Zugl.: Augsburg, Univ., Diss., 2009

Thesis (doctoral)--Rheinische Friedrich-Wilhelms-Universität Bonn, 2005.

M.Tech. / PURPOSE: Impingement syndrome of the shoulder is a very common problem, yet the diagnosis and management of it is still not completely understood. The purpose of this pilot study was to determine the most effective chiropractic treatment protocol in the management of impingement syndrome due to supraspinatus tendonitis. This was done by comparing objective and subjective measures gained during a treatment protocol consisting either of administering corrective chiropractic manipulative therapy to the cervical spine and/or the thoracic spine, to the glenohumeral joint or to both of these areas. METHODS: This randomised controlled trial consisted of three groups of fifteen patients, each between the ages of eighteen and forty-five years old. All potential candidates were examined and cleared for participation in the clinical trials subsequent to a selection process and X-ray examination if necessary. Diversified chiropractic manipulative techniques were used for all patients provided joint restrictions were detected. Group A received glenohumeral joint manipulations, Group B received spinal manipulations and Group C received a combination of spinal and glenohumeral joint manipulations. PROCEDURE: Patients were treated for six consultations over a two-week period. A follow-up appointment was scheduled for four weeks after that in order to determine the lasting effects of the treatment protocol. At the first, third, sixth and follow-up visit, measurements were recorded. Objective data included pain free shoulder abduction range of motion, the presence of a painful arc of the shoulder and the presence of a positive supraspinatus test. Subjective data included the numerical pain rating scale-101 scores. RESULTS: statistical analysis was conducted using the parametric One Way ANOVA (analysis of variance) and unpaired t-tests as well as the non-parametric Kruskal-Wallis One Way ANOVA on Ranks and Mann-Whitney Rank Sum tests to compare intragroup and intergroup data. III CONCLUSIONS: Although all three groups showed numerical improvements throughout the treatment period, only group A showed statistically significant improvements. This study therefore suggests that manipulation of the glenohumeral joint is more effective in the treatment of impingement syndrome of the shoulder with regard to short-term as well as long-term symptomatic relief. This however requires further research, as a larger sample size is required

This study compared the effectiveness of three different Chiropractic treatment protocols in the treatment of post-partum low back pain. This was done in order to establish whether or not a combined treatment of Chiropractic Manipulative Therapy (CMT) of the sacroiliac joint combined with slow dynamic strengthening exercises to strengthen and stabilise the pelvis is a more effective treatment than CMT of the sacroiliac joint alone, or slow dynamic strengthening exercises in isolation. Thirty participants were used for this study. They were randomly placed into one of three groups namely; group 1, group 2 and group 3. Group 1 received CMT solely to the involved sacroiliac joint. Group 2 received slow dynamic strengthening exercises of gluteus medius, piriformis and psoas muscles. These exercises were designed to strengthen and stabilise the pelvis. Group 3 received a combination of the above two treatments. Six treatments were administered over a period of three weeks with each participant receiving two treatments per week. Prior to the commencement of treatments one, three and six; each participant was objectively measured for forward flexion range of motion using the Modified Schober’s test. The subjective measurements used in this study were the Numerical Pain Rating Scale and the Oswestry Lower Back Pain and Disability Questionnaire, these were also completed prior to first, third and sixth treatments. All the collected data was statistically analysed using the one-way Anova test, the Scheffe Multiple Comparisons test and the Paired-t test. This statistical analysis revealed statistical differences on intra-group analysis, for all the three groups involved, mostly between treatment three and treatment six for both the objective and subjective measurements. On inter-group analysis no statistical differences were found although group three subjective and objective measurements improved by a larger percentage than both group one and group two. It was thus concluded that a combined treatment of CMT and slow dynamic strengthening exercises of gluteus medius, piriformis and psoas muscles was the most effective protocol to use on women with post-partum low back pain. / Dr. C.D. Losco Dr. B. Losco

Dissertation submitted to the Faculty of Health in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Technikon Natal, 2000. / The purpose of this study was to test the effectiveness of anterior night splints alone compared to the combination of foot and ankle manipulation with anterior night splints, in terms of subjective and objective clinical findings, in the treatment of plantarfasciitis. / M

