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.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Introduction: Motion palpation is a commonly utilised clinical assessment tool of joint fixations. Most research surrounding motion palpation discusses inter and/or intra-examiner reliability as a pre-treatment tool. However, only two studies have assessed the reliability of motion palpation as a post-treatment diagnostic tool, and both these studies demonstrated that motion palpation has the ability to identify end-feel improvement in a restricted segment which had been manipulated. Therefore the use of motion palpation as a post-manipulation tool within the spine showed a relatively high level of responsiveness/efficacy of motion palpation. However little research has yet to be conducted on the use of motion palpation as a post-manipulation tool on the extremities and therefore this study aims to provide a clearer insight into the use of motion palpation as a post-treatment assessment tool in an extremity in terms of clinical responsiveness/validity of motion palpation. Furthermore the relationship between motion palpation and other clinical measures/short term outcomes, such as pain, functionality, range of motion and proprioception has yet to be seen i.e. when motion palpation indicates a reduction in a fixation due to manipulation does this correlate to a decrease in pain and increase in functionality, range of motion and proprioception. Therefore the primary aim of this study was to determine the clinical responsiveness of motion palpation as a post-manipulation diagnostic tool within the joints of the ankle in symptomatic participants with Chronic Ankle Instability (CAI). Method: Forty participants with CAI (Grade I and II) were recruited. One Group received manipulation (n=21), the other Group received no treatment (n=19). Motion palpation was performed, and subjective/objective measures were taken in both Groups pre- and posttreatment. Statistical analysis was performed using SPSS 15.0. Results: The findings of this study demonstrated that when using motion palpation as a posttreatment assessment tool a high level of responsiveness was observed (a highly significant association between being manipulated and End-Feel Improvement (EFI) occurred (p<0.001)); it was highly sensitive (0.90); and was highly specific (0.95). Overall no statistically significant association was observed in either group between, motion palpation results (with respect to EFI or no EFI noted) and any of the short term outcomes (the five subjective/objective clinical measures). Within the manipulation group; Visual Analogue Scale (VAS) (p=0.944), Functional Ankle Disability Index (FADI) (p=0.490), Pressure Algometer v (p=0.634), Berg Balance Scale (BBS) (p=0.512) and Weight Bearing Dorsiflexion (WBD) (p=0.966). In comparison, the control group; Visual Analogue Scale (VAS) (p=0.063), Functional Ankle Disability Index (FADI) (p=0.491), Pressure Algometer (p=0.828), Berg Balance Scale (BBS) (p=0.695) and Weight Bearing Dorsiflexion (WBD) (p=0.747). The most common fixations noted in this study, were mortise Long Axis Distraction (LAD), subtalar LAD and subtalar eversion. Conclusion: Therefore, motion palpation appears to be valid when used as a post-treatment tool in the foot and ankle; and overall, common fixations found in symptomatic participants with CAI in this study are similar to those found in previous studies.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2018. / Background: Cervicogenic headaches are usually chronic, debilitating and tend to be unresponsive to common headache medications. Manual therapy has been shown to be an effective form of management for cervicogenic headache. The Electromechanical Adjusting Instrument is a hand-held device offered as an alternative to manual therapy for musculoskeletal treatment. Aim: The aim of this study was to determine the effectiveness of the Electromechanical Adjusting Instrument compared to cervical spine manipulation in terms of subjective and objective measures in the treatment of cervicogenic headache. Methodology: This study was a randomised single-blinded clinical trial. There were 41 participants between the ages of 18 and 59 years who were randomly divided into two groups of 21 and 20 respectively by means of a randomisation table drawn up by the statistician. Participants in Group A received cervical spine manipulation while those in Group B received the Electromechanical Adjusting Instrument. Subjective headache intensity was determined using a Numerical Pain Rating Scale. The effect of neck pain on the participants’ activities of daily living before and after treatment was assessed using the Neck Disability Index. The effect of the headache on the participants’ activities of daily living before and after treatment was assessed using the Headache Disability Index. Objective cervical range of motion in all six planes of motion was assessed using a CROM goniometer. Participants in both groups received six interventions over a three-week period with a minimum interval of 48 hours between each intervention. The subjective and