M.Tech. (Chiropractic) / Headache is the most common type of pain and is one of the most frequent reasons for medical consultation (Rasmussen, 1995). Tension-type headaches cause substantial levels of disability for the patient as well as the global society because of its high prevalence in the general population (Stovner, Hagen, Jensen, 2007). Tension-Type headache is a primary headache commonly found in three forms: infrequent episodic, frequent episodic and chronic with or without pericranial tenderness (International Headache Society, 2009). The aim of this study was to determine the effectiveness of chiropractic manipulation of the temporomandibular joint in conjunction with ischemic compression of the lateral pterygoid muscle as a treatment protocol for tension-type headache. Method: This study consisted of three groups of sixteen participants each with tension-type headaches. The participants were between the ages of 18 and 25 years of age. Potential participants were examined and selected based on the inclusion and exclusion criteria. Group one received chiropractic manipulation of the temporomandibular joint. Group two received ischemic compression of the lateral pterygoid muscle. Group three received a combination treatment of chiropractic manipulation of the temporomandibular joint and ischemic compression of the lateral pterygoid muscle. Objective and subjective finding were based on the treatment sessions. Procedure: All participants received a total of six treatments over two weeks followed by a seventh visit which consisted of data gathering only. The subjective data collected was in the form of a TMJ symptom questionnaire completed at visit one and seven and a Headache Disability Index (HDI) completed at visits one, three and seven. TMJ motion was measured by means of a vernier caliper.

A thesis presented in partial compliance wnh the requirements for the Master's Degree in Chiropractic, Technikon Natal, 1999. / Sacroiliac syndrome is a common condition causing low back pain (Mierau et al. 1984, Guo and Zhao 1994). It is a painful, debilitating condition that may cause considerable discomfort (Haldeman 1992:220). According to Frymoyer et al. (1991:2114), sacroiliac syndrome is a frequently overlooked source of low back pain as it may mimic other well known causes of low back pain / M

M.Tech. / This study was conducted to determine the effect of Sacroiliac joint adjustment to the restricted Sacroiliac joint in combination with myofascial dry needling to the active/latent Rectus Femoris muscle trigger point and Rectus Femoris myofascial dry needling on its own on Quadriceps Femoris muscle strength. Thirty participants between the ages of 18 and 40 years were recruited through the use of advertisements placed in and around the University of Johannesburg’s Chiropractic Day Clinic. Participants were assessed for exclusion criteria by performing a Full Case History, Pertinent Physical Examination, Lumbar Spine and Pelvis Regional Examination and S.O.A.P note. The participants who conformed to the specific inclusion criteria were accepted for this study. These participants were randomly placed into two groups of sixteen participants each. Group One receive Sacroiliac joint adjustment to the restricted Sacroiliac joint and ipsilateral myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger points. Group two received myofascial dry needling of the Rectus Femoris muscle active/latent myofascial trigger point on the same side as the Sacroiliac joint restriction. Each participant received five treatments over a three week period, i.e. two treatments for the first two weeks and one follow-up treatment in the third week. The subjective data of the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the Isometric Dynamometer measuring the Quadriceps Femoris muscle strength before and after each treatment. In addition the Algometer was used for measuring the pressure pain threshold of the Rectus Femoris trigger points. An analysis was performed using Repeated Measures Analysis, t-Test, Frequencis, Descriptives and Friedman’s Tests. The results of this study demonstrate that Sacroiliac joint adjustment to a restricted Sacroiliac joint with ipsilateral myofascial dry needling of the Rectus Femoris muscle showed a statistically significant, but temporary increase in Quadriceps Femoris muscle strength. Myofascial dry needling of the Rectus Femoris muscle on its own was found to be statistically insignificant for the increase in Quadriceps Femoris muscle strength.