M.Tech. / This study aimed to compare either separately or in combination the effects of chiropractic manipulation and ergonomic advice on cervical and thoracic pain and discomfort in those working at computer workstations or in desk bound professions. Three groups were chosen. Group A was treated with chiropractic manipulation only. Group B received ergonomic advice only, which they were required to adhere to for the duration of the study. Group C received a combination of chiropractic manipulation and ergonomic advice. Subjects within each group were attended to over a period of three weeks. It was anticipated that a combination of the therapies would yield the most favorable results in comparison to either of the therapies alone. The study was a clinical trial involving three groups of ten subjects of women only. Volunteers responded to posters placed throughout the University of Johannesburg, Doornfontein campus and at companies in and around Johannesburg. Objective data was collected using the Cervical Range of Motion (CROM) Instrument and the Digital Inclinometer to measure cervical and thoracic spine range of motion. Subjective data was obtained by participants recording their progress on the Vernon Mior Neck Pain and Disability Index and the Numerical Pain Rating Scale. Both the objective and subjective data was collected prior to the commencement of the first, third and sixth treatments for Groups A and C and at the first, second and third consultations for Group B. All the collected data was statistically analyzed using the One Way and the Repeated Analysis of Variance tests. Data obtained from cervical and thoracic ranges of motion testing showed some significant differences for the three groups throughout the treatment however no consistent pattern was revealed to determine which treatment group was favored. Statistical analysis of the data obtained from the questionnaires indicated that all three groups responded with statistical significance to the treatments. All three groups responded with a reduction in the subject‟s perceived pain and disability and the Combination group responded most favorably followed by the Advice/Ergonomics group and then lastly the Adjustment group. This study concluded that a combination of the therapies resulted in a quicker response to treatment with regards to the subject‟s pain and disability. All of the three treatments however provided some improvement therefore also reiterating the effects of ergonomic advice and chiropractic treatment alone.

M.Tech. / OBJECTIVE: To determine and compare the effect of Spinal Manipulative Therapy (SMT) to the cervico-thoracic junction on the activity of the ipsilateral latissimus dorsi with regards to muscle activity measured by electromyography and activity of the trigger points measured by the algometer. STUDY DESIGN: Fourty subjects with lower cervical spine pain and dysfunction underwent six spinal manipulative treatments on alternative days over a 3 week period (excluding weekends) to test the changes in activity of the ipsi-lateral Latissimus Dorsi muscle. SETTING: Chiropractic Day Clinic at the University of Johannesburg, Johannesburg, South Africa. SUBJECTS: Forty subjects with lower cervical spine pain participated in this study. Each of the subjects was randomly assigned to one of two groups. Group A consisted of 20 subjects receiving SMT to the cervico thoracic junction. Group B consisted of 20 subjects receiving de-tuned ultra-sound to the area of cervical spine pain. METHODS: Latissimus Dorsi muscle activity and its trigger point activity were tested before and after the first consultation using electromyography and the algometer respectively. After consultations two, four and six readings were taken. For the electromyography readings subjects were asked to lie down in a prone position with their arms next to their sides. They were then instructed to lie as still as possible for three minutes. The mean, peak and minimum values from the surface electromyographic meter were recorded, analysed and compared for reference. For the algometer readings, the researcher grasped the Latissimus Dorsi muscle along the free border at the posterior axillary fold of the midscapular level. The algometer was then pushed into this point and candidates had to indicate when they started to feel pain. This measurement was then recorded. RESULTS: Data was analysed using the T-test for independent samples to compare the two individual groups. Repeated measures ANOVA was useful to investigate changes over time. If one considers Group A as the superior group, no statistical significant difference were noted between Group A and Group B regarding the electromyographic readings. With regards to the algometer readings no statistically significant differences were identified between the two groups except for the last consultation (treatment 4) of Group A where the p-value = 0.035<0.05. CONCLUSION: In light of these findings, it can be concluded that there were no statistically significant differences between Group A and Group B, regarding the electromyographic readings. Group A showed the most favourable treatment efficacy in terms of the algometer readings. The trends shown in this study should be used and tested in future similar research studies incorporating larger sample groups.

