Most sociological explanations for the success of chiropractic in attracting and maintaining its clientele have failed to consider the clinical context and the nature of the interaction between chiropractors and clients. Rather, most studies have focussed on leadership qualities, the professionalization process, and the ancillary role of chiropractic in health care to account for its success with clients. This study argues that chiropractic in British Columbia is successful in making its clientele because: (1) it is able to persuade new clients toward chiropractic health care by using strategies that are designed to minimize the political, social and economic constraints upon it; (2) chiropractors are able to negotiate successfully, the differences in the health and illness beliefs [HMs] that are held by new clients and chiropractors as well as differences in explanations [EMs] for "present" health problems; and (c) chiropractors are able to provide potential patients with "positive" experiences in chiropractic clinics, which are different, in some respects, from experiences they have had elsewhere, for example, in their relationships with allopathic medicine. This study, therefore, describes how new clients are socialized in chiropractic clinical relationships and subsequently become chiropractic patients. 20 randomly selected chiropractors and a total of 60 new clients were interviewed for their impressions of chiropractic as well as their health beliefs and explanations for "present" health problems prior to encountering each other in the clinical setting. Their interactions were observed in the twenty clinical settings, with special focus on the negotiation of explanatory models. The patients were interviewed again, regarding their experiences and impressions, following their fourth visit to the clinic after their initial encounter. 20 "regular" or long-term chiropractic patients, one from each clinic, were also interviewed regarding their experiences. Data were analyzed by comparing pre- and post-interview results and by describing the nature of clinical interactions, relationships, and negotiation of explanatory models in the context of Kleinman's ethno-medical perspective and Goffman's social ethnographic perspective on interactions in everyday life. It was found that chiropractors (1) provide potential patients with "adequate" information and the opportunity to ask questions; (2) express non-judgemental views on the health problems of clients, which provides new clients with the opportunity to fully explain their health concerns; (3) utilize persuasive interaction structures and processes to minimize both the constraints upon chiropractic and the effects of deviancy and marginality labels, and to manage the impressions of potential patients; and (4) negotiate with potential patients over explanations for the causes of their health problems, which enables the delivery of chiropractic treatment by integrating, "shifting" and modifying clients' explanatory models and, to some extent, their own. These techniques for 'making' the chiropractic clientele appear to be successful. In this study, 53 of the 60 new clients were retained beyond the fifth visit. More generally, chiropractic is now the second largest primary health care provider group in B.C., next to allopathy, and is attracting an increasing number of patients. / Arts, Faculty of / Anthropology, Department of / Graduate

M.Tech. (Chiropractic) / Purpose: A kinematic chain consists of a succession of joints linking several fixed components (Levangie and Norkin, 2005). Any tension or restriction within a component of this chain increases the load placed on the remaining components (Commorford and Mottram, 2001). Pathomechanics of the hip may have an effect on the areas of pressure exerted by the plantar surface of the foot during gait through the kinematic chain (Levangie and Norkin, 2005). Chiropractic manipulative therapy restores the correct biomechanical function to a joint (Gatterman, 2005). No previous research to determine the effect of hip manipulation on lower limb biomechanics and gait patterns has been identified. The purpose of this study was to determine the effect of chiropractic manipulative therapy of the hip on gait patterns, particularly the degrees of foot rotation and the pathway of the centre of pressure of the foot. Method: Sixty participants matching the inclusion and exclusion criteria for this study were recruited. The procedure, risks and benefits were explained to each of them and they were required to sign an information and consent form. The participants then underwent a full case history accompanied by a physical and hip regional examination, including motion palpation of the hip. This ensured that none of the participants matched the exclusion criteria consisting of serious gait abnormalities, contraindications to manipulation and the receipt of simultaneous forms of treatment. Individual gait analysis by the Zebris FDM-System was performed for each participant before they received a hip manipulation. A second gait analysis was then conducted to determine a change. Procedure: Each participant was required to walk barefoot over the Zebris platform for approximately 2 minutes while 3 – 5 gait cycles were recorded for gait analysis. The participant then received manipulative therapy of the restricted hip. A second gait analysis was performed just as the first. The Zebris software calculated the average results from before and after the hip manipulation and displayed the changes of foot rotation and the parameters of the pathway of the centre of pressure in a report for each participant. The focus of this study was the manipulated hip. Changes of the non-manipulated hip were mentioned only where applicable. The Zebris FDM-System allows for accurate gait analysis due to its “capacitive force sensors,” each of which possesses its own calibration curve (Zebris Medical GmbH, 2006). Results: Statistically significant changes were found for certain gait parameters representing the pathway of the centre of pressure. These included anterior/posterior variability, lateral symmetry and lateral symmetry variability. Conclusion: This study demonstrates that chiropractic manipulative therapy of the hip has an effect on certain centre of pressure parameters and chiropractors, therefore, should be consulted for the treatment of gait abnormalities. The study trial involved only a single treatment per participant. Further studies should be conducted to determine whether multiple treatments and manipulation of other kinematic chain components have an effect.