M.Tech. / The aim of this research study was to determine the most effective way of treating sacroiliac joint dysfunction with associated gluteus medius trigger points, using adjusting of the sacroiliac joint or needling of the gluteus medius muscle or both. The participants were recruited randomly and placed in 3 different groups. Participants in group 1 were treated with an adjustment of the sacroiliac joint, as well as needling of the most prominent gluteus medius trigger point. Participants in group 2 were adjusted only and participants in group 3 were needled only. The treatment of the participants took place at the University of Johannesburg’s chiropractic day clinic. The objective data was acquired using a Digital Inclinometer to measure the ranges of motion at the spinal levels of the 5th lumbar vertebra and the first sacral vertebra (L5/ S1). An Algometer was used to measure the amount of pressure required to evoke pain, within the most prominent trigger point being treated. The subjective data was acquired using the Oswestry Pain and Disability Questionnaire, as well as the Numerical Pain Rating Scale. The results of the trial were of no statistical significance, but clinical improvement in both objective and subjective data was found. Group 2’s mean value percentage improvement was the greatest, when looking at range of motion. Group 1’s mean value percentage improvement was the greatest, with the Algometer and the subjective readings. The outcome of this study was that overall all three treatment protocols had a positive effect on the participants. Group 1 and group 2 had a slightly greater overall improvement. Thus it is suggested that when treating sacroiliac joint dysfunction with associated gluteus medius trigger points, the doctor can use an adjustment or adjusting with needling, both are effective. It is important to take the patients preference into account in order to make them feel at ease with the treatment they are receiving.

M. Tech. / Purpose: Trigger points in the paraspinal muscles are commonly associated with lameness or stiffness in horses, and unless they are “released”, muscle power and flexibility are impaired and athletic performance is reduced (Rogers, Fischer, Pontinen, and Janssens, 1996). The aim of this study was to determine the immediate and the prolonged effects of Sacroiliac mobilization on spot tenderness within the Erector spinae muscles of performance horses. Method: Horses from a selected stable yard underwent a screening process under the supervision of a qualified Chiropractor and Veterinarian to identify horses suitable for the study. Thirty horses were selected for the study based on the inclusion and exclusion criteria. The sample was divided into two groups of fifteen horses. The experiment group received mobilization therapy for SI joint restrictions, while the control group did not receive any treatment intervention. Procedure: Horses received an initial treatment and two follow ups, totaling three treatments. The first follow up treatment was two days after the initial and the second was four days post initial treatment. During these treatment sessions, trigger points in the Erector spinae muscles were located in each horse and algometer measurements were taken. Sacroiliac restrictions were then identified using motion palpation and passive range of motion as indicators. The researcher performed a mobilization technique on the Sacroiliac joints of horses in the experiment group only, and thereafter both groups were reassessed two minutes later, via an algometer, for spot tenderness within the same trigger points. The Sacroiliac restrictions and trigger points were re-assessed without treatment two weeks later. Conclusion: The results indicated that low-velocity Sacroiliac mobilization was effective in increasing the pain-pressure tolerance within the Erector spinae muscles of performance horses immediately and over the treatment period of two weeks.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Sacroiliac joint syndrome is diagnosed in patients who complain of various painful symptoms associated to their lower back, for example: hip and groin pain, sciatica pain, and / or a need to frequently urinate. They further report that their pain is further intensified when standing from sitting, stair walking, bending forward or from sitting or standing too long. Sacroiliac joint syndrome has been widely accepted by health professions as a contributor to low back pain. Spinal manipulation has shown to be an effective method for pain relief of this condition. Studies have been done using physical therapy in conjunction with manipulation in treating sacroiliac joint syndrome. However, little research has been done on the effects of static stretching and manipulation combined. The posterior oblique sling group of muscles is created by the biceps femoris, gluteus maximus, erector spinae and latissimus dorsi muscles. The sacroiliac joint can be affected by the functional relationship of the posterior oblique sling muscles. These muscles are involved in forces across the sacroiliac joint. Tightness of muscles can affect the sacroiliac joint. Flexibility is an essential element of normal biomechanical functioning. Flexibility of muscles, tendons and ligaments can influence a joints range of motion. There is evidence that suggests that stretching could increase a joint’s range of motion which was evident one or more days after the stretching protocol in people without clinically significant contractures. Upon review of the related literature, it appears that there is insufficient literature assessing the clinical effectiveness of static stretching of the posterior oblique muscle sling group with respect to sacroiliac joint syndrome. Therefore this study is aimed at providing insight into the role of the posterior oblique muscle sling group in participants with and chronic sacroiliac joint syndrome. It