Dissertation submitted to the Department of Chiropractic in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2006. / Myofascial pain syndrome (MPS) is defined as the sensory, motor and autonomic symptoms caused by myofascial trigger points (MFTPs), or hyperirritable spots within skeletal muscles that are associated with palpable nodules in a taut band. The fact that MFTPs have been described in the literature for acupuncturists, anaesthesiologists, chronic pain managers, dentists, family practitioners, gynaecologists, neurologists, nurses, orthopaedic surgeons, paediatricians, physical therapists, physiologists, rheumatologists and veterinarians is evidence of the syndrome’s clinical importance. As a result of a large amount of research, a large number of different treatments have been shown to be clinically effective in the treatment of MFTP. These treatments include amongst others: - Ischaemic compression. - Myofascial manipulation. - Spray and stretch. - Ultrasound. - Transcutaneous electrical nerve stimulation. - Dry needling. As can be seen from the above, it is important to be able to treat MPS effectively because it is such a common disorder. According to Schneider an effective treatment is needed for MPS, despite the array of treatments available to a clinician. Han and Harrison agree that more studies are required to determine the efficacy of these treatments. The aim of this study is to evaluate the relative effectiveness of Myofascial Trigger point Manipulation (MFTPM) as compared to Proprioceptive Neuromuscular Facilitative (PNF) stretching in the treatment of active Myofascial Trigger Points (MFTPs) in the trapezius muscle (TP 1 and/or TP 2) in terms of subjective and objective clinical findings. The study required a total of 60 patients, which following acceptance were then randomly divided into two groups of 30, with an equal number of male patients in Group one (MFTPM) and two (PNF), and female patients in Group one and Group two. Each patient had four consultations (three treatments and one follow up visit) in a two week period. Subjective and Objective Data was recorded at each consultation prior to the treatment. Subjective measurements (Numerical Pain Rating Scale and Short Form McGill Pain Questionnaire) were taken prior to the treatment at all four visits. Objective measurements (Cervical Range of Motion Meter and Algometer) were also taken prior to the treatment at all four visits, except for Algometer readings which were taken at the initial consultation and the fourth treatment only. SPSS version 11.5 was used for analysis of data (SPSS Inc, Chicago, Ill, USA). Baseline comparisons were done between treatment groups using Pearson’s chi square tests or Fisher’s exact tests as appropriate for categorical variables, and student’s t-tests for quantitative normally distributed variables. Treatment effect was assessed with repeated measures ANOVA. A significant time by group interaction indicated a significant differential treatment effect. A p value <0.05 designated statistical significance. The direction of the treatment effect was assessed with profile plots. Evaluation of data collected from both groups showed a significant improvement in terms of objective and subjective clinical findings to a value of p=< 0.001. There was no statistical difference between the two groups in terms of objective and subjective clinical findings, although a trend was shown when looking at the objective findings that suggest that MFTPM was more effective than PNF stretching. The sample population was drawn from a very homogenous group of people (i.e. SARS call centre), in order to achieve greatest emphasis on clinical outcomes. This process however limits the clinical applicability of the results and thus will not always be applicable to all patients within the population. It is therefore the researcher’s conclusion that there is no statistical difference between MFTPM and PNF stretching in terms of objective and subjective clinical findings. Both treatment modalities have been shown to be equally effective in the treatment of subacute active TPs in the upper tarpezius. There is a definite trend when looking at the objective data that may support the hypothesis that MFTPM is as effective as, if not more effective than PNF stretching. It is of the opinion of the author that a larger sample size is needed to make it clinically significant.