Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Durban University of Technology, 2010. / Episodic Tension–type headache (ETTH), which has a high prevalence, is the most common headache. Manual therapeutic approaches towards Episodic Tension-Type Headaches (ETTHs) have not been fully explored. However, cervical spine manipulation (CSM) and dry needling are found to be successful modalities for the treatment of tension-type headache (TTH). Therefore, this study aims to determine the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in the treatment of ETTHs. Objectives The objectives of this study include: determining the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in terms of objective and subjective data for the treatment of ETTHs. Method Forty five participants suffering from ETTHs, between the ages of eighteen and fifty, were recruited through convenience sampling and were randomly allocated to one of three equal groups (15 per group). The three different groups were: (A); CSM alone, (B); dry needling alone and (C); CSM in addition to dry needling. The study took place over a period of four weeks involving six consultations. Each participant received a headache diary for the duration of the study. At the first consultation the participant received the headache diary and was monitored for one week before the treatments commenced. Thereafter, four treatments were administered over the next two weeks, depending on group allocation. Participants were also monitored with the headache diary for one week after the last treatment. The objective data for each participant consisted of cervical range of motion (CROM) and pressure–pain threshold readings, measured using a CROM goniometer and an algometer respectively. The subjective data for each participant was collected using a headache diary and a headache questionnaire/disability index. SAS version 9.1.3 was used to analyse the data. A p value of <0.05 was considered as statistically significant. Results A decrease in headache duration, frequency, intensity and severity and increases in CROM and algometer measurements were observed in all groups. However, no statistically significant differences were found between the three groups in terms of objective and subjective measurements although, a statistically significant improvement from consultation five to six was found in Group C in terms of headache disability. Conclusion CSM and dry needling, used in isolation or in combination are effective in the treatment of ETTHs although Group C did show superiority over the other groups in the long term with respect to the disability index.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2011. / BACKGROUND: Plain film radiography is the most common imaging technique requested by chiropractors to assist in the management of patients with musculoskeletal complaints. There is a paucity literature indicating that chiropractors’ interpretive radiographic skills are consistently able to achieve the same outcome given a particular set of radiographs. An important indication for the use of radiography in chiropractic is to exclude any possible contraindications to spinal manipulative therapy (SMT) that could cause serious injury to a patient if it is left unmodified or excluded as a treatment option. OBJECTIVES: The study aimed to investigate the inter- and intra-examiner reliability of chiropractor’s diagnosis on cervical spine radiographs. Additionally, the effect of clinical history added to the radiographs was assessed. METHODS: Inter- and intra-examiner evaluations occurred on two consecutive readings of 30 radiographs by six qualified chiropractors. No clinical history was given during Round One, but was available during Round Two. RESULTS: The inter-observer agreement for categorisation and management went from “poor agreement” in Round One (Κ=0.1962 and Κ=0.1996 respectively) to “fair agreement” (Κ= 0.2041 and Κ=0.2036 respectively) beyond that expected by chance in Round Two. Identification remained “fair agreement” beyond that expected by chance over both rounds (Κ=0.3113 and Κ=0.2159). Sensitivity at Round One was 94.4% and the specificity was 61.1%. At Round Two the sensitivity had decreased to 93.8% and the specificity had decreased to 50%. There was no significant difference between the accuracy of the Round One and Round Two results for categorisation (p=0.243) and management (p=0.220), but there was a clinical difference for identification (p=0.014). iii CONCLUSION: Differences in the result were small indicating clinical relevance with regards to inter-examiner reliability was fair in most instances. Although clinical history did not influence categorisation or management, it did improve accuracy of identification of pathology. Chiropractors successfully identified between 93.8% and 94.4% of abnormal radiographic findings demonstrating that chiropractors use of radiographs as a diagnostic tool when looking for contraindications to spinal manipulative therapy was sensitive. This demonstrates that its use as a diagnostic tool for contraindications to spinal manipulative therapy (SMT) is sensitive.