Dissertation submitted to the Faculty of Health at the Durban University of Technology in partial compliance with the requirements for the Master‟s Degree in Technology: Chiropractic, 2009. / The prevalence of neck pain in musculoskeletal practice is second only to that of low back pain (Vernon et al., 2007). There is a growing interest in neck pain research due to the escalating disability burden and compensation costs associated with neck pain (Côte et al., 2003). Manual therapies are commonly used in the treatment of neck pain (Côte et al., 2003). After an extensive literature review by Haldeman et al. (2008) they found that manual therapy techniques have some benefit but no one technique was clearly superior to the next. Therefore, the purpose of this study is to compare three commonly used manual therapy techniques in the treatment of chronic mechanical neck pain. OBJECTIVES The purpose of this study was to compare three different manual therapy techniques (SMT, MET and PNF) which are commonly used in the treatment of chronic MNP in terms of range of motion, pain and disability. METHOD Forty-five patients with chronic mechanical neck pain were obtained through non-probability convenience sampling and assigned into one of three treatment groups (15 per group) using a computer generated randomized table. The three different treatment groups were: Spinal Manipulative Therapy (SMT), Muscle Energy Technique (MET) and Proprioceptive Neuromuscular Facilitation (PNF). Each group received six treatments over a period of three weeks with a follow-up consultation. Measurements were taken at the first, third and sixth treatment and at the follow-up consultation. SPSS version 15.0 was used to analyse the data. A p value of <0.05 was considered as statistically significant. An intra-group analysis was done using repeated measures ANOVA testing to assess the time effect for each outcome separately. For inter-group analyses the time x group interaction effect was assessed using repeated measures ANOVA testing, and profile plots were used to assess the trend and direction of the effects. RESULTS Intra-group analysis of the results revealed that all three groups improved significantly between the first and the final consultation, for all measures. Inter-group analysis of the data did not show any difference between the three groups by the end of the final consultation. However, extension range of motion appeared to improve slightly faster in the PNF group iv but it was not significant when compared to the other two groups. Therefore, there was no statistical significance between the three groups. CONCLUSION It was concluded that all three treatment groups responded equally to the treatment, thus, suggesting that MET or PNF techniques can be used if SMT is contra-indicated.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The aim of this research was to investigate the relative effectiveness of manipulation versus core rehabilitation in the treatment of acute mechanical low back pain in sedentary patients. Recent research has found that dysfunction of the primary core stabiliser muscles is linked with an increasing number of the general population suffering from low back pain; this is thought to be due to the fact that people in general are living more sedentary lifestyles. The Aims and Objectives of this study were to determine the relative effect of manipulation and core rehabilitation in sedentary patients suffering from acute mechanical low back pain in terms of subjective findings, objective findings and to determine any correlations between these findings Thirty-two participants, with acute low back pain participated in the study. They received treatment over a period of three weeks, two treatments in the first week, two treatments in the second week and a follow up seven days later. Group A received a spinal manipulation while Group B received core rehabilitation exercises. Readings were taken at three time points, namely visit one, three and five before the treatment, they included the following readings: Numerical Pain Rating Scale, Algometer, Roland Morris Low Back Pain and Disability Questionnaire, Biofeedback Stabiliser and the Surface EMG. The results showed that there was no differential (p<0.05) treatment effect between the two Groups, and that both Groups showed a clinical improvement in their low back pain. In conclusion, it appears that even though both these treatment protocols have very different mechanisms of action, both can be effective treatment protocols and that core rehabilitation exercises when properly performed are as effective as manipulation in the treatment of acute low back pain.

