Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial Pain Syndrome is a condition characterized by the development of hyperirritable foci in muscle. Treatments include modalities such as cryotherapy, electrotherapy, ultrasound, ischeamic compression and dry-needling, the latter of which is reported to be the most effective. A side-effect of dry-needling is post-needling soreness which results from bleeding in the area of needle insertion. The application of heat as a therapy to an injured area has been reported to decrease pain by blocking nociceptors, decreasing muscle spasm, and increasing connective tissue extensibility. Objectives: To determine the relative effectiveness of heat therapy immediately after dry-needling versus dry-needling alone on post-needling soreness in the deltoid muscle of asymptomatic subjects. This was done in terms of subjective and objective clinical findings. Methodology: This study was designed as a randomised, parallel-controlled clinicaltrial. Thirty asymptomatic subjects were used. Each subject acted as their own control in that both the left and right arms of each subject were dry-needled. One of the arms received heat therapy after the dry-needling procedure while the other arm acted as a control. Algometer readings, a Numerical Pain Rating Scale-101 (NRS- 101) and a 24 Hour Pain Diary were used as assessment tools. Algometer and NRS-101 readings were taken before and after the dry-needling procedure and during the 24 hour follow up visit. Subjects used a 24 hour pain diary which was filled out at 3 hour intervals, to record the development of post-needling soreness. Independent samples t-test and Pearson’s chi square test were used to compare age and gender between the treatment groups. Repeated measures ANOVA testing was used to compare the effect of heat treatment with no heat treatment in the 60 arms over the three time periods of assessment for the outcomes which were 4 5 measured as continuous variables (NRS-101 and algometer). For binary outcomes such as the presence or absence of pain at any time point, Fisher’s exact tests were used to compare the heat treated with the control arms in the left and right arms separately. A p value of less than 0.05 was considered as statistically significant. Results: Both the objective and subjective measurements from the heat intervention and control groups revealed the development of post-needling soreness. There was a slight trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings which was however, not found to be statistically significant. Conclusion: Although the results of the study revealed no statistical evidence of a beneficial effect of heat therapy on objective or subjective findings clinical significance could not be excluded due to the observed trend of heat therapy decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary) and objective (algometer) findings. Further investigation is recommended.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2012. / Background : A lack of peaceful sleep and adequate neck support during sleep has been described as a significant contributing factor to the development of chronic non-specific neck pain. Health-care practitioners often prescribe a cervical pillow for the treatment of chronic non-specific neck pain despite the ambivalent findings of several studies. Recently Simmons South Africa introduced the Simmons Beautyrest® pillow which it claims is able to support the cervical spine and promotes a restful sleep. This study, therefore, set out to determine the potential of the Simmons Beautyrest® pillow in alleviating chronic non-specific neck pain. Objective : This study aimed to determine the effectiveness of the Simmons Beautyrest® pillow compared to the participant’s usual pillow (the control) in terms of objective and subjective findings in the management of chronic non-specific neck pain. Methods : Forty individuals, aged 18 to 45 years of age, experiencing chronic non-specific neck pain were recruited via convenience sampling. The study was a single-blinded, cross-over interventional study. All participants underwent a case history, physical and cervical orthopedic examination. Objective (algometer and Cervical Range of Motion measurements) and subjective (Numerical Pain Rating Scale, Neck Disability Index, Sleep and pain diary) outcome measures were obtained at each of the five consultations over a four week period, with the cross-over occurring after two weeks. SPSS version 18.0 was used to analyze the data. Demographic data was analyzed using the Chi square tests and t-tests. The consultations were averaged for each phase of the cross over design to result in a two treatment, two period cross over design. Repeated measures ANOVA testing was used to evaluate the effect of the intervention on subjective and objective measurement according to the method of Dallal (Esterhuizen, 2011). The sleep and pain diary