Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background CrossFit is a workout program developed in 2000 which involves high intensity interval training coupled with resistance training elements of powerlifting and gymnastics. CrossFit has grown to include competitive events and there are an ever increasing number of affiliate gyms internationally. CrossFit’s greatest criticism is related to safety. There is limited published data on the exercise program. Aims The aims of this study were: to determine a retrospective cohort analysis of the demographic, injury and treatment profiles of participants at the 2013 United We Stand CrossFit Games who presented to the Durban University of Technology’s sports treatment facility; to determine the association, if any, between demographics and injury types; and, to provide any recommendations regarding the clinical record form used. Methods This study was a retrospective, quantitative, descriptive study on the chiropractic Student Sports Association’s report form in order to produce a retrospective cohort analysis of the injury and treatment profiles. Persons who made use of the chiropractic treatment facility at the 2013 United We Stand CrossFit Games were required to complete an informed consent form. A sixth year chiropractic student then filled in a Chiropractic Student Sports Association report form to record participant, complaint and treatment information. The study was not limited to competitors, but all persons who had access to the chiropractic treatment facility. These forms were then collated and data captured on the complaints which presented and were treated at the chiropractic treatment facility. Results The data collected revealed that 137 participants presented to the chiropractic treatment facility in 162 visits, with 263 complaints treated. The age range of the sample was between 18 and 43 years, with a mean age of 27.49 years. The majority of participants who presented to the CTF were competing athletes and just under half of the study sample reported to not having a history of previous injury. The study found that the lumbar region (20.9%), wrist/hand (14.4%), shin/calf (11.0%) and knee (10.2%) were the most commonly presented regions of complaint. The highest presenting mechanism of injury was that of overuse (22.4%) followed by running (19.0%). Acute injuries accounted for 72.20% of all injuries. With regards to diagnoses, myofascial trigger points made up 21.6% of all injuries, followed by muscle strains (19.7%). Facet syndromes of the spinal column accounted for 13% of diagnoses.It was shown that kinesiotape, manipulation, massage and ischemic compression were the top treatment interventions utilised. It was also shown that rest, ice and referrals were types of treatment that were not utilised. Due to statistical inconsistencies no significance tests were possible between demographic and injury characteristics. Recommendations were proposed in order to maximise the quality of data captured. Conclusion: The results add insight into the injuries presented and the treatment they acquired at the chiropractic treatment facility at a national CrossFit event. The most common injuries require investigation in both training and competitive environments. Various recommendations have been proposed for the record form used at sporting events in order to facilitate the collection of high quality data. / M

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background Headaches affect different proportions of many populations and are experienced by any age, gender or ethnicity group. There is a paucity of data on the prevalence of headaches in South Africa, particularly amongst the university student population. Previous studies have suggested that headaches impact on daily activities as well as family and/or social activities. Studies on the impact of headaches on students are limited. Aim of Study The aim of this research study was to determine the prevalence and impact of primary headaches amongst students at the Durban University of Technology (DUT). Methodology A quantitative descriptive cross sectional survey was used to determine the prevalence of primary headaches in the student population at DUT. A minimum sample size of 384 was calculated using a confidence level of 95% and confidence interval of five percent. All six faculties were included. The course programmes and levels were chosen by multi-stage sampling. Each willing participant was required to sign a written consent form prior to enrolment in the study. Subsequently a self-administered questionnaire was filled out. The International Classification of Headache Disorder Criteria was used to classify primary headaches. All data was captured on an Excel spreadsheet and subsequently analysed using SPSS version 23.0. Results The total of 471 completed questionnaires was received. The prevalence of primary and secondary headaches was similar (50.2%; n = 222 versus 49.8%; n = 220, p = 0.92). More participants suffered from tension type (68.5%; n = 152) headaches