Thesis (M.Med.Sc.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 113-133). Also available in print.

M.Tech.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of technology, 2002. / Background: Low back pain is a common problem for which many conservative treatments are available. Spinal manipulation is considered one of the most effective of these treatments. Interferential therapy is widely used especially for pain control and often forms part of a treatment protocol. However, there is little clinical evidence to support this usage. Objective: The purpose of this investigation was to evaluate the effectiveness of interferential current therapy as an adjunct to manipulation in the treatment of acute mechanical low back pain in terms of subjective and objective measures. Methods: Sixty subjects suffering from acute mechanical low back pain were recruited through advertising and randomly divided into two groups with thirty patients each. Group A received manipulation and interferential therapy and group B received manipulation only. Both groups received 4 treatments and a follow-up consultation over a 2 week period. Subjective measurements were taken using the Numerical Rating Scale - 101and revised Oswestry low back pain questionnaire. Objective measurements were taken using an algometer and an orthopaedic rating scale. All measurements were taken before treatment on the first, third and fifth consultations. Statistical inter-group analysis was completed using the two sample unpaired t-test and the Mann-Whitney U-test. Friedman's T test was used to evaluate the intra-group information. The null hypothesis was rejected at a = 0.05 level of significance. Results: Both treatment groups A and B achieved a significant improvement in pain and disability over the treatment period. However, no significant differences in terms of pain and disability could be found between the two groups at any stage during, or at the end of the treatment period. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background to the study: Chronic low back pain (CLBP) is a common musculoskeletal complaint, which results in increased absenteeism from work and other disabilities. Interferential current (IFC) is one of the treatment modalities used by manual and physical therapists to alleviate CLBP. Interferential current involves electrical stimulation of medium frequency using two currents that cross over each other. There have been numerous mechanisms proposed on how IFC works with regard to pain inhibition; however, these remain unconfirmed. Common theories include those based on the gate control theory of pain and integrated pain theories. Although the placement of the electrodes used in the IFC application has been well defined, the optimum treatment time for CLBP has not been well researched. Therefore, this study aimed to determine what protocol regarding the duration of IFC is most appropriate in the treatment of CLBP. Aim: The aim of this study was to investigate the effect of interferential current in the treatment of chronic low back pain using variable time intervals Methodology: This study was a randomised single-blinded clinical trial which consisted of 45 participants residing in the eThekwini municipality, divided into three groups of 15 each. The participants were randomly assigned using concealed allocation to one of three treatment groups of 15 each viz. 15, 20 or 30 minutes of interferential current (IFC). Low back pain level was determined using a numerical pain rating scale (NRS-101). Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of low back pain on participants’ activities of daily living was assessed using the Oswestry low back questionnaire (OLBQ).The participants received three treatments over a two week period with the fourth consultation being used for the final subjective and objective measurements a week later. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS-101 and algometer readings. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. Conclusion: This study concluded that neither group is more effective than the other with respect to participants’ pain perception and the OLBQ. However, groups one and three showed the largest individual improvement between consultation one and three, compared to group two which showed consistent improvement throughout for the NRS-101 readings. Based on the results collected from this study, the shortest time frame of 15 minutes of IFC application can be used in the treatment of CLBP. / M

M.Tech.

M.Tech.

This unblinded, controlled pilot study was undertaken to determine if cervical spine adjustments had an effect on improving the low back pain in the workforce of the corporate environment. Subjects were treated at the Technikon Witwatersrand chiropractic day clinic in Johannesburg, South Africa. Thirty corporate employees suffering from low back pain were selected for this study. Subjects were recruited using posters put up at the Technikon Witwatersrand campus and at companies in and around Johannesburg. The patients were divided into three groups of ten. One group received chiropractic adjustments of the cervical spine. The second group received chiropractic adjustments of the lumbar spine and sacroiliac joints. The third group received a combination of chiropractic adjustments of the cervical spine, lumbar spine and sacroiliac joints. Patients were treated nine times over a four-week period. Objective data was recorded using a Digital Inclinometer to measure lumbar spine range of motion. Subjective data was obtained by participants recording their progress on the Oswestry Back Disability Index and Visual Analogue Pain Scale. The results showed that there was a statistically significant improvement in the pain and disability experienced by the patients in all three groups for the subjective measurements. There was however no statistically significant increase in range of motion in the lumbar spine for all three groups according to the objective measurements. This study concluded that cervical spine adjustments had a positive effect on improving the low back pain and disability experienced by the workforce in the corporate environment. / Dr. Barrett Losco Dr. Pauline Moolman

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic low back pain is a highly prevalent condition in industrialized nations. It is associated with activity limitations, disability, has significant economic impact on society and incurs personal cost. Today's working environment increasingly demands more time spent sitting due to computerization and other advances in technology. Sitting for hours without taking breaks may influence posture, and alignment of the lumbar spine. Therefore, it may influence low back pain. Kenya as a developing country has an increasing number of people involved in sedentary work. The aim of this study was to identify the predisposing factors of chronic low back pain among sedentary office workers in Nairobi. The main objectives were to establish the prevalence of chronc low back pain; to determine the possible predisposing factors of chronic low back pain and to determine the impact of chronic low back pain on work related quality of life among sedentary office workers in Nairobi, Kenya. / South Africa

