Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Graston Technique Instrument-assisted Soft Tissue Mobilization (GTISTM), is a relatively new form of myofascial pain syndrome (MPS) treatment, that is thought to be an advanced form of soft tissue mobilization. The stainless steel instruments that are used are specifically designed for various parts of the body and are used to detect and release scar tissue, adhesions and fascial restrictions (Carey-Loghmani, 2003:7). It is speculated that the Graston Technique instruments may be superior to other instruments due to the uniqueness of the instrument design, instrument material (stainless steel), delivery method and technique process. The instruments have been designed to adapt to the various curves of the body allowing the clinician to detect and treat soft tissue dysfunctions in an accurate and specific manner (Carey-Loghmani, 2003;2). Other soft tissue therapeutic techniques make use of specifically designed aluminium instruments have shown to be successful in the treatment of tendonitis (Davidson et aI., 1997).Thus it was the aim of this study to determine if there was a significant clinical difference between the Graston Technique instruments and instruments of the exact design but of a constitutionally different material (i.e. aluminium). This was achieved by varying the instrument material, while maintaining all the other features of the instrument, as well as the treatment protocol in the management of myofascial trigger points (MTrPs) of the trapezius and the levator scapula muscles. III This pilot study was a comparative clinical trial conducted on a quasiexperimental basis, aimed at establishing the influence of component materials of the Graston Technique instruments in the treatment of MPS in terms of clinical outcomes. The sample size consisted of sixty patients selected from the Durban Metropolitan Area. Patients between the ages of 18 and 55 and diagnosed / M

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

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The aim of this placebo-controlled\xB7 trial was to investigate the efficacy of action potential therapy (APT) versus placebo, and the relative effectiveness of abdominal versus paraspinal electrode placement, in the treatment of Irritable Bowel Syndrome (IBS). Convenience sampling was used to recruit sixty patients with IBS from the community. These patients were randomly divided into four groups (A, B, C and D). Each group consisted of 15 patients, aged between 20 and 69 years. Patients attended five consultations over three weeks. Treatment was given with either active or placebo APT during the first four consultations. The fifth consultation was for data collection only. Patients in group A and C both received active APT. In group A, the electrodes were placed over the abdomen, while in group C the electrodes were placed paraspinally. Patients in group Band 0 both received placebo APT using a placebo APT device. In group B, the electrodes were placed over the abdomen, while in group 0, the electrodes were placed paraspinally. The measures of efficacy were the IBS Quality of Life Questionnaire (IBS-QOl), the Shortform McGill Pain Questionnaire (SF-MPQ) and the life line Stress Questionnaire (ll-SQ). Using these questionnaires, data was collected at the 1st. 3rd and s' consultations for each participant. The data was then analysed using the SPSS package. Assessment of intragroup and inter-group change was performed using Friedman's T-test and the Mann-Whitney U-Tests respectively. Analysis was performed at the 95% confidence level. Patients in all four groups showed a,n improvement in quality of life (measured by the IBSQOl), as well as in the perceived quantity of pain experienced (measured by the SF-MPQ), between initial and final consultations. As regards the patients' levels of stress (measured by the ll-SQ), there was no statistically significant improvement in any of the four groups between initial and final consultations. Inter-group comparison of the data showed a higher perceived quantity of pain in the active, paraspinally placed APT group (group C) at the first consultation when compared to both the / M

