Thesis (M.Tech.: Chiropractic)- Dept of Chiropractic, Durban Institute of Technology, 2005. xiii, 129 leaves :|bill. (some col.) ;|c30 cm / Research indicates the sacroiliac joint (prevalence of sacroiliac syndrome ranges from 19.3% and 47.9% (Toussaint et al., 1999)) as being the primary source of low-back pain in 22.5% of patients with back pain (Bernard et al., 1987:2107-2130). Treatment options that are available for the treatment of low-back pain include allopathic (Hellman and Stone, 2000), and manual therapies such as hydrotherapy and traction (Cull and Will, 1995). It has been found that allopathic interventions have been less effective than spinal manipulative therapy, even with spinal manipulative therapy having various modes of application (e.g. side posture and drop piece manipulations) (Gatterman et al., 2001). Drop table thrusting techniques were found to be effective for patients with neuromuskuloskeletal problems such as facet syndrome (Haldeman et al., 1993), however, it is still not known which specific drop piece technique is the most appropriate for sacroiliac syndrome. Thus it is important to ascertain the clinical effectiveness of the technique as certain conditions prevent the patient from being positioned in the conventional side posture for treatment of sacroiliac syndrome (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Therefore this study aims at determining the efficacy of a maintained contact drop piece manipulation technique.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003. x, 101 leaves / Anecdotal evidence and some developmental theory suggest that lower respiratory tract pathologies may be associated with thoracic spine pain and dysfunction. This hypothetical association may be better described either as respiratory conditions occurring as a result of musculoskeletal dysfunction of the thoracic spine, or as respiratory conditions causing thoracic musculoskeletal dysfunction. Optimal function of the lungs and the process of ventilation is dependant on the normal function of the thoracic spine and the rib cage. Disturbances of the musculoskeletal components of the thoracic spine may lead to increased respiratory efforts, decreased lung function and in turn affect bronchopulmonary function. Obstructive respiratory diseases such as asthma, bronchitis and emphysema place an increased demand on the musculoskeletal components involved in expiration, as air has to be forcefully expired. The purpose of this quantitative, non experimental, demographic retrospective clinical survey was to retrospectively describe lower respiratory tract disorders and thoracic spine pain and dysfunction in subjects presenting to the Durban Institute of Technology Chiropractic Day Clinic, in terms of the prevalence of lower respiratory tract disorders as well as any association between the presenting respiratory conditions and their vertebral distribution in the thoracic spine.

Thesis (M.Tech.: Chiropractic)-Durban University of Technology, 2008. xviii, 83, [29 ], 25 leaves / Golfing literature today recommends to both the amateur and professional golfers to try and achieve maximum performance with each golf club (Seaman, 1998 and Bulbulian, Ball and Seaman, 2001). This encourages golfers to use a state of maximum spinal rotation in their golf swing in order to achieve optimal performance (Seaman, 1998), thus resulting in back pain becoming endemic in the golfing population. Thus if it is considered that performance, in terms of the golf swing, is mainly influenced by; • the strength and power of the torso, i.e. the low back and abdominal muscles (Chek, 2003), • as well as muscle balance and flexibility, i.e. those muscles which are responsible for the static and dynamic postural stability of the golf swing (Chek, 2003). It then stands to reason that any decrease in the range of motion of the lumbar or thoracic spine of the amateur golfer, in terms of biomechanics, could affect their performance (Nordin and Frankel, 2001). In this regard it is hypothesised that altered biomechanics could be that of asymptomatic segmental joint dysfunction . In terms of interventions Kirkaldy-Willis and Burton (1992) explained the effect of SMT in the treatment of low back pain, similarly Bergmann et al. (1993) and Vernon and Mrozek (2005) further proposed the following effects of spinal manipulative therapy (SMT): • SMT may stretch or break intra-articular adhesions that form from immobilised