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Wong and Deyo (2001) believe that 98% of the LBP cases are musculoskeletal (mechanical) in origin and 51,7% of these individuals are chronic sufferers (Andersson, 1999). Weak spinal stability muscles have shown to be an aetiological cause (Chok, Lee and Latimer, 1999). Wolff, Weinik and Maitin (2003) agree a combination of brace aided pelvic stabilization combined with a spinal stability programme may be the best treatment intervention for chronic low back pain (CLBP). Objective: The purpose of this research was to determine the relative effectiveness of three treatment protocols with (Group A-Groovi-SI-Belt®; Group B-standard SI belt) and without (Group C-control) brace aided pelvic stabilization in patients with CLBP. Method: Forty-six patients suffering from CLBP were randomly allocated to one of the three treatment groups. A spinal stability programme was progressively taught and enforced in all three groups. Weekly follow-up consultations were required to assess subjective and objective outcomes of the three treatment interventions. Outcomes were obtained by using the Numerical Pain Rating Scale (NRS); Quebec disability scale; Active straight leg raiser test; Biofeedback device and the static trunk extensor endurance test. Results: Data was analysed using the SPSS version 15.0 (SPSS Inc. Chicago, Ill, USA).Comparing pre and post outcome measurements using a p value <0.05 which was considered to be statistically significant. All three treatments improved most outcomes significantly over time. The Groovi-SI-Belt® showed non significant trends of quicker rates of improvement. . Conclusion: This study revealed that brace aided pelvic stabilization combined with a spinal stability programme was a beneficial treatment intervention with the Group A being superior to Group B.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Attempts to determine the association between the radiographic and clinical findings of knee pathology have produced conflicting results. It is also not yet known how knee radiographs influence the conservative management of patients with knee pain. Objectives: 1. To determine the association between the clinical and radiographic diagnoses of knee pain. 2. To record the consultation at which a radiograph of the knee was requested by the student or clinician and the reasons thereof. 3. To record the suspected clinical diagnoses and management of the patients prior to referral for radiographs of the knee. 4. To determine the number of incidental radiographic findings in the selected radiographs. 5. To determine any change in the clinical diagnoses and management following radiographic reporting of the selected radiographs. Method: Radiographic and clinical data from 1 January 1997 to 31 December 2010 were retrospectively collected from knee radiographs and corresponding patient files from the archives of the Chiropractic Day Clinic (CDC). Statistical analysis included the use of percentages, mean, standard deviation, range and frequency counts for the descriptive objectives. Diagnoses were categorized into specific groups and to construct two-by-two tables of absence or presence of radiographic vs. clinical diagnosis for each specific diagnosis to determine the association indicator variables were used. Results: The overall agreement between the clinical and radiographic diagnoses was 85.5%. For degenerative joint disease there was a 97.8% agreement while in Osgood Schlatter’s disease the agreement was 100%, and in chondromalacia patella the agreement was 50%. However, there was no agreement between the clinical and radiographic diagnoses for each of the other specific conditions. Degenerative changes were the most common radiographic findings. The iv majority of the knee radiographs were requested at the initial consultation and as the length of treatment increased, the frequency of radiograph requests decreased. The most common reasons for referral for radiographs were to identify degenerative changes (47.5%) and to assess for unspecified pathology (37.4%). Of the 146 patients in this study, 125 patients did not have a change in diagnosis after radiographs were obtained which means that 85.6% of the diagnoses remained the same after radiographic examination. There was a wide range of treatment modalities utilized in the management of patients with knee pain, including soft tissue therapy, electrotherapeutic modalities and manual therapy (manipulation and mobilization). The use of manual therapy increased from 67.8% prior to radiographs being taken to 82.9% after radiographs were obtained. Conclusion: Knee radiographs were over-utilized at the CDC and the findings on radiography did not have much influence on the diagnosis and the management of the patient presenting with knee pain. The majority of the clinical diagnoses were degenerative causes of knee pain. / Durban University of Technology Research Fund

