A dissertation presented in partial fulfillment of the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / The purpose of this study was to determine the effectiveness of the spinous push versus the transverse process contact rotary type adjustments in the treatment of sub-acute and chronic mechanical upper thoracic and neck pain. It was hypothesized that both adjustments, over a maximum of nine treatments with two treatments per week and a further four week follow-up period, would be effective in terms of improving the patients' cervical ranges of motion, vertebral pressure pain threshold levels and their perceptions of pain and disability. The study design was a randomized, un-blinded, un-controlled comparative group study with a sample population consisting of thirty consecutive patients (Ave. age 35.4 years; M:F 16: 14) suffering from joint dysfunction of the cervical or upper thoracic spine. Each group received one adjustment two times a week for a maximum of nine treatments. Soft tissue therapy was employed in each treatment as a pre-adjustment procedure. The objective data collected was goniometrically assessed cervical range of motion and algometrically assessed vertebral pressure pain thresholds. The subjective data was collected by means of the CMCC Neck Disability, the Short Form McGill Pain and the Numerical Pain Rating Scale-l0 1 Questionnaires. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, Durban, 1999. / The purpose of this study was to determine the relative effectiveness of adjusting the ipsilateral side of the fixated segment versus adjusting the side contralateral to that of the fixated segment, in patients with facet syndrome of the cervical spine, in terms of subjective and objective clinical fmdings, as well as patient comfort. The rationale for adjusting the cervical spine on the side contralateral to fixation is that the spinal dysfunction is of a soft tissue nature, as opposed to joint or bone. Thus the effectiveness of the spinal adjustment may be due to a reprogramming of the central nervous system, whereby the principal effect seems to be to stretch muscles to their normal resting length before spinal mobility can be restored. Adjusting the side opposite to the fixation may cause a sudden stretch of the muscle spindle resulting in a barrage of afferent impulses to the central nervous system, which reflexly turns down the gamma motor neuron tone. The resetting of the gamma motor neuron tone and resultant restoration of the muscle spindle's normal resting length, thereby helps to relieve the associated muscle spasm and possibly removes the fixation. This study was comprised of 30 subjects, all of whom were diagnosed with cervical facet syndrome. The subjects were randomly divided into two groups of 15 each with ap average age of24 years per group. The average male:female ratio was 1,1:1. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The paucity of clinical research into the efficacy and effects of the different treatment protocols available for cervical facet syndrome has led to a continued variation in standard care for this condition. The aim of this study was to determine the relative effectiveness of spinal manipulative therapy in conjunction with the administration of a nonsteroidal antiinflammatory drug (NSAID) versus spinal manipulative therapy in conjunction with the administration of a placebo medication in the treatment of cervical facet syndrome. It was hypothesised that treatment with spinal manipulative therapy and NSAIDs over a two week period, with a further four week follow-up period, would be more effective than spinal manipulative therapy and placebo medication in terms of the objective and subjective clinical findings. The study design chosen was that of a double-blind, comparative, clinical trial. Thirty consecutive patients diagnosed with cervical facet syndrome were randomly assigned either to the manipulation and NSAID group or the manipulation and placebo group. The age range of the patients extended from nineteen to fifty-three years. Forty percent of patient occupations in both groups involved work on a computer. Each patient in the NSAID group received 139.5mg of diclofenac free acid a day over five days. The placebo group received the same dosage of similar appearance and taste over the same period. Each group of fifteen patients received treatment three times a week for two weeks. After a follow-up period of four weeks the patients were re-assessed. The patients were assessed by means of obtaining subjective information consisting of three questionnaires: the McGill Short-Form Pain Questionnaire, the Numerical Pain / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / Purpose. Patellofemoral pain syndrome (PFPS) refers to a syndrome associated with the following signs and symptoms: anterior knee pain, inflammation, imbalance, instability, or any combination thereof (Wood 1998). The purpose of this investigation was to evaluate whether spinal manipulation, as an adjunct to patella mobilization, contributed significantly to the improvement of patients diagnosed with PFPS. A prospective trial using convenient sampling was implemented using the first 60 volunteers that met the requirements. These were randomly divided into two groups. Participants in group 2 received combined patella mobilization and spinal manipulative therapy, while those in group 1 received patella mobilization only. Each patient selected for the study was required to complete an informed consent form. The selected patients underwent a general medical case history, lower back and knee orthopaedic regional examinations. 8 clinical experiments were done: pain threshold (ALGI), pain tolerance (ALG2), the mean least pain experienced (NRS 1), the mean worst pain experienced (NRS2), the mean pain experienced (NRS3), pain quality (McGill), patellofemoral joint evaluation scale (PFJE) and a patient specific functional scale (PSFS). All were continuous variables except McGill, which was a categorical variable. For each clinical experiment, readings were taken 3 times, i.e. at the first, third and sixth consultations / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Waddell (2000) describes low back pain as a 20th century medical disaster as, despite the efforts, skills and resources available today, the management of simple backache has not reduced the rate of chronic back pain and disability. Foster (1989: 9) indicates that as many as 60-80% of the general population experience LBP during adult life, with between 12-35% suffering from it at anyone time. Waddell (2000: 301) states that while 90% of acute or recurrent attacks settle within 6 weeks, 60% of people have at least one re-occurrence within the next year. Swenson (1998: 108) estimates that mechanical disorders of the spine represent at least 98% of LBP cause. Waddell (2000: 305) believes the aim of primary management is to provide symptomatic control of pain and prevention of disability. A large number of therapeutic options may be considered to provide symptomatic relief however, there is no good, scientific evidence that these options produce lasting benefits or that they change the natural history of back pain. He believes that symptomatic measures are only valuable if they facilitate active exercise and rehabilitation. Waddell (2000: 303) states that there is considerable evidence that manipulation can provide short-term symptomatic benefit in patients with acute back pain without nerve root pain of less than 1 month's duration. Manipulation may be equally effective in dealing with recurrent attacks, however there is limited evidence for the effectiveness of manipulation in patients with chronic LBP and nerve root pain. With the rising popularity of magnetic field diagnostic techniques such as MR! (magnetic resonance imaging), magnets and electrical devices are beginning to gain mainstream medical. / M