OBJECTIVE: To determine the most effective chiropractic treatment protocol in the management of chronic non-complicated low back pain. This was determined by comparing subjective and objective results gained from two treatment protocols, one of which included corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of an independent home prescribed rehabilitation program. The second treatment protocol consisted of a combination of corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of a spinal rehabilitation program under the close supervision and guidance of the researcher. DESIGN: The study was a clinical trial, which consisted of two groups of 15 patients each. These patients were procured using information pamphlets and advertising posters and were selected on the basis of particular inclusion and exclusion criteria. In addition, the selected candidates were also required to have a static isometric back extensor endurance test of 55 seconds and less as well as a decreased lumbar range of motion in the sagittal plane. INTERVENTION AND DURATION: Once the patients were randomized into two groups, the respective treatment protocols were implemented over a six week period. The control group was prescribed with a home exercise spinal rehabilitation program and the experimental group received a supervised spinal rehabilitation program. Both groups received chiropractic manipulation to the lumbar spine and pelvis to restore mobility and correct the mechanical dysfunction in the hypomobile joint. The frequency of follow-ups for this study was three times weekly for the first and second weeks, twice weekly for the third and fourth weeks, and then once weekly for the fifth and six weeks. MEASUREMENTS: Objective measurements included lumbar spine flexion and extension range of motion and Sorenson’s test. Subjective measurements were the Oswestry Low Back Pain and Disability Index and Numerical Pain Rating Scale 101 questionnaires. Measurements were taken at the first, sixth and twelfth consultations. CONCLUSION: The aim of this study was to determine whether chiropractic care in conjunction with a supervised “in-office” spinal rehabilitation program would prove to be a more effective method in decreasing low back pain measurements and indices when compared to a home prescribed exercise program in the management of chronic low back pain. Although the supervised group did show improvements on the areas indicated, none of the two groups showed statistically significant differences. Therefore it can be concluded from the results of this study that the home exercise group demonstrated as good a response as the supervised exercise group thus highlighting the positive effects of the adjustment alone. / Dr. E. Garlick Dr. B. Losco

M.Tech. (Chiropractic) / Purpose: The purpose of this study was to determine if inversion therapy is beneficial for participants with lower back pain and if there is an additive effect when combining it with manipulation. Three treatment approaches were utilized: inversion therapy, lumbar spine manipulations and a combination of inversion therapy with lumbar spine manipulations. Method: Thirty participants who qualified for the study were randomly divided into three equal groups consisting of ten participants each. Depending in which group the participant was allocated, determined if they received lumbar spine manipulation (Group 1), inversion therapy (Group 2), or a combination of inversion therapy performed after the lumbar spine manipulation (Group 3). Procedure: Each participant was treated a total of six times over a course of three weeks, furthermore there was a seventh day of final data collection. The measurements were taken on the first, fourth and seventh visit. Subjective measurements consisted of the numerical pain rating scale (NPRS) and the Oswestry Low Back Pain Disability Index. Objective measurements were done with the inclinometer (lumbar range of motion) and the flexicurve (lumbar lordosis measurement). Results: It is clear that there were statistically significant improvements in all three of the groups in both the NPRS and the Oswestry disability index. The inversion therapy group performed the best with the NPRS and the Oswestry disability index, with the spinal manipulation and combination group following narrowly. However, there were no statistically significant differences on the intergroup analysis with regards to the subjective results. The results of the subjective measurements indicated that there was a relative decrease in lumbar spine lordosis measurements, over the trial period, but with no statistical significance. With the lumbar range of motion-flexion measurements it was clear that the spinal manipulation group and the inversion therapy group had superior results compared to the combination group, with both indicating statistical significance over the trial period. Extension, lateral flexion and rotation did not show any statistical significance over the trial period. Conclusion: There were statistically significant improvements within each of the three groups on intragroup analysis, but no statistically significant differences were found on intergroup analysis. Therefore, none of the groups could be singled out as being the superior treatment for mechanical lower back pain. All three groups’ demonstrated improvement. There was no significant additive effect by combining the two treatments. Therefore there is no benefit to adding inversion therapy to the treatment protocol. Manipulation alone demonstrated to have similar effects. However, should a patient not be able to see a chiropractor for treatment, home based inversion therapy can be beneficial. A concern that should be addressed is that home based treatment wouldn’t be supervised and as such it is not advised to do without some form of professional management. Inversion therapy can definitely be utilized as a home based treatment option for a patient with LBP, patients that can’t make use of regular chiropractic care due too logistical or financial restraints will benefit from inversion therapy home usage. Home usage will provide the patient with regular general traction therapy and can result in patient pain relief, increase overall functioning of the patient and the patient compliance may improve.