is hypothesized that effective treatment of these muscles will allow for a more effective outcome of symptoms. The study design chosen was a randomised, clinical trial consisting of thirty voluntary participants’ between the ages 18 to 45 years suffering from chronic sacroiliac joint syndrome. There were two groups of fifteen participants, who received four treatment consultations within a two week period. Participants placed into Group One received sacroiliac joint manipulation only, while participants in Group Two received static stretching of the posterior oblique muscle sling and sacroiliac joint manipulation. Subjective and objective readings were taken at the first, third and fourth (final) consultations. The Numerical Pain Rating Scale (NRS) and the Oswestry Low Back Pain Disability Index (OSW) questionnaires were used to assess the subjective findings whilst the objective measurements were collected from results of algometer and inclinometer readings. The intra-group analysis revealed there was a statistically significant improvement within both groups for NRS, OSW, and inclinometer results. It appeared that Group Two fared better in terms of the algometer (pressure) results. The inter-group analysis revealed that all comparisons apart from the algometer readings had no statistically significant improvement between the two groups. From the intra-group comparisons of the objective data, participants in both groups experienced a statistically significant improvement. However, Group Two fared better in terms of the algometric pressure readings (p = 0.001). This study confirms that both treatment protocols were effective in reducing the signs and symptoms associated with sacroiliac joint syndrome. Although the readings were not statistically significant, there is evidence that Group Two responded better than Group One in terms of the algometer readings (Figure 4.13). There is insufficient literature on studies related to the posterior oblique sling muscles, and therefore, comparisons are needed with respect to the posterior oblique muscle sling group and its effects on the sacroiliac joint. This study concludes that overall there was no statistically significant difference between the two groups and recommends that further studies be undertaken with a greater number of participants to gauge if a more significant result can be achieved. / M

Objective : Low back pain (LBP), and in particular sacroiliac joint syndrome, is a significant health concern for both patient and their chiropractor with regards to quality of life and work related musculoskeletal disorders. Therefore, chiropractors often utilise mechanical aids to reduce the impact on the chiropractor’s health. It is, however, important to establish whether these mechanical aids are indeed clinically effective, therefore, this study evaluated the Activator Adjusting Instrument (AAI) against an AAI placebo to determine whether this adjusting instrument is an effective aid for both the chiropractor and the patient. Method : This randomised, placebo controlled clinical trial consisted of 40 patients (20 per group), screened by stringent inclusion criteria assessed through a telephonic and clinical assessment screen. Post receipt of informed consent from the patients, measurements (NRS, Revised Oswestry Disability Questionnaire, algometer) were taken at baseline, prior to consultation three and at the follow consultation. This procedure occurred with four interventions over a two week period. Results: The AAI group showed clinical significance for all clinical measures as compared to the AAI placebo group which attained clinical significance only for the Revised Oswestry Disability Questionnaire. By comparison there was only a statistically significant difference between the groups in terms of the algometer readings (p= 0.037). Conclusion : Therefore, it is evident that the AAI seems to have clinical benefit beyond a placebo. However this is not reflected in the statistical analysis. It is, therefore, suggested that this study be repeated with a larger sample size in order to verify the effect on the statistical analysis outcomes.

Submitted in partial compliance with the requirements for the Masters’ Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2014. / Background: Spinal manipulation has been shown to result in neurophysiological changes, most often noted in the paraspinal muscles. These effects have been associated with an increase in paraspinal muscle contractibility; it is unclear if this leads to an increase in paraspinal muscle endurance. Objectives: To determine the effect of sacroiliac joint (SIJ) manipulation compared to a placebo treatment of the SIJ on lumbar extensor muscle endurance time. Method: A randomised, placebo-controlled pre-test post-test experimental trial, involving 40 asymptomatic male participants divided into an intervention group receiving SIJ manipulation using an impulse adjusting instrument and a placebo group receiving a pre-load force without the delivery of an impulse thrust. Outcome measures were lumbar extensor muscle endurance time, surface electromyographic (SEMG) readings, lumbar spinal range of motion, paraspinal muscle length assessment and a subjective pain measurement. Results: There was a significant difference between the groups (p=0.004) with the SIJ manipulation group showing an increase in endurance time compared to the placebo group which showed a decrease. SEMG readings increased for both groups with no statistically significant difference between the groups (p>0.05). Only extension lumbar spinal range of motion significantly improved in both groups (p=˂0.001) with no significant differences between groups (p=0.876). Only one participant reported pain during the research procedure. Conclusions: SIJ manipulation may enhance the endurance of the paraspinal muscles. This study should be conducted in a larger sample to validate the findings.

