M.Tech. / Manual medicine practitioners rely on clinical skills to diagnose and treat patients with musculoskeletal complaints. Palpatory analysis of a patient is used to identify their problem, treat the problems found and evaluate the result of the treatment (Ward 1996). Despite this reliance on palpation as a clinical tool, the reliability of palpation remains to be proven (O'Haire & Gibbons 2000). Chiropractors' and other manual medicine practitioners' ability to accurately identify bony anatomical landmarks needs to be validated as static palpation, followed by motion palpation are based on the assumption of this ability (O'Haire & Gibbons 2000). The most common method of identifying lumbar interspaces is to use the intercrestal line, which is drawn between the two iliac crests (Reynolds 2000). The intercrestal line is reported to most frequently cross the vertebral column at the L4-5 disc (Mac Gibbon & Farfan 1979; Quinelle & Stockdale 1983), L4 spinous process (Cunningham & Romanes 1979; Nimmo et al 1994), or L4-5 interspinous space (Render 1996). From this it is clear that no clear consensus exists, at least not in the literature, as to where exactly the intercrestal line intersects the spine. This study aimed to determine whether palpation of the superior aspect of the iliac crest is a reliable, accurate and/or valid method of determining the location of the spinous process of the fourth lumbar vertebra in the standing, seated and prone positions. Thirty participants were marked by three examiners in the standing, seated and prone positions, using the iliac crests to locate the fourth lumbar vertebra. An X-ray was taken of each participant in each of the three positions, after being marked by all three examiners. Measurements were then made on the x-rays, as well as visual assessments by examiners to assess the location of the markers on the lumbar anatomy. The results demonstrated consistent inter-examiner reliability, however the accuracy of using the iliac crest to locate the fourth lumbar vertebra was poor. This is disappointing as the ability to palpate spinal levels is a basic skill and a pre-requisite to more complex palpatory tasks within manual medicine. As for the validity aspect of using the iliac crests to locate the fourth lumbar vertebra, this method was found to be valid in locating the spinous process of the fourth lumbar vertebra. However, it is not a very reliable method, considering that there is only a 53.3% chance of locating the spinous process of L4 once in three attempts in the standing and seated positions and only a 46.7% in the prone position. The reliability of palpation of anatomical landmarks needs to be validated further in future studies as motion palpation and the palpatory assessment of effectiveness of treatment applied to correct motion restriction are predicted upon accurate localization of anatomical landmarks The large variation in intersection points of the intercrestal line does however possibly explain the different opinions found in the literature, and it can be said that to a certain degree all of them are correct.

M.Tech. (Chiropractic) / Please refer to full text to view abstract

M.Tech. (Chiropractic) / The purpose of this study is to evaluate whether action potential simulation (APS) therapy is more effective than placebo therapy in terms of pain relief and improvement in lumbar spine range of motion when treating chronic lumbar spine pain. The comparison of the two therapies was accomplished by objective and subjective assessments. The study was conducted by means of a double blind clinical trial with two experimental groups. Thirty subjects eighteen years of age and older who suffered from chronic lumbar spine pain were chosen from the general population who responded to the advertisements and from Tarentaal Home for the Aged. The researcher examined each of these subjects in order to be accepted into the study. Each subject was treated ten times over a two-week period and underwent a one-month follow-up consultation to be re-examined. Subjects in both groups received therapy for eight minutes at an amplitude of 1-2mA. Only the APS group received the electric current and the placebo group did not receive the electric current. The objective assessment was by means of measurement of the lumbar spine ranges of motion using an inclinometer. The subjective assessment was measured by means of two questionnaires, which are widely accepted in the research community namely: a) Oswestry Low Back Pain and Disability Questionnaire b) McGill Pain Questionnaire. The results, which were obtained, were statistically analyzed using the Mann-Whitney Rank Sum test (inter-group comparison) and the Wilcoxon Signed Rank test (intra-group comparison). Graphs were created using the actual values of each patient in each group and using the medians obtained. The study concluded that both the APS and the placebo group improved in terms of lumbar spine range of motion and pain relief even though not all the results were statistically significant. The graphs representing the mean values at the first, final and one-month follow-up consultations of each group showed the apparent improvement in terms of range of motion in the lumbar spine and pain relief. The APS group's mean values, at the above mentioned consultations, showed a greater improvement in range of motion and pain relief when being compared to the placebo group's mean values that are represented on the respective graphs.

Dissertation in partial compliance with requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was establish if Leander versus Static traction was useful for the treatment of facet syndrome, a common type of mechanical lower back pain seen by chiropractors. Two groups of fifteen participants were chosen on the basis of the inclusion and exclusion criteria. The first objective was to determine if Static linear traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective findings. The second objective was to determine if Leander traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective clinical findings. Lastly the third objective was to compare the subjective and objective clinical findings for both groups. Design: A randomised, two group parallel controlled clinical trial was carried out between the two sample groups. Participants had to have had chronic lower back pain (> 3months). Thirty symptomatic volunteer participants between 25 and 55 were randomly divided into two equal groups – group A (Leander traction) received 5 treatments over a 2 week period. Similarly, group B (Static linear traction) also received 5 treatments over a 2 week period. Algometer readings, Numerical Pain Rating Scale (NRS101), Pain Severity Scale (PSS) and Oswestery Disabilty Index (ODI) were used as v assessment tools. Subjective and objective clinical findings were taken on the first and second visits (i.e. 48 hours) prior to treatment and immediately after treatment. Another set of subjective and objective readings were taken one week after the fifth treatment in order to gauge the long term effects of both treatments. No treatment was given on the sixth visit. Pressure tolerance measurements using an algometer were taken at the end ranges of motion in Kemp’s test and spinal extension. Outcome measures: SPSS version 15 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis of data. A p value of <0.05 was considered as statistically significant. The two groups were compared at baseline in terms of demographics variables and location using Pearson’s chi square tests and ttests as appropriate. Intra-group comparisons were made between all time points. A significant time effect indicated successful treatment intervention. Inter-group comparisons were achieved using repeated measures ANOVA tests for each outcome measured separately. A significant time group interaction effect indicated a significant treatment effect. Profile plots were used to assess the trend and direction of the treatment effect. Results: The results of the study showed that Leander traction and Static linear traction were both effective for treating chronic lumbar facet syndrome and no statistically significant difference was found between subjective and objective clinical findings between the two groups.

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Bibliography: leaves 102-116. / 116, [43] leaves, [51] leaves of plates : ill. (some col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Analyses the characteristics and relative incidence of annular defects in the human lumbar spine and investigates their role in the pathogenesis of invertebral disc degeneration. / Thesis (Ph.D.)--University of Adelaide, Dept. of Pathology, 1992