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background: Therapeutic dry needling is an established modality for the treatment of myofascial pain, whereas limited research on Kinesiotape® exists. Kinesiotaping® is becoming popular, with the main benefit of being non-invasive and long wearing, thereby extending the treatment to the patient. This study aimed to determine the relative effectiveness of these two treatment modalities in patients with myofascial pain syndrome of the Trapezius muscle. Methods: The study design was a quantitative prospective randomised clinical trial. Fifty patients were equally and randomly allocated into either the dry needling or Kinesiotape® groups. Each patient received two treatments on separate visits to the upper trapezius muscle. Follow-ups were scheduled two to four days after the previous visit. Subjective measures were the Visual Analog Scale (VAS) and the Neck Disability Index (NDI), whilst objective measures were pain pressure threshold (PPT) and cervical range of motion (CROM). Results: Kinesiotape® demonstrated statistical significant treatments with the VAS (p < 0.001), NDI (p < 0.001) and PPT (p= 0.022) (95% CI). Dry needling showed statistical improvements in VAS (p= 0.001) and NDI (p < 0.001) only. Also, Kinesiotape® demonstrated a clinically significant improvement with the VAS when compared to the minimal clinically important differences (MCIDs). Trends of a superior treatment effect of Kinesiotape® over dry needling was observed in the VAS and PPT groups (p= 0.155; p= 0.428). Future studies could repeat the study with larger sample sizes to determine if these trends can be validated. Conclusion: This study demonstrated that Kinesiotape® was at least as effective as dry needling in the treatment of Myofascial Pain Syndrome. Therefore, Kinesiotaping® is a non-invasive alternative to dry needling. Kinesiotape® therapy resulted in a greater change in pain and disability scores than did dry-needling trigger point therapy, implying that Kinesiotape® may be a noninvasive alternative to dry needling.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / The lifetime incidence of low back pain is between 48% to 79% in South Africa. Globally, chronic Sacroiliac Joint Syndrome occurs in 13% to 63% of the world’s population. Therefore, chronic Sacroiliac Joint Syndrome is a significant health problem that has the potential to have a major impact on quality of life. Chronic Sacroiliac Joint Syndrome is described as an alteration in normal motion or mechanics. The Sacroiliac Joint fibrous capsule contributes to proprioceptive and nociceptive output, which may be exacerbated when the joint is in a dysfunctional state. Chronic Sacroiliac Joint Syndrome may be effectively treated by spinal manipulative therapy. Spinal manipulative therapy is professed to have four therapeutic effects – mechanical correction, pain reducing effects, circulatory increase and neurobiologic effects. Similarly, Kinesio Tex® Tape therapy is professed to have comparable therapeutic effects – circulatory increase, pain reduction and stimulation of proprioceptive systems. Spinal manipulative therapy and Kinesio Tex® Tape therapy may, therefore, have similar therapeutic effects which, if used in adjunction, may produce enhanced therapeutic effects and accelerated results regarding reduction of symptoms in patients with chronic Sacroiliac Joint Syndrome. This investigation aimed to determine whether Kinesio ® Taping methods would have any relative effect on the Sacroiliac Joint, and whether it would be appropriate to use as an adjunct to spinal manipulative therapy in the treatment of chronic Sacroiliac Joint Syndrome. The study was a prospective stratified clinical trial with three intervention groups, twenty participants in each (n = 60). All participants were 18-50 years of age and suffering from chronic Sacroiliac Joint Syndrome. Subjective measurements included the Numerical Rating Scale and Oswestry Low Back Pain Disability Index. Objective measurements included the Algometer Scores. Numerical Rating Scale and Algometer measurements were taken before and immediately after treatment at the first consultation and at the second consultation. Oswestry Low Back Pain Disability Index measurements were taken at the first and second consultation. Group One underwent spinal manipulative therapy alone, Group Two underwent Kinesio Tex® Tape therapy alone and Group Three underwent both spinal manipulative therapy and Kinesio Tex® Tape therapy in combination. Comparisons were made using the Unpaired and Paired t-tests. The results for the Inter-group analyses suggested that most comparisons were statistically insignificant (p ≥ 0.05) which indicated that all treatment groups appeared to improve to a similar degree. The results for the Intra-group analyses suggested that most comparisons were statistically significant (p < 0.05) which indicated that Kinesio Tex® Tape therapy was effective as an adjunct to spinal manipulative therapy, however not statistically more or less effective that spinal manipulative therapy or Kinesio Tex® Tape therapy alone. In conclusion, it was found that some differences did occur, however these differences were not sufficient enough to conclude that one treatment was more effective than the other. Further research with a larger sample size, more frequent treatments and follow-ups, a more homogenous stratification of age, ethnic group, gender, side of diagnosis and categorizing participant occupation is needed in order for the power of the study to be amplified and, therefore, any results would carry more weight.