compared to migraines (16.2%, n = 36) and mixed migraine and tension type headaches (15.3%, n = 34; p < 0.001). None of the study participants suffered from cluster headaches. Poor vision and stress increased the risk of a headache occurrence. The main relieving factor identified was the use of medication. Other relieving factors reported were sleep and relaxation. There was no correlation between suffering from headaches across the different faculties (p = 0.65), age of the participant (p = 0.77), ethnicity (p = 0.40), marital status (p = 0.84) and gender (p = 0.35). Headaches had a negative impact on the academic activities of the affected participants, including limited concentration and a complete halt to studies. Conclusion Tension type headaches were more prevalent amongst the study population. The impact of headaches limited concentration during tests and examination periods. An increased frequency and intensity of headaches was reported during this period. Family, social or leisure activities were also neglected when a headache occurred. This study adds to the current literature on headache prevalence in the student population. It also highlights that chiropractors are not consulted for headaches by students in the South African context. The chiropractic profession can benefit by tapping into this population. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background Literature has shown that clinical and radiological diagnoses do not always correlate in patients with neck pain (Ferrari and Russel, 2003; Peterson and Hsu, 2004). It is not known if this applies to the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) and if the radiological diagnosis leads to a change in the patient’s initial management plan. The impact of cervical spine plain film radiographs will therefore be investigated in the diagnosis and management of patients that presented with neck pain to the CDC at the DUT. It is also not known whether the reason for referral for cervical spine plain film radiographs is always indicated as per the indications in the clinic handbook and radiological referral guidelines. Objectives Objectives were: (1) To determine the suspected pre-radiographic clinical diagnosis and management of the selected clinical records prior to referral for cervical spine plain film radiography; (2) To record the reasoning to send for cervical spine plain film radiographic imaging and to establish whether these are in line with proposed guidelines for referral as found in the literature; (3) To determine the relationship between the suspected pre-radiographic clinical and the radiological diagnoses of patients with neck pain; (4) To determine the number of incidental findings in the selected patients’ plain film radiographs; (5) To determine any change in the pre-radiographic clinical diagnoses and management following radiological reporting of the selected patient’s plain film radiographs. Method This was a quantitative, retrospective, clinical study. The archives at the CDC at the DUT were searched for cervical spine plain film radiographs between 1 January 1997 to 31 December 2013 and these were matched with the corresponding clinical records. After applying the inclusion and exclusion criteria, 73 records were included in the study. The patient’s personal information was coded to ensure confidentiality (Appendix A) and specific clinical and radiological information was recorded (Appendix B). Statistical analysis included the use of frequency counts, percentages, mean, standard deviation and range for the descriptive objectives. Results A total of 73 clinical files and corresponding plain film radiographs were assessed. The mean age of the patients was 44 years. The gender distribution was 64.4% (n=47) females and 35.6% (n=26) males. The most frequent primary radiological diagnosis was loss of lordosis at 41.1% (n=30) followed by cervical spondylosis at 35.6% (n=26) and old cervical spinal trauma at 12.3% (n=9). Sixty four percent (n=47) of patients in this study were sent for cervical spine plain film radiographs after their initial clinical consultation. Reasons that are not considered relevant indications for plain film radiographic referral were present in 46.2% (n=34) of cases; these described non-specific mechanical disorders. The most common reason for plain film radiographic referral was due to positive orthopaedic tests 57.5% (n=42). A total of 27.4% (n=20) of clinical files reviewed had a change in their initial clinical diagnosis and 72.6% (n=53) of these patients had no change in diagnosis. All of the post-radiographic clinical diagnoses were non-specific mechanical conditions. Numerous treatment modalities were utilized by the students with the most common pre-radiographic treatment being soft tissue therapy at 63.0% (n=46). A total of 75% (n=55) of patients had a change of treatment after plain film radiographs were performed and spinal manipulative therapy (SMT) was the main treatment added in 41% of cases. Conclusion Cervical spine plain film radiographs have little impact on the diagnosis of patients with non-specific mechanical neck pain without red flags. It was however found that plain film radiographs had an impact on the management in the majority of cases, especially with an increase in SMT use after plain film radiographs. / M

