M.Tech. (Chiropractic) / The aim of this research study was to determine whether the adjustment of the cervical spine, specifically the atlanto-occipital joint, resulted in an increase in quadriceps muscle strength. Patients were recruited in response to advertisements placed in and around Technikon Witwatersrand (TWR), Doornfontein Campus. One hundred patients were included in the research (N=l00). The patients were then randomly divided into a treatment/adjustment group and a control group. Each group consisted of fifty patients. Both groups were then further divided into athletes without pain, athletes with pain, nonathletes without pain and non-athletes with pain. A full cervical spine regional examination was performed on each patient to isolate atlanto-occipital joint dysfunction and to rule out any contra-indications to treatment. The quadriceps muscle strength was measured three times at one-minute intervals in both groups. The treatment/adjustment group was then treated with a single chiropractic adjustment, specifically the superior condyle technique, to the atlanto-occipital joint and the control group rested for one-minute. Three quadriceps muscle strength readings were taken again in both groups. Each patient was treated once. The results from the two groups were then statistically analysed. It was hypothesised that the treatment group would benefit with regard to an increase in quadriceps muscle strength and that the control group would remain unchanged. The objective data was gathered using an isometric force-plate dynamometer and this was used to measure bilateral quadriceps muscle strength in kilograms. The objective data was analysed using Sign Test, Mann-Whitney U Test, One Sample t-Test and Independent Samples t-Test. The results of the study showed that the treatment group benefited with regard to quadriceps muscle strength, while the control group responded negatively and a decrease in quadriceps muscle strength was noted. The group with the greatest increase in quadriceps muscle strength was the non-athletic group with pain

M. Tech.

Current understanding concerning the human deep cervical fascia (DCF) differs between anatomists, surgeons, and radiologists. One reason has been the varying methodologies used to examine the DCF and the terminology assigned to each layer or potential space formed. Previous knowledge concerning the DCF originally came from cadaveric studies. However, such findings were highly subjective, reliant on the dissectionist�s skill with a scalpel. With the recent advent of radiological imaging and sheet plastination, there has been a re-examination of the fascial layers (investing, pretracheal, and prevertebral) that constitute the DCF. Although there is general consensus regarding the existence of the three layers, there is continuing conjecture over the concise anatomical description of these fascial structures. Recently, the investing (superficial) fascia, as a separate fibrous structure, has been questioned with a small number of plastination studies reporting its absence in the postereolateral regions of the neck. Within the suboccipital region (SOS) it is widely reported that the nuchal ligament, extending from the investing layer, directly connects with the spinal dura mater. However, a recent plastination study by Johnson et al. (2000b) found these fibres to dissipate in the SOS.The question remains as to what fibres directly communicate with the spinal dura? The fibrous connective bridge is reported in some clinical studies to originate from the rectus capitis posterior minor (RCPm) via the SOS. The origin of the connective fibrous bridge is essential in understanding the mechanism in the prevention of the phenomenon of 'infolding' and cervicogenic neck pain? Anteriorly, the investing fascia is regarded as a continuance of a 'fibrous collar' that encapsulates the entire neck, yet if it does not truly exist in the posterior