A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, 2002. / The purpose of this study was to determine the effectiveness and relative effectiveness of a topical Capsaicin cream and knee joint mobilization in the treatment of Osteoarthritis (OA) of the knee. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2017. / Radiographs are the most commonly used modalities for the purpose of diagnosing skeletal disorders. Radiographs are important for chiropractors to exclude any contra-indications prior to spinal manipulative therapy. If contra-indications are found treatment is modified to what best suits each patient. There is a gap in the literature regarding chiropractors reading the same set of radiographs and agreeing on findings. Objectives The study investigated inter- and intra-examiner reliability of lumbar spine radiograph analysis by chiropractors and its impact on clinical management. Methods Inter- and intra-examiner examination of radiographs occurred in two rounds separated by two weeks. Six chiropractors read the same 30 radiographs and clinical history was only available in the second round. Results Inter-observer agreement for categorisation for Round One was 96.78% and Round Two 89.49%. Inter-observer agreement in management was 96.45% in round one and 96.00% in Round two. Agreement between chiropractors had no statistically significant difference. Identification average improved from 0.09 to 0.89 kappa. Overall specificity was relatively high and sensitivity was relatively low. Conclusion Reliability/Agreement between chiropractors was strong in both rounds. Categorising of the diagnosis improved from poor to substantial from Round One to Round Two. Case history improved the accuracy of interpreting the radiographs although this change was not statistically significant. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Aim: There is a paucity in the literature regarding the effectiveness of the Impulse Adjusting Instrument® (IAI) in treating myofascial trigger points (MFTPs) and regarding the effectiveness between dry needling and the IAI in the treatment of MFTPs. There are many limitations and an array of contraindications for dry needling. Therefore, an alternative method should be sought as this will be beneficial to the patient. Thus, the aim of this study was to determine the effectiveness of the IAI compared to dry needling in the treatment of MFTPs found in the upper trapezius muscle. Methodology: This study was a randomised single-blinded clinical trial. This study consisted of 41 participants between the ages of 18 and 40 who were divided into two groups. The participants were randomly allocated into their respective groups using a blinded allocation method that was drawn up by the statistician. Groups were divided into dry needling (Group one (n=18)) and IAI (Group two (n=23)) treatment groups. Subjective neck pain level was determined using a numerical pain rating scale (NRS). The neck disability index (NDI) subjectively assessed the effect neck pain had on the participants’ activities of daily living before and after treatment. The Patients Global Impression of Change (PGIC) tool was used to determine the participants’ subjective impression of treatment outcomes since the beginning of the treatment. Objective pain pressure thresholds (PPT) were measured with an algometer. Objective cervical range of motion (CROM) in lateral flexion (LF) was measured with a goniometer. Each participant had four visits over a two week period, which included three treatments and a final visit for final measurements. Data was analysed using IBM SPSS version 23. Repeated measures ANOVA was used to examine the effect on each outcome measure. Directional trends in effectiveness were drawn up using profile plots to assess the direction and trends of the effects. A p value of < 0.05 was considered to be statistically significant. Results: Intra-group and inter-group statistical analysis revealed all subjective measurements improved in both groups with no significant differences between the groups. With respect to objective measurements, there was no statistical improvement in LF CROM and dry needling had no improvement in PPT. Impulse Adjusting Instrument trigger point therapy showed an increase in PPT, however, when compared to dry needling there was no statistical difference in PPT. Conclusion: The conclusion for this study states that the trends in each of the outcomes suggest that the IAI is as effective as dry needling for the treatment of MFTPs. / M

Submitted in partial fulfillment of the requirements for Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: Ankle sprains are a frequently occurring injury sustained by sports individuals accounting for approximately 20% to 40% of all sports injuries (DiStefano et al. 2008; LeBrun and Krause, 2005). Ankle sprains are mainly caused by excessive inversion (Takao et al., 2005; Andersen et al., 2004), when the foot is twisted inwards and lands at a high velocity damaging the lateral capsule-ligamentous complex (Beynnon et al., 2005). According to Naqvi, Cunningham and Lynch (2012) untreated or inappropriately managed ankle sprains can lead to a cascade of negative alteration to both the joint structures and the individual’s lifestyle. According to Hale, Hertel and Olmsted-Kramer (2007) 30% of ankle sprains result in chronic ankle instability (CAI) and 78% of the CAI cases develop into post-traumatic ankle osteoarthritis. This poses a negative impact on an individual’s athletic performance. Ankle sprains can be managed conservatively with the utilization of the PRICE protocol during the acute stage, cross friction massage or instrument assisted soft tissue mobilization techniques (for example Graston®, FAKTR© Concept) for both acute and subacute ankle sprains (Bleakley, 2010). Aim: The purpose of this study was to determine the effectiveness of a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy compared to cryotherapy and sham laser in the treatment of sub-acute and acute ankle inversion sprains. Objectives: 1. To determine the effectiveness of a myofascial treatment protocol combined with cryotherapy in terms of subjective (numerical pain rating scale [NRS] and foot function index [FFI]) and objective (oedema measurements [EDM], digital inclinometer readings [DIR], algometer readings [AR] and stork balance stand test score [STR]) measurements in the treatment of acute and sub-acute ankle sprains. 2. To determine the effectiveness of sham laser combined with cryotherapy in terms of subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements in the treatment of acute and sub-acute ankle sprains. 3. To compare the relative improvement between the two groups in terms of subjective (NRS and FFI) and objective measurement (EDM, DIR, AR and STR). Study design: This was a quantitative randomised controlled clinical trial. Methods: Forty participants with sub-acute or acute ankle sprains of not more than three weeks were recruited into the study. All participants had a full case history, physical, and foot and ankle regional examination to assess for their eligibility for entry into the study in terms of inclusion and exclusion criteria. These participants were randomly allocated using the hat method into one of two study groups, Group A (treatment group) or Group B. Participants in Group A received a myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy and Group B received cryotherapy and sham laser. These participants had four treatments in two weeks where the appropriate treatment was administered. Pre-treatment subjective (NRS and FFI) and objective (EDM, DIR, AR and STR) measurements were taken at each consultation. This data was analysed using SPSS software version 24.0. Results: The General Linear Model for repeated measures was used for the intra- group and inter-group analysis of the data. Intra-group analysis of the FAKTR© treatment group showed that the group had statistically significant improvements in terms of the subjective and objective measurements of the study with the p-value < 0.05 between all treatment periods. Intra-group analysis of the control group showed no statistically significant improvements in terms of subjective and objective measurements of the study. Inter-group analysis showed no statistically significant difference in terms of the DIR and EDM. The NRS, AR, STR and FFI readings showed statistically significant differences between the two groups with a p-value of < 0.05 mainly on the last two consultations. Conclusion: This study concluded that the myofascial treatment protocol (FAKTR© Concept) combined with cryotherapy was more effective than cryotherapy and sham laser in the treatment of sub-acute and acute inversion ankle sprains. The FAKTR© Concept treatment group appeared to show statistically significant improvements compared to the control group.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.

