Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1998. / Currently, no scientific evidence exits to demonstrate that radiolucent cavities, or an increase in joint space in the cervical zygapophyseal joints, occur following the manipulation of these joints. However, previous studies have demonstrated the presence of these phenomena in the metacarpophalangeal joints following the application of linear traction to these joints to the point of cavitation ('cracking'). This study was designed to determine whether such phenomena occurred in the cervical spine. Plain film and computed tomographic imaging were used for this purpose. It was hypothesized that an increase in joint space and a decrease in joint density (radiolucent cavity) would be demonstrable following the application of the manipulation in the non-traction and particularly the traction positions of the neck. Volunteers were screened for conformity with the inclusion criteria. Of these, 22 asymptomatic subjects were selected. The subjects were then assigned to one or two of 6 possible experimental groups. The subjects of each group were radiographically imaged before and immediately after the manipulation. In all cases except for Experiment 1 the subjects received : o a pre-manipulation X-ray and/or CT scan, o a pre-manipulation plus traction X-ray and/or CT scan, a post-manipulation X-ray and/or CT scan and o a post-manipulation plus traction X-ray and/or CT scan. A total of 83 CT scans consisting of 1660 images and 36 fluoroscopy-assisted plain-film radiographs were performed. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005 / Patellofemoral Pain Syndrome (PFPS) is a common knee problem that affects 25% of the general population. PFPS generally affects adolescents, especially females, young adults and sports men and women. PFPS is defined as anterior knee pain arising from dysfunction of the patellofemoral articulation including its connective and contractile tissues. Literature suggests an extensor mechanism dysfunction as the most probable etiology. The majority of literature suggests that PFPS is associated with restricted patella motion, especially medial glide, resulting from a tight lateral retinaculum and/or tight iliotibial band. The beneficial effect of patella mobilization in the management of PFPS, suggested by the results of a number of studies, further suggests that restricted patella motion may be an integral feature of PFPS, as a causative and/or perpetuating factor. The purpose of this study was to assess the associations between the severity of PFPS (in terms of the objective and subjective clinical measures) and patella mobility (direction of mobility loss and degree of motion loss). / M

Submitted in fulfilment of the requirements for the Degree of Master of Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of Myofascial Adhesion Manipulation (grip and rip) in the treatment of Myofascial Pain Syndrome. The study was a prospective, unblinded, randomized, placebo-controlled, clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients diagnosed with active trigger points in either the Trapezius and/or the Levator Scapulae muscles were accepted into the study. The sample was divided into two groups of 30 patients each. One group received Myofascial Adhesion Manipulation, whilst the other group received placebo ultrasound. Each patient received four treatments over a maximum period of 3 weeks. Data was obtained from the patients at the first and second consultations, prior to treatments, and at the fourth consultation, immediately following the treatment. Subjective data was obtained with the Numerical Pain Rating Scale (NRS 101) and the Short-Form McGill Pain Questionnaire (S-FMPQ). Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale (MDS) / 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

Dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Chiropractic, Technikon Natal, 1995. / This study was aimed at establishing the degree to which the concept of holism and the practise of well ness formed part of chiropractic health care. It set out to discover how patients and practitioners perceived holism, and to determine the degree to which the practice of well ness was incorporated into patient management programmes. The study ultimately integrated and evaluated the responses of two questionnaires. One was directed at patients in order to recognize how they perceived holism and well ness in chiropractic health care, and the other was directed to practitioners to discover the extent to which holism and the practice of well ness were incorporated into their patient management programmes. Throughout this study/holism was viewed as a philosophical concept acknowledging an interdependence of mind and body. On the other hand.the term wellness was used in reference to a form of patient management based on the practical application of holistic approach, as opposed to a purely philosophical concept . . For the purpose of this study the concept of holism was evaluated in terms of the following factors; exercise, stress management, religion, emotional well-being, diet and nutrition, smoking, alcohol consumption, medication and drug use and occupational hazards. The data generated by the questionnaires was analyzed by means of frequency tabulation and cross-tabulation. The results were discussed and displayed by means of bar-charts and frequency tables. These results revealed that both patients and practitioners were very aware of the concept of holism in their personal lives. However, it also revealed that there were inconsistencies between the patients' experience of wellness and the holistic approach supposedly offered by their practitioners. Areas of inconsistency included discussion in the following areas: a) medication and drug use, b) alcohol consumption, c) occupational hazards and d) emotional well-being of patients. In the final chapter recommendations were made with regards to research methodology for future studies of a similar nature, as well as suggestions for the development of a holistic approach in chiropractic education and health care. A re-evaluation of chiropractic philosophy and the mission statement of chiropractic health care was suggested, in order to establish what a practitioner's responsibility is towards the community and his/her patients. It was recommended that practitioners and chiropractic students be made aware of their responsibility to humankind as Doctors of Chiropractic.6 / M

M.Tech.