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Chronic Idiopathic Constipation (CIC) is a common patient complaint (Browning 1999) and as such is defined as : “Constipation” being the infrequent or difficult evacuation of faeces, “idiopathic”, denoting the condition occurs in the absence of any known cause and “chronic”, implying a problem that has persisted for a long time (Anderson 1989). It has been suggested that the bony subluxation or motion segment dysfunction in the spine, could produce these symptoms (e.g. altered visceral function) in the segmentally related visceral structures (Korr 1976, Nansel and Slazak 1995, Budgell 2000). In support of this three case reports in the literature suggest that spinal manipulative therapy to effect removal of these bony subluxations or motion segment dysfunctions, may relieve chronic idiopathic constipation (Hewitt 1993, Marko 1994, Redly 2000). However all three cases involved a single patient case analysis, where patients received spinal manipulation and a vast improvement in bowel function within three weeks of the initiation of the intervention was noted. Only one case report measured global wellbeing outcomes and was able to document a steady increase in the patient’s sense of wellbeing (Redly 2000). As a result of the above evidence in the literature, the researcher was led to the following hypotheses regarding spinal manipulation and chronic idiopathic constipation: • That spinal manipulation would affect a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. • That placebo would affect an increase in the subject’s abdominal pain intensity and level of constipation and a decrease in the subject’s sense of wellbeing and spinal range of motion. • That spinal manipulation would be more effective than placebo in bringing about a decrease in the subject’s abdominal pain intensity and level of constipation and an increase in the subject’s sense of wellbeing and spinal range of motion. / M

A Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / Headaches are one of the most common clinical problems in medicine (Edwards et al. 1995). It is estimated that one in three people suffer from headaches at some stage in their life (Kim et al. 1995). It is an extremely common complaint in the industrialized world (Nilsson, 1997) and has a significant impact on employee absenteeism, productivity and quality of life (Schwartz et al. 1997). In the United States more than 15 000 tons of Aspirin is consumed annually for the relief of headaches, and the cost of evaluation and treatment of headache patients consumes millions of dollars a year (Bernat and Vincent, 1993). Tension - type headache is the commonest form of headaches (Edwards et al. 1995). It is a highly prevalent condition experienced annually by 30 - 70% of the population, and as a chief complaint, it constitutes 5 - 8% of Chiropractic patients (Vernon and McDermaid, 1998). It is divided into an Episodic and Chronic form (IHS, 1991:29), with Episodic Tension-type headache being far more prevalent than Chronic Tension-type headache (Schwartz et al. 1998). Episodic Tension-type headache is further subdivided according to the presence or absence of a muscular factor. According to the International Headache Society (1991:29) for decades a dispute has prevailed concerning the importance of muscle contraction in the pathogenesis of the headache, but conclusive studies are still lacking (IHS, 1991:29). Based on the IHS (1991:29) classification that tension-type headache is associated with a muscular component, the purpose of this study was to investigate the effect of specific myofascial trigger point therapy in the clinical presentation of Episodic Tension-type headache. / M

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 81 leaves ; 30 cm / Damage to the proprioceptive organs, as well as lack of proprioceptive retraining, after an inversion ankle sprain, has been shown to contribute to the problem of recurring ankle joint injuries, which has the highest incidence of sports related injuries. The proprioceptive organs are important as afferent pathways in reflexes and for the adjustment of posture and muscle tone (Miller and Narson, 1995 and Jerosch and Bischof, 1996). Manipulation is thought to cause a change in the afferent pathways of the manipulated joints and it is proposed that this change may restore normal proprioceptive input, in a previously injured joint (Wyke, 1981 and Slosberg 1988). This however is unproven as indicated in a study by Lephart and Fu, (1995), where techniques to improve proprioception remain untested and according to Brynin and Farrar (1995), screening for proprioceptive and neuromuscular co-ordination should be carried out as part of a chiropractor’s physical examination and injury evaluation. This was a qualitative pre-post clinical study. Forty (40) subjects between the ages of 25 and 45, who had been diagnosed with chronic ankle instability syndrome, were recruited.

