatments within a three week period. Group one received manipulation of the symptomatic sacroiliac joint / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / It has generally been accepted that 60 to 80% of the general population will suffer from low back pain at some point in their life. (Kirkaldy - Willis, 1992). The use of manipulation for the treatment of low back pain is well documented but lumbar mobilization has undergone comparatively little investigation (Goodsell et al., 2000). Furthermore, there remains little evidence to advocate the use of Muscle Energy Technique (MET) in the form of a randomized clinical trial (Wilson, 2003). The purpose of this study was to determine whether patients with acute and sub-acute low back pain would demonstrate a reduction in disability after being treated with MET or specific passive mobilization. Both interventions are joint mobilization techniques the only difference being that one is passive and the other (MET), is an active technique / M

Dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 2002. / This comparative, randomized, controlled clinical trial consisted of sixty patients, suffering from low back pain (LBP) attributable to sacroiliac and/or lumbar facet syndrome. The aim of the study was to determine the relative effectiveness of frequent and infrequent chiropractic treatments in the management of mechanical low back pain. It was hypothesised that the Frequent Treatment Group would produce better results than the Infrequent Treatment Group. Treatments consisted of spinal manipulative therapy (SMT) using diversified techniques to dysfunctional sacroiliac (SI) and or lumbar facet joints. All treatments were preceded with 5 minutes soft tissue therapy to the lumbar region. The study population was randomly divided into two treatment groups. The Frequent -Treatment Group received 9 treatments over a three-week period and the Infrequent Treatment Group received 3 treatments over the same treatment period. Data was collected before the treatment commenced and again at the beginning of the second and third weeks of the trial and finally the week following the last treatment. Subjective data gathered included results from the Numerical Pain Rating Scale 101 and the Oswestry Low Back Pain Disability Questionnaires. Objective data included an orthopedic rating scale used to assess the sacroiliac and lumbar facet joints and lumbar spine range of motion (ROM) as measured with the BROM II goniometer. Data obtained during the trial period was statistically analysed. No significant difference between the two treatment groups was found at the 95% level of confidence. These findings imply that once weekly treatments are as effective as three treatments per week in terms of the clinical measure employed in this study. The results from this study suggest that patients who receive treatments more than once a week could be receiving excessive treatments, which would make the cost of chiropractic treatment unnecessarily expensive. Intra-group analysis of the results indicated that both treatment groups improved significantly (0 =0.05) between the first and final consultation, for all measures. These findings demonstrate that chiropractic treatment is beneficial to patients with mechanical LBP. The mean values obtained for each group for the levels of pain intensity, disability, ROM and joint dysfunction show the Frequent Treatment Group to have improved slightly more than the Infrequent Treatment Group, however not significant at the 95 % level of confidence. The cost of more frequent treatment needs to be justified with superior long-term effects. Research into factors such as whether or not more frequent treatments maintain productivity and avoid chronicity may provide support for more frequent treatments. / M

M.Tech.

M.Tech. / This research study was conducted as an unblinded controlled pilot study. The aim of this research was to investigate the effects of spinal manipulation in conjunction with proprioceptive rehabilitation on proprioceptive ability with regards to balance in patients with mechanical low back pain. Candidates for the research were recruited through advertisements in the local newspapers, posters put up at the Technikon Witwatersrand Doornfontein Campus as well as at the Technikon Witwatersrand Day Clinic. Candidates that fitted the selection criteria were selected to participate and were randomly divided into three groups. Each group consisted of 10 patients. Group A received chiropractic manipulation of the lumbar spine and sacroiliac joints ...

A dissertation submitted to the Faculty of Health Sciences, in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Objectives: To determine if serum cortisol levels are increased following Spinal Manipulation Therapy (SMT) to the low back region and to determine the effect of a short rest interval on the cortisol levels. Project Design: The research project was in the form of a randomised, clinical trial using human subjects. Setting: Patients presenting with low back pain to the Chiropractic Day Clinic at the Durban Institute of Technology and the Community Health and Indigent Programme Services clinic. Subjects: Adult, male patients, aged between 18 and 35 years of age, diagnosed with mechanical low back pain. Outcome measure: Daytime, serum cortisol levels. Results: A decrease in serum cortisol levels following SMT. Serum cortisol levels decreased significantly following a short rest interval. Conclusions: The results of this study support the previous finding that a neuroendocrine effect can be stimulated by SMT, albeit, a decrease in serum cortisol levels. A short-term rest period also influenced the serum cortisol levels. However, the mechanism of these effects is not established and requires further investigation as this was not within the scope of the present study. / M