A dissertation submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The purpose of this research is to conduct a descriptive study of cases that presented with thoracic complaints to Durban University of Technology chiropractic Day Clinic from the 13 January 1995 to 30 November 2005. This is a retrospective, quantitative, non-experimental, clinical survey. The sample size for this study included 7111 cases obtained from the Durban University of Technology chiropractic day clinic. There were no thoracic cases recorded in the random sample for the year 1995, therefore the random sample allocated for this year was subtracted from the total sample. 249 Thoracic cases were included in this research. The overall prevalence for the time period 1996 - 2005 was 3.5%. Gender: 248 of the 249 patients had recorded gender information. The majority were female 54.8% while 45.2% were male. Age: The ages ranged from 11 to 73 years. The mean age was 33.3 years. Occupation: 241 patients had a recorded occupation. 21.6% of them were classified as active or non-sedentary while the majority had sedentary jobs. The main complaint was mid-back pain which was noted in 41.4% of the population. Thoracic facet syndrome was the primary diagnosis given in 74.7% of the population; myofasciitis was the second most diagnosed condition with 8.8% of the population having this primary diagnosis. The most common treatment was joint manipulation, which was used in 82.6% of the cases, followed by soft tissue therapy (79.4%) and stretches (44.9%). The facets that were most commonly found to be fixated were in the T5 toT8 region. The investigative procedure that was used most often in the sample was x-rays. Fourteen patients were sent for x-rays (5.6%). One patient was sent for a blood test (0.4%). No other investigative procedures were used in these patients. Even though the overall prevalence of thoracic pain sufferers was only 3.5% over the ten year period, it is still an area of pain that must be investigated. The thoracic spine has been overlooked as a major region for research. This study has proved that there is need for continuing research in this area, to assist chiropractors to treat the thoracic spine more effectively. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / To determine the efficacy of the Harpago and celery seed cream in mild to moderate degenerative joint disease of the knee in terms of subjective and objective clinical findings / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Purpose: Chronic ankle instability (CAl) is characterised by ankle pain, weakness, edema, crepitus, adhesions, restrictions and ligamentous laxity. Various treatment options target a variety of aspects of this condition. However, there is a paucity of literature with regards to combined treatment choices. The purpose of this study was to investigate the relative effectiveness of combining manipulation with rehabilitation, compared to rehabilitation only, in participants with CAl. Methods: The study was a single blinded, randomised and comparative clinical trial at a chiropractic day clinic. Thirty participants with grade I and II CAl were recruited and randomly allocated into one of two treatment groups. Fifteen participants received a combination of manipulation and rehabilitation (coupled peroneal muscle strengthening and proprioception) and fifteen received the rehabilitation only programme. All six treatments in each group were conducted over five weeks. Results: A P value of <0.05 was considered statistically significant. The intra-group outcomes in the Manipulation and Rehabilitation Group indicate that statistically significant improvements were achieved for all six parameters in this study (VAS p<0.001; FAOI p<0.001; Algometer p<0.001; motion palpation p<0.001; WBO p=0.001 and BBS p<0.001). This is in comparison to the three outcomes where statistical significance was achieved (VAS p<0.001; FAOI p<0.001 and BBS p<0.001) in the Rehabilitation only Group. Inter-group analysis revealed statistically significant improvement in favour of the Manipulation and Rehabilitation Group for VAS (p<0.001); algometer readings (p=0.002) and Motion palpation findings (p<0.001). Conclusions: The findings of this study show that manipulation in combination with rehabilitation is relatively more effective than rehabilitation only for most outcome measures. III Key indexing terms: Ankle; Combination Therapy; Joint Instability; Manipulation; Rehabilitation / 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