A ocorrência de lesões intra-articulares é uma das principais causas de incapacidade em atletas, sejam eles humanos ou da espécie eqüina. Um dos grandes avanços observados na medicina esportiva foi o advento das cirurgias intra-articulares minimamente invasivas, realizadas com auxílio de um artroscópio. A artroscopia é técnica diagnóstica ou cirúrgica que se caracteriza principalmente por causar mínimo dano tecidual, permitir ampla inspeção das estruturas intra-articulares, com baixo índice de morbidade e complicações. Apesar da realização da artroscopia ser tradicionalmente realizada por distensão líquida, a utilização do gás dióxido de carbono (CO2) como meio para distensão capsular e suas inúmeras vantagens já foram relatadas em diversos estudos. Embora os efeitos inflamatórios causados pela distensão capsular durante a artroscopia sejam discretos e sobrepujados pelos benefícios decorrentes de sua indicação, já foi descrito, em eqüinos, a ocorrência de sinovite de grau leve e caráter transitório. Entretanto, observa-se ausência de estudos referentes aos efeitos inflamatórios causados pela distensão capsular gasosa com dióxido de carbono. Desta forma, este estudo visou avaliar o grau de injúria sinovial decorrente do uso de CO2 intra-articular comparativamente à distensão líquida. Foram utilizados nove eqüinos adultos hígidos, seis machos e três fêmeas, de idade e raças variadas. Cada animal foi submetido a artroscopia bilateral da articulação tarsocrural e realização de biopsia da membrana sinovial no início, ao término do procedimento (30 minutos) e após 48 horas. Em uma articulação, a distensão para realização da artroscopia foi realizada com solução de Ringer com lactato (Grupo DL) e na articulação contra-lateral foi utilizada distensão gasosa com CO2 (Grupo DG). Para avaliação da resposta inflamatória, foram realizadas artrocenteses seriadas 0, 6, 12, 24 e 48 horas após o procedimento para mensuração de leucócitos totais, PT, Hb, PGE2, TNF-α e avaliação do burst oxidativo das células no líquido sinovial, assim como exame histopatológico e imunoistoquímico para COX-2 e E-selectina da membrana sinovial. Ambos os meios utilizados para distensão capsular causaram aumento nas concentrações de leucócitos, PT, Hb, TNF-α e PGE2. Também foi observado aumento do burst oxidativo de neutrófilos e macrófagos presentes no líquido sinovial. Em geral, as variáveis analisadas no líquido sinovial apresentaram discretas diferenças entre os grupos, sendo significativas em momentos isolados. A análise histológica da membrana sinovial demonstrou alterações inflamatórias agudas e de pouca intensidade em ambos os grupos. Apesar de semelhante entre os grupos, a imunoistoquímica para COX-2 na membrana sinovial apresentou discreta correlação com o grau de sinovite demonstrada nos outros parâmetros analisados, enquanto a E-selectina se mostrou um bom marcador em alterações inflamatórias precoces da membrana sinovial. A utilização do CO2 como meio para distensão capsular durante o exame artroscópico em eqüinos causou uma sinovite de grau leve e caráter transitório, promovendo alterações inflamatórias no líquido e membrana sinovial de forma semelhante às observadas com a utilização da solução de Ringer com lactato como meio para distensão capsular. Além disso, ambos os meios para distensão capsular causaram mínimas manifestações clínicas e ausência de complicações pós-operatórias aos animais. / Intra-articular disorders are the leading cause of human and equine athlete´s functional incapacity. The development of arthroscopy as a minimal invasive intra-articular surgery was one of the greatest medical advances in sports medicine. The defining characteristic of diagnostic or surgical arthroscopy is featured by minimal tissue damage and broad inspection of internal structures inside the joint associated with low morbidity and complications. Although liquid distension is widely used for arthroscopy, gas distension using carbon dioxide (CO2) has already been described and has pointed out a larger number of advantages of this technique in several studies. The inflammatory response to liquid capsular distension was studied in horses and described as minimal, transient and frequently overwhelmed by its benefits to treatment. However none of these effects had been investigated employing CO2 during arthroscopic examination. Therefore, the aim of this study was to asses comparatively the inflammatory damage followed by CO2 joint capsular distension to that of Ringer´s lactate solution distension. Nine healthy adult horses of various breeds, genders and ages were used. Each animal was submitted to a bilateral tarsocrural arthroscopy employing gas distention (group GD) in one joint and fluid distention (group LD) in the contralateral joint, both for 30 minutes. Synovial membrane specimens were collected before, at the end of the procedure and after 48 hours. Arthrocentesis were aseptically performed at 0, 6, 12, 24 and 48 hours after arthroscopy in order to assess the degree of inflammation within the joint. Synovial fluid was collected for cytological examination and determination of total protein, hemoglobin, TNF-α and PGE2 contents and evaluation of synovial fluid cell oxidative burst. The synovial membrane was examined histologically and also imunostained for COX-2 and E-selectin. Either distension protocol caused an increase in total white blood cells, total protein, hemoglobin, TNF-α, PGE2 and also in neutrophil and macrophage oxidative burst. In general terms, those parameters analyzed in the synovial fluid demonstrated minimal differences between groups with only a few isolate significant differences. Histological evaluation of synovial membrane shows a rapid, but mild inflammatory response in both groups. Imunostaining for COX-2 was similar between DG and DL, but showed a weak correlation to the degree of synovitis demonstrated by other parameters. Contrarily, the imunostaining for E-selectin revealed that this molecule is a good biomarker for early inflammatory changes in the synovial membrane. The use of carbon dioxide for capsular joint distension during arthroscopic examination causes an acute and mild synovitis that promotes inflammatory changes in the synovial fluid and membrane that are similar to the effects caused by the liquid capsular distension using Ringer´s lactate solution. Moreover, both distension protocols induced minimal manifestations of clinical signs and no post-surgery complications.

