Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Purpose: Ankle sprains are amongst the most common injury sustained by athletes and the general public. When an ankle is repeatedly sprained it results in chronic ankle instability syndrome (CAIS). This repeated trauma results in disruption of the afferent nerve supply from the injured joint, which affects the motor neuron pool excitability of the peroneal and soleus muscles resulting in arthogenic muscle inhibition (AMI). Traditional treatment for CAIS focuses on rehabilitation of the affected muscles via strength and proprioceptive training. Recent literature has shown that the addition of ankle joint manipulation resulted in improved clinical outcomes in the treatment of CAIS. The mechanism on how joint manipulation affects AMI is under-investigated especially in extremity joints. Thus this study aimed to determine the immediate effect of ankle joint manipulation on peroneal and soleus muscle activity, by assessing surface electromyography (sEMG) H/M ratio to detect a change in the proportion of the total motor neuron pool being recruited, in participants with CAIS. Methods: The study utilised a quantitative, experimental, pre-test post-test study design. Forty two participants with grade I and II CAIS, aged 18-45 years, were randomly allocated into one of three groups. Group one received a single talocrural joint long axis distraction manipulation, group two received a sham manipulation and group three was the control receiving no intervention. sEMG H/M ratio measurements were taken before and immediately after the intervention using a Biopac wireless emg system. Results: The groups were comparable at baseline for age, gender, body mass index and H/M ratio measurements for the soleus and peroneal muscles (p < 0.050). Intra-group analysis of the soleus muscle H/M ratio showed no statistically significant change over time for the manipulation (p = 0.975) and sham (p = 0.056) groups, with the control group showing a statistically significant (p = 0.019) decrease in the H/M ratio. For the peroneal muscle no statistically significant (p > 0.050) differences were observed in any of the three groups. Inter-group analysis of the soleus muscle H/M ratio measurements showed no statistically significant differences between the three groups (p = 0.470; F = 1.010) over time, with Tukey’s HSD post-hoc test revealing a statistically significant (p = 0.028) difference being observed between the sham and control groups in terms of post soleus muscle H/M ratio measurements. Conclusion: This study failed to show that ankle joint manipulation affects the soleus and peroneal muscles in terms of H/M ratio measurements in participants with CAIS. There may have been a trend of an effect of the sham and manipulation interventions counteracting the muscle fatigue experienced in the control group, however further investigation is required. / M

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was to determine the inter-examiner reliability of motion palpation to detect joint dysfunction in hindfoot and midfoot joints of asymptomatic feet and feet with chronic ankle instability syndrome. The rationale for this study was that motion palpation is a commonly used assessment tool that is used by the chiropractic profession to detect the need for manipulation of the spine and extremities. Also until the reliability of motion palpation is known, other studies using motion palpation as an assessment tool to detect the need for manipulation in the hindfoot and midfoot are questionable. The study was conducted at Durban University of Technology (DUT). Patients that responded to the adverts were then screened via telephonic interview. The researcher performed a case history, physical examination and a foot and ankle regional examination on each patient. Three masters chiropractic students then independently assessed both the symptomatic and asymptomatic feet of each patient and recorded their results. The data was then statistically analysed using SPSS version 15. It was found that the inter-examiner reliability of motion palpation for detecting restrictions in feet with chronic ankle instability syndrome was fair and for detecting instability, there was moderate reliability. In the asymptomatic group the examiners showed to have poor reliability in detecting restrictions and moderate reliability in detecting instability. Inter-examiner reliability was better in the symptomatic group and in this group examiners had more agreement on detecting instability as opposed to restrictions. This study has showed that inter-examiner reliability ranged from poor to moderate in the symptomatic and asymptomatic group with the reliability ranging from poor to moderate. Therefore, one can conclude that motion palpation can be used as an assessment tool to detect joint dysfunction in hindfoot and midfoot joints. However, further studies are warranted to address other subjective and objective measurements such as tenderness and range of motion together with motion palpation.