facet joints due to acute synovial reactions. • SMT allows entrapped menisci to exit the facet joint in which it became entrapped. • If the capsule of the facet gets lodged between two adjacent articular surfaces, the process of SMT could allow this to be freed. • SMT re-aligns misaligned spinal segments to conform to the centre of gravity. It was thus assumed that if these mechanical and reflex mechanisms occur in the symptomatic amateur golfer, they should also occur in the asymptomatic amateur golfer. Currently however very little is known about the effects of spinal manipulative therapy (SMT) on asymptomatic segmental joint dysfunction. Objective: Therefore, the purpose of this study was to evaluate the immediate and short term effect of spinal manipulative therapy (SMT) on asymptomatic amateur golfers in terms of performance indicators. Methods: Forty three asymptomatic participants were randomized to four equal groups consisting of ten participants each (and three drop outs). Three of the groups received a single intervention, i.e. spinal manipulative therapy (SMT) while the last group acted as a placebo control group and received no intervention. Objective measurements were taken using the EDH Sports-FlightScope Pro Electronic Swing Analyser. All objective data collection took place pre and post SMT. Statistical analysis included various statistical methods and correlation analyses, by means of the latest version of SPSS. Results and conclusions: The main findings were that certain outcomes seem to be better with lumbar manipulation alone (smash, horizontal azimuth) and others better with thoracic manipulation alone (CHV, vertical azimuth, distance), but none are better with both lumbar and thoracic manipulation. Therefore in terms of future studies of this nature the treatment groups should be analysed separately and the research powered for such analyses (e.g. larger sample sizes).

Thesis (M.Tech.: Chiropractic)--Durban University of Technology, 2008 / The core stability, club head velocity and ball carry in golfers with and without low back pain – a comparative study. Objective: The aims of this study was to establish whether an observable difference exists in the abdominal core stability of two comparable groups of golfers: one asymptomatic and the other suffering from low back pain, and whether an observable reduction of performance, expressed as club head velocity and ball carry can be observed in those with low back pain. First Objective was to differentiate the groups at baseline with respect to core stability strength between asymptomatic golfers and golfers suffering from low back pain. Whereas the Second Objective was to establish whether a relationship exists between abdominal core stability, CHV and ball carry in the two population groups under study. Following the above the Third Objective was to establish which other factors besides core stability strength have an effect on CHV and ball carry. And lastly the Fourth Objective was to establish the correlation between CHV and ball carry. Design: A comparative study was carried out between the two sample groups. A sample of forty patients were selected for this study, where twenty patients were asymptomatic and had no current episode of low back pain and were able to maintain a core contraction; and the other twenty patients low back pain and could not maintain a core contraction. Because the patients presented in a random manner, the patients were matched as close as possible according to age, so as to have better comparative value between the groups (the maximum age difference of a year was instituted). This allowed for comparisons among similar ages, with the difference being their low back pain and core contraction status. Outcome Measure: Each golfer was required to hit 5 balls using a standard club (in this study, a standard driver was used), after which an average value v was calculated for CHV and ball carry. All measurements were carried out using the Flightscope Pro machine at the Durban Pro Shop. Results: Core stability and low back pain did not influence CHV. However there was a non significant trend which indicated higher ball carry in the group with better core stability and no low back pain than in the group with low back pain and poor core stability. Increasing age and handicap reduced the CHV and ball carry values significantly. Ball carry and CHV were positively correlated together in both groups.

