Thesis (D.PT.)--Sage Colleges, 2010. / "May 2010." "A Capstone project for PTY 768 presented to the faculty of The Department of Physical Therapy Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

M. Tech. / Low back pain is experienced by approximately 60-90% of the population and is one of the most expensive public health problems today (Shin and Slipman, 2005). Lumbar facet joint syndrome is a common condition, involving about 79% of patients suffering from low back pain (Schleifer, et al., 1994). The aim of this study was to determine the effectiveness of treatment for lumbar facet syndrome with the homeopathic injectable Discus compositum® by using the pressure algometer, Helbig and Lee scorecard system and the Oswestry low back pain questionnaire. This double-blind placebo-control trial, with matched pairs, was conducted at the University of Johannesburg and participants were recruited with posters and by word of mouth. Thirty-two participants that met the inclusion criteria, and were not outside of treatment parameters, were included in the study. These participants were then randomly divided into two groups: Group A was treated with Discus compositum® injectables and Group B was treated with placebo injectables. In addition, participants were matched according to activity levels of more than 3 times per week and activity levels of less than 3 times per week. Participants in both groups were treated four times over a period of two weeks; two treatments per week. A one month post-injection follow-up consultation was carried out in order to determine if the treatment had a lasting effect. The subjective and objective data was analysed by using non-parametric tests in order to establish statistical significance between visits and between groups. The subjective data was obtained by using the Oswestry low back pain and disability questionnaire. The objective data was gathered by using the Helbig and Lee scorecard system as well as the algometer readings. The two sample groups did exhibit statistical differences. The results showed that there was a significant decrease in the pain experienced by the participants, as well as a significant change in the participant’s pain pressure threshold, for both groups. With regards to the diagnostic criteria a higher percentage of participants that were treated with Discus compositum® injections were no longer diagnosed with lumbar facet syndrome according to the Helbig and Lee scorecard system, than those participants that were treated with the placebo injections. In addition, it was determined that a combination of Discus compositum® injections and activity levels of more than 3 times per week proved to be beneficial. Based on the results of this study, one can determine that Discus compositum® is effective in the treatment of lumbar facet syndrome.

Thesis (doctoral)--Lund University, 1996. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1996. / Added t.p. with thesis statement inserted.

Thesis--Auburn University, 2006. / Abstract. Vita. Includes bibliographic references (p.108-111, etc.).

Intervertebral disc(IVD) degeneration is associated with low back pain (LBP).Despite the endplates are located adjacent to the IVD, the phenotypes of endplate and vertebral bone marrow changes remain unclear. The objective of this study is to assess the prevalence and the associated determinants of these phenotypes of the lumbar spine. 2449 Southern Chinese subjects (aged 10 –88 years) undergone sagittal T2-weighted magnetic resonance imaging (MRI)examination to assess the presence of endplate and vertebral bone marrow changes including Schmorl’s nodes (SN) and Modic changes (MC),respectively, and scored for additional radiographic features over the lumbar spine. Subjects’ demographics, clinical profile, and functional status were assessed by means of standardized questionnaires. Anovel6-domain SN morphological classification based on MRI was developed to further analyze the characteristics of SN and its association with disc degeneration (DD). The prevalence of SN was 16.4%. Males, taller and heavier individuals had a significantly increased likelihood of SN. Overall presence of SN was age-independent, but was significantly associated with DD, and linearly correlated with increase in severity of DD. SN were particularly associated with severe DD at the upper two lumbar levels (L1/2 – L2/3). Based on the SN classification system, specific SN characteristics and endplate linkage patterns were found. Of these, two SN types were identified:“Typical SN” and “Atypical SN”. “Typical SN” were those smaller size SN with various shapes that were frequently located at caudal endplates of L1/2–L3/4disc levels. One variant of “Atypical SN” were those rectangular shape SN, which predominantly located at the posterior region of the rostral endplates of L1/2–L2/3disc levels. The other variant of “Atypical SN” was larger size SN with irregular shape that frequently presented at the L4/5endplates, they were also likely to be associated with marrow changes. Despite “Atypical SN” only entailed 8.3% of all identified SN, they were associated with increased severity of DD than “Typical SN”. Although the overall prevalence of MC among Southern Chinese was low (5.8%), after adjustments for other confounding factors, the presence of MC was associated with the presence and severity of LBP. Interestingly, the determinants of MC at upper (L1/2 – L3/4) and lower (L4/5 – L5/S1) lumbar showed distinct difference. The presence of MC at upper lumbar levels was only associated with the disc integrity only (i.e. the presence of disc displacement, and DD score), while the presence of MC at the lower levels, apart from the disc integrity, was also associated with increasing age, the presence of SN, smoking and obesity status. This study is the largest MRI study assessing the phenotypes of endplate and vertebral bone marrow changes in-vivo. The prevalence and distribution of SN and MC vary throughout the lumbar spine, and there are level and region-specific variations regarding these phenotypes. Determinants of SN and MC may be similar but do vary, suggesting distinct etiological factors. Findings of this study broaden the understanding of the various phenotypes of the lumbar spine and its association with DD. / published_or_final_version / Orthopaedics and Traumatology / Doctoral / Doctor of Philosophy