OBJECTIVE: To determine the most effective chiropractic treatment protocol in the management of chronic non-complicated low back pain. This was determined by comparing subjective and objective results gained from two treatment protocols, one of which included corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of an independent home prescribed rehabilitation program. The second treatment protocol consisted of a combination of corrective spinal manipulative therapy directed towards the lumbar spine and pelvis with the implementation of a spinal rehabilitation program under the close supervision and guidance of the researcher. DESIGN: The study was a clinical trial, which consisted of two groups of 15 patients each. These patients were procured using information pamphlets and advertising posters and were selected on the basis of particular inclusion and exclusion criteria. In addition, the selected candidates were also required to have a static isometric back extensor endurance test of 55 seconds and less as well as a decreased lumbar range of motion in the sagittal plane. INTERVENTION AND DURATION: Once the patients were randomized into two groups, the respective treatment protocols were implemented over a six week period. The control group was prescribed with a home exercise spinal rehabilitation program and the experimental group received a supervised spinal rehabilitation program. Both groups received chiropractic manipulation to the lumbar spine and pelvis to restore mobility and correct the mechanical dysfunction in the hypomobile joint. The frequency of follow-ups for this study was three times weekly for the first and second weeks, twice weekly for the third and fourth weeks, and then once weekly for the fifth and six weeks. MEASUREMENTS: Objective measurements included lumbar spine flexion and extension range of motion and Sorenson’s test. Subjective measurements were the Oswestry Low Back Pain and Disability Index and Numerical Pain Rating Scale 101 questionnaires. Measurements were taken at the first, sixth and twelfth consultations. CONCLUSION: The aim of this study was to determine whether chiropractic care in conjunction with a supervised “in-office” spinal rehabilitation program would prove to be a more effective method in decreasing low back pain measurements and indices when compared to a home prescribed exercise program in the management of chronic low back pain. Although the supervised group did show improvements on the areas indicated, none of the two groups showed statistically significant differences. Therefore it can be concluded from the results of this study that the home exercise group demonstrated as good a response as the supervised exercise group thus highlighting the positive effects of the adjustment alone. / Dr. E. Garlick Dr. B. Losco

M.Tech. (Chiropractic) / Purpose: The purpose of this study was to determine if inversion therapy is beneficial for participants with lower back pain and if there is an additive effect when combining it with manipulation. Three treatment approaches were utilized: inversion therapy, lumbar spine manipulations and a combination of inversion therapy with lumbar spine manipulations. Method: Thirty participants who qualified for the study were randomly divided into three equal groups consisting of ten participants each. Depending in which group the participant was allocated, determined if they received lumbar spine manipulation (Group 1), inversion therapy (Group 2), or a combination of inversion therapy performed after the lumbar spine manipulation (Group 3). Procedure: Each participant was treated a total of six times over a course of three weeks, furthermore there was a seventh day of final data collection. The measurements were taken on the first, fourth and seventh visit. Subjective