Mini-dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is a prevalent condition and is the most common cause of lateral knee pain in long distance runners and cyclists. There are a significant number of aetiological factors related to ITBFS. As a result of this the general chiropractic approach to the treatment of ITBFS is multimodal and include interventions such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the available literature suggests that to determine its efficacy, it should be performed in isolation. The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are thought to co-exist and perpetuate one another. It is recommended that chiropractors include pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature showing its effectiveness in the treatment of this condition. There appears to be a need for further research in the form of randomized controlled clinical trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the sacroiliac joint manipulation and dry needling in the treatment of ITBFS. Objectives The study aimed to determine the comparative effectiveness of dry needling alone versus manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS. Methods This study was a randomised, open label trial. 47 participants with ITBFS were divided into three groups, each group receiving a different intervention i.e.: group one received dry needling of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac joint manipulation, group three received a combination of the two interventions. Subjective measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test as well as digital inclinometer readings of Modified Obers test, were utilised to determine the effects of the respective interventions. These measurements were recorded twice, once prior to commencing the treatment programme. These values were then evaluated to compare the efficacy of the different treatment interventions. Each participant received four treatments over a two week period. Results There were no statistically significant differences between the three treatment groups as they all seemed to parallel one another with regards to overall improvement in subjective and objective measurements (P<0.5). However on closer examination subtle differences between the groups were noted. An interesting endpoint is that the combination group did not fair the best throughout the study, which was contrary to the original hypothesis. The groups receiving only the single intervention appeared to fair marginally better over the combination group. A secondary endpoint that became evident during the study and on analysis of the data, was that hip joint instability must also be considered when treating ITBFS when there is concomitant sacroiliac joint dysfunction. Conclusion A decision needs to be made with regard to which intervention best suits the individual at the time. A combination therapy, which originally was thought to be the best treatment option, should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling should be decided upon. In totality, all intervention proved to be effective in the treatment of ITBFS.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology, Durban University of Technology, 2010. / Episodic Tension–type headache (ETTH), which has a high prevalence, is the most common headache. Manual therapeutic approaches towards Episodic Tension-Type Headaches (ETTHs) have not been fully explored. However, cervical spine manipulation (CSM) and dry needling are found to be successful modalities for the treatment of tension-type headache (TTH). Therefore, this study aims to determine the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in the treatment of ETTHs. Objectives The objectives of this study include: determining the effectiveness of CSM alone, dry needling alone and CSM combined with dry needling in terms of objective and subjective data for the treatment of ETTHs. Method Forty five participants suffering from ETTHs, between the ages of eighteen and fifty, were recruited through convenience sampling and were randomly allocated to one of three equal groups (15 per group). The three different groups were: (A); CSM alone, (B); dry needling alone and (C); CSM in addition to dry needling. The study took place over a period of four weeks involving six consultations. Each participant received a headache diary for the duration of the study. At the first consultation the participant received the headache diary and was monitored for one week before the treatments commenced. Thereafter, four treatments were administered over the next two weeks, depending on group allocation. Participants were also monitored with the headache diary for one week after the last treatment. The objective data for each participant consisted of cervical range of motion (CROM) and pressure–pain threshold readings, measured using a CROM goniometer and an algometer respectively. The subjective data for each participant was collected using a headache diary and a headache questionnaire/disability index. SAS version 9.1.3 was used to analyse the data. A p value of <0.05 was considered as statistically significant. Results A decrease in headache duration, frequency, intensity and severity and increases in CROM and algometer measurements were observed in all groups. However, no statistically significant differences were found between the three groups in terms of objective and subjective measurements although, a statistically significant improvement from consultation five to six was found in Group C in terms of headache disability. Conclusion CSM and dry needling, used in isolation or in combination are effective in the treatment of ETTHs although Group C did show superiority over the other groups in the long term with respect to the disability index.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013. / The lifetime incidence of low back pain is between 48% to 79% in South Africa. Globally, chronic Sacroiliac Joint Syndrome occurs in 13% to 63% of the world’s population. Therefore, chronic Sacroiliac Joint Syndrome is a significant health problem that has the potential to have a major impact on quality of life. Chronic Sacroiliac Joint Syndrome is described as an alteration in normal motion or mechanics. The Sacroiliac Joint fibrous capsule contributes to proprioceptive and nociceptive output, which may be exacerbated when the joint is in a dysfunctional state. Chronic Sacroiliac Joint Syndrome may be effectively treated by spinal manipulative therapy. Spinal manipulative therapy is professed to have four therapeutic effects – mechanical correction, pain reducing effects, circulatory increase and neurobiologic effects. Similarly, Kinesio Tex® Tape therapy is professed to have comparable therapeutic effects – circulatory increase, pain reduction and stimulation of proprioceptive systems. Spinal manipulative therapy and Kinesio Tex® Tape therapy may, therefore, have similar therapeutic effects which, if used in adjunction, may produce enhanced therapeutic effects and accelerated results regarding reduction of symptoms in patients with chronic Sacroiliac Joint Syndrome. This investigation aimed to determine whether Kinesio ® Taping methods would have any relative effect on the Sacroiliac Joint, and whether it would be appropriate to use as an adjunct to spinal manipulative therapy in the treatment of chronic Sacroiliac Joint Syndrome. The study was a prospective stratified clinical trial with three intervention groups, twenty participants in each (n = 60). All participants were 18-50 years of age and suffering from chronic Sacroiliac Joint Syndrome. Subjective measurements included the Numerical Rating Scale and Oswestry Low Back Pain Disability Index. Objective measurements included the Algometer Scores. Numerical Rating Scale and Algometer measurements were taken before and immediately after treatment at the first consultation and at the second consultation. Oswestry Low Back Pain Disability Index measurements were taken at the first and second consultation. Group One underwent spinal manipulative therapy alone, Group Two underwent Kinesio Tex® Tape therapy alone and Group Three underwent both spinal manipulative therapy and Kinesio Tex® Tape therapy in combination. Comparisons were made using the Unpaired and Paired t-tests. The results for the Inter-group analyses suggested that most comparisons were statistically insignificant (p ≥ 0.05) which indicated that all treatment groups appeared to improve to a similar degree. The results for the Intra-group analyses suggested that most comparisons were statistically significant (p < 0.05) which indicated that Kinesio Tex® Tape therapy was effective as an adjunct to spinal manipulative therapy, however not statistically more or less effective that spinal manipulative therapy or Kinesio Tex® Tape therapy alone. In conclusion, it was found that some differences did occur, however these differences were not sufficient enough to conclude that one treatment was more effective than the other. Further research with a larger sample size, more frequent treatments and follow-ups, a more homogenous stratification of age, ethnic group, gender, side of diagnosis and categorizing participant occupation is needed in order for the power of the study to be amplified and, therefore, any results would carry more weight.