Thesis (M.Tech.: Chiropractic) - Dept. of Chiropractic, Durban Institute of Technology, 2005 221 leaves ; 30 cm / Previously the focus has been on the improvement of strength prior to proprioception (Calliet, 1997; Flemister et al. 1998 and Buhler et al. 2002). However according to Oloff (1994); Vegso (1995); Calliet (1997); Kawaguchi (1999); Buhler et al. (2002) and McGrew et al. (2003), focus should lie in obtaining a functional range of motion (increased flexibility) and proprioceptive ability and strength will follow with normalization of the relationship of the anatomical structures. All research in this regard has never assessed the assumption that the strength of the relevant musculature would return (Blokker et al.1992 and Klaue et al.1998). The objectives of this study were: to determine the relative effectiveness of Proprioceptive Neuromuscular Facilitation as compared to the Active Rocker-Board Exercises in the rehabilitation of chronic ankle sprains; as well as to determine the best sequence of applying these techniques to chronic ankle sprains in terms of objective clinical findings.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 117 leaves of pages : ill. / The purpose of this pre-post crossover clinical trial was to investigate the relative effectiveness of the combination of stretching followed by strengthening, versus the combination of strengthening followed by stretching, of the gluteus medius and iliotibial band (ITB), in the rehabilitation of chronic Iliotibial Band Syndrome (ITBS) in long distance runners. The results were based upon subjective and objective clinical findings, as well as effect on running performance.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2003 1 v. (various pagings) / Mechanical low back pain is one of the most common clinical disorders that most people seek help for (Painting et al. 1998:110). Epidemiological studies indicate a lifetime prevalence of low back pain ranging from 60 to 80% with an annual incidence of approximately 30% (Mosheni-Bandepi et al., 1998). The Sacroiliac (S.I.) joint is a significant source of pain in patients with chronic low back pain and it therefore warrants further study (Schwarzer et al. 1995:31). S.I. syndrome is defined as pain over the S.I. joint in the region of the posterior superior iliac spine, which may be accompanied by referred pain over the buttock, greater trochanter, groin, posterior thigh, knee, and occasionally to the postero-lateral calf, ankle and foot (Kirkaldy-Willis, 1992:123). Research indicates that there seems to be a correlation between low back pain, more specifically S.I. pain and hip rotation (Ellison et al. 1990, Cibulka et al. 1999, Fairbank et al. 1984). Cibulka et al. (1998) found that patients with lower back pain who were classified as having signs suggestive of S.I. regional pain had significantly more external rotation than internal rotation on the posterior innominate side i.e. side of S.I. dysfunction (approximately a 20 difference). Manipulation is recognised as an effective means of treating mechanical low back pain, with respect to both Lumbar Facet Joint Syndrome and S.I. Joint Syndrome (Assendelft et al. 1992 and Koes et al. 1996). Kirkaldy- Willis (1992:123) states that manipulation is the most certain way of relieving the symptoms of S.I. syndrome. This investigation aimed to determine the effect of a sacroiliac joint manipulation on hip rotation ranges of motion (active and passive motion) in patients with chronic sacroiliac syndrome in terms of objective measures.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Technikon Natal, 2002 1 v. (various pagings) / The purpose of this study was to evaluate the effect of wearing a scuba diving cylinder on static lumbar spine posture, in terms of clinical objective findings, namely radiographic changes in the lumbar lordosis, lumbosacral angle, lumbosacral disc angle, and the lumbar gravity line, during upright standing on land.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 / The purpose of this randomized controlled clinical trial was to investigate the relative effectiveness of proprioceptive neuromuscular facilitation (PNF) versus ultrasound therapy for the treatment of Temporomandibular joint (TMJ) dysfunction caused by masticatory myofascial trigger points, in terms of subjective and objective clinical findings.

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2004. xvi, 155 leaves / The aim of this investigation was to investigate whether an immediate objective increase in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome. The actions of hip flexion, extension, abduction and adduction were assessed. The study also investigated the patients’ subjective perception of pain due to the chronic sacroiliac syndrome before and after the manipulation. The proposed increases in strength would have been as a result of a reduction in arthrogenic muscle inhibition. Stimulation of nociceptors caused by the chronic sacroiliac syndrome would have lead to the presence of the arthrogenic muscle inhibition within the joint. Arthrogenic muscle inhibition has been described as an inability of a muscle group to utilise all its muscle fibres when performing a maximum voluntary contraction of that muscle group. Arthrogenic muscle inhibition is a joints natural response to pain, damage or distension within the joint. The response is an ongoing reflex inhibition of the muscles surrounding the joint in order to protect the joint. The inhibition of the surrounding musculature clinically manifests itself as a decrease in strength of the affected muscles. The decreased strength levels hampers rehabilitation of the affected joints as active exercise forms a vital role in the rehabilitation process. Current treatment options used to reduce arthrogenic muscle inhibition include lidocaine injection into the joint, cryotherapy and transcutaneous nerve stimulation. These treatments are aimed rather at the reduction of pain, joint effusions and atrophy of the related musculature than at the reduction of arthrogenic muscle inhibition. Recent studies have proposed that manipulation reduced arthrogenic muscle inhibition by causing excitation of the joint receptors, called the Wyke receptors. Stimulation of these joint receptors is thought to cause an alteration in the afferent input to the motorneuron pool resulting in a reduction of arthrogenic muscle inhibition. This study aimed to investigate whether sacroiliac manipulation could reduce arthrogenic muscle inhibition at the hip by assessing the immediate gains in hip muscle strength. The problem statement was to evaluate if an immediate subjective or objective change in hip strength was observed after an ipsilateral sacroiliac manipulation in patients suffering from chronic sacroiliac syndrome.