data was analyzed using repeated measures ANOVA and Wald chi square test. Results : A significant difference in the perceived comfort levels between the two pillows (p < 0.001) was observed with the Simmons Beautyrest® pillow having a higher comfort rating. A significant decrease in NRS scores (p = 0.018); NDI scores (p < 0.001); and NRS scores on awakening (p < 0.001); neck stiffness rating on awakening (p < 0.00); headache rating on awakening (p = 0.043) was observed in relation to the Simmons Beautyrest® pillow. A significant improvement (p = 0.001) in algometer readings was observed when using the Simmons Beautyrest® pillow when compared to participants usual pillow. A significant increase in mean right lateral flexion measurements was observed in both groups when using the Simmons Beautyrest® pillow (p = Conclusions : The Simmons Beautyrest® pillow was effective in improving chronic non-specific neck pain. It was regarded as comfortable and provided relief with regards to the clinical features of non-specific neck pain. / Simmons South Africa Company

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to compare two forms of mobilization in the treatment of symptomatic Hallux abductovalgus (bunions). The study was a prospective, randomized clinical trial involving sixty subjects, thirty in each group, which were selected by means of convenience sampling from the general population within the greater Durban area. Group A received a Strain counter-strain mobilization (SCSM) of the first metatarso- phalangeal joint, used in conjunction with cryotherapy. Group B received Brantingham's mobilization (BM) of the first metatarso-phalangeal joint, used in conjunction with cryotherapy. Each group received five treatments over a two-week period and were required to attend a one-week follow up consultation for data collection. Subjective assessment was carried out by means of the Numerical Rating Scale-101 (NRS-101) and the Foot Function Index (FFI). Objective assessment included measuring the pain pressure threshold using a digital algometer, the hallux valgus angle and passive dorsiflexion and plantarflexion of the first metatasal phalangeal joint were also measured using a goniometer. The Hallux-metatarsophalangeal-interphalangeal Scale (HAL) included assessment of both subjective and objective measurements. Subjective and objective assessments were performed and data collected on the first, third, fifth and one week follow up consultations. Statistical analysis was completed at a 95% confidence interval. Inter-group analysis was done, using the Mann-Whitney U-test for subjective data and the unpaired t-test for objective data. Intra-group analysis was carried out using Friedman’s test and Dunn’s procedure. In terms of subjective findings, both groups revealed a statistically significant improvement in terms of pain perception (NRS-101) over the treatment period. Both groups experienced a significant improvement in the Foot Function Index (FFI) in terms of pain and disability. Despite both groups improving, it seemed that Group B (Brantingham’s Mobilization) improved considerably more that Group A ( Strain counter-strain mobilization) when comparing the percentage improvement over the treatment period. / M

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Health care practitioners have known for some time that patients benefit from specific manual intervention effects, but also from the manner in which these are presented. The latter at times having as much impact on patient health as the former. Thus the purpose of this study was to determine the effect of the clinical ritual during instrument assisted adjusting whilst managing mechanical lower back pain. The study was a randomized prospective study comprising of sixty participants aged 18-59. These individuals were randomly allocated into two groups of thirty and then further stratified to control for gender. Both Groups were diagnosed according to the Activator Methods Chiropractic Technique (AMCT), however the tension was set at maximum for group A, whilst the device was set to the minimum tension for group B. Each patient received three treatments and one follow up visit over a two-week period. Subjective data was collected at the first, third and follow up visit. Subjective data was recorded using the Visual Analogue Scale, the Numerical Pain Rating Scale, the Roland Morris Questionnaire and the Short-form McGill Pain Questionnaire. Outcomes were analysed through with the SPSS statistical package at a 95% level of confidence. After analysis of the collected data it was found that there was no statistical difference between the groups, but there was a non-specific trend suggesting a better outcome in the full tension activator group (Group A). Thus, the research indicated that patients perceptions, the patient-practitioner relationship, and the assumption of an outcome of success as well as the power of placebo or non-specific effects play a large role in the managing of lower back pain in a chiropractic environment. / M