Submitted in partial compliance with the requirements for Master’s degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2015. / Background Functional dyspepsia is a chronic pain/discomfort centred in the upper abdomen in the absence of any known structural cause. Epidemiological studies have shown that functional dyspepsia is a common complaint affecting all population groups that over time places considerable financial strain on public and private resources due to frequent doctors’ visits and expensive diagnostic procedures. The development of non-surgical and non-pharmaceutical treatments of functional dyspepsia would not only make economic sense but would also provide a means to improve patients’ quality of life in the least invasive way possible. Although not traditionally seen to be within the chiropractic scope of practice, anecdotal evidence suggests that chiropractic care and management may have the ability to alleviate visceral symptomatology. Objectives The purpose of this placebo controlled pilot study was to evaluate the preliminary effects of chiropractic manipulation versus inactive laser in the treatment of adult patients suffering from functional dyspepsia. Due to the small sample size, time and budgetary constraints it was hypothesised that the dyspepsia symptoms of participants treated with active chiropractic manipulation would not respond more favourably to the treatment, nor would these patients experience a greater improvement in terms of quality of life, compared to those participants receiving placebo treatment. Method Thirty participants with pre-diagnosed functional dyspepsia were selected after being screened according to the inclusion and exclusion criteria identified by the researcher. These participants were then divided into two groups using consecutive sampling. Data was collected at the Chiropractic Day Clinic at the Durban University of Technology. Group A received an active chiropractic manipulation using diversified technique to pre-identified levels in the cervical, thoracic and lumbar spine. Group B received inactive laser to pre-identified levels in the cervical, thoracic and lumbar spine. Both groups received one treatment a week for three weeks. The fourth and final consultation consisted only of data capturing. At each visit both groups of participants filled in three validated questionnaires: The numerical pain rating scale; PAGI-SYM physical symptom assessment; Results Results were statistically analysed using IBM SPSS version 20 and a p value ≤ 0.05 was considered to be statistically significant. Repeated measures ANOVA testing was used to assess the effect of each of the treatments separately and to assess the comparative effects of the spinal manipulation vs the placebo. Conclusion and Recommendations The gathered results and analysis were statistically insignificant. Clinical improvement in their symptomotology was however noted within both groups over the trial period in terms of treatment received and their perceived quality of life, symptomatology and pain levels. Both groups tended to have reduced pain and discomfort over time, improved: emotional distress, sleep disturbance, food problems, vitality, post-prandial fullness and abdominal pain. This study should be repeated with selected outcome measurements, and perhaps objective outcome measurements, and a larger sample size in order to determine any benefit.

