Dissertation submitted in partial compliance with the requirements for the Masters Diploma in Technology: Chiropractic, Technikon Natal, 1994. / The purpose of this study was to investigate the effects of essential oils, applied by means of effleurage massage, in the treatment of mechanical low back pain, in terms of the patient's physical and psychological responses to the essential oils, in order to determine the role of essential oils in the management of mechanical low back pain. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1997. / Mechanical low back pain is one of the most common and costly conditions confronting health care providers and medical insurers today. Despite' the magnitude of the problem no general consensus exists concerning an appropriate treatment for this condition. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1997. / The purpose of this study was to evaluate the .ost effective electrotherapy wavefore, in the treatment of mechanical low back pain, by comparing a Relief Pulse wavefor to that cf Transcutaneous Electrical Nerve Stimulation wavefore, in combination with a chiropractic lumbar roll adjustment. This was accoaplished by means of objective and subjective assesments / M

OBJECTIVE: To determine and compare the electromyographic effect of cervical and lumbar spinal adjustments on the lumbar paraspinal muscles in subjects with chronic lower back pain. STUDY DESIGN: Thirty subjects with chronic lower back pain underwent 5 spinal manipulative treatments on alternative days over a 2 week period (excluding weekends) to test the electromyographic effect on the lumbar spinal muscles. SETTING: Technikon Witwatersrand Chiropractic Clinic, Johannesburg, South Africa SUBJECTS: Thirty subjects with chronic lower back pain participated in this study. Each of the subjects was assigned to one of three groups using age-matched sampling methods. Group 1 consisted of 10 subjects (mean age of 25 years) receiving lumbar spine and pelvis adjustments (L1 - L5, including Sacroiliac joints); Group 2 consisted of 10 subjects (mean age of 26 years) receiving cervical spine adjustments (Occiput - C7); and Group 3 consisted of 10 subjects (mean age of 26 years) receiving adjustments to the cervical spine, lumbar spine and pelvis. METHODS: Lumbar paraspinal muscle electrical activity was tested before and after the treatment one, three and five using surface electromyography (sEMG). One pair of bipolar electrodes was placed bilaterally over the paraspinal muscles at the level of L3. Subjects were asked to lie down in a prone position with their arms next to their sides. They were then instructed to perform a single voluntary lower back extension exercise by lifting their chests and shoulders as high as possible off the plinth. Each contraction lasted five seconds. The baseline and peak values from the surface electromyographic meter were recorded, analyzed and compared for reference. Information regarding the intensity and quality of the pain experienced by the subjects were also collected at the start of treatment one, three and five using approved research measurements, i.e. the Oswestry Questionnaire and the Visual Analogue Pain Scale. iv RESULTS: Comparison of the results indicated no statistically significant difference between the three groups and their responses to the treatments. Subjectively, all three groups showed trends of improvement, with group 2 showing the greatest percentage of improvement in pain. Objectively, group 2 also showed the greatest percentage of improvement in the resting rate of the paraspinal muscles, assuming that ideal sEMG resting rate is the lowest one possible. Comparing the results of the contraction ability of the paraspinal muscles, both prior to and after spinal manipulative treatment (SMT), group 1 demonstrated the greatest percentage in improvement followed by group 3. Group 3 also demonstrated the most balanced paraspinal muscles at the end of the study. CONCLUSION: In light of these findings it can be concluded that the treatment protocol as represented by group 2 showed the most favourable treatment efficacy in terms of subjective results and resting rate of the paraspinal muscles. The trends shown in this study should be used and tested in future similar research studies incorporating larger sample groups. / Ms. M. Jansen van Rensburg Dr. M. Buchholtz