Final submission of a dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this randomised, placebo-controlled clinical trial was to investigate the efficacy of foot and ankle manipulation and mobilization as opposed to a placebo treatment (de-tuned ultrasound), in terms of objective and subjective findings in the treatment of Morton's neuroma. This clinical trial consisted of two groups, each with twenty patients. Patients who were diagnosed by the researcher as suffering from Morton's neuroma were included in the study. The patients were randomly allocated into the respective groups. The ages of the patients ranged from 23 to 79 years old. Group A received the de-tuned ultrasound as the placebo treatment and Group B received foot and ankle manipulation and mobilization as well as the de-tuned ultrasound to eliminate any massage effect that may have been incurred. It was hypothesised that foot and ankle manipulation and mobilization would be effective in the treatment of Morton's neuroma. The treatment protocol consisted of a course of six treatments over a treatment period of three weeks. Subjective and objective measurements were taken at the initial, third and final consultations. Subjective data was obtained via the use of the Numerical Rating Scale 101, the Short-form McGill Pain Questionnaire and the Foot Function Index. Objective data was obtained by means of digital algometer measurements / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of muscle energy technique in the treatment of chronic mechanical neck pain. This was a randomized placebo controlled study. Two groups of thirty subjects from Durban and the surrounding areas were selected to participate in the study, which was carried out at the Technikon Natal Chiropractic Day Clinic. Subjects were diagnosed with the condition by the researcher. Each subject received six treatments within a period of three weeks. Group A received muscle energy technique and de-tuned laser therapy applied to joint fixations. Group B received de-tuned laser therapy applied to the fixated areas. Subjective assessment was by means of the Short-Form McGill Pain Questionnaire and the Numerical Pain Rating Scale-101. Objective assessment was by means of the digital algometer (The Commander\x99 Algometer by Jtech Medical Industries) and the Cervical Range of Motion Device. Both the subjective and objective readings were taken prior to the first treatment and a day following the final (sixth) treatment. / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this investigation was to determine the relative effect of the four-electrode as opposed to the pen-electrode interferential current method in the treatment of myofascial pain syndromes. This was a randomised clinical trial consisting of two groups. Group A received four-electrode interferential current therapy, while Group B received pen-electrode interferential current therapy. Each group consisted of 15 subjects, between the ages of 18 and 55 years, selected from the general population. Subjects diagnosed with active myofascial trigger points in any of the following muscles: trapezius, levator scapulae, supraspinatus, infraspinatus and rhomboid major and minor, were admitted into the study. Each subject received five treatments over a period of three weeks followed by a one-month follow-up consultation. Each subject was assessed by means of the CMCC Neck Disability Index, short-form McGill Pain Questionnaire and the Numerical Pain Questionnaire; as well as pain threshold readings by means of an algometer and cervical spine ranges of motion measurements by means of a cervical goniometer. Readings were taken at the first, fifth and follow-up consultations for all subjective and objective measurements. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / There has previously been a significant number of clinical trials supporting the efficacy of manipulation for the treatment of low back pain. In addition, the use of manipulation for the treatment of sacroiliac syndrome is well recognised. However, the management protocols involving the use of orthotics, used alone, or in combination with manipulation were found to be controversial. Orthotics seem to be frequently used in the clinical setting and yet there is a paucity of controlled clinical research advocating their application. The aim of this study was to determine the relative effectiveness of chiropractic manipulation used in combination with a non-stabilising sacroiliac orthotic (strapping) versus chiropractic manipulation used in combination with a stabilising sacroiliac orthotic in the treatment of sacroiliac syndrome. It was hypothesised that both treatment protocols would be effective in the management of sacroiliac syndrome, and that manipulation used in combination with a stabilising sacroiliac orthotic over a two week period would be more effective than manipulation used in combination with a non-stabilising sacroiliac orthotic, in terms of subjective and objective clinical f-Indings. The study design chosen was a comparative, randomised, controlled clinical trial. Sixty consecutive patients diagnosed with sacroiliac syndrome were randomly assigned either to the group receiving manipulation used in combination with a non-stabilising sacroiliac orthotic or the group receiving manipulation used in combination with a stabilising sacroiliac orthotic. The age range of patients extencled from eighteen to forty-nine, and included thirty-one males and thirty-three females. Statistically patients\x8F\x8F / M

A dissertation proposal presented in the partial fulfilment of the requirement for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2001. / The purpose of this investigation was to perform a placebo controlled, randomised clinical study to determine the efficacy of manipulative therapy of the elbow, based on motion palpation findings, in the treatment of lateral epicondylitis . Forty patients participated in the study, all of who underwent a case history, physical examination, and elbow regional examination. They were then randomly assigned to one of the two groups, so that twenty patients received manipulative therapy of the elbow, and the remainder of the patients received detuned ultrasound. All patients received 6 treatments over a 3-week period, with subjective and objective data being collected before the first, third and sixth treatments. The short-form McGill pain questionnaire and the NRS101 questionnaire where used to monitor each patients subjective response, while algometer and dynamometer readings were taken to provide objective data. Motion palpation of the symptomatic elbow was performed on all patients before treatments 1,3, and 6. Examination of the statistical data reveals that there was no significant difference in improvement between the two groups, ie. manipulative therapy of the elbow was found to be no more / 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