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1998. / The purpose of this study was to evaluate the relative effectiveness of adjusting the superior vertebral segment as opposed to adjusting the inferior vertebral segment, of the two vertebral motion segments forming the facet joint responsible for the patient's symptoms and resulting in the diagnosis of facet syndrome, in the treatment of mechanical low back pain. Thirty subjects with mechanical low back pain were screened for facet syndrome and randomly divided into two groups of fifteen. Each patient received spinal manipulation for six treatments over 4 weeks, but the contact vertebra was different for each group. In the one group, contact was taken on the superior of the two vertebrae making up the facet syndrome, whereas contact was taken on the inferior of the two involved vertebrae in the second group. In the 'superior' group, the manipulative thrust was directed in the direction of the motion palpation findings, whereas in the 'inferior' group, the manipulative thrust was directed in the opposite direction to the motion palpation findings of the superior segment. Both groups were evaluated in terms of subjective and objective clinical findings by making use of questionnaires (Oswestry Back Pain and Disability Index; Numerical Pain Rating Scale-1 01; Short Form McGill) and goniometer measurements respectively. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1999. / The aim of this placebo-controlled clinical trial was to determine the role of spinal manipulation in the management of irritable bowel syndrome (IBS), in terms of the patients' subjective response to treatment. It was hypothesized that spinal manipulation would have a greater effect than placebo in reducing the intensity of the symptoms of IBS. Thirty subjects diagnosed with IBS were randomly divided into two groups. Each group consisted of 15 subjects, aged between 18 and 50. Patients were treated twice a week for three weeks and once in the fourth week. Thereafter, each patient returned approximately 1 month later to be assessed for any longer-term benefit to treatment. Patients in the experimental group received spinal manipulation directed at areas of spinal fixation, as determined by motion palpation. Patients in the control group were treated using a detuned ultrasound machine over areas of spinal fixation. Treatment was performed with the same degree of enthusiasm in both groups, where possible. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / The purpose of this study was to determine the relative effectiveness of combined Action Potential Therapy (APT) and patella mobilization versus combined patella mobilization and placebo Action Potential Therapy in the treatment of Patellofemoral Pain Syndrome. The study was a prospective, randomized, placebo controlled study. The study involved 60 subjects, 30 in each group which were selected from the general population. Group one received patella mobilization and APT while group two received patella mobilization and placebo APT. Patients received four treatments over a period of two weeks. The first treatment consisted of patella mobilization and APT (group one) or patella mobilization and placebo APT (group two), treatment 2,3 and 4 consisted of APT (group one) or placebo A,PT (group two). Subjective assessment was by means of the short form Me Gill pain Questionnaire, Numerical Pain Rating Scale - 101 Questionnaire and the Patient Specific Functional Scale. Objective assessment of tenderness was by means of an algometer. Assessments were taken on the first, second and fifth consultations for all subjective and objective measures. Statistical analysis was completed under the supervision of Dr Myburgh at Technikon Natal, at a 95% confidence interval. The parametric two-sample paired t-test and the non-parametric Wilcoxon signed rank tests were used to analyze data within each group, while the parametric / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / Myofascial trigger points are a frequently overlooked and misunderstood phenomenon in medical curricula, yet with correct diagnosis and appropriate treatment the prognosis is usually excellent. Many effective treatments have been devised for myofascial trigger points, but the problem is that there is very little research to substantiate which of these treatments are the most effective. The aim of this randomised uncontrolled study was to justify the hypotheses which stated that both dry needling and saline injection would prove to be effective in the treatment of myofascial trigger points, with saline injection proving to be the most effective of the two. Patients were obtained for this study by convenience sampling, whereby any patients presenting to the Chiropractic clinic at Technikon Natal with neck,\xB7 upper back or shoulder pains were considered for the study. Of these patients, only those who conformed to the specified delimitations and diagnostic criteria were accepted. The sample size of thirty patients was randomly divided into two treatment groups of fifteen, one of which received saline injection and the other dry needling of active myofascial trigger points. Both groups were educated with regards to the nature and perpetuating factors of the condition, \xB7andwere instructed to follow a specific stretching programme. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Lower back pain and lower back injuries have been documented as one of the most common musculoskeletal problems in both amateur and professional tennis players. It has also been documented that the serve, which may be considered one of the most important strokes of the game, is also the most likely stroke to cause back pain. A good tennis serve requires considerable trunk rotation. The serve is the highest stress strain action during tennis. In a two set game the minimum number of serves a player may hit is 24 with a maximum excluding deuces and advantages of 96. The “Topspin serve” in particular requires the player to arch their back and this puts the lumbar spine into hyperextension. These movements thus put considerable pressure on the facet joints and multifidi muscles. It stands to reason that any joint related clinical entity can change biomechanics and affect the serve. In research done on golfers with mechanical lower back pain, it was found that club head velocity as well as pain decreased in symptomatic golfers with mechanical lower back pain after manipulation (Jermyn, 2004). No research has yet been done on manipulation of tennis players with lower back pain. The aim of this investigation was to determine the immediate effect of a lumbar manipulation on the clinical and performance measures of amateur tennis players suffering from lower back discomfort associated with playing tennis. / M