measurements consisted of the numerical pain rating scale (NPRS) and the Oswestry Low Back Pain Disability Index. Objective measurements were done with the inclinometer (lumbar range of motion) and the flexicurve (lumbar lordosis measurement). Results: It is clear that there were statistically significant improvements in all three of the groups in both the NPRS and the Oswestry disability index. The inversion therapy group performed the best with the NPRS and the Oswestry disability index, with the spinal manipulation and combination group following narrowly. However, there were no statistically significant differences on the intergroup analysis with regards to the subjective results. The results of the subjective measurements indicated that there was a relative decrease in lumbar spine lordosis measurements, over the trial period, but with no statistical significance. With the lumbar range of motion-flexion measurements it was clear that the spinal manipulation group and the inversion therapy group had superior results compared to the combination group, with both indicating statistical significance over the trial period. Extension, lateral flexion and rotation did not show any statistical significance over the trial period. Conclusion: There were statistically significant improvements within each of the three groups on intragroup analysis, but no statistically significant differences were found on intergroup analysis. Therefore, none of the groups could be singled out as being the superior treatment for mechanical lower back pain. All three groups’ demonstrated improvement. There was no significant additive effect by combining the two treatments. Therefore there is no benefit to adding inversion therapy to the treatment protocol. Manipulation alone demonstrated to have similar effects. However, should a patient not be able to see a chiropractor for treatment, home based inversion therapy can be beneficial. A concern that should be addressed is that home based treatment wouldn’t be supervised and as such it is not advised to do without some form of professional management. Inversion therapy can definitely be utilized as a home based treatment option for a patient with LBP, patients that can’t make use of regular chiropractic care due too logistical or financial restraints will benefit from inversion therapy home usage. Home usage will provide the patient with regular general traction therapy and can result in patient pain relief, increase overall functioning of the patient and the patient compliance may improve.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2006 x, 65 leaves, Annexures A-H / Patient satisfaction is an important, desired measure of quality of care and has a significant influence on the perceived quality of care and outcome of treatment, and for this reason, it holds great value to the treating clinician. Satisfied patients are more likely to comply with treatment instructions and advice, remain with their service provider and refer others. Dissatisfaction, in the event of an unfavourable outcome, can result in legal action and complaints to regulatory bodies. Studies have indicated a high level of satisfaction with chiropractic care; however, none have been in a student clinic setting even in view of the suggested importance in the literature. In view of this significance and lack of understanding of the patients’ satisfaction / dissatisfaction in the history of DIT’s clinic operation the question remains as to what extent the students at the DIT Chiropractic Day Clinic satisfy their patients. This study evaluated the patient satisfaction at the DIT Chiropractic Day Clinic in order to establish a baseline for future comparison. Cronbach’s alpha scores were used to determine questionnaire reliability in a South African student context.

