Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002 xiii, 93 leaves / The purpose of this study was to determine the short to medium term effectiveness of Proprioceptive Neuromuscular Facilitaion (P.N.F.) stretching [using the Contract- Relax-Antagonist-Contract (C.R.A.C.) technique] as an adjunct treatment to cervical manipulation in the treatment of Mechanical Neck Pain.

Neck manipulation is commonly used in the management of some musculoskeletal disorders to reduce pain and improve movement. There is, however, little understanding about the underlying mechanism. Recent research has alluded to a neurophysiological mechanism mediated through supraspinal pathways in the central nervous system, that may alter motor activity. The purpose of this study was to determine the effect of neck manipulation on the excitability of cortical motoneurons by means of activating corticospinal pathways to the flexor carpi radialis (FCR) muscle in an active motor system using the transcranial magnetic stimulation (TMS) technique.Motor evoked potentials (MEPs) were elicited by TMS and recorded in 20 normal subjects using established procedures. The peak-to-peak amplitude of MEPs were measured both before and after C6/7 manipulation and before and after neck positioning. Both interventions were applied to the normal subjects in random order on two different days. MEPs were recorded immediately after the intervention, then seven minutes and 14 minutes later to assess the time course of the effect. Five neck pain subjects participated in the manipulation experiments. The effects of manipulation, resulting in joint cavitation, were also explored. Two trials were undertaken before the intervention and these served as control measures. MEP data was represented in two ways. Firstly, 40 MEPs were averaged over 120 seconds; secondly, 15 MEPs were average over 60 seconds. A percentage change calculation was used to express the data relative to the baseline. Alterations in cortical excitability before and after manipulation were analysed by repeated measure analysis of variance (ANOVA) on the MEP data, and percentage change scores.Cortical neurons projecting to FCR were significantly facilitated up to 60 seconds after the manipulation of the non-painful segment, relative to baseline values and the positioning control. A small but significant latent increase in excitability was also observed 15 minutes after manipulation. The response to manipulation of the painful cervical segment was significantly different from that of the non-painful segment. When manipulation of the painful segment did not result in joint cavitation, an inhibitory effect was observed. In contrast, however, cortical motoneurons were facilitated when joint cavitation was associated with manipulation.In conclusion, motor activity is enhanced with neck manipulation when cortical motoneuron excitability is measured by TMS in human subjects performing a voluntary contraction. This may explain the clinically observed improvement in spinal motion and motor control with spinal manipulation. Further, joint cavitation may be important in signifying the success of the joint manipulation. The excitatory effect on cortical motoneurons is probably mediated through a transcortical pathway by means of the activation of muscle afferents with the manipulative thrust.These findings assist in understanding the neurophysiological mechanism underlying the effect of spinal manipulation.

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xi, 123 leaves ; 30 cm / The differential diagnosis of back and leg pain should include sacroiliac joint disease as the prevalence of sacroiliac joint pain appears to range from 13%-30%, thus making the sacroiliac joint a significant source of pain in patients with chronic low back pain. Sacroiliac syndrome is well-defined and usually presents with pain over the sacroiliac joint in the region of the posterior superior iliac spine, with possible referral to the buttock, groin, and leg. Most patients with sacroiliac syndrome seem to present with spastic or hyperactive muscles which leads to increased pain and decreased range of motion. Because of the close proximity of the Piriformis muscle to the sacroiliac joint, it is likely to be one of these hyperactive muscles. Various studies on low back pain, including a study on sacroiliac syndrome, have shown a correlation between low back pain, hip rotation range of motion asymmetry, and decreased hip mobility. In addition, the muscles responsible for movements of the hip have an overlapping innervation with the hip joint (L2 to S1) and sacroiliac joint (L2 to S3). It is assumed that the hypertonic muscles associated with sacroiliac syndrome decrease hip joint proprioception as the proprioceptors are facilitated erratically in a highly facilitated neuronal pool common to the innervation levels of the sacroiliac joint and the hip and associated with the level of the involved hypertonic muscle. This is thought to result in aberrant proprioceptive function at the identified levels, affecting the hip. Thus the aim of this study was to investigate the effect which sacroiliac joint manipulation had on hip functional ability in patients suffering from sacroiliac syndrome by means of various measurement tools: . Active hip joint ranges of motion were assessed using an Inclinometer, . Pressure threshold of the Piriformis muscle was measured by using an Algometer, and . Hip joint proprioception was assessed by measuring joint position sense of the hip joint using an Inclinometer.

M.Tech. (Chiropractic) / During gait the force transferred through the body is dived between the two lower limbs, according to Kaplan, Barak & Spiel (2012) this force should to be constant and equal with each gait cycle in an asymptomatic individual. In the presence of spinal dysfunction there is an alteration of sensory motor integration as a result of impaired proprioception (Taylor & Murphy, 2007), this altered proprioception may then produce a negative effect on the fore distribution during gait, resulting in abnormal biomechanics and an altered gait pattern. Chiropractic adjustments have been shown to restore normal biomechanics to the spine and in so doing improve proprioception. The purpose of this study was to determine the effects of cervical and lumbar chiropractic adjustments on the force distribution through the lower limbs during gait. Method: Thirty participants between the ages of 18 and 45 were invited to participate in the study. The details of the study were fully explained to each participant, after which an informed consent form was signed, followed by a full physical examination to determine if the potential participant was eligible for inclusion in the study, and did not have any of the following exclusion criteria. Individuals suffering from any form of mechanical back pain, hip, knee and ankle pathologies, females, and individuals were manipulation was contra-indicated were excluded from the study. A full lumbar or cervical spine examination was then performed in order to test for joint dysfunction. The participants then underwent gait testing after which they then received either a cervical or lumbar spine adjustment to the dysfunctioning joint. Procedure: The participants received a total of seven chiropractic adjustments with the objective data being recorded on the first, fourth and seventh consultations. The objective data was captured with the Zebris FDM gait analysis system. The system consisted of a 3 meter long sensory platform that is built into the floor, the pressure platform was made up of multiple force sensors arranged in a matrix of columns and rows and was capable of measuring the exact force through each lower limb during gait. The recorded sensory information was transferred to the WinFDM program which then interpreted all the data.