M.Tech. / Objective. Previous studies have provided evidence of cervical manipulation as an effective treatment in the management of cervicogenic headache reduction, however there is no record of studies ascertaining the effectiveness of biomechanical pelvic blocking in such treatment. This controlled clinical trial aimed at establishing biomechanical pelvic blocking as an alternative treatment for cervicogenic headaches yielding similar results. Methods. In this study 30 participants between the ages of 18 and 60, symptomatic of cervicogenic headaches were included in the clinical trial. These 30 participants divided in to three groups of equal size by means of random selection. Group A received cervical spine manipulation only, group B received biomechanical pelvic blocking and group C was treated by means of both cervical spine manipulation and biomechanical pelvic blocking. The design of this pilot study was such that the spinal manipulative therapy was the control between the groups, therefore allowing us to identify whether biomechanical pelvic blocking was effective in the treatment of cervicogenic headaches. The patients were treated 6 times, twice weekly over a period of three weeks. Objective data collected on the first, third and sixth visits by means of the Saunders digital inclinometer. Cervical Range of Motion digital inclinometry measurements taken were that of forward flexion, extension and both right and lateral flexion. Subjective data collected by means of The Numerical Pain Rating Scale and Mc Gill Pain Questionnaire as well as the Neck Disability Index. The Numerical Pain Rating Scale and the Mc Gill Pain Questionnaire measured the headache pain intensity and the Neck Disability Index ascertained the degree of cervical disability as well as neck pain intensity experienced by the patients. These questionnaires were completed by the patient on the first, third and sixth consultation. Results. In terms of the digital inclinometry assessment, statistically significant results existed although not consistently for the same group per ROM. Extension showed Group C demonstrating the greatest increase in terms of cervical extension range of motion. Statistically significant difference existed between the groups for extension ROM. Forward flexion calculated as the most improved for group C however, no statistically significant difference existed. Group A proved most effective in increasing both cervical left and right lateral flexion range of motion. The reliability of digital inclinometer in obtaining accurate measurements is questionable. The subjective data although overall no statistically significant difference was noted between the groups for the period of the treatments, a definite clinical significance was established, group A did show the greatest overall improvement in pain intensity. Group C followed group A, the difference between these groups indicating the small relevance of the pelvic blocking. The Neck Disability Index demonstrated the greatest improvement within group C followed by group A and then group B. This marked improvement in group C in comparison to group’s A and B is suggestive of the immediate effects of cervical manipulative therapy as well as the spinal compensation due to treatment of the pelvis by the means of blocking. As this questionnaire, serves to establish the patients’ perception in terms of cervical pain and disability it indicated the biomechanical pelvic blocking to be questionably effective in the improvement in neck disability and pain.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the efficacy of dry needling latent myofascial trigger points, in the treatment of Myofascial Pain Syndrome. The study was a prospective, randomized placebo controlled study. Sixty patients, between the ages of 18-60, from the greater Durban area participated in the study. They underwent a case history, relevant physical examination and a cervical spine examination. The sixty subjects were randomly allocated into two groups of thirty. Group one received sham/ placebo needling while group two received dry needling, after being diagnosed systematically as suffering from latent myofascial trigger points of the trapezius and/or the levator scapulae muscle/muscles. Each patient received two treatments within a week with a one-week follow-up. Subjective and objective measures were taken at all three visits. Subjective data was obtained from the Numerical Pain Rating Scale 101 and objective data was obtained from the use of the algometer. This data was used to perform statistical analysis using parametric unpaired and paired t-tests to compare inter- and intra-group data respectively, at a 95% level of confidence. / M

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. xii, 62, [18] leaves / The purpose of this study was to determine the comparative effectiveness of cryo-ischaemic compression, using the Cold Tennis-ball Technique, and ischaemic compression, using normal tennis balls, in the treatment of Myofascial Pain Syndrome The study was a randomised, controlled, comparative clinical trial. The samlpe population comprised of sixty patients between the ages of 18-35 years. Patients were screened according to the inclusion and exclusion criteria, were selected and randomly divided into two groups. One group, of thirty patients, received ischaemic compression using normal tennis balls, whilst the second group, of thirty patients, received ischaemic compression using the Cold Tennis-ball Technique. Patients received four treatments over a period of two weeks. Data was obtained from each patient prior to and immediately after each treatment. Objective data was obtained from pressure threshold algometry and the Myofascial Diagnostic Scale. Subjective data was obtained from the Numerical Pain Rating Scale (NRS) and patients were required to give a sensory description of their pain at two-minute intervals during the course of the treatment. Statistical analysis of the data was performed using the SPSS version 11.5 and Stata version 9.0 software. Treatment effects for quantitative outcomes were analysed using repeated measures ANOVA. Profile plots were examined in order to assess in which direction the significance lay. Ordinal outcomes were examined for a treatment effect using ordinal logistic regression modelling. These models also examined a time by group interaction. Nonparametric Spearman’s correlation coefficients were used to examine intra-group relationships. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to investigate the immediate and short term effectiveness of dry needling the primary, active Biceps TrP on the pain experienced during shoulder flexion and abduction range of motion, as well as on an associated bicipital tendonitis and satellite TrP's. The study was a prospective, controlled, pilot study that included 30 patients from the greater Durban area. All patients were between the ages of 20 and 45 years and all were diagnosed with an active trigger point (TrP) in the Biceps muscle. Each patient was required to attend three visits on three consecutive days. The treatment intervention was dry needling of the active Biceps TrP. Subjective and objective data was obtained from the patients before and after the first consultation. At the second consultation, if the Biceps TrP was still present andactive, the subjective and objective data was obtained before and after the treatment again (Group lA). If, however, at this consultation, the TrP had resolved,no treatment intervention wasgivenand both types of data were obtained only once (Group lB). The third consultation was reserved for data collection only, no treatment intervention wasgiven to the patients. / M