Thesis (M.App.Sc. (Physio))--University of South Australia, 1998.

Thesis (M.S.)--University of Toledo, 2009. / Typescript. "Submitted as partial fulfillment of the requirements for the Master of Science Degree in Mechanical Engineering." "A thesis entitled"--at head of title. Bibliography: leaves 92-98.

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. / OBJECTIVE: The aim of this study was to determine the electromyographic effect of flexion distraction therapy of the lumbar spine on the Erector Spinae muscles in participants with lumbar facet dysfunction. STUDY DESIGN: Thirty participants with lumbar facet dysfunction underwent 6 flexion distraction therapy treatments on alternate days over a 2-week period (excluding weekends) to test the electromyographic effect on the Erector Spinae muscle. SETTING: University of Johannesburg Chiropractic Clinic, Johannesburg, South Africa. SUBJECTS: Thirty participants with lumbar facet dysfunction participated in this study. The participants were divided into two groups of fifteen participants each and matched according to age and gender. Group 1, the study group, received flexion distraction therapy to the restricted segments in the lumbar spine. Group 2, the control group, did not receive any flexion distraction therapy and rested during the duration of the treatment. METHODS: Lumbar Erector Spinae muscle electrical activity was tested before and after treatment one, three and six using surface electromyography (sEMG). One pair of bipolar electrodes was placed bilaterally over the Erector Spinae muscles at the level of L3. Participants were asked to lie down in a prone position with their arms next to their sides. They were then instructed to perform five maximum voluntary lower back extension exercises by lifting their chests and shoulders as high off the plinth as possible. Each contraction lasted five seconds, with a rest period of ten seconds between each contraction. The average rest and work surface electromyography readings were recorded, analysed and compared for reference. Information regarding the intensity of the pain experienced by the vii subjects was also collected at the start of treatment one, three and five using the Numerical Pain Rating Scale. RESULTS: Comparison of the results indicated a statistically significant difference between the two groups and their responses to the treatments. Subjectively, a statistically significant improvement was observed in Group 1 between the third and the sixth treatments and the first and the sixth treatments, with an overall 80% improvement in pain, thus demonstrating the medium to long term effects of flexion distraction therapy. Objectively, Group 1 demonstrated a statistically significant medium to long term improvement in the resting rate of the Erector Spinae muscles as observed between the first and sixth treatments. Statistically, the two groups responded differently over time with regards to the contraction ability of the Erector Spinae muscle. A statistically significant and immediate improvement was observed in the sixth treatment in Group 1, thus further supporting the long term effects and benefits of flexion distraction therapy. CONCLUSION: In light of these findings it can be concluded that flexion distraction therapy, as represented by Group 1, demonstrated favourable treatment results in terms of the pain experienced by the subjects, the resting rate and contraction ability of the Erector Spinae muscles. The trends observed in this study should be used and tested in future research studies of a similar nature incorporating larger sample groups.