M.Tech. (Chiropractic) / This study aims to compare sacroiliac joint adjustments versus pubic symphysis adjustments in the treatment of sacroiliac joint dysfunction with regards to pain and disability as well as alternative treatment approaches in treating sacroiliac joint dysfunction.This study was a comparative study that consisted of two groups of fifteen participants each. The participants were between the ages of eighteen and forty five with an equal male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria for the study. The method of treatment that was administered was determined by group allocation. Group 1 received Chiropractic manipulative therapy delivered to the restricted sacroiliac joint and Group 2 received Chiropractic manipulative therapy delivered to the pubic symphysis.Treatment consisted of six treatment sessions with an additional follow up consultation over a three week period. Objective and subjective data was measured at the beginning of the 1st, 4th and 7th consultations. Subjective readings were taken from The Oswestry Pain and Disability Questionnaire as well as The Numerical Pain Rating Scale. Objective measurements were taken from The Orthopaedic Rating Scale. Analysis of the data collected throughout the study were performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data collection only.

M.Tech. / Purpose: This study aims to compare the effects of a manual high velocity, low amplitude spinal manipulation and a mechanical force, manually assisted spinal manipulation in the treatment of sub acute lumbar facet syndrome with regards to pain, disability, lumbar spine range of motion and pressure pain threshold. These effects were based on two questionnaires, the McGill Pain Questionnaire and the Oswestry Low Back Pain and Disability Questionnaire, lumbar spine range of motion readings using a digital inclinometer and pressure pain threshold readings taken with an algometer. Method: Thirty participants who met the inclusion criteria were randomly allocated to one of two groups. One group received a manual lumbar spine manipulation using the Diversified Technique. The second group received lumbar spine manipulative therapy with the use of the Activator Adjusting Instrument. Treatment occurred over a three week period, with participants receiving treatment six times out of a total of seven consultations. Procedure: Subjective data was collected using both the McGill Pain Questionnaire and the Oswestry Low Back Pain and Disability Questionnaire. Objective data was collected using a digital inclinometer to measure lumbar spine range of motion, and an algometer to measure pressure pain threshold. The questionnaires and all readings were recorded prior to treatment on the first, fourth and seventh visits. The data was then analysed by a statistician. Results: Clinical improvements in both groups were noted over the duration of the study with regards to pain, disability, left rotation and left and right lateral flexion. The group receiving a spinal manipulation with the Activator Adjusting Instrument also showed clinical improvement for flexion and right rotation and only the manual manipulation group improved in algometer measurements. Both groups displayed a decrease in lumbar extension readings over time. Statistical significance was observed for subjective measurements only. Conclusion: The results show that both spinal manipulative therapies are effective in the treatment of sub acute lumbar facet syndrome, however neither proved to be preferential over the other for subjective and objective measurements.

M.Tech. (Chiropractic) / Chronic lower back pain (LBP) is considered as one of the most prevalent conditions in our society with 70-85% of the population experiencing pain at some point in their lives and 80% having recurrent episodes. The majority of chronic LBP is treated with conservative care, with spinal manipulation being a treatment modality shown to be beneficial resulting in restoration of normal ranges of movement, decrease of muscle spasm and there is an overall biomechanical change. One of the more modern trends is combining manipulation with taping. It has been shown that with the application of Kinesio tape to the lumbar para-spinal muscles effectively increases lumbar range of motion and decreases pain with the relaxation of tense muscles as well as increase in proprioception as the tape increasingly stimulates cutaneous mechanoreceptors. Elastic bandage has been shown to improve proprioceptive acuity as it stimulates cutaneous mechanoreceptors, as well as providing support to joint structure. The purpose of this study was to determine the superiority of one tape versus the other as well as the efficacy of the individual tape and whether the combination treatment of spinal manipulative therapy and taping of the lumbar paraspinal muscles are possibly a more effective treatment protocol in the treatment of chronic lower back pain. Method: This clinical study was a comparative study and consisted of two groups of fifteen participants who met the inclusion and exclusion criteria. The participants were between the ages of eighteen and forty-five years of age. Group 1 was treated with lumbar spine and sacroiliac joint adjustments and the application of Kinesio tape􀂥. Group 2 was treated with lumbar spine and sacroiliac joint adjustments and the application of elastic bandage. Treatment took place over a period of three weeks and participants were treated six times out of a total of seven consultations. Procedure: Subjective data was recorded at the first and fourth consultation prior to treatment and on the seventh consultation by means of a Numerical Pain Rating Scale and an Oswestry Low Back Pain Disability Questionnaire to assess pain and disability. Objective data was recorded at the first and fourth consultation prior to treatment and on the seventh consultation by means of a digital inclinometer for assessing lumbar spine range of motion. Data recorded was analyzed by a statistician. Results: Clinically and statistically significant improvements were noted in both groups over the course of the study with regards to pain, disability and lumbar spine range of motion. Conclusion: The results show that both combination treatments of spinal manipulative therapy and the application of Kinesio™ tape or elastic adhesive bandage are effective treatment protocols, both clinical and statistical in decreasing pain, disability and improving lumbar range of motion in patients with chronic lower back pain. However neither treatment protocols proved to be superior over the other.

M.Tech.