The first documented case of improved hearing following chiropractic adjustment was by D.D. Palmer in 1895 in which he restored Harvey Lillard’s hearing. Mr Lillard had been deaf for seventeen years. This brought about the birth of a new profession called chiropractic (Terrett 2002). It has been postulated that dysfunction or spinal joint motion restrictions of the cervical spine may lead to irritation of the sympathetic nervous system which may cause decreased blood flow to the auditory nerve via the labyrinthine artery (also known as the internal acoustic artery or internal auditory artery), which in turn may lead to a decrease in hearing acuity (Hawley 1964). The purpose of the dissertation was to determine whether cervical spine joint adjustment had an effect on the hearing acuity in individuals with some level of sensorineural hearing loss. Thirty symptomatic patients of either gender participated in this study. These patients were recruited by the use of advertisements placed in the Chiropractic Day Clinic, University of Johannesburg, Doornfontein Campus and by word of mouth. The inclusion criteria required the patients to present with some level of sensorineural hearing loss, be over the age of fifty years and have no contra-indications to chiropractic adjustments. Objective data was obtained by the Interacoustics Diagnostics Audiometer AD 229b, which determined the level of auditory acuity before and after chiropractic treatment was administered. Middle ear function and acoustic reflex was also tested with the GSI 38 Auto Tymp acoustic reflex machine. The objective results demonstrated that there was no statistically significant increase in auditory acuity following either the chiropractic treatment, or the detuned ultrasound treatment. In conclusion, it was shown that chiropractic adjustments in some patients presenting with sensorineural hearing loss, in the same subjects, exhibited a clinical improvement in hearing acuity however, not a statistically significant improvement following the treatment protocol discussed in the chapters that follow. These improvements suggested that the adjustment resulted in a decrease in sympathetic nervous system stimulation and an increase in blood flow through the labyrinthine artery, and therefore an increase in auditory acuity. These improvements were noted to a larger degree in individuals with a greater sensorineural hearing loss and not across the entire sample population. / Dr. M. Moodley Dr. S.M. Wilcox

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

M.Tech. (Chiropractic) / Please refer to full text to view abstract

Sacro-iliac joint (S.I joint) dysfunction can result in leg length discrepancies (LLD). LLD has been associated with many musculoskeletal problems such as osteoarthritis of the hips, knee pain and lower back pain. It has been theorised that LLD alters a persons body posture, which in turn changes the forces acting on the joints in the lower extremity and spine. These unnatural forces then create the excessive forces seen as the causative factors in the previously mentioned musculoskeletal conditions. (Murrel, Cornwall, Doucet 1991) The purpose of this pilot study was to was to compare the effect of chiropractic manipulative therapy on the S.I joints with chiropractic mobilisations of the S.I joints on the weight transfer from the spine into the lower limbs. This randomised study consisted of two groups of fifteen patients between the ages of eighteen and fifty years. All potential candidates were examined and admitted once all the inclusion and exclusion criteria had been met. Once S.I joint restrictions were detected the patient received either chiropractic manipulation or mobilisation to the restricted joint. Group A received chiropractic manipulation while group B were treated with mobilisations of the S.I joints. Patients were treated over a two week treatment period. Objective measurements were taken before the 1st treatment and after the 1st ,3rd ,5th and final consultations one month later. The measurements were taken with the Spinal Analyses Machine (S.A.M). This instrument has got two scales on a platform that determines the patients weight distribution from the spine through the left and right lower limbs. The data collected was then statistically analysed using the One Way ANOVA Test (analyses of variance) as well as the Student-Newman-Keuls Method to compare the inter-group and intra-group data. Statistically significant changes in the weight distribution between the lower limbs were seen in group A. Based on the results from the study chiropractic manipulation to the S.I joint proved to be more effective than mobilisation in the treatment of S.I joint dysfunction. This does however require further research, and a larger sample size. / Dr. M. Moodley Dr. J. Kotze