Dissertation in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, submitted to the Faculty of Health at the Durban University of Technology, 2009. / Although kayaking is an Olympic sport and said to be one of the top ten growth sports in America, relatively little literature has been written on it by sports scientists and there is a paucity of available literature. Previous research has described the effects of spinal manipulation on muscles at distant sites to the joint being manipulated, and there have been trends which have shown a positive increase in strength and in muscle activity at these sites. There has, however, been a lack of literature to show that these positive trends would influence sporting performance in any way. 30 volunteer kayakers, who train and compete on a regular basis, were actively recruited and randomly allocated into one of three groups. Group 1 received manipulation on a fixated cervical segment, group 2 on a non-fixated cervical spine segment, and group 3 received placebo laser to the posterior cervical area. Subjects were then required to complete two 200m sprint tests on a kayak ergometer. Measurements were taken pre and post manipulation and included maximum watts recorded for the duration of the sprint test and time taken to complete 200m. Although no statistically significant results were found between the groups, trends revealed that in group 1, which received spinal manipulation on a fixated joint, there was an increase in the mean peak watts post manipulation, as compared to the placebo and non-fixated groups which showed a decrease in peak watts post manipulation. Group 1 also demonstrated a mean decrease in time taken to complete the second 200m sprint test. Group 2 and 3 again showed an increase in time taken to complete the second sprint test post manipulation. iv It is, therefore, concluded that manipulation of a fixated cervical joint in asymptomatic kayakers results in an increase in performance, although it must be noted that these were only trends and that there was no statistical significance in these results. This research has, furthermore, opened the door to future studies which may test the performance enhancing benefits of competitive sports such as kayaking. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, Durban, 2006. / Core strengthening has become a major trend in the rehabilitation of patients suffering with lower back pain. Clinical trials have shown that core strengthening is beneficial for patients with low back pain. According to the literature, core strengthening consists of activating the trunk musculature in order to stabilize hypermobile symptomatic joints and thus lessen mechanical stress to the spine. Spinal manipulative therapy has also proved itself to be beneficial, particularly in the case of post-natal low back pain sufferers, as manipulation may correct hypomobility associated with spinal subluxations. Literature suggests that spinal manipulative correction of spinal subluxations in combination with core stability exercises, that stablise symptomatic hypermobile joints, may have more advantages than using these interventions singularly in the treatment of post-natal low back pain. However, the combination of a core stability muscle training program with spinal manipulative therapy has yet to be investigated. In order to choose the most appropriate therapy for managing this condition, it is essential for research to be carried out to identify the most effective treatment, which would allow for better overall management of low back pain during the post-natal period. Therefore this study was designed to establish the effectiveness of a combined protocol of spinal manipulation and core stability exercises in the treatment of post-natal mechanical low back pain and to establish whether this protocol should be utilized routinely in the management of this condition. / M

A dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / Plantar fasciitis (PF) is a syndrome that causes pain at the insertion of the plantar fascia to the medial calcaneal tubercle of the calcaneaus. This syndrome has been described as an overuse injury with subsequent inflammation at the insertion of the plantar fascia to the bone. The literature describes inflammatory changes that occur within the body and attachment of the plantar fascia, together with biomechanical aberrances that may be the result of the PF. The purpose of this study was to determine the relative effectiveness of pulsed ultrasound as an adjunct to foot manipulation in the treatment of plantar fasciitis. The foot manipulations are used to correct the biomechanical abnormalities, while the pulsed ultrasound is used for its anti-inflammatory properties. The combination of pulsed ultrasound and foot manipulation was compared to foot manipulation alone to determine if this ultrasound manipulation combination had any beneficial effect over and above foot manipulation alone. Thus determining whether it is of importance to o approach and treat both aspects of the syndrome described. This was a prospective, randomised, comparative controlled trial. Forty subjects were diagnosed with plantar fasciitis and chosen to participate in the study. They were subsequently divided into two groups (Group A and Group B) of twenty. Group A was the experimental group receiving foot manipulation and ultrasound as treatment, and Group B, the control group received foot manipulation alone as treatment. Each subject received six treatments within a period of three weeks, with a seventh follow-up within one week of the sixth treatment. There was no treatment at the seventh consultation; this was used for obtaining subjective and objective readings. Subjective assessment was by means of the Foot Function Index, and objective was by means of the manual algometer. Both the subjective. and objective readings were taken prior to the first, sixth and at the seventh (final) consultations. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, 2008. / Objectives: To compare trunk flexion and lateral flexion range of motion (ROM) pre-post intervention. To compare the bowling speed of Action Cricket fast bowlers pre-post intervention. To determine the correlation between change in bowling speed immediately post-intervention to change in trunk flexion and lateral flexion ROM immediately post-intervention. To determine the association between change in bowling speed immediately postintervention and the subjects' perception of change in bowling speed. Methods: Forty asymptomatic Action Cricket fast bowlers were divided into four groups of ten each. Group 1 received lumbar spine manipulation, Group 2 received thoracic spine manipulation, Group 3 received combined thoracic and lumbar spine manipulation and Group 4 received the sham laser intervention (placebo). Pre- and post-intervention trunk flexion and lateral flexion ROM and bowling speed were measured using a digital inclinometer and a SpeedTrac\x99 Speed Sport Radar. The subjects' perception of a change in bowling speed post-intervention was also recorded. SPSS version 15.0 was used to analyse the data. Twotailed tests were used in all cases. Results: Trunk flexion and lateral flexion increased significantly (p < 0.05) post-spinal manipulation. There was a significant increase in bowling speed post-thoracic (p = 0.042) and postcombined manipulation (p < 0.000). A significant yet weak positive correlation (p = 0.003; r = 0.451) was seen in change in bowling speed and change in thoracic flexion and lateral flexion. There was no significant difference in the percentage subjective change by intervention group (p = 0.217). Conclusions: Spinal manipulation is a valid intervention for short-term increase in bowling speed. / M