Dissertation submitted to the Faculty of Health in compliance with the requirements for a Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2005 / Due to sustained partial neck flexion when operating a computer terminal for prolonged periods and by holding a stooped posture being proposed aetiologies for hypertonic posterior cervical muscles and subsequent mechanical neck pain, subjects for this research study were chosen according to their occupation and had to sit at a desk for more the three hours and less than eight hours a day. The purpose of this study was to investigate the effectiveness of proprioceptive neuromuscular facilitation combined with heat therapy as opposed to proprioceptive neuromuscular facilitation combined with cryotherapy in the treatment of mechanical neck pain caused by hypertonic posterior cervical muscles. This was a comparative, randomised, clinical trial consisting of two groups. Group A received proprioceptive neuromuscular facilitation (PNF) combined with heat therapy as their treatment protocol. Group B received proprioceptive neuromuscular facilitation combined with cryotherapy as their treatment protocol. Each group consisted of thirty people between the ages of 25 and 50 who were randomly allocated to their respective groups. It was hypothesized that the analgesic properties related to cryotherapy would result in the treatment group that received PNF stretching combined with cryotherapy yielding better results in terms of objective clinical findings. It was also hypothesized that the therapeutic effects of heat therapy would result in the treatment group receiving PNF stretching combined with heat therapy would yield better results in terms of subjective clinical findings and it is hypothesized that there is an association between the subjective and objective clinical findings between the cryotherapy and the heat therapy groups. The treatment regimen consisted of each participant receiving three treatments over a period of one week and then a one-week follow-up consultation. Subjective data monitored consisted of the Numerical Pain Rating Scale –101 (NRS-101) and the CMCC Neck Disability index. Objective data was collected using the Cervical Range of Motion goniometer (CROM) and the Algometer. At the end of all treatment protocols, statistical (quantitative) analysis was performed to determine whether one treatment protocol was more effective than the other. The analysis of the data collected showed that for all outcomes measured, either of the two treatments was effective overall. Trends suggested optimum treatments were dependent on the age of the patient. Age groups of 46-50 years old, 41-45 years old and the 31-35 years old responded best and improved the most with heat intervention, while age group of 36-40 years old responded best to the cryotherapy intervention. For the youngest age group of 25-30 years old, it did not make a difference whether they received heat therapy or cryotherapy as an intervention. It would seem that the older the patient the more effective the application of heat therapy as a result of the effect of heat therapy on the collagen and elastin fibers within the muscle and its fascia which allowed for increased and sustained improvement of the majority of the age groups represented in this study. Conversely it would seem that the cryotherapy group had only immediate and unsustained effects in the long term, which suggests that the cryotherapy had only a pain relieving function that allowed for the improvement of patients in the study, which when removed resulted in regression to the initial clinical syndrome severity. Most of the outcomes did not show a statistically significant interaction between time, age group and treatment group. The study was underpowered at the age group level, with only 12 subjects per age group. Further studies with a larger sample size in each of the age groups are needed in order to determine whether age is a definitive factor in one treatment being preferred over the other.

Dissertation submitted to the Faculty of Health in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, at the Durban University Of Technology, 2008. / Objectives: To determine a profile of soccer injuries prevalent in amateur Indoor and Outdoor soccer players in the greater Durban areas. Methods: This study used the Outdoor Supersport corporate league and the Kwa-Zulu Natal (KZN) Indoor soccer league. A total of 103 out of a possible 147 players participated in the study which included 41 Outdoor and 62 Indoor players. The Indoor soccer players were contacted to complete the questionnaire at their match days at the Gale street Indoor soccer arena and the Outdoor players were contacted during their training sessions and/or match days. The researcher was present to answer any questions posed by the participants. In the case of participants having difficulty in understanding English, a bilingual Zulu translator accompanied the researcher in every interaction with the participants. Results: Out of a total of 103 participants, the foot/ankle (62.1%) was the most frequently injured site. This was followed closely by the knee (55.3%). The rest of the sites in descending order were wrist, back, head, elbow, shoulder, chest, genital and abdomen. All participants reported a first injury, 69 participants reported a second injury and 27 participants reported a third injury. Outdoor soccer players reported the knee as being the most affected area, while Indoor soccer players injured the foot/ankle frequently. Furthermore, age was stated as a significant positive correlation when compared with number of sessions missed, meaning the older the participants, the more sessions they missed. The findings suggest that the use of protective equipment can decrease injury rates due to the use of ankle guards decreasing missed sessions. Conclusion: The profile of soccer injuries in selected amateur league Indoor and Outdoor soccer players in the greater Durban area has been described in this study. In terms of number of injuries, there seems to be no significant differences iv between Indoor and Outdoor soccer players. With regard to site of injuries, the lower limb was affected more than any other body part. The Outdoor players showed more knee injuries than the Indoor players who showed higher incidences of foot/ankle injuries.