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. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree of Technology: Chiropractic, Durban University of Technology, 2007. / The Transversus Abdominis (TrA) muscle is recognised in the literature as playing a vital and protective role in maintaining a healthy core and aiding lumbar biomechanics in the dampening of external forces applied to the lumbar spine. Pilates purports to employ the principles of core training yet there remains a deficit in the literature despite its popularity in rehabilitation and fitness industries. This study aimed to evaluate the efficacy of Pilates method in training the TrA in comparison to a moderately active population that regularly exercises in a gym environment, as well as a sedentary control. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Ankle sprains account for 85% of all injuries to the ankle (Garrick, 1997). Inversion sprains result from a twisting of a weight-bearing foot into a plantarflexed and inverted position leading to lateral ankle ligament injury. Louwerens and Snijders (1999) state that there are multiple factors involved in ankle sprains or lateral ankle instability. These include injury to the lateral ankle ligaments, proprioceptive dysfunction and decrease of central motor control. Other factors that still need further research include the role of the fibularis muscles, the influence of foot geometry and the role of subtalar instability in ankle sprains (Louwerens and Snijders, 1999). This study focused on the fibularis muscles. Fibularis longus and brevis muscles are found in the lateral compartment of the leg and function to evert/pronate the foot and plantarflex the ankle. Fibularis tertius is found in the anterior compartment and its function is to evert and dorsiflex the foot. Myofascial trigger points in these three muscles refer pain primarily over the lateral malleolus of the ankle, above, behind and below it (Travell and Simons, 1993 2: 371). This is the exact area where ankle sprain patients experience pain. Travel and Simons (1993 2:110) state that a once off traumatic occurrence can activate myofascial trigger points. When considering the mechanism of injury of a lateral ankle sprain, the importance of the fibularis muscles becomes obvious. When the ankle inverts during a lateral ankle sprain, these muscles are forcefully stretched whilst trying to contract to bring about their normal action. Therefore these muscles are often injured from traction when the foot inverts (Karageanes, 2004). It stands to reason that as a result of this mechanism of injury myofascial trigger points may develop in the fibularis muscles. It was hypothesised that fibularis muscle trigger points would prove to be more prevalent in the injured leg when compared to the uninjured leg. To further investigate this hypothesis, an analytical, cross sectional study (phase 1) was done on 44 participants between the ages of 15 and 50. Consecutive convenience sampling was used and participants were screened according to phase 1’s inclusion and exclusion criteria. According to Travel et al. (1999 1: 19) myofascial trigger points (whether active or latent) can cause significant motor dysfunction. Trevino, et al. (1994) stated that fibularis muscle weakness is thought to be a source of symptoms after an inversion sprain. Treatment for ankle sprains involves minimising swelling and bruising and encouraging adequate ankle protection in the acute phase. The patient is advised to rest for up to 72 hours to allow the ligaments to heal (Ivins, 2006). After the acute phase has passed, rehabilitation is focused on. This includes improving the ankle range of motion and proprioception. Attention is also given to strengthen the muscles, ligaments and tendons around the ankle joint. In the recommended treatment protocol however, no mention is made of evaluating the musculature around the ankle joint for myofascial trigger points and or treating these points. McGrew and Schenck (2003) noted that if the musculature and neural structures surrounding the ankle joint were affected during an ankle sprain injury, and were left unresolved, they would lead to chronic instability. It was hypothesised that lateral ankle pain due to inversion ankle sprain injuries may be due to referred pain from the fibularis muscle trigger points. Patients treated with dry needling of the fibularis muscle trigger points would therefore show a greater improvement in terms of subjective and objective clinical findings when compared to a placebo treatment (detuned ultrasound) applied to the fibularis muscle trigger points. / M

