Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / 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. / M

A dissertation presented in partial compliance with the requirements for the Master's Degree technology: Chiropractic, Durban Institute of Technology, 2002. / Low back pain is estimated to effect 60-90% of the world's population sometime during their lives while 20-30% of people suffer from low back pain at any given time (Cassidy and Burton, 1992:3). Locally, epidemiological studies into low back pain have revealed incidence rates of 57.6% amongst black South Africans (Van der Meulen, 1997) and between 70 and 80% amongst Indians and Coloureds (Docrat, 1999). The use of spinal manipulation with the emphasis on restoring joint mobility, has been proven to be one of the most effective and cost effective approaches in the management low back pain of a mechanical origin (Di Fabio, 1992). McMorland (2000), showed in a study of 199 patients, that spinal manipulation resulted in an average of 52.5% and 52.9% reduction in low back pain and disability respectively. Panjabi (1992:1) has postulated a theory of a 'neutral zone' around which the passive lumbar spine operates. He describes the neutral zone as a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column. It is, according to Panjabi (1992:1), possible for this neutral zone to increase with injury to the spinal column or with weakness of stabilising muscles, which could result in low back pain. The trunk muscles therefore have to be able to co-contract isometrically to control the neutral zone and protect the spinal tissue from excessive motion (Richardson et aI.1990). The transversus abdominis muscle and multifidus muscle have been identified as playing an important role in the complex synergistic interaction of the trunk (Norris, 1995). The above concept involving muscles attempting to maintain a neutral zone is commonly referred to as 'core stabilisation' (Norris, 1995). / M

A dissertation presented in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 2000. / The literature shows neck pain, including cervical facet syndrome, to be a common problem. It also provides evidence that inflammation plays a role in cervical facet pathology. Prescription of nonsteroidal anti-inflammatory drugs (NSAIDs) is the first line treatment of allopathic physicians for neck pain. Traumeel S is a complex of homoeopathic remedies indicated in a variety of anti-inflammatory, traumatic and degenerative disorders. It has been clinically shown that Traumeel S is effective in the treatment of inflammation. There is a paucity of clinical research into the treatment of acute neck pain, including cervical facet syndrome, with antiinflammatory agents. The aim of this study was to compare the relative effectiveness of piroxicam, an NSAID, with Traumeel S in the treatment of acute cervical facet syndrome. The study was a double-blind, comparative, clinical trial. Fifty consecutive patients complying with all inclusion criteria were randomly assigned to either the Traumeel S group or the piroxicam group. Each patient in the NSAID group received 40 mg of piroxicam per day for the first two days and 20 mg per day for the following 5 days. The Traumeel S group received the same dosage of placebo piroxicam capsules and 3 Traumeel S tablets in crushed form, per day. Placebo Traumeel Stablets, also in crushed form, were taken 3 times a day by the NSAID group to facilitate blinding. III Patients were assessed on days 1, 3 and 7 of the trial. Subjective assessment involved two questionnaires: the CMCC Neck Disability Index, and the NRS-101 / M

Dissertation submitted in the partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / Symptomatic cervical spondylosis is a common condition in patients over the age of forty. This condition has been successfully treated by means of chiropractic adjusting. However, to date little research has been conducted to investigate whether the combination of chiropractic adjusting and an alternative therapy may be more effective than just chiropractic treatment alone. The purpose of this study was to investigate whether the combination of chiropractic adjusting and an Anthroposophical remedy, Disci comp.cum Stanno, would be more effective in the treatment of symptomatic cervical spondylosis than chiropractic adjustments alone. It was hypothesized that cervical spine manipulation, and the combination of chiropractic adjusting and the Disci remedy would both be effective in the treatment of symptomatic cervical spondylosis. Moreover, with reference to objective and subjective clinical findings, it was assumed that the combined chiropractic adjustments and the Disci remedy would be more effective than chiropractic adjusting alone. The study was a controlled, double-blind clinical trial consisting of thirty patients, fifteen comprising the control group and fifteen the experimental group. The age range of the sample group was from forty