Dissertation submitted to the faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, 2007. / The objectives of this study were: To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. To determine how the frequency of manual work contributes to low back pain in nurses in state versus private hospitals in the Durban area. Hospital nurses have a high prevalence of low back pain (LBP) (Smedley et al., 2003). It has been found that nursing personnel ranked fifth in occupations claiming worker compensation for low back injuries (Owen and Garg, 1994). A number of studies have also indicated a strong association between musculoskeletal disorders and work related factors (Maul, 2002). An epidemiological study by Smedley et al (1997) has suggested that repetitive lifting, frequent bending and twisting play a role in the development of LBP, and that heavy physical workload has played a major role in the development of LBP in nurses. LBP is therefore a serious problem in the nursing field with a relatively high prevalence worldwide. It causes increased absenteeism from work and could impact on patient care. This study was a survey, which was quantitative in nature. Data was collected by means of a questionnaire. The questionnaires were handed out in randomly selected hospitals in the Durban Metropolitan area. The names of all state and private hospitals in the Durban Metropolitan area were put into two boxes and three names were picked from each box. A letter requesting permission to carry out this research was sent out to each hospital and a positive response was received from one state hospital, R.K Khan Hospital and two private hospitals, Westville and Entabeni hospitals. Questionnaires were handed out to the nurses by the researcher, as requested by the hospitals, and collected at a later time by the researcher. Questionnaires were handed out at each ward in the hospitals to nurses who met the criteria for the study and agreed to participate in this study. Questionnaires were also handed out to nurses in the nurses lounge during lunch breaks. The questionnaire was developed as combination of; a pre-validated questionnaire made available by Yip (2001), questions on socio-demographic data, work history, patient handling activities and LBP. The compiled questionnaire was tested for face and construct validity through a focus group, and piloted before being used in the study. A total of 500 questionnaires were handed, 250 to state hospitals and 250 to private hospitals. Participants consisted of nurses (registered, enrolled and student) between the ages of 18 and 45 years, both male and female. Nurses from all hospital wards were allowed to participate in this study. A total of 124 questionnaires were received back, ( 50 from private hospitals and 74 from the state hospital), from the nurses in all the hospitals. Data was then collected from these questionnaires and was analysed using the statistical package SPSS version 13 (SPSS Inc. Chicago, Illinois, USA). A p value of <0.05 was considered as significant. The data collected from the questionnaires was analysed and the results obtained were as follows: The prevalence of work related LBP in this study was 59.7%. Of the 74 nurses with LBP, only 7 (9.5%) reported having LBP before working as a nurse. 35.1% of participants reported that they experienced pain on a daily basis while 62.2% described their LBP as moderate and 27% described their pain as severe. The median duration of LBP was 3.5hours per episode. Of all the participants in this study, 64,9% had needed bed rest due to their LBP with 43.2% having taken sick leave from work for LBP. Back pain in nurses has been found to be a major cause of days lost due to sickness (French et al., 1997). The majority of nurses (93.2%) reported lifting to be the cause of their LBP, standing and bending were also found to be important causes. Low Back injury was reported in 31.1% of participants with up to 51.4% receiving treatment for their injuries, the main choice of treatment was from a hospital or General practitioner. With regards to the frequency of manual work on LBP, there was found to be a slight tendency toward LBP with more frequent manual activity, however this was viii found to be non significant. In those respondents with LBP, the activity associated with the most intense LBP was carrying or lifting patients. Time spent; standing, holding up hands and bending were found to be higher in the group which reported LBP. Having 1-2 children was also associated with increased LBP. The prevalence of LBP was found to be higher in the state hospital (67.6%) than in the private hospitals (48%). The aim of this study was to determine the association between frequency and intensity of manual work on LBP in nurses. The results showed that frequently performed manual activities were associated with LBP but not significantly. In terms of intensity of manual work, carrying or lifting patients was found to be most associated with LBP, standing and bending were also significantly associated with LBP. This study also aimed to determine any difference in LBP between state and private hospitals and a significant difference in LBP prevalence was noted between state and private hospitals. The findings of this study suggest that LBP is a common problem among hospital nurses. The results of this study were also found to be within the same prevalence rates of international studies, which ranged from 35.9% in New Zealand to 66.8% in the Netherlands (Nelson et al., 2003). As was found in the literature (French et al., 1997 and Smedley et al., 1997), lifting was reported to be a major cause of LBP.