objectives assessments were taken at baseline, post-third and post-sixth interventions. The data was analysed using the IBM SPSS version 24.0. Repeated measures ANOVA was used to examine the effect on each outcome measure separately of time and treatment group interaction. Profile plots were generated to show the rates of changes in outcomes over time by the intervention group. A p value <0.05 was considered statistically significant. Results: For most of the outcomes, there was no clinical or statistical interaction present, i.e. the intervention effect was similar in both groups irrespective of the intervention. Conclusion: The trends in each of the outcomes suggest that the Electromechanical Adjusting Instrument is as effective as cervical spine manipulation for the treatment of cervicogenic headache / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1997. / There have been few studies performed to determine the combined effects of spinal manipulative therapy with other modalities known to have beneficial physiological effects, especially in terms of mechanical low back pain (Ottenbacher and Difabio 1985). / M

Dissertation submitted in compliance with the requirement for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / The purpose of this study was to compare the effects of McMannis traction and Intermittent traction, both m conjunction with chiropractic manipulation in the treatment of chronic i.e. longer than four weeks, mechanical lower back pain. It was hypothesised by the author that McMannis traction would be the traction treatment of choice, as it enables the joints of the lumbar vertebrae to be moved through their normal anatomical range of motion while being traeticned axially. In addition this type of traction is more specific and allows the therapist to determine the amount of traction that is being applied to the patient because it is being applied manually. Intermittent traction on the other hand is a motorised non-specific traction and affects several joints at one time (Saunders 1979). / M

M. Tech. / Background: No substantiated theory exists by which chiropractic adjustments are known to correct myofascial trigger points (MTrPs). Myofascial trigger points are theorized to be either a primary muscle dysfunction or a secondary manifestation to central/ peripheral neurological mechanisms. Chiropractic adjustments are theorized to exert their therapeutic influence either primarily through biomechanical effects and/ or via neurophysiological mechanisms. Objective: The objective of this study was to investigate the effects of chiropractic adjustments on chronic, active rhomboid MTrPs, by comparing the clinical effects attained with rhomboid attachment-segment (C7-T5) relative to rhomboid innervation-segment (C4 and/ or C5) chiropractic adjustments. Setting: University of Johannesburg Chiropractic Day Clinic in Johannesburg, Gauteng. Participants: Thirty female subjects selected from the general population (from 18 to 40 years) were randomly divided into two different treatment groups of 15 each. Methods: The subjective information required the completion of the Subjective Pain and Discomfort Questionnaire, including the Numerical Pain Rating Scale (NPRS). The objective measures collected were pressure-pain threshold (PPT) and range of motion measurements using the algometer and digital inclinometer, respectively. Additionally, the change in the number of active MTrPs over the treatment period was recorded. All measurements were recorded at the first, third and fifth consultations, over a 3 to 4 week period. The data gathered were then statistically analyzed with the use of a 95% confidence interval. The nonparametric Friedman and Wilcoxon Signed Rank tests were used for the intragroup comparisons, and the Mann Whitney- U test was used for the intergroup comparisons. Interventions: Treatment group 1 received upper-thoracic/ attachment- segment chiropractic adjustments, and treatment group 2 received mid-cervical/ innervation-segment chiropractic adjustments. The research project was carried out so that both groups received 5 treatment sessions over 3 to 4 weeks. Results: There were no statistically significant results obtained for intergroup comparisons. Attachment-segment chiropractic adjustments revealed statistically significant changes in NPRS values (p=0.000), PPT values (p=0.000), cervical spine right lateral flexion range (p=0.004), thoracic spine extension (p=0.005) and left rotation range (p=0.003) over time. Innervationsegment chiropractic adjustments revealed statistically significant changes in NPRS values v ii (p=0.001), cervical spine right rotation (p=0.003), thoracic spine flexion (p=0.001) right lateral flexion (p=0.001) and left rotation (p=0.005) over time. Conclusions: This study does not suggest that attachment-segment or innervation-segment chiropractic adjustments possess greater clinical efficacy relative to one another in terms of improving the clinical picture associated with chronic, active rhomboid MTrP activity. In a further study, a larger sample size will be necessary to identify subtle changes in measurement parameters.