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Technikon Natal, 2002. / The purpose of this study was to determine the efficacy of a conservative chiropractic management approach in the treatment of symptomatic hallux abductovalgus (bunions). The study was a prospective, randomised clinical trial involving sixty subjects, thirty in each group, which were selected from the general population. Group A received a conservative chiropractic management approach, encompassing progressive mobilization of the first metatarsophalangeal joint, used in conjunction with cryotherapy and adjustment of all other fixations found in the foot and ankle. Group B received a placebo treatment by means of de-tuned Action Potential Therapy administered to the involved foot. Each group received six treatments over a two-week period and attended a one-week follow up consultation for data collection. Objective assessment was performed by measuring the pressure pain threshold using a digital algometer. Subjective assessment was by means of the Numerical Rating Scale-101 (NRS-101) and the Foot Function Index (FFI). The Hallux-metatarsophalangeal-interphalangeal Scale (HAL) incorporated assessment of both objective and subjective measurements. Assessments were taken at the first, third, sixth and one week follow-up consultations, for all the subjective and objective data. Statistical analysis was completed under the supervision of Mr K. Thomas at . the Technikon Natal, at a 95% confidence interval. The parametric two-sampled paired t-test, the Friedman's test and the Dunn's post test were used to analyse the data within each group (intra-group analysis), whilst the parametric two-sampled unpaired t-test and the non-parametric Mann Whitney unpaired U-test were used to analyse the data between the two groups (inter-group analysis). / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1998. / Purpose: The purpose of this study was to determine the relative effectiveness of two seemingly different approaches to manipulation of the cervical spine in the treatment of cervical spine dysfunction. The researcher postulated that a manual manipulation would have a greater effect in reducing pain and increasing range of motion that accompanies cervical dysfunction than an instrumental, low force, high velocity thrust delivered by means of an Activator Adjusting Instrument. The reason for this is that it provides greater joint movement. Methods This randomised controlled trial consisted of two treatment groups. Each group consisted of 15 subjects, between the ages of 16 and 65 years, selected from the general population and randomly allocated to treatment group A or B. Group A received instrumental thrusts delivered by an Activator Adjusting Instrument (AAI), while group B received standard diversified manual manipulations to the dysfunctional joints in the cervical spine. Each subject was assessed by using subjective measures of the CMCC Neck Disability Index, Numerical Pain Rating Scale and McGill Short- Form questionnaire; and the objective measure of degrees of cervical range of motion obtained using a cervical goniometer (CROM). Two tailed statistical analysis was conducted at a = 0.05, using the non-parametric Wilcoxin Signed Rank Test and the Mann-Whitney U Test comparing intra-group and inter-group data respectively. Further assessment of the data was conducted using power analysis. This data as well as the descriptive statistics were presented in tables and bar charts. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic at Technikon Natal, 1999. / The purpose of this study was to determine the efficacy of patella mobilization in patients suffering from patellofemoral pain syndrome, This was a prospective, randomized, placebo controlled, pilot study, Group A received patella mobilization, while Group B, the placebo group, received detuned ultrasound, The study involved 30 subjects, 15 in each group selected from the general population, Each subject was treated eight times within a four week period, however if they became asymptomatic prior to their eighth treatment the subjective and objective data normally collected on the eighth treatment was collected on their last consultation, patients were required to return for a one month follow-up from the date of their last consultation, Each subject was assessed by means of the short-form Mc Gill Pain Questionnaire, Numerical Pain Questionnaire and the Patient-Specific Functional Scale, Objectively their pressure-pain threshold and tolerance was assessed by means of an algometer, Assessments were taken at the first, eighth, and follow-up consultation for all the subjective and objective measurements, Algometer readings were also obtained at the fourth consultation, the pressure was applied at approximately one