Dissertation submitted in partial compliance with the requirements for the Masterà ¢ s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Objectives: To determine the short-term effect of an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of spinal manipulation (SMT) and ribcage mobilisation on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of a combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. Methods: Forty-five chronic moderate asthmatics who met all the inclusion criteria of the study were divided into three groups of fifteen each. Group A received a short-acting 2-agonist bronchodilator, Group B received SMT and ribcage mobilisation and Group C received a combination of SMT, ribcage mobilisation and a short-acting 2-agonist bronchodilator. Baseline measurements and testing included chest wall expansion and the lung function parameters FEV1, FVC and FEV1/FVC%. These measurements were repeated 15 minutes post-intervention. Data was analyzed using SPSS version 15.0. Results: There were no statistically significant changes between pre- and post-intervention in the short-acting 2-agonist bronchodilator group with respect to any of the chest wall expansion measurements. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group (p = 0.008). There was a statistically significant increase in the mean pre- and post-intervention axillary chest wall expansion (p = 0.014) as well as the mean of the half-way measurement (p = 0.014) and the overall mean chest wall expansion value (p = 0.001) following SMT and ribcage mobilisation. There were no statistically significant changes in any of the lung function parameter values following SMT and ribcage mobilisation. There was a significant increase for the half-way measurement in chest wall expansion (p = 0.018) in the combination of SMT, ribcage mobilisation and the inhaled, short-acting 2-agonist bronchodilator group. There were no statistically significant changes in any of the lung function parameter values in the combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator. For FEV1, the effect in the short-acting 2-agonist bronchodilator group vs. the SMT and ribcage mobilisation group was statistically significant (p = 0.018). There was no statistical difference in any of the chest wall expansion measurements and FVC and FEV1/FVC% parameters between all three groups. Conclusions The results did not point specifically to one intervention over another for all outcomes. SMT and rib mobilisation had no effect on the lung function parameters, at least in the short term. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / The purpose of this study was to determine the efficacy of Therapeutic Faradic Stimulation in patients with Myofascial Pain Syndrome of theTrapezius and Levator Scapula musculature. This study was a quantitative pilot placebo controlled clinical trial. The sample size used was 60 patients selected from the Durban Metropolitan Area. Only patients between the ages of 30 and 50, who were office workers and were diagnosed with active trigger points in either the Trapezius and/or the Levator Scapula muscles were accepted into this study. The sample was divided into 3 groups of 20. One group received Faradic Stimulation in the form of the Transeva, another group received Placebo Transeva and the third group received Pulsed Ultrasound. Each patient received 2 research treatments with a maximum of 72 hours between treatment 1 and 2, and the third free Chiropractic treatment being a week later. Data (both subjective and objective) were obtained from the patients at the first and second consultations, prior to treatments and at the third follow up before treatment. Subjective data were obtained with the Short form McGill pain questionnaire, the Numerical Pain Rating Scale and the CMCC Neck Disability Index. Objective data were obtained from the Pressure Algometer and the CROM Cervical Range of Motion Instrument. Statistical Analysis of the data was conducted using the SPSS (version 9) software suite. This Statistical software program was manufactured by SPSS Inc, 444N. Michigan Avenue, Chicago, Illinois, USA. Various Descriptive and Inferential Statistical techniques were used. The Descriptive procedures used were various tables and graphs and a few summary statistics including but not limited to means, proportions and percentages. Inferential Statistics included iv various Hypothesis testing techniques. Due to the size of our samples, namely 20 in each