M.Tech. / Purpose: This study aims to compare the effects of chiropractic manipulation versus mobilisation on Pressure Pain Threshold in chronic posterior mechanical cervical spine pain sufferers with regards to pain, disability and cervical spine range of motion. These effects were evaluated using a questionnaire consisting of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire, and by measuring cervical spine range of motion using a Goniometer as well as Algometer readings over the restricted facet joint/s in the cervical spine. The questionnaires were completed and the range of motion readings and algometer readings were taken prior to treatment on the first, fourth and seventh consultations. Method: Thirty participants who met the inclusion criteria were divided into two groups of equal size (15 participants each). Group one received spinal manipulation to restricted cervical spine joint/s. The second group received spinal mobilisation to restricted cervical spine joint/s. Participants were treated six times out of a total of seven sessions, over a maximum three week period. Procedure: Subjective data was collected at the beginning of the first and fourth consultations, as well as on the seventh consultation by means of a McGill Pain Questionnaire, and a Vernon – Mior Neck Pain and Disability Questionnaire in order to assess pain and disability levels. Objective data was collected at the beginning of the first and fourth session, as well as on the seventh consultation by means of a Goniometer and Algometer in order to assess cervical spine range of motion and to measure the Pressure Pain Threshold at the restricted facet joint/s in the cervical spine. Analysis of collected data was performed by a statistician. Results: Clinically significant improvements in group 1 and group 2 were noted over the duration of the study with reference to pain, disability, and cervical spine range of motion. Statistically significant changes were noted in group 1 and group 2 with reference to pain and disability, and in group 1 and group 2 with v reference to certain cervical spine range of motions as well as algometer readings to measure the Pressure Pain Threshold at the restricted facet joint/s. Conclusion: The results show that both spinal manipulation and mobilization are effective treatment protocols (as demonstrated clinically, and to a lesser extent, statistically) in decreasing pain and disability, and increasing cervical spine range of motion and most importantly Pressure Pain Threshold at the restricted facet joint/s in patients with chronic posterior mechanical cervical spine pain. Although the study did not allow for a definite conclusion to be drawn, the results suggest that Chiropractic manipulative therapy is an effective treatment protocol to increase the Pressure Pain Threshold in chronic posterior mechanical neck pain sufferers. The advantage of this is that the treatment modality is used to its full potential, thereby providing the patient with the best results in terms of lasting benefits. It also shows that in cases where manipulation is contra-indicated mobilization will have a similar effect, but the long term benefits are questionable.

M.Tech. / Soccer is the most widely played sport in the world and, of all the skills required to participate, the instep soccer kick is considered to be the primary offensive action within the game of soccer. Biomechanical analysis of the instep soccer kick has revealed that the action of kicking is characterised by a proximal to distal series of multi-articular movements with distal segmental movements being predetermined by more proximal ones (Kellis and Katis, 2007). According to Smith, Gilleard, Hammond and Brooks (2006), the lower spine and pelvis play a pivotal role in determining the placement and actions of distal segmental motion during the action of the instep soccer kick. The aim of this study was to determine the effectiveness of chiropractic adjustments in soccer players with lumbar facet and sacroiliac joint dysfunctions by assessing the resultant speed of a soccer ball once kicked with an instep soccer kick. By correcting the lumbar facet and sacroiliac joint dysfunction of the affected soccer players, it was postulated that with restoration of joint motion and reduction of pain, the speed of the soccer ball, when kicked, would improve. When kicked the resultant ball speed is indicative of biomechanical kicking success. Thirty male professional soccer players from the Jomo Cosmos football establishment who met the study’s selection criteria were selected and randomly divided into one of two groups. The study group received chiropractic adjustments of dysfunctional lumbar facets and sacroiliac joints and the control group received a placebo treatment in form of a de-tuned stationary ultra-sound head over the effected facets joints for five minutes. Treatment for both groups occurred over a two week period with treatment being administered twice a week, totalling of four treatments per participant. Data capture was collected 3 times over the 2-week period; 1st reading done before the 1st treatment, the 2nd reading before the 3rd treatment and the final reading taken after the 4th and final treatment. Data capture consisted of both subjective and objective readings. The subjective data consisted of the measurements of pain experienced by the participants in the form of a Numerical Pain Rating Scale. Objective data involved the measurement of ball speed once kicked, with the use of a radar speed gun as well as lumbar spine range of motion measurements by means of a Digital Inclinometer. In executing the group comparisons, it was found that both groups would present with contrasting results. The group undergoing the chiropractic adjustments would show an improvement in their ball speed, reduction in their overall pain and increased lumbar spine extension and rotation ROM; where as the group undergoing the placebo treatment experienced a decrease in their ball speed, an increase in their overall pain and decreased lumbar spine ROM. The results obtained from the study demonstrated that the majority of the data was not statistically significant in either of the groups however, from a clinical perspective there was a definite effect on the lumbar spine range of motion, ball speed and pain reduction as a result of the Chiropractic adjustments that would warrant further investigation. There is a definite link with the negative effects that lumbar facet and sacroiliac joint dysfunctions have on the proximal to distal sequence of events that take place during the instep soccer kick. Therefore, treating the lumbar facet and sacroiliac joint dysfunction with chiropractic adjustments allows for better transfer of energy between segments and for greater resultant ball speed. In conclusion, the study demonstrated that chiropractic adjustment of lumbar facet and Sacroiliac joint dysfunctions showed good improvement in the resultant ball speed, reduction in lower back pain and improved lumbar spine extension and rotation ROM. From these results, it would be prudent to incorporate more chiropractic treatment into mainstream soccer and encourage further research into the advantages that chiropractic treatment has in better understanding the biomechanics involved in the instep soccer kick.