Les chaînes de glycosaminoglycanes (GAGs) des protéoglycanes (PGs) jouent un rôle majeur dans la régulation de multiples événements cellulaires et le maintien de l'architecture des tissus. Des perturbations de la synthèse des GAGs sont impliquées dans des pathologies d'origine dégénérative, tumorale et génétique, tel que le syndrome progéroïde d'Ehlers-Danlos (ED). Ce déficit résulte de mutations de la [bêta]1,4-galactosyltransférase 7 ([bêta]4GalT7) humaine associées à des atteintes sévères du système musculo-squelettique. En effet, cette enzyme catalyse une étape essentielle de l?initiation de la synthèse des GAGs à partir de la protéine "core" des PGs et de xylosides exogènes. Notre travail a porté sur l'étude structure-fonction de la [bêta]4GalT7 recombinante humaine. Nous avons associé des approches in vitro et ex vivo afin d?explorer le rôle des acides aminés des motifs 163DVD165, 221FWGWGREDDD230 et 257HLH259, strictement conservés au sein des [bêta]4GalTs. L'étude des conséquences de mutations systématiques sur les propriétés cinétiques et fonctionnelles de la [bêta]4GalT7 recombinante a permis d'identifier des acides aminés essentiels du site actif. Nous avons montré que les résidus D165 et H257 forment des liaisons de coordination avec le cation Mn2+ et proposé le rôle du résidu D228 dans la catalyse. Nous avons mis en évidence un rôle central du résidu W224 dans les interactions avec les substrats donneur et accepteur. Nous avons également établi les bases moléculaires des mutations de la [bêta]4GalT7 associées au syndrome ED. Enfin, l'étude de mécanismes de régulation épigénétique des voies de biosynthèse des GAGs dans les cellules H-EMC-SS de chondrosarcome humain a mis en évidence une hyperméthylation spécifique des gènes de la famille des 3-O-sulfotransférases, associée à un phénotype invasif. L'ensemble de ce travail ouvre des perspectives vers de nouvelles stratégies thérapeutiques dans le traitement des arthropathies / Proteoglycans (PGs) and their glycosaminoglycan chains (GAGs), play a major role in the architecture of extracellular matrices and are implicated in numerous cell events. The impairment of GAG synthesis and sulfation is involved in degenerative, tumor and genetic diseases, such as the progeroid form of Ehlers-Danlos (ED) syndrome. This inherited disorder is due to mutations of human [bêta]4GalT7 ([bêta]4GalT7) causing a defect in GAG synthesis, associated with severe musculo-skeletal alterations. Indeed, this enzyme catalyzes a key step in GAG synthesis linked to the core protein of PGs and from exogenous xylosides. Our work has been focused on the structural and functional characterization of human recombinant [bêta]4GalT7 enzyme. We combined in vitro and ex vivo approaches to explore the role of amino acids located in 163DVD165, 221FWGWGREDDD230 and 257HLH259 motifs, which are highly conserved within [bêta]4GalTs. The study of the consequences of site-directed mutations on kinetic and functional properties of the [bêta]4GalT7 enzyme allowed us to identify key active site amino acids. Our results indicate that D165 and H257 residues form coordination bonds with Mn2+ divalent cations. Furthermore, we suggested a catalytic role for D228 residue and highlighted a central role of W224 residue via interactions with the donor and acceptor substrates. We also determined the molecular basis of [bêta]4GalT7 mutations associated with ED syndrome. Finally, the study of epigenetic regulation mechanisms by DNA methylation of GAG biosynthesis in human chondrosarcoma cells (H-EMC-SS) revealed the specific hypermethylation of the 3-O-sulfotransferase gene family, associated with the invasive phenotype of these cells. Together, this work paves the way towards innovative strategies in the treatment of arthropathies