group, non-parametric Statistical Tests were used. All the tests were set at type 1 error at 5%, or mentioned differently = 0.05. If our p value as reported was less than 0.05 we declared a significant result and our Null Hypothesis was rejected. Evaluation of the statistical analyses revealed significant improvements with regards to subjective and objective data for mostly the Attenuated Faradic Treatment (Transeva) group. Although significant Placebo and Ultrasound effects were obtained initially after the first treatment, the Transeva group showed more favourable results between consultations two and three, giving a good indication of the progression of the treatment regimen. Comparison between groups showed a significant difference with regards to CMCC Neck Disability Index scores, NPRS 101 questionnaires, CROM extension and right lateral flexion readings and Algometer readings. It was concluded that the Transeva is an effective form of treatment for the active trigger points of Myofascial Pain Syndrome of the Trapezius and Levator Scapula musculature in terms of both subjective and objective clinical findings. Suggestions were made to double-blind further studies as this will aid in reducing researcher bias toward a favoured treatment protocol. This study and observations made by the author with respect to Myofascial Transeva treatment are hoped to contribute to the limited literature available on this modality.

Mini-dissertation in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Background: Many previous South African studies exploring the relationship between the public, chiropractic and other health care professionals have indicated a poor level of knowledge and perception between the researched populations. The aim of this study was to determine the knowledge and perceptions of second and third year medical students at The Nelson Mandela School of Medicine towards chiropractic. Objectives: The objectives of this study were firstly, to document the demographic details of the second and third year participants, secondly, to determine the level of knowledge and exposure of the second and third year participants to chiropractic, thirdly, to determine the perceptions of second and third year participants regarding chiropractic and to compare this between second and third year participants, fourthly, to determine the utilization of chiropractic by second and third year participants, and finally, to determine any relationship between demographic factors, knowledge, perception and utilization of chiropractic. Method: A survey method was employed with the measuring tool being a questionnaire. It was decided that only second and third year medical students would be included in the study. Results: The response rate of the study was 42.5%. It was found that the majority of participants were female, of Black ethnicity and all participants were younger than 33 years old. Participants had a wide range, and a relatively satisfactory level of knowledge of chiropractic, however, the 3rd year participants had a significantly higher mean knowledge score than the second years. There was a wide range of perceptions of chiropractic, but a relatively negative level of perception. There were no significant differences in perception scores between the groups (p=0.859). III The third year participants seemed to have a better view of the scope of chiropractic than second year participants. The utilization of chiropractic by the participants, their friends and family was found to be low. A few areas of concern, with regards to the limited exposure that medical students at The Nelson Mandela School of Medicine have towards chiropractic, were raised. Conclusion and recommendations: It can be concluded that second and third year medical students from The Nelson Mandela School of Medicine had a generally poor knowledge and perception of the chiropractic profession, which may be a possible reason for the poor communication between chiropractors and qualified medical practitioners. The presence of chiropractic students, who served as human anatomy demonstrators at The Nelson Mandela School of Medicine, may have had an impact on the results of the study. It is therefore recommended that further studies be done to investigate the effect that these demonstrators have at The Nelson Mandela School of Medicine. Basic information on chiropractic should also be included at The Nelson Mandela School of Medicine to educate medical students on chiropractic.