Thesis (M.Tech.:Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2006 22, xii, 44 leaves, Appendices 1-10 / 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.

Mini-dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Purpose: Patellofemoral Pain Syndrome is a common condition in all age groups, with a multifactorial etiology. This study aimed to investigate the association between the Quadriceps femoris muscle group, Hamstring muscle group and Adductor muscle group, and to establish the relationship between myofascial trigger points (MFTP’s) in these muscle groups and patellofemoral pain syndrome (PFPS). Methods: A cross-sectional, observational, quantitative non-intervention clinical assessment study was conducted at the Chiropractic Day Clinic at Durban University of Technology (DUT), to determine the extent of the PFPS, the MFTPs and thus the relationship between the two. The study included eighty patients with PFPS, who were recruited by convenience sampling. The results were captured using Microsoft excel and SPSS version 15.0 was used to analyze the data. Results: Quadriceps femoris muscle group MFTPs were noted in 92.5% of the patients (most prevalent being Vastus medialis TP1 (63.8%), Vastus lateralis TP1 (33.8%) and Vastus intermedius at 27,5%). Least common was Vastus lateralis TP2 only presenting in 2,5% of the patients. Hamstring muscle group MFTPs were found overall in 86.3% of patients (most prevalent being in Biceps femoris muscle (66%), and least prevalent being in Semitendinosus muscle (11,3%)). MFTPs were present in 64% overall of the Adductor muscle group (Adductor magnus muscle being the most common). Significant associations were made between the presence of MFTPs in the Vastus lateralis TP2 (p=0.00), Vastus medialis TP1 (p=0.046; 0.005; 0.004), the NRS and the PPSS. Also significant was the relationship between the NRS, PPSS and the Semimembranosus and Adductor magnus muscles indicated that these muscles were the most likely causes of pain even though they had fewer MFTPs than other comparable muscles. Conclusion: The outcomes of this study supports previous research indicating that an extensor dysfunction of the Quadriceps femoris muscle group may be of MFTP origin and indicates that other muscles in the thigh require further research indicating their role in the development of PFPS.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xii, 72, Annexures 1-10, [19] leaves / The purpose of this research was to conduct a descriptive study of cervical cases recorded at the Durban University of Technology Chiropractic Day Clinic from 1995 to 2005 as there is a paucity of information on the recorded cases of neck pain in South Africa.

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Forward head posture (FHP) is a common postural abnormality, often associated with myofascial trigger points which can result in head and neck pain. The craniovertebral (CV) angle lies between a horizontal line running through C7 spinous process and a line connecting C7 spinous process to the tragus of the ear. The smaller the angle the greater the FHP. Cervical musculoskeletal abnormalities have often been linked to headache types, most especially episodic tension-type headache (ETTH) and cervicogenic headaches (CGH). Objectives: To determine whether an association exists between FHP, distance of the external auditory meatus (EAM) from the plumbline and cervical range of motion and the presentation of ETTH and CGH. Method: This was a quantitative comparative study (n=60) comparing three equal groups, one with ETTH, CGH and healthy controls. The FHP of the Subjects FHP was assessed by measuring the CV angle. A lateral digital photograph was taken to assess the distance of the external auditory meatus from the plumbline. Lastly, cervical range of motion was measured. The two symptomatic groups also received a headache diary for a fourteen day period monitoring frequency, intensity and duration of their headaches. Result: The two symptomatic groups had a smaller CV angle and a greater distance from the plumbline (p<0.05) than the asymptomatic group. The asymptomatic group had a significantly greater flexion (p=0.009), extension (p=0.038) and left rotation (p=0.018) range of motion than the two symptomatic groups. The CGH group had a significant positive correlation between the distance of the EAM from the plumbline and the intensity of headaches. The ETTH group had a significant positive correlation between the right craniovertebral angle and the mean duration of headaches. Conclusion: Therefore, it can be concluded that patients presenting with ETTH and/or CGH may have associated postural abnormalities that may act as a trigger or a contributory factor to the presenting headache. / Durban University of Technology / M