neck region, does it actually exist as a tangible structure in the anterior neck? With regard to the deep midline fascial structures that arise from the pretracheal fascia, the presence of two separate spaces, the retropharyngeal and danger space, divided by the alar fascia in the posterior pharyngeal region, is still debated and is yet resolved in the clinical literature. The aims of this qualitative study were to: 1. determine the dural ligamentous and tendinous connections in the posterior atlanto-occipital (PAO) interspace region, and establish the morphology of the PAO membrane, 2. determine whether the investing layer of the DCF is a distinct fibrous structure in the anterior neck and examine the relationship with the subcutaneous platysma muscle, and 3. determine the relationship between the RPS and DS in the posterior pharynx region and identify the configuration of the alar fascia. Twenty-seven cadavers were examined at the gross, macro- and, microscopic level. Blunt and sharp dissections were conducted on 12 specimens. Fifteen cadavers were prepared as epoxy sheet plastinates. Light, fluorescent and confocal microscopy was conducted on the sheet plastinations.The findings of the first study demonstrated that small discrete bundles from medial tendinous fibres of RCPm formed a fibrous connective tissue bridge directly with the spinal dura in the SOS (in all 6 median-sectioned plastinated specimens), not the nuchal ligament as commonly reported. The RCPm fascia, in conjunction with lateral contributions from the perivascular sheath, formed the PAO membrane (ligamentum flavum) which was not continuous with the neural arch of C1 as often cited in anatomical texts. The cerebrospinal junction was also demonstrated to be a naturally formed multi-layered structure in all plastinates and not the result of pathological change as widely reported in clinical literature.The Gross dissection findings of the second study supported the traditional view that the investing layer formed a covering over the anterior triangle neck region. However, findings from plastinations, in conjunction with confocal microscopy, demonstrated clearly that the investing layer is formed from the epimysium of superficial muscles in the anterior neck. In the suprahyoid neck, it appeared disjointed with the fascia of the sternocleidomastoid (SCM) fascia isolated from the neighbouring submandibular fascia. In the infrahyoid neck, it was formed by medial fascial extensions from the omohyoid fascia, SCM fascia, and fused at the midline to the infrahyoid fascia, (pretracheal layer) resulting in two ipsilateral compartments. Distal 'finger-like' fascicles of platysma presented with individual epimysial fascia, which gave the false appearance of a thickened investing layer. These findings contravene those of the traditional view that the investing fascia is continuous at the mid-line.The findings of the third study agreed with both those reported in radiological and cadaveric studies respectively, in that the alar fascia was not present above the level of C1 as purported by radiologists, but became more apparent below this level. The alar fascia was observed to be formed from medial extensions of the carotid sheath, with some minor contributions from the lateral slips of the prevertebral fascia posteriorly, and was visible within transverse plastinated slices to the level of C7. However, at the levels of C4 and C6, the alar fascia appeared to fuse with the buccopharyngeal fascia, (posterior pretracheal layer of the DCF), a finding not previously reported. This study demonstrated, through E12 sheeted plastinated sections, that the morphology and topography of the DCF is complex, and a more precise understanding of the anatomy of the DCF and associated potential spaces is paramount clinically in otolaryngology, concerning the cervical fascial pathways of potentially life-threatening commutative pathologies.