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

Sacro-iliac joint (S.I joint) dysfunction can result in leg length discrepancies (LLD). LLD has been associated with many musculoskeletal problems such as osteoarthritis of the hips, knee pain and lower back pain. It has been theorised that LLD alters a persons body posture, which in turn changes the forces acting on the joints in the lower extremity and spine. These unnatural forces then create the excessive forces seen as the causative factors in the previously mentioned musculoskeletal conditions. (Murrel, Cornwall, Doucet 1991) The purpose of this pilot study was to was to compare the effect of chiropractic manipulative therapy on the S.I joints with chiropractic mobilisations of the S.I joints on the weight transfer from the spine into the lower limbs. This randomised study consisted of two groups of fifteen patients between the ages of eighteen and fifty years. All potential candidates were examined and admitted once all the inclusion and exclusion criteria had been met. Once S.I joint restrictions were detected the patient received either chiropractic manipulation or mobilisation to the restricted joint. Group A received chiropractic manipulation while group B were treated with mobilisations of the S.I joints. Patients were treated over a two week treatment period. Objective measurements were taken before the 1st treatment and after the 1st ,3rd ,5th and final consultations one month later. The measurements were taken with the Spinal Analyses Machine (S.A.M). This instrument has got two scales on a platform that determines the patients weight distribution from the spine through the left and right lower limbs. The data collected was then statistically analysed using the One Way ANOVA Test (analyses of variance) as well as the Student-Newman-Keuls Method to compare the inter-group and intra-group data. Statistically significant changes in the weight distribution between the lower limbs were seen in group A. Based on the results from the study chiropractic manipulation to the S.I joint proved to be more effective than mobilisation in the treatment of S.I joint dysfunction. This does however require further research, and a larger sample size. / Dr. M. Moodley Dr. J. Kotze

M.Tech. / This unblinded, controlled pilot study was conducted in order to compare the effectiveness of soft tissue therapy and ultrasound therapy, versus chiropractic manipulation and mobilization therapy, or a combination of the aforementioned therapeutic protocols in the treatment of acute Achilles tendinitis. In executing the comparison, it was hypothesized that both treatment protocols would be effective, but the combined therapy would be the most effective for the treatment of acute Achilles tendinitis, as this treatment protocol focused not only on the symptomatic pathological area entailing the Achilles tendon in this case, but also focused on the entire kinetic chain which perhaps was contributing to the pathomec.hanics in turn causing Achilles tendinitis. It is hoped that this combined therapy will be more effective in terms of a more speedy recovery and long term effect. This will not only benefit the patient from the point of view of health and quality of life, but financially as well, as less consultation fees will have to be paid. Patients were recruited for the study by the use of advertisements in newspapers and posters, or from patients entering the Technikon Witwatersrand Chiropractic Day Clinic complaining of Achilles pain. Only those forty-five patients who conformed to the specified delimitations and diagnostic criteria were accepted. These patients were randomly placed into three groups of fifteen patients each. Group one received chiropractic manipulative and mobilisation therapy and group two received soft tissue therapy and ultrasound therapy. Group three received a combination of the aforementioned therapies. Each patient received eight treatments over a three week period, ie. three treatments in weeks one and two, and two treatments in week three. After the treatment period there was a month break from the treatment and a follow-up consultation at the end of this month. This follow-up period was used to determine the lasting effects of the treatment protocol. The subjective data was collected with the use of the McGill Pain Questionnaire. The objective data was obtained from readings on the digital inclinometer, showing the extent of the ankle range of motion in dorsiflexion and plantarflexion, as well as from muscle activity levels in the triceps surae complex, recorded with the use of electromyography. Depending on normality being reached, both parametric testing and non-parametric tests were used to analyse the data. These tests were conducted on a 95% confidence level. The results indicated that all three treatments were in treating acute Achilles tendinitis. Treatment received by group one caused a generalized increase in EMG muscle activity levels specifically in the triceps surae, where as group two and group threes' treatment protocols caused an overall decrease in EMG muscle activity levels in the triceps surae. Group one showed the greatest improvement achieved in ankle range of motion in both dorsiflexion and plantarflexion throughout the study. And group one and group three showed the most significant response to treatment in terms of 100% reduction of pain and return to activity. Overall it was deduced that chiropractic manipulative and mobilization therapy were very effective in creating an increase in range of motion of the ankle joint as well as causing a significant improvement in reduction of pain in the Achilles tendon. It was noted that soft tissue therapy was beneficial in certain cases in terms of causing a relaxation in the triceps surae, as well as clearing any scar (fibrin) tissue found in the Achilles tendon. In summary group three showed the best response to treatment carried out in the study. The therapy used in group three not only directly treats the pathological injured-,Achilles tendon and associated triceps surae, but also the kinetic chain, thereby correcting any biomechanical dysfunction that could potentially be the cause of tension overload in the Achilles tendon.