M.Tech. (Chiropractic) / Purpose: According to Jonhagen, Nemeth and Erikson (1994), hamstring muscle injury as a result of weakness is prevalent. Hoskins and Pollard (2005) states that a previous or recent hamstring muscle injury is the most recognized risk factor for future injury. Given the high reoccurrence rate, hamstring injuries provide a significant challenge to the treating clinician. Knowledge surrounding the optimal treatment is critical to improve hamstring muscle strength in preventing these injuries. The aim of this study is to determine the most effective treatment method, when comparing sacroiliac joint manipulation with or without dry needling and the effect it has on hamstring strength. Design: Thirty participants between the ages of 18 and 35 years old presenting with SI joint dysfunction and hamstring trigger points, were considered for this study. The participants were randomly divided into two groups of 15 participants each (group A and B). Group A received manipulation to the sacroiliac joint and group B received manipulation to the sacroiliac joint, as well as dry needling of the active myofascial trigger points in the semimembranosus muscles. Each participant was treated six times over a period of three weeks. Measurements: All measurements were collected at the first, third and fifth consultation prior to treatment and on the seventh consultation where no treatment was performed. Subjective measurements included the McGill questionnaire and a visual analogue pain scale. Objective measurements included algometer, readings of pressure pain threshold of the hamstring muscle trigger points and hamstring muscle strength recorded using a dynamometer instrument. Results and Conclusion: Group A and group B proved to have a statistical and clinical improvement overall. Group A had a better improvement in both subjective tests and in the objective tests. In comparing the statistically significant data for hamstring muscle strength in this study, it would appear that Group A responded better to treatment than Group B. Although both groups did improve, it suggests that Group A achieved the greatest overall improvement. Therefore it can be suggested that myofascial dry needling of the hamstring muscle was found not to have an additive effect for improving vii hamstring muscle strength, it actually appears to have done worse. The reason for this might be due to the post treatment soreness after needling. This may cause muscle inhibition and decreased muscle contraction, due to the pain or tenderness, which could have affected the muscle strength. In conclusion, the results in this study show that chiropractic manipulation combined with dry needling did not have better results in improving hamstring strength.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Aim: This study aimed to compare the effectiveness of the Impulse iQ® Adjusting Instrument and ischaemic compression on trigger points in pain relief and quality of life in adults presenting with non-specific neck pain. Methodology: This study was a randomised single-blinded clinical trial which consisted of 40 participants residing in the eThekwini municipality, divided into two groups of 20 each. The participants were randomly assigned using concealed allocation to one of two treatment groups of 20 viz. Impulse iQ® Adjusting Instrument (IAI) trigger point therapy group and ischaemic compression (IC) group. Neck pain level was determined using a numerical pain rating scale (NRS). Degree of lateral flexion (LF) was determined by a cervical range of motion (CROM) goniometer. Pain pressure thresholds (PPT) were measured with a pain pressure algometer. The effect of neck pain on participants’ activities of daily living was assessed using the Canadian Memorial Chiropractic College (CMCC) Neck Disability Index (NDI). The participants’ overall perception of improvement since the initiation of treatment was assessed using the Patients Global Impression of Change (PGIC). The participants received three treatments over a two and half week period with the fourth consultation being used for the final subjective and objective measurements. Results: Repeated measures ANOVA testing was used to examine the intra-group effect of time and the inter-group effect of treatment on the outcomes of NRS, algometer readings and CROM goniometer measurements. Profile plots were used to assess the direction and trends of the effects. An intra-group analysis revealed that, objectively and subjectively, all groups responded positively to treatment over time, with no significant time-group interaction. It was noted that there was a higher rate of improvement in IAI Group with respect to algometer readings over time; however, this difference was not statistically significant. Conclusion: This study concluded that neither IAI nor IC is more effective than the other with respect to participants’ pain perception and CROM. However, the IAI was more effective on pain pressure threshold. Based on the results collected from this study, both therapies can used in the treatment protocols of neck pain associated with MFTPs. / M

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.