Thesis (M.Tech.:Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2006 xvi, 82 leaves, Annexures A-L / To determine the efficacy of the Harpago and celery seed cream in mild to moderate degenerative joint disease of the knee in terms of subjective and objective clinical findings

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 96, [20] leaves / Strengthening of the rotator cuff muscles forms an integral part of any rehabilitation programme for the shoulder. Shoulder rehabilitation programmes which incorporate early motion and emphasize strengthening, have a lower incidence of recurrent subluxations and dislocations. If cervical manipulation were proven to increase the strength of the rotator cuff muscles, then this could be used to develop and implement more effective treatment and rehabilitation protocols for patients with musculoskeletal painful shoulders and rotator cuff pathologies, and therefore provide future patients with more effective health care. Studies have shown consistent reflex responses associated with spinal manipulative treatments. These reflex responses have been hypothesized to cause the clinically beneficial effects of decreasing hypertonicity in muscles, pain reduction and increasing the functional ability of the patient, and although spinal manipulation has been shown to affect muscle strength, it has not been extensively researched and it is unclear whether increased muscle strength is yet another reflex effect of manipulation. As the rotator cuff is innervated by nerves arising from the mid and lower cervical spine, it is theorised that dysfunction of the spinal joints adversely affects nerve endings, causing inhibition of nerve function and affecting the rotator cuff. This is congruent with research which describes how there could be a decrease in muscular activity due to interference with the nerve supply of a muscle by means of a spinal joint fixation. In light of this, one could hypothesize that removal of a cervical joint dysfunction by manipulation, could increase motor unit recruitment and muscular activity of the muscles supplied by that cervical level and therefore possibly strengthen the muscles involved. Therefore the aim of this study was to determine whether cervical manipulation could contribute to the strengthening process of the rotator cuff.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2006. xiii, 44 leaves, Annexures A-F / The purpose of this study is to determine whether the cumulative effect of studying, and practising manual therapeutic techniques (including receiving manipulation), is associated with chiropractic students experiencing low back pain (LBP). According to Smith (2005), students currently registered in the Durban Institute of Technology Health faculty were found to have the highest proportion of LBP when compared to students in other faculties. Thirty seven percent of the students with LBP were chiropractic students. In a study performed by Macanuel et al. (2005) on undergraduate chiropractic training, it was concluded that chiropractic students experience side effects during chiropractic technique class. There is epidemiological evidence that chiropractors are a high-risk group of health professionals who experience low back disorders (Tim 1996, Lorme and Naqv 2003, Rupert and Ebete 2004). Rupert and Ebete (2004) suggest that the majority of chiropractors have suffered an occupational injury primarily related to administering manual procedures.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2008. ix, 106 leaves / Pharmacists are seen as a trustworthy source of advice and information to many people. Their accessibility, approachability and availability enable them numerous opportunities to offer health education and advice in an informal environment. Patient use of and demand for complementary and alternative practitioners including chiropractors, continues to increase, however there have been no studies to determine the extent of the pharmacists knowledge and perceptions/attitudes towards these alternative practitioners. Thus the purpose of this study was to determine the current perceptions, attitudes and knowledge of selected South African pharmacists with respect to the chiropractic profession. This will provide a basis for future studies, as well as a knowledge base to facilitate greater understanding and co-operation between pharmacists and chiropractors.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology, in the Department of Chiropractic at the Durban University of Technology, 2009. / Introduction: National Olympic Committees (NOCs) select medical personnel to support their athletes at the Olympic Games. To best support athletes the knowledge, perception and utilisation of all medical professions is assumed to be high, however literature seems to indicate that this is not so. Objective: To determine the knowledge, perception and utilisation of Chiropractic by NOCs in order to develop a better relationship so that more athletes can benefit from Chiropractic care. Methods: A questionnaire was emailed to the 205 NOCs worldwide. Respective executive committee and medical commission members were asked to complete the questionnaires. Results: 76 NOCs responded (37%), returning 27 questionnaires. 30% of the respondents were high ranking members. 93% were highly educated with a bachelor’s degree or higher and 33% had represented their country as an athlete. Both committees agreed on the importance of a post-graduate sports qualification and perceived the profession to be one of spinal care specialists. Overall knowledge of Chiropractic was poor. A trend was observed among the medical commissions in their choice of Medical Doctors or Physiotherapists over Chiropractors and other professionals. The executive committees in contrast seemed more open-minded in their choice of professionals. No association was found between the knowledge and perception of Chiropractic and use of Chiropractic Conclusion: There is confusion regarding the role and scope of practice of Chiropractic by NOCs. In order to achieve a greater level of acceptance and utilisation of Chiropractic in international sports medical teams the profession needs to clarify their role, better educate NOC members on the benefits of Chiropractic, and obtain sports specific post-graduate programmes that are recognised internationally.