published_or_final_version / Public Health / Master / Master of Public Health

Neck pain is an increasing problem in industrialized societies. Research is necessary to find ways to objectively measure neck dysfunction. The purpose of this Master's project was to examine the test-retest properties of a dynamometric system for neck force measurements and to obtain reference measures on isometric cervical strength in a healthy population. Twenty-eight healthy subjects participated in this study; 16 males and 12 females. Cervical strength was measured using the MCU(TM) Multi-Cervical Unit (BTE Technologies(c)) in six directions: flexion, extension, protraction, retraction and right and left lateral flexion. The test-retest reliability was good to excellent (≥ 0.85) for all directions. Males were on average 58% stronger than females, with the greatest difference in t1exion. The standard error of measurement and minimal detectable change values were found to be much smaller than the average strength measures. Studies are needed to address the implementation of the MCU in clinical settings.

No description available.

Current understanding concerning the human deep cervical fascia (DCF) differs between anatomists, surgeons, and radiologists. One reason has been the varying methodologies used to examine the DCF and the terminology assigned to each layer or potential space formed. Previous knowledge concerning the DCF originally came from cadaveric studies. However, such findings were highly subjective, reliant on the dissectionist�s skill with a scalpel. With the recent advent of radiological imaging and sheet plastination, there has been a re-examination of the fascial layers (investing, pretracheal, and prevertebral) that constitute the DCF. Although there is general consensus regarding the existence of the three layers, there is continuing conjecture over the concise anatomical description of these fascial structures. Recently, the investing (superficial) fascia, as a separate fibrous structure, has been questioned with a small number of plastination studies reporting its absence in the postereolateral regions of the neck. Within the suboccipital region (SOS) it is widely reported that the nuchal ligament, extending from the investing layer, directly connects with the spinal dura mater. However, a recent plastination study by Johnson et al. (2000b) found these fibres to dissipate in the SOS.The question remains as to what fibres directly communicate with the spinal dura? The fibrous connective bridge is reported in some clinical studies to originate from the rectus capitis posterior minor (RCPm) via the SOS. The origin of the connective fibrous bridge is essential in understanding the mechanism in the prevention of the phenomenon of 'infolding' and cervicogenic neck pain? Anteriorly, the investing fascia is regarded as a continuance of a 'fibrous collar' that encapsulates the entire neck, yet if it does not truly exist in the posterior neck region, does it actually exist as a tangible structure in the anterior neck? With regard to the deep midline fascial structures that arise from the pretracheal fascia, the presence of two separate spaces, the retropharyngeal and danger space, divided by the alar fascia in the posterior pharyngeal region, is still debated and is yet resolved in the clinical literature. The aims of this qualitative study were to: 1. determine the dural ligamentous and tendinous connections in the posterior atlanto-occipital (PAO) interspace region, and establish the morphology of the PAO membrane, 2. determine whether the investing layer of the DCF is a distinct fibrous structure in the anterior neck and examine the relationship with the subcutaneous platysma muscle, and 3. determine the relationship between the RPS and DS in the posterior pharynx region and identify the configuration of the alar fascia. Twenty-seven cadavers were examined at the gross, macro- and, microscopic level. Blunt and sharp dissections were conducted on 12 specimens. Fifteen cadavers were prepared as epoxy sheet plastinates. Light, fluorescent and confocal microscopy was conducted on the sheet plastinations.The findings of the first study demonstrated that small discrete bundles from medial tendinous fibres of RCPm formed a fibrous connective tissue bridge directly with the spinal dura in the SOS (in all 6 median-sectioned plastinated specimens), not the nuchal ligament as commonly reported. The RCPm fascia, in conjunction with lateral contributions from the perivascular sheath, formed the PAO membrane (ligamentum flavum) which was not continuous with the neural arch of C1 as often cited in anatomical texts. The cerebrospinal junction was also demonstrated to be a naturally formed multi-layered structure in all plastinates and not the result of pathological change as widely reported in clinical literature.The Gross dissection findings of the second study supported the traditional view that the investing layer formed a covering over the anterior triangle neck region. However, findings from plastinations, in conjunction with confocal microscopy, demonstrated clearly that the investing layer is formed from the epimysium of superficial muscles in the anterior neck. In the suprahyoid neck, it appeared disjointed with the fascia of the sternocleidomastoid (SCM) fascia isolated from the neighbouring submandibular fascia. In the infrahyoid neck, it was formed by medial fascial extensions from the omohyoid fascia, SCM fascia, and fused at the midline to the infrahyoid fascia, (pretracheal layer) resulting in two ipsilateral compartments. Distal 'finger-like' fascicles of platysma presented with individual epimysial fascia, which gave the false appearance of a thickened investing layer. These findings contravene those of the traditional view that the investing fascia is continuous at the mid-line.The findings of the third study agreed with both those reported in radiological and cadaveric studies respectively, in that the alar fascia was not present above the level of C1 as purported by radiologists, but became more apparent below this level. The alar fascia was observed to be formed from medial extensions of the carotid sheath, with some minor contributions from the lateral slips of the prevertebral fascia posteriorly, and was visible within transverse plastinated slices to the level of C7. However, at the levels of C4 and C6, the alar fascia appeared to fuse with the buccopharyngeal fascia, (posterior pretracheal layer of the DCF), a finding not previously reported. This study demonstrated, through E12 sheeted plastinated sections, that the morphology and topography of the DCF is complex, and a more precise understanding of the anatomy of the DCF and associated potential spaces is paramount clinically in otolaryngology, concerning the cervical fascial pathways of potentially life-threatening commutative pathologies.

Thesis (M App Sci in Physiotherapy) -- University of South Australia, 1992

Thesis (M.App.Sc. in Physiotherapy)--University of South Australia, 1997.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Also available in print.