M.Tech. / This unblinded, controlled pilot study was conducted in order to compare the effectiveness of soft tissue therapy and ultrasound therapy, versus chiropractic manipulation and mobilization therapy, or a combination of the aforementioned therapeutic protocols in the treatment of acute Achilles tendinitis. In executing the comparison, it was hypothesized that both treatment protocols would be effective, but the combined therapy would be the most effective for the treatment of acute Achilles tendinitis, as this treatment protocol focused not only on the symptomatic pathological area entailing the Achilles tendon in this case, but also focused on the entire kinetic chain which perhaps was contributing to the pathomec.hanics in turn causing Achilles tendinitis. It is hoped that this combined therapy will be more effective in terms of a more speedy recovery and long term effect. This will not only benefit the patient from the point of view of health and quality of life, but financially as well, as less consultation fees will have to be paid. Patients were recruited for the study by the use of advertisements in newspapers and posters, or from patients entering the Technikon Witwatersrand Chiropractic Day Clinic complaining of Achilles pain. Only those forty-five patients who conformed to the specified delimitations and diagnostic criteria were accepted. These patients were randomly placed into three groups of fifteen patients each. Group one received chiropractic manipulative and mobilisation therapy and group two received soft tissue therapy and ultrasound therapy. Group three received a combination of the aforementioned therapies. Each patient received eight treatments over a three week period, ie. three treatments in weeks one and two, and two treatments in week three. After the treatment period there was a month break from the treatment and a follow-up consultation at the end of this month. This follow-up period was used to determine the lasting effects of the treatment protocol. The subjective data was collected with the use of the McGill Pain Questionnaire. The objective data was obtained from readings on the digital inclinometer, showing the extent of the ankle range of motion in dorsiflexion and plantarflexion, as well as from muscle activity levels in the triceps surae complex, recorded with the use of electromyography. Depending on normality being reached, both parametric testing and non-parametric tests were used to analyse the data. These tests were conducted on a 95% confidence level. The results indicated that all three treatments were in treating acute Achilles tendinitis. Treatment received by group one caused a generalized increase in EMG muscle activity levels specifically in the triceps surae, where as group two and group threes' treatment protocols caused an overall decrease in EMG muscle activity levels in the triceps surae. Group one showed the greatest improvement achieved in ankle range of motion in both dorsiflexion and plantarflexion throughout the study. And group one and group three showed the most significant response to treatment in terms of 100% reduction of pain and return to activity. Overall it was deduced that chiropractic manipulative and mobilization therapy were very effective in creating an increase in range of motion of the ankle joint as well as causing a significant improvement in reduction of pain in the Achilles tendon. It was noted that soft tissue therapy was beneficial in certain cases in terms of causing a relaxation in the triceps surae, as well as clearing any scar (fibrin) tissue found in the Achilles tendon. In summary group three showed the best response to treatment carried out in the study. The therapy used in group three not only directly treats the pathological injured-,Achilles tendon and associated triceps surae, but also the kinetic chain, thereby correcting any biomechanical dysfunction that could potentially be the cause of tension overload in the Achilles tendon.

M.Tech. (Chiropractic) / Please refer to full text to view abstract

M.Tech. / The purpose of this study is to determine whether chiropractic care has an effect on a patient's quality of life using the endpoints of: "the ability to perform general activities of daily living" (patient's level of disability, and restored function) and their "general emotional state" (energy level, depression, interference from emotional problems and feeling of wellness), also how these endpoints affect quality of life. Two hundred and fifty-three subjects participated in this study. The inclusion requirements were that subjects had to be aged 20 — 60, having been under chiropractic care previously. The subjects were recruited from 14 private practices from the whole of South Africa. All subjects were required to complete a self administered quality of life questionnaire. The quality of life questionnaire was developed to suit the South African population. Each questionnaire took about 5 minutes to complete. Domains used to calculate the results were changes in aerobic activity, physical activity, hygiene, activities of daily living and emotional state, after chiropractic care compared to before chiropractic care. The results overall showed that subjects experienced an improvement in their quality of life after chiropractic care. Chiropractic care therefore, had a beneficial effect on patients' quality of life. The overall results were statistically significant. The researcher therefore concludes that chiropractic care has an effect on patients' quality of life. It is recommended that future studies / research utilize a more comprehensively developed research questionnaire

M.Tech. / Terrett (1994) has a theory that diminished blood flow to the brain causes some areas to ‘hibernate’ that is, remain alive, but not function, resulting in diminished mental capacity. He also states that he is sure this is exactly what happens to many people every day, and that it could be the reason they suffer from problems such as tiredness, headache, depression, irritability, difficulty concentrating, poor attention span, visual difficulty, and so forth (Terrett, 1994). Brain function can be detrimentally affected by occipito-atlanto-axial subluxations (Eriksen, 2004). Research showed an improved brain stem evoked response after patients were adjusted. This indicated that the neural messages were going through their brain stems more quickly or with less delay (Shambaugh, Pearlman & Hauck, 1991). The aim of this study was to determine whether spinal manipulative therapy of the cervical spinal segments have any influence on the attention and higherlevel cognitive functioning and processing of an individual who has not received any chiropractic treatment to his/her cervical spine three months prior to the study. Any patient presenting to the University of Johannesburg Chiropractic Day Clinic was considered a potential candidate for the study. The patients were briefly screened through a case history, pertinent physical examination, cervical spine examination and soap note (Appendix E, F, G and H) that were performed at the initial consultation to determine the patients’ suitability for the study. The participants were invited to sign a consent form. In total forty participants were invited to take part in the study. Participants were put into either the adjusting group, or the control group, according to their gender and age. Participants received spinal manipulative therapy to all restricted segments in their cervical spines. Participants in the PDF created with pdfFactory Pro trial version www.pdffactory.com iv control group received detuned ultrasound therapy over the posterior aspect of their cervical spines. Both groups performed the coding test (Appendix D) before their first treatment and after their third treatment, as well as a questionnaire to obtain some personal information and to indicate their present feelings and emotions (Appendix C). The results indicate that there was a statistical difference at the ten percent level of significance in terms of the average number of blocks completed and the average number of blocks filled in correctly for the adjusting group. There was also a statistical difference at the ten percent level of significance in terms of the average number of blocks / symbols changed for the control group. The adjusting group worked more effectively and made fewer mistakes than the control group after the treatment trial was completed. For the chiropractic profession this opens huge potential with regards to the chiropractic benefits and improving the functioning of the society.

M.Tech.

M.Tech.