to seventy-nine years. The patients were randomly divided into the two groups. The control group was treated with chiropractic adjustments to the / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Headaches have been described as the most common medical complaint in society (Dalessia 1987:3), and Tension-type headaches constitute approximately 80% of these (Martin 1993:22). Although Episodic tension-type headache is more prevalent than Chronic tension-type headache and may have a greater societal impact, Chronic tension-type headache has by far a greater individual impact (Schwartz et aI, 1998) on the patient. The exact causes of Chronic tension-type headaches are not known and, as a result, treatment is commonly symptomatic in nature and aimed at reducing pain. To date, treatment commonly involves the use of drugs and with it comes the threat of drug-induced side-effects (Bendtsen et aI, 1996). The purpose of this study was to investigate two non-pharmacological treatments in the management of Chronic tension-type headaches, namely the relative effectiveness of Spinal Manipulative Therapy (SMT) in conjunction with Trans-cutaneous Electrical Nerve Stimulation (TENS), as compared with SMT and placebo TENS. ABSTRACT It was hypothesized that SMT in conjunction with TENS would provide a greater immediate and short-term benefit in comparison to SMT and placebo TENS in the treatment of mild / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2004. / Arthrogenic muscle inhibition (AMI) is the reflex inhibition of the muscles that surround an injured joint in consequence to disturbed afferent feedback originating from the receptors of that joint. The resultant altered afferent innervation of the motor neuron pool leads to a decrease in recruitment ability within the motor neuron pool, a decrease in contraction force of the muscles that fall within the motor neuron pool, and hence the clinical manifestation of AMI as a decrease in muscle strength. Spinal manipulation has been proposed to activate mechanoreceptors and proprioceptors within and around the manipulated joint. The altered afferent input arising from their stimulation is thought to cause changes in motor neuron excitability. In this respect, sacroiliac manipulation has been shown to effectively reduce muscle inhibition and increase muscle strength of the quadriceps muscle group in patients with anterior knee pain. The focus of AMI has been aimed primarily at the quadriceps muscle group whereas little information is available on the functional properties of the muscles moving the hip joint. Thus, the purpose of the present cohort study was to determine the short - term effect of sacroiliac manipulation on ipsilateral hip muscle strength and subjective low back pain intensity in thirty male subjects presenting with low back pain, attributable to chronic sacroiliac syndrome. The first objective of the study was to evaluate the short - term effect of sacroiliac manipulation on the strength of the musculature of the ipsilateral hip joint for the actions of flexion, extension, adduction and abduction by means of the Cybex Orthotren II Isokinetic Rehabilitation System, with respect to objective clinical findings. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at the Durban Institute of Technology, Durban, 2006. / The purpose of this study was to evaluate the immediate and short term effects of spinal manipulative therapy on the club head velocity of amateur golfers suffering from mechanical low back pain. This purpose was identified as low back pain which has been noted as the most common musculoskeletal problem affecting amateur and professional golfers. In the right handed golfer the golf swing produces a distinctly asymmetric trunk motion, involving a combination of left axial rotation and right lateral bending. The significant lateral bending, shear, compression and torsional forces that the lower back contends with during the golf swing causes a peak compression load of more than eight times the body weight. In addition it is found that at the end of the follow through phase the golfer's lumbar spine is rotated and hyperextended. This is known as the reversed C position, in which the facet joints approximate and in addition torsional stress is placed on the annular fibers of the disc. With repetitive swings and incorrect form the lumbar facets bear the brunt of the abnormal forces on the lumbar spine. IV In addition to this, during the downswing phase of a golf swing the role of the multifidus is to limit flexion whilst the external oblique muscle induces rotation of the lumbar spine. Together both muscles produce rotation in the lower lumbar spine. Thus the golf swing, particularly during the downswing phase, places a tremendous burden on the multifidus muscle and may cause; o muscle injury which will contribute to the golfer's low back pain and I or o joint injury as a result of muscle fatigue. Furthermore the resultant uncontrolled contractions of the multifidus muscle produces torsion to the facet joints and disc. It is therefore likely that facet syndrome may be the main cause of low back pain in golfers, as modern golf publications urge golfers to use a maximum state of spinal rotation to generate a high club head velocity. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, Durban, 1998. / The aim of this study was to determine the effectiveness of adjustments versus the use of ultrasound in the treatment of mechanical neck pain. It was hypothesized that treatment with adjustments over a four week period, with a further four week follow-up period, would be more effective than ultrasound in terms of improving patients' cervical ranges of motion and their perceptions of pain and disability. Thirty consecutive patients suffering from mechanical neck pain were randomly assigned to either the adjustment or ultrasound groups. An experimental design was employed, whereby both groups received treatment twice a week for four weeks. After a follow-up period of a month, the patients were re-assessed. Measurements of the cervical spine ranges of motion with the CROM goniometer, algometer readings, and the completion of the Numerical Pain Rating Scale-101, CMCC Neck Disability Index and the Short Form McGill Pain questionnaires were performed before the first, fourth and final treatments as well as at the one month follow-up consultation. The data were then transferred to spreadsheets and underwent statistical analyses, using a 95 % confidence level. Analyses within each group were performed, using the Wilcoxon Signed Rank test and various readings were compared. The reading taken before the first treatment was compared to the reading taken before the final treatment. The initial reading was then again compared with the reading taken at the one month follow-up consultation. Comparison of the results of both treatment groups was statistically evaluated, using the Mann-Whitney U-Test. The comparison was made using the readings of the first, fourth and final treatments, as well as the one month follow-up consultation. This was done for all measurement parameters. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / Emergency medical personnel have a number of occupational risk factors that are listed in the reviewed literature (Davis and Heaney 2000, Volinn 1997 and Andersson 1999) as risk factors for low back pain. Physical lifting and carrying of patients and equipment increases stress on the lower back, while occupational stress and a high level of patient responsibility are mental risk factors (Davis and Heaney, 2000). Emergency medical personnel that spend long hours in response vehicles, ambulances or helicopters are exposed to vibrational stressors and may therefore have an increased risk of low back pain due to this whole body vibration (Palmer et al, 2000). In addition it has been noted that the number of motor vehicle accidents will also increase the risk of low back pain due to mechanical injury (Cassidy et al, 2003). Low back pain could therefore interfere with their ability to carry out their duties, affect their attitude towards patients and colleagues, impact on the level of patient care required of them, and result in increased absenteeism. Persistence of chronic low back with the inability to perform their duties may result in the need to find alternative employment or result in premature dismissal. The objectives of this study were: to determine if emergency medical personnel have a higher risk factor for the development of low back pain due to their occupation than the general population; as well as determine if an increase in the number of years working in the field (i.e. years of exposure) leads to an increased incidence and / or prevalence of low back pain. / M

A dissertation submitted to the Faculty of Health in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic,Technikon Natal, 2001. / The purpose of this study was to evaluate Piroxicam versus Protease administration, in terms of subjective and objective clinical findings, in order to determine the effectiveness of each approach in the treatment of grade 1 and 2 acute ankle inversion sprains. The study was a prospective, randomized, double blinded, controlled study. The study involved 30 subjects, 15 in each group which were selected from the general population. One group received Protease and strapping while the other group two received Piroxicam and strapping. Patients received 3 treatments over a period of one week. Patients in the Protease group received 1200mg (3 x 400mg) of Protease daily before meals for seven days. Patients in the Piroxicam group received 40mg (2 x 20mg) of Piroxicam for the first two days, and then 20mg (1 x 20mg) for the following five days, administered with meals. All patients were taught how to apply an elastic crepe bandage to the ankle, which was to be used at all times, except during bathing for the duration of the study / M