This unblinded, controlled clinical trial was undertaken in order to demonstrate the advantage of education concerning low back pain in the labour intensive workplace and to show that education alone as well as in conjunction with chiropractic manipulative therapy, is a valuable time and cost-effective mechanism for reducing low back pain. This will be achieved by comparing comprehensive industrial back school (CIBS) in combination with chiropractic manipulative therapy (CMT) and CIBS in isolation. In the execution of the study it was hypothesised that both the treatment protocols would be effective in the treatment of low back pain, but that the combined therapy would be more effective due to the fact that the treatment protocol involving the combined treatment would be assessing and correcting lumbar spine pathomechanics. The patient base for the study was drawn from the technical services division (labour force) of the Technikon Witwatersrand in Johannesburg, South Africa. Patients were recruited by consulting the managers of the technical services departments at the Technikon Witwatersrand, and a presentation concerning low back pain was given to the labour forces involved in the technical services division, detailing the treatment protocols and the risks and benefits involved. After the presentation anyone suffering from low back pain was invited to participate in the study. Only males were included in the study, rendering the data more valuable relative to the small sample group. Thirty patients whom conformed to the diagnostic criteria and did not have any conditions that contraindicated CIBS or CMT were included in the study. The patients were divided into two groups according to where they worked (Doornfontein or Auckland Park campus). Fifteen (15) people were selected from each campus (both campuses are under the same labour demands). This situation was decided upon as to not allow cross contamination of the groups; it was also logistically more practical. The Doornfontein group (DFC) received CMT in combination with the CIBS. All fifteen patients attended one CIBS per week for four weeks; and received six CMT treatments over four weeks. The Auckland Park group (AKP) received the CIBS in isolation; also running once a week for four weeks. All patients (both groups) were assessed and data captured at the first week, fourth week and at a follow up visit one month after the final session (eighth week), where all the data was captured again. The subjective data was collected using the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Index. Objective data was obtained using the cervical and lumbar range of motion instruments (Goniometers) and a universal inclinometer. Anecdotal data was collected using a questionnaire. The data was analysed using “Jandell Scientific Sigma Stat and Sigma Plot 2.02”. The subjective results indicate that both treatment protocols were equally effective in reducing low back pain in men involved in labour intensive work. A statistically significant difference presented in both groups. The results indicated that in order to reduce the period of intense pain more rapidly, a combination of CMT and CIBS would be the treatment of choice. However the long-term benefit of both protocols was equally beneficial. This is believed to be as a result of education changing the way in which people live and work and therefore taking effect over a longer period but having a more lasting effect. The objective results indicate that the protocols were equally as effective in improving the patient’s range of motion. However it was noted that range of motion was seen to reduce over a shorter period of time in the DFC group (combined treatment protocols). Based on the results of this study, the protocols were equally effective in the long term. This is due to the fact that as patients are educated about caring for their backs in the work place, and during activities of daily living, the amount of times they place their backs in positions resulting in excessive loading is reduced, therefore resulting in a reduction in pain, disability and further pathology. / Dr. M.A. Khoury Mr. S. Nalla

The purpose of this study was three fold: 1. To determine the life time incidence, 6 month prevalence and point prevalence of Low Back Pain (LBP) in the work environment of ABSA Bank and compare it to the rest of the world. 2. To determine whether individual factors such as age, gender, body mass index and work environment factors like main daily position and activity could be causal factors contributing to LBP. 3. To determine whether treatment is sought, the type of care sought for LBP and the cost of sick leave due to LBP to the company. A Review of the data indicates that LBP is a condition that 60-80% of people will suffer from at some stage in their lives. Epidemiological studies have shown that simple backache has a point prevalence and 1-month prevalence of 15-30% and 30-40% respectively. (1, 2, 3) LBP could be caused by many disorders of the spine, but for many sufferers no causative diagnosis will be made. There are a large number of occupational causes that could lead to the development of LBP. The major causes are the following: forceful lifting of heavy objects, twisting coupled with bending of the trunk, whole body vibration and heavy manual work. (60) There are a number of causal factors of LBP that are non work related such as personal risk factors including age, gender, fitness level, trauma to the back, cigarette use and recreational activities (60). LBP is seen to be one of the most common ailments affecting people, but most do not seek medical attention. Those patients who do seek medical attention seem to seek the help of the following specialities: physicians, chiropractors, nurses, orthopaedic surgeons, neurosurgeons, physical therapists or alternative medical practitioners. (20) Researchers in the USA, in 1992 found that 73.1% of LBP sufferers sought medical care, while many saw a multiple variety of health care providers. Of those people who sought medical care, 64% consulted a general practitioner, 55% consulted an orthopaedic surgeon, 29% consulted a physical therapist and 25% consulted a chiropractor. (8) A cross sectional, systematic random sample to study the incidence and prevalence of low back pain (LBP) was conducted on 355 employees of ABSA Bank and Unibank. The data was collected by the researcher by means of a personal interview. A permission letter from ABSA Bank Health Clinic (Appendix A) was used to gain access to those who needed to be interviewed in the sample group. The data was recorded on a questionnaire (Appendix B) and a low back diagram (Appendix C) was used to define LBP so that it would be easier to understand. The results of this study showed that the lifetime incidence of LBP was 63% (225/355), the 6 month prevalence of LBP was 41% (147/355) and the point prevalence of LBP was 9.6% (34/225). The major daily activity that was associated with the 6 month prevalence of LBP was computer type work at 93.88% (138/147); this was followed by telephonic work at 65.31% (96/147). Physical and administrative work was only reported to have caused LBP in 4.76% (7/147) and 22.45% (33/147) of the sample population. The major daily position that was associated with the 6 month prevalence of LBP was sitting - 97.28% (143/147). This was followed by walking - 61.64% (90/147), standing - 17.69% (26/147) and lifting-t 6.57% (9/147). Treatment was sought by 46.94% (69/147) of the sample population that suffered from LBP in the last 6 months. Treatment was sought from the pharmacy in 21.99% (31/141) of the cases. Chiropractors were consulted in 8.51% (12/141) of the cases; medical doctors were consulted in 14.89% (21/141) of the cases, physiotherapists in 17.02% (24/141) of the cases, while acupuncture and private hospitals were used by only 0.71% (1/141) of those who suffered from LBP. Biokinetics, homeopathy and osteopathy were three other disciplines that were on the questionnaire, but none of these disciplines were made use of by the study population. This study showed that the lifetime incidence, six month prevalence and point prevalence of LBP in the South African workplace is similar to other countries in the world and that this condition is costing the South African economy millions of rand each year due to lost working days as a result of absenteeism. The only individual factor that seemed to be statistically significantly associated with LBP was trauma to the lumbar spine. Other factors like age, gender and race did not seem to have statistically significant effects on the prevalence of LBP. The results regarding the individual factors that could lead to LBP seem to vary between the different studies evaluated. Just under half of those who suffer from LBP seek treatment for the condition. When evaluating what kind of treatment is used by the study population, it was seen that the majority used drugs from the pharmacy to treat the condition. / Dr. B. Losco Dr. M. Moodley

