Purpose: This study will identify that patients with chronic neck pain have an altered autonomic functioning compared to a control group, and that manipulation might directly influence the autonomic nervous system as measured by using a fully automated pupillometry system. Subjects: 100 chronic pain patients and 50 control subjects participated in this study to achieve a power of 0.80, effect size of 0.5, and a type I error rate of 0.05 for two-tailed hypothesis testing. Method: A quasi-experimental design was be used. The ANOVA and Chi square test were used to establish homogeneity of baseline characteristics. The Mann-Whitney U test was performed to compare the pre-intervention pupil diameter amongst the groups. The Friedman's test was used to determine the pupil diameter change during the three measurements. The Wilcoxen Signed-ranks test was used to analyze the difference in pupil size between the pre- and post-intervention measures and to determine if there was a difference in pupil diameter between the two groups undergoing the thoracic manipulation. The Kruskal-Wallis test was used to compare the pupil diameter change to the presence of joint sounds. And the Fisher's Exact test was used to determine the relationship between the number of pops and the VAS change score > 13mm. Results: This study demonstrated that the chronic pain group had a statistically significant smaller pupil diameter than the healthy control group (P=0.022). Manipulation resulted in a relative increase in pupil diameter following the manipulation, however this was not statistical significant. There was a statistical significant decrease in pupil diameter in the placebo group (pConclusions: It appears that a T3-T4 manipulation results in a relative non-specific increase in sympathetic activity. Recommendations: Manipulation may be used by physical therapists to affect the autonomic nervous system. Visual pupil assessment may become part of the evaluation process to identify patients that might present with autonomic dysfunction and to determine the effect of treatment modalities.

Background: Temporomandibular disorder (TMD) is a common and costly problem often leading to chronic pain. There exists moderate evidence for physical therapy (PT) interventions in the management of TMD. A known relationship between TMD and the cervical spine exists with some evidence to support cervical intervention treatments. Cervical spine thrust joint manipulation (TJM) is an effective PT intervention explored in a limited fashion for this population. Objectives: To determine the immediate and short term (1 and 4 week) effects of cervical TJM on pain, dysfunction, and perception of change in individuals with a primary complaint of TMD. Methods: In this single blind randomized clinical trial, individuals with TMD (n=50) were randomly assigned to receive cervical TJM or sham manipulation in 4 PT visits over 4-weeks. All participants also received behavioral education, a home exercise program, and soft tissue mobilization. Primary outcomes included jaw range of motion (ROM), Numeric Pain Rating Scale (NPRS), TMD Disability Index, Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia (TSK-TMD), and Global Rating of Change (GROC). Self-report and objective measurements (with blinded assessor) were taken at baseline, immediately after baseline treatment, 1-week, and 4-weeks. A 2 x 4 mixed model ANOVA was used with treatment group as the between-subjects factor and time as the within-subjects factor. Separate ANOVAs were performed for dependent variables and the hypothesis of interest was the group by time interaction. Results: Statistically significant 2-way interactions were noted in JFLS (p = .026) and TSK-TMD (p = .008), favoring the thrust manipulation group. Both groups showed statistically significant main effects in all measures over time. GROC and PASS favored the thrust manipulation group with statistically significant differences in successful outcomes noted immediately after baseline treatment (NNT = 5) and at 4-weeks (NNT = 4). Conclusion: Both groups received identical multi-modal treatments with the addition of the randomized intervention: cervical TJM or sham manipulation. Differences between groups were small, however, improvements favored the TJM on all measures. Cervical TJM may be beneficial in the treatment of TMD.

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Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / The relationship between TMD and dysfunction in the cervical spine has been reported in the literature and there are many case studies which have shown favourable results when treatment was aimed at the TMJ, cervical spine relationship. However, the numerous TMD treatment protocols described in the literature concerning this relationship, and the effectiveness of these treatments have not been well established. In spite of this many chiropractors treat TMD. TMD is a multifactoral condition and conservative treatment options need to be further investigated in order to determine if manual interventions directed at the cercival spine in the treatment of TMD are beneficial. Objectives: The purpose of this study was to compare myofascial trigger point therapy and manipulative therapy of either the TMJ, cervical spine or a combination of the two in order to determine their effectiveness for the TMD. Method: Thirty participants with TMD were randomly assigned to one of three treatment groups. Participants in each group received two treatments per week for two weeks with a follow up consultation in the third week. Data were collected before the commencement of the first, second, and fourth treatments and at the follow up consultation. Outcome measures included algometer readings, CROM, Mouth opening readings, NRS and a disability questionnaire. SPSS version 15.0 was used for analysis of the data. A p value <0.05 was considered as statistically significant. Multivariate testing was used for intra- and inter-group comparisons. Profile plots were generated to assess the direction and trend of the effect and to visually compare the trends in the different treatment groups. Results: Inter-group comparisons did not reveal any statistically significant different improvements between the three treatment groups. Conclusion: All groups responded favourably to treatment and showed trends towards improvement. However, statistically analysis revealed that no one treatment protocol was superior to the other. Although no definitive inferences may be drawn regarding the effectiveness of each treatment approach, within group trends indicated that the combination of the two treatment approaches may be preferred. / M