kilogram per centimeter squared per second, Excessively high or low readings were retaken, Statistical analysis was completed under the guidance of the statistician at Technikon, Natal, using the non-parametric Wilcoxon sign-rank test and the Mann- Whitney unpaired test comparing intra-group and inter-group data respectfully, / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / This study was done in order to compare the effectiveness of chiropractic treatment in association with a wellness approach, to chiropractic treatment without a wellness approach in the management of Mechanical Low Back Pain. Low back pain is an enormous problem in today's society. Vast amounts of money are spent annually on the investigation into and treatment of low back pain, and numerous work days are lost due to absenteeism. Chronic low back pain also affects the individual's life\xB7style, and can lead to psychological problems. Thousands of low back operations are done yearly, with a significantly high failure rate. (Frymoyer et al. 1980.) In this study factors such as cost, recovery tine and incidence of reoccurrence were used as criteria to determine the effectiveness of chiropractic treatment applied to the two groups of patients. The concept of holise was applied to one group, whereas the other group was treated without this approach. The study was conducted as a clinical trial, with two experimental groups. Thirty patients who had responded to an advertiselOent were selected and randomly divided into two groups. The patients were selected fro~ the general population on the grounds of their signs and sylllptoos. Group A received chiropractic treatment in association with the wellness approach. This comprised patient education in the form of guidance towards life-style changes and exercises. Patients were also given a detailed explanation of their problems, leading to an understanding of their conditions. Group B received chiropractic treatment only. Their condition was not explained, and they did not receive any of the holistic aspectts mentioned for group A. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal,1997. / Asthma, one of the most frustrating medical conditions known to man, has been a thorn in the side of physicians world wide. A condition that seems to consist of all exceptions and no rules has resulted in endless debates regarding the correct treatment protocol for its management, which at present only seem to subdue the patient's symptomatology rather than eliminate them. The ever increasing number of asthmatic sufferers and the increasing number of deaths related to asthma are both reflections of the inadequacy of present treatment protocols and therefore demonstrate the need for their revision. It is thus the aim of this study to ascertain the therapeutic efficacy of spinal adjustive procedures a n the management of asthma. Patients were obtained for this study by consecutive sampling, whereby any patients presenting to the Chiropractic Clinic at Technikon Natal, as a response to the newspaper adverts and pamphlets placed ln the greater Durban area, were considered for the study. Of these patients, only those who conformed to the specified delimitations and diagnostic criteria were accepted. The study was divided into 3 distinct periods. The first, called the baseline study, required the entire sample of 30 patients to undergo subjective and objective tests, whilst receiving no chiropractic treatment, in order to establish the patients' astrunatic condition. The second period, called the initial treatment period, required the entire sample to undergo further subjective and objective testing while receiving chiropractic treatment, which comprised soft tissue therapy and adjustments of fixations in the CO-C2 and T2-T7 areas. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / According to research, continuing symptoms of pain, instability, crepitus, weakness, stiffness (Pellow and Brantingham, 2001) and swelling (Patel and Warren, 1999:332) commonly follow an acute ankle sprain. The cause of these symptoms is often attributed to the development of a tight sensitive scar (Reid, 1992:251) within the injured ligament. The treatment options available include scar tissue debridement (Bassewitz and Shapiro, 1997), manipulation (Edmond, 1993:164), mobilization, (Hockenbury and Sammarco, 2001) and ultrasound (Thomson, Skinner & Piercy, 1991:43-44). Transverse friction massage could also be used to reduce adhesions (Kessler, 1990:85) and improve mobility of the tissues (Kessler, 1990:140). The Graston Technique Instrument Assisted Soft Tissue Mobilization (GTIASTM) comprises a set of stainless steel instruments (Carey 2003:2) designed to detect and reduce scar tissue and adhesions (Carey 2003:7) by bringing about an area of controlled microtrauma (Hammer, 2003(b):1) and inflammation (Carey 2003:32) through a mechanism similar to that of friction massage. / M