This study was conducted in order to determine the effectiveness of ischaemic compression and myofascial dry needling in the treatment of lower back pain due to an active trigger point in the quadratus lumborum muscle. It was also conducted in order to compare the effects of ischaemic compression to the effects of myofascial dry needling of an active trigger point to determine which of the two treatment protocols was superior. It was hypothesised that ischaemic compression and myofascial dry needling would have a positive outcome on the subjective and objective findings in patients with lower back pain. Participants were recruited into the study by the use of advertisements placed in local newspapers and at the University of Johannesburg’s Chiropractic Day Clinic. Thirty patients who conformed to the specified limitations and diagnostic criteria were accepted. These patients were randomly placed into two groups of fifteen patients each. Group one received ischaemic compression and group two received myofascial dry needling. Each patient received six treatments over a three week period, therefore two treatments per week. The subjective data, which was the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the readings on the algometer, measuring the pressure threshold of trigger points. All the algometer readings were statistically analysed using repeated measures tests. These tests were conducted on a 95% confidence level (P<0.05). The results of this study indicate that both treatment protocols were very effective for the treatment of quadratus lumborum myofascial trigger points and lower back pain. Based on the results of this study, ischaemic compression and myofascial dry needling are suggested treatments for myofascial trigger points associated with lower back pain, however ischaemic compression proved to be significantly the most effective. / Dr. S. Wilcox Dr. M. Moodley

M.Tech. (Chiropractic) / The purpose of this study was to assess the prevalence of lower back pain in registered pharmacists in Johannesburg, in terms of workplace and individual factors, in order to establish under which circumstances workplace and individual factors could influence the prevalence of lower back pain in pharmacists. The sample population of registered pharmacists in Johannesburg (N=300) was selected from the register of pharmacists of Gauteng and a questionnaire was sent to the relevant pharmacists. A total of 92 questionnaires were returned and represented a 30,7% response rate. The questionnaire consisted of questions regarding : The prevalences of previous and current lower back pain; the intensities and frequencies of previous and current lower back pain; the location of previous and current lower back pain; the radiation of pain occurring in the lower extremities during previous and current lower back pain; the weakness or numbness perceived in the lower extremities during previous and current lower back pain; the professionals consulted for previous and current lower back pain; the medication administered for previous and current lower back pain. The questions asked regarding individual factors included : age; gender; anthropometry; exercise and smoking; the workplace factors included : number of years in practice; number of hours and days worked per week; bending, twisting and lifting; static work postures and repetitive work. The results were statistically analysed using frequency distributions, cross-tabulations and the Kruskal-Wallis.Chi-squared approximation test. The results were represented by pie charts, frequency tables and cross-tabulations, and descriptively analysed. The overall prevalence of lower back pain in registered pharmacists in Johannesburg was 41,3%. Among other findings, the weight and build were found to be significantly associated with the respondents increased lower back pain. Other significant findings were that respondents who worked more days per week as well as those who had an increased frequency of reaching above shoulder height at work, had an increased incidence of lower back pain. It must be emphasised that great caution should be exercised in attempting to generalise the findings of this survey, 'since workplace and individual factors associated with the lower back pain were based on the respondent's subjective evaluations. This study was not designed to establish cause and effect relationships between individual and workplace factors, and prevalence of lower back pain among pharmacists.

M.Tech. / The purpose of this study was to determine the role of treating the gastrocnemius-soleus complex (GSC) through dry needling and passive stretching, in the management of chronic low back pain. This research aims to compare the effects of treating the GSC alone, lumbar spine manipulation alone or the combination of the two modalities in people suffering from chronic low back pain. Thirty candidates suffering from chronic low back pain between the ages of eighteen to forty years participated in this study. These candidates were recruited from the local surrounding area, through information pamphlets distributed throughout the Technikon Witwatersrand Doornfontein and advertisements placed in the local newspapers. Only those candidates that conformed to the selection criteria were allowed to participate in the study. Each candidate was randomly assigned to one of three groups as they enrolled for participation. Each group consisted of ten candidates. Group 1 candidates received treatment to the GSC by means of dry needling and passive stretching only. Group 2 candidates received lumbar spine manipulation only. Group 3 candidates received a combination of lumbar spine manipulation and dry needling and passive stretching of the GSC. Each candidate received treatment three times a week, every second day over three weeks thus receiving a total of nine treatments each. 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 the lumbar spine range of motion in flexion, extension, right and left lateral flexion and right and left anterior rotation. Pressure algometry of the most active trigger point in the GSC was also recorded. Both the subjective and objective data were recorded on the first, third, fifth and ninth treatment consultations before any treatment was administered.

No description available.