M.Tech. / Purpose: This study was undertaken in order to demonstrate the effects of static magnetic field therapy on acupuncture points in the treatment of those suffering from mechanical neck pain. Isolated spinal manipulative therapy of the cervical spine was compared to spinal manipulative therapy of the cervical spine in conjunction with magnetic field therapy on acupuncture points using both objective and subjective measurements. Before the execution of this study, it was hypothesised that both treatment protocols would be effective in the treatment of mechanical neck pain, although the combined therapy would be more effective. Method: Patients were recruited by way of advertisements placed in and around the University of Johannesburg, Doornfontein campus and their health clinic. Thirty patients with mechanical neck pain were recruited and randomly divided into two groups. Group one received manipulation to the affected joints of the cervical spine and group two received manipulation to the cervical spine combined with magnetic field therapy on acupuncture points. Procedure: Each patient in each group attended six treatment sessions; three in the first week and three in the second week. The Vernon Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale (subjective measurements) were completed by each patient and the Cervical Range of Motion instrument (objective measurements) was used to collect readings from each patient in both the control and experimental groups, subjective and objective measurements were taken before treatment one, three and six. Specific treatment protocols were then adhered to. Results: The results indicated that both treatment protocols were effective in reducing mechanical neck pain although not one group was more effective than VI the other. Both groups improved subjectively and objectively as they had cervical spinal manipulation directed at joint dysfunction. Conclusion: The experimental group who received spinal manipulative therapy to correct joint dysfunction in conjunction with magnetic field therapy on acupuncture points was not more effective than the control group who received spinal manipulation only, in the treatment of mechanical neck pain.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / One of the most common clinical disorders known is mechanical low back pain (Painting et al. 1998:110). A significant source of low back pain is the sacroiliac joint and therefore, according to Schwarzer et al. (1995:31), it warrants further study. With respect to treatment, Gatterman (1995) states that specific manipulative therapy is the treatment of choice for sacroiliac dysfunction. This is supported by clinical studies (Cassidy et al., 1992), which have shown significant improvement with daily manipulation over a 2-3 week period in 90% of the patients suffering from sacroiliac dysfunction. Different adjusting techniques for the sacroiliac joint include side posture adjustment and prone drop piece adjustments (Bergmann, 1993). With respect to side posture, Bergmann (1993) further states that the side posture adjustment is the most common position used. However, it has been noted that side posture can produce unwanted rotation in the lumbar spine. This may be detrimental to patients who have contra-indications to torsioning such as abdominal aortic aneurisms, nerve root entrapment or disc pathology. Patients, who experience anterior catching of the hip capsule or decreased flexibility with side posture adjustments, experience more discomfort and could therefore benefit from a different technique (Gatterman, 1995). Hence the need for an effective adjustment technique that does not rely on torsioning (e.g. drop piece technique). (White, 2003; Pooke, 2003; Hyde, 2003; Pretorius, 2003; Haldeman, 2003; Cramer, 2003; Engelbrecht, 2003). Although drop table thrusting techniques were rated as being effective for the care of patients with neuromuskuloskeletal problems (Haldeman et al., 1993) as cited by Gatterman et al., (2001), it is still unknown which specific drop piece technique is the most appropriate for sacroiliac dysfunction. Therefore this study was aimed at